Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). Behaviors can include changes in the following: Readiness for oral feeding in the preterm or acutely ill, full-term infant is associated with. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Key criteria to determine readiness for oral feeding include. Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. The long-term consequences of feeding and swallowing disorders can include. The SLP plays a critical role in the neonatal intensive care unit (NICU), supporting and educating parents and other caregivers to understand and respond accordingly to the infants communication during feeding. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Provider refers to the person providing treatment (e.g., SLP, occupational therapist, or other feeding specialist). The Laryngoscope, 128(8), 19521957. Dysphagia, 33(1), 7682. 0000017421 00000 n SLPs conduct assessments in a manner that is sensitive and responsive to the familys cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. In their role as communication specialists, SLPs monitor the infant for stress cues and teach parents and other caregivers to recognize and interpret the infants communication signals. Pediatrics, 135(6), e1458e1466. A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder. https://doi.org/10.1044/leader.FTRI.18022013.42, Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., Klin, A., Jones, W., & Jaquess, D. L. (2013). https://doi.org/10.1542/peds.2015-0658. 0000090091 00000 n https://www.asha.org/policy/, Arvedson, J. C. (2008). Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. 0000027867 00000 n Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. Additional components of the evaluation include. . Children are positioned as they are typically fed at home and in a manner that avoids spontaneous or reflex movements that could interfere with the safety of the examination. Silent aspiration is estimated at 41% of children with laryngeal cleft, 41%49% of children with laryngomalacia, and 54% of children with unilateral vocal fold paralysis (Jaffal et al., 2020; Velayutham et al., 2018). has a complex medical condition and experiences a significant change in status. Children who demonstrate aversive responses to stimulation may need approaches that reduce the level of sensory input initially, with incremental increases as the child demonstrates tolerance. International Journal of Eating Disorders, 48(5), 464470. Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. The appropriateness of the treatment format often depends on the childs age, the type and severity of the feeding or swallowing problem, and the service delivery setting. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). Early introduction of oral feeding in preterm infants. Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved functional feeding skills. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. The Journal of Pediatrics, 161(2), 354356. Therefore, a large randomized clinical trial would be beneficial to clearly define the role of NMES in recovery of swallowing ability following a brain injury. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. Behavioral interventions include such techniques as antecedent manipulation, shaping, prompting, modeling, stimulus fading, and differential reinforcement of alternate behavior, as well as implementation of basic mealtime principles (e.g., scheduled mealtimes in a neutral atmosphere with no food rewards). Copyright 1998 Joan C. Arvedson. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. The two most commonly used instrumental evaluations of swallowing for the pediatric population are. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. The school SLP (or case manager) contacts the family to notify them of the school teams concerns. 0000004839 00000 n Early Human Development, 85(5), 303311. An individualized health plan or individualized health care plan may be developed as part of the IEP or 504 plan to establish appropriate health care that may be needed for students with feeding and/or swallowing disorder. Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. Singular. Postural/position techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. Although thermal perception is a haptic modality, it has received scant attention possibly because humans process thermal properties of objects slower than other tactile properties. Members of the Working Group on Dysphagia in Schools included Emily M. Homer (chair), Sheryl C. Amaral, Joan C. Arvedson, Randy M. Kurjan, Cynthia R. O'Donoghue, Justine Joan Sheppard, and Janet E. Brown (ASHA liaison). Warning signs and symptoms. Tube feeding includes alternative avenues of intake such as via a nasogastric tube, a transpyloric tube (placed in the duodenum or jejunum), or a gastrostomy tube (a gastronomy tube placed in the stomach or a gastronomyjejunostomy tube placed in the jejunum). The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. (Practice Portal). Silent aspiration: Who is at risk? Journal of Adolescent Health, 55(1), 4952. The control group was given thermal-tactile stimulation treatment only, while in the experimental group neuromuscular electrical stimulation and thermal-tactile stimulation treatments were applied simultaneously. Swallowing function and medical diagnoses in infants suspected of dysphagia. International Classification of Functioning, Disability and Health. