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Oral Motor Therapy and feeding

method used. Defined our questionsRefined our questions - PICOPopulation - the client groupInterventionComparison interventionOutcomeCompleted searches hand searched additional referencesSelected articles from title, abstract information and ordered themReviewed the articles re: level of evidence, points of interest to allied health professionalsDeveloped a clinical bottom line.

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Oral Motor Therapy and feeding

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    1. Oral Motor Therapy and feeding Critically Appraised Topic Does Oral Sensorimotor Therapy Improve Oral Skills in Feeding in Children with a Disability?

    3. answerable question

    4. Objective The Paediatric Feeding Interest Group (PFIG) members who worked in disability were interested in determining the efficacy of oral motor therapy in this population, as it is a widely used therapy.

    5. results

    6. Gisel (1994) Limited (but not significant) improvements in the eating domains (spoon feeding, biting, chewing) but not in drinking. As a group children maintained their weight but did not have catch up growth. Most improvements seen over a 20 week period No significant treatment difference between chewing only therapy vs sensorimotor therapy Type of sensorimotor therapy was tailored to the individual – therefore not consistent approach. This study was an unstructured literature review and commentary: To summarise what we know about young children and AAC Technology To stimulate discussion for future research regarding design of AAC Technologies RESULTS There is some evidence to support: the idea of AAC Technology and AAC Design needing to have a high smile value (should be fun) if it is to engage young children children show some preference for integrated systems e.g. something you can play with, use as a telephone and also use as a communication system for concrete concepts use of graphic metaphor or scene layout has some advantages for young children. However more abstract concepts are difficult to display in this way. of the five ways to group vocabulary: taxonomic (categories) , schematic (event schema), semantic / syntactic, alphabetic, idiosyncratic, young children generally have a preference for personally relevant schematic layout. Currently insufficient evidence to know: whether dynamic or fixed displays are more appropriate for young childrenThis study was an unstructured literature review and commentary: To summarise what we know about young children and AAC Technology To stimulate discussion for future research regarding design of AAC Technologies RESULTS There is some evidence to support: the idea of AAC Technology and AAC Design needing to have a high smile value (should be fun) if it is to engage young children children show some preference for integrated systems e.g. something you can play with, use as a telephone and also use as a communication system for concrete concepts use of graphic metaphor or scene layout has some advantages for young children. However more abstract concepts are difficult to display in this way. of the five ways to group vocabulary: taxonomic (categories) , schematic (event schema), semantic / syntactic, alphabetic, idiosyncratic, young children generally have a preference for personally relevant schematic layout. Currently insufficient evidence to know: whether dynamic or fixed displays are more appropriate for young children

    7. Gisel (1996) No significant changes in feeding times or mealtime duration across the group – no significant difference in any group because of large variations within each group. All children maintained weight but no catch-up growth. Many confounding variables noted eg. Health status, degree of disability and ambulatory status This paper takes the form of a non-structured literature review and commentary focussing on: To provide an overview of some of the considerations in visual cognition that applies to AAC display design. To consider how design properties can enhance / inhibit access and use of visual symbols. Four key areas: - grid vs schematic displays - symbol location - colour and contrast symmetry and axial orientation This paper takes the form of a non-structured literature review and commentary focussing on: To provide an overview of some of the considerations in visual cognition that applies to AAC display design. To consider how design properties can enhance / inhibit access and use of visual symbols. Four key areas: - grid vs schematic displays - symbol location - colour and contrast symmetry and axial orientation

    8. Ottenbacher (1983) Mixed results – 4 subjects: 2 subjects improved their oral motor evaluation score, 2 subjects declined slightly. 2 subjects increased their weight and 2 subjects showed decreased weight. Lack of homogeneity between subjects (in regards to age / weight) – several variables. Results are mixed and the study is unclear about which changes are statistically significant To evaluate the performance of typically developing 3 year olds locating vocabulary in AAC technologies within - grid layout with options on a menu page containing an array of screen shots to represent alternate pages - a contextual scene with options on a menu page containing an array of screen shots to represent alternate pages To consider learning with these different layouts and generalization. Method: The authors measured accuracy of ability to target items during learning, sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. To evaluate the performance of typically developing 3 year olds locating vocabulary in AAC technologies within - grid layout with options on a menu page containing an array of screen shots to represent alternate pages - a contextual scene with options on a menu page containing an array of screen shots to represent alternate pages To consider learning with these different layouts and generalization. Method: The authors measured accuracy of ability to target items during learning, sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    9. Gisel et al (1995) No significant changes in eating efficiency (eating time) in response to treatment. Children maintained their weight: age and skinfold:age measurements but there was no catch up growth. Articles suggested that increased texture may not improve eating time or growth but may improve oral skills (as occurred in a small number of subjects). Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    10. Gisel et al (1996) Some significant improvements noted in spoon feeding, normal chewing and swallowing but no control group to compare results (cohort study). Non-aspiration group did better than aspiration group. No significant improvements in weight gain. Study had too many variables, large age range. Compliance with daily treatment was 68%. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    11. Davies (2003) Articles reviewed varied. Limited evidence to suggest that children with moderate feeding difficulties improved oral motor skills with oromotor treatment. No significant evidence to suggest that oral motor therapy results in decreased mealtime duration or increased weight gain. No evidence to support that oral motor treatment results in improved clearance from the pharynx. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ˝ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    12. Topic: clinical bottom line The search results gave insufficient high quality evidence available to suggest that oral motor treatment improves eating skills / weight gain – growth / time taken to eat a meal / oral motor skills. Studies showed small but not significant changes across these domains and factors such as health status, disability and ambulatory status may have influenced treatment outcomes.

    13. Clinical Practice In clinical practice, clinicians need to be aware that the evidence for oral motor treatment is limited however it may be used in conjunction with other treatment programs and in conjunction with feeding.

    14. acknowledgments Jenny Wood Dorothea Gray Sudi Veerabangsa Lenore Scali Liora Ballin Helen McLaren Harriet Korner Hayley Smithers- Sheedy Alison Wu Lisa Hanley Jenny Lee

    15. references Gisel, E.G. (1994) “Oral Motor Skills Following Sensorimotor Intervention in the Moderately Eating Impaired Child with Cerebral Palsy” Dysphagia 9: 180-192. Gisel, E.G. (1996) “Effect of Oral Sensorimotor Treatment on measures of Growth and Efficiency of Eating in the Moderately Eating Impaired Child with Cerebral Palsy. Dysphagia 11: 48-58. Ottenbacher, K., Hicks, J., Roark, A. & Swinea, J. (1983) “Oral Sensorimotor Therapy in the Developmentally Disabled: A Multiple baseline study.” The American Journal of Occupational Therapy 37:8, 541-547. Gisel, EG., Applegate-Ferrante, T., Benson, JE. & Bosma, JF. (1995) “Effect of Oral Sensorimotor Trreatment on Measures of Growth, Eating Efficiency and Aspiration in the Dysphagic Child with Cerebral Palsy”. Developmental Medicine and Child Neurology 37, 528-543. Gisel, EG., Applegate-Ferrante, T., Benson, JE. & Bosma, JF. (1996) “Oral-motor skills following Sensorimotor Therapy in two groups of moderately Dysphagic Children with Cerebral Palsy: Aspiration vs Nonaspiration.” Dysphagia11, 59-71. Davies, F. (2003) “Does the end justify the means? A critique of oromotor treatment in children with cerebral palsy.” Asia Pacific Journal of Speech, Language and Hearing 8,146-152

    16. PFIG EBP Leaders Alana Lum alum@tscnsw.org.au Anna Bech abech@tscnsw.org.au

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