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. (2014). oversee the day-to-day implementation of the feeding and swallowing plan and any individualized education program strategies to keep the student safe from aspiration, choking, undernutrition, or dehydration while in school. This might involve decisions about whether the individual can safely eat an oral diet that meets nutritional needs, whether that diet needs to be modified in any way, and whether the individual needs compensatory strategies to eat the diet. Feeding and swallowing challenges can persist well into adolescence and adulthood. Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies. Intraoral prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize the intraoral cavity by providing compensation or physical support for children with congenital abnormalities (e.g., cleft palate) or damage to the oropharyngeal mechanism. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. Developmental Medicine & Child Neurology, 50(8), 625630. These cues can communicate the infants ability to tolerate bolus size, the need for more postural support, and if swallowing and breathing are no longer synchronized. Prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%83% (Caron et al., 2015; de Vries et al., 2014; Reid et al., 2006). Sensory stimulation techniques vary and may include thermaltactile stimulation (e.g., using an iced lemon glycerin swab) or tactile stimulation (e.g., using a NUK brush) applied to the tongue or around the mouth. .22 The study protocol had a prior approval by the . Anatomical and physiological differences include the following: Chewing matures as the child develops (see, e.g., Gisel, 1988; Le Rvrend et al., 2014; Wilson & Green, 2009). The school-based feeding and swallowing team consists of parents and professionals within the school as well as professionals outside the school (e.g., physicians, dietitians, and psychologists). Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. SLPs provide assessment and treatment to the student as well as education to parents, teachers, and other professionals who work with the student daily. Clinicians may consider the following factors when assessing feeding and swallowing disorders in the pediatric population: As infants and children grow and develop, the absolute and relative size and shape of oral and pharyngeal structures change. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 837851. https://doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, Section 504, 29 U.S.C. (1998). Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. 0000090522 00000 n When conducting an instrumental evaluation, SLPs should consider the following: Procedures take place in a child-friendly environment with toys, visual distracters, rewards, and a familiar caregiver, if possible and when appropriate. a school psychologist/mental health professional; medical issues common to preterm and medically fragile newborns, medical comorbidities common in the NICU, and. Results There were eight participants, six women and. 0000075777 00000 n Establishing a public school dysphagia program: A model for administration and service provision. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and person- and family-centered care. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. These changes can provide cues that signal well-being or stress during feeding. (2017). MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). 0000089415 00000 n SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional. Sensory stimulation may be needed for children with reduced responses, overactive responses, or limited opportunities for sensory experiences. discuss the process of establishing a safe feeding plan for the student at school; gather information about the students medical, health, feeding, and swallowing history; identify the current mealtime habits and diet at home; and. See International Dysphagia Diet Standardisation Initiative (IDDSI). See, for example, Manikam and Perman (2000). Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Journal of Developmental & Behavioral Pediatrics, 23(5), 297303. A. 0000089512 00000 n Huckabee, M. L., & Pelletier, C. A. 0000089121 00000 n Decisions are made based on the childs needs, their familys views and preferences, and the setting where services are provided. Those section letters and numbers from 2011 are 210.10(g)(1) and can be found at https://www.govinfo.gov/content/pkg/CFR-2011-title7-vol4/pdf/CFR-2011-title7-vol4-sec210-10.pdf. https://wayback.archive-it.org/7993/20170722060115/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm, Velayutham, P., Irace, A. L., Kawai, K., Dodrill, P., Perez, J., Londahl, M., Mundy, L., Dombrowski, N. D., & Rahbar, R. (2018). Oralmotor treatments are intended to influence the physiologic underpinnings of the oropharyngeal mechanism to improve its functions. The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. Further investigative research to clarify NMES protocols and patient population is needed to optimize results. Disability and Rehabilitation, 30(15), 11311138. facilitate the individuals activities and participation by promoting safe, efficient feeding; capitalize on strengths and address weaknesses related to underlying structures and functions that affect feeding and swallowing; modify contextual factors that serve as barriers and enhance those that facilitate successful feeding and swallowing, including the development and use of appropriate feeding methods and techniques; and. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. 128 0 obj <> endobj xref See ASHAs resource on transitioning youth for information about transition planning. The evaluation process begins with a referral to a team of professionals within the school district who are trained in the identification and treatment of feeding and swallowing disorders. 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