Oral Motor Therapy and feeding

1
Oral Motor Therapy and feeding

• Critically Appraised Topic
• Does Oral Sensorimotor Therapy Improve Oral
  Skills in Feeding in Children with a Disability?

2
method used

• Defined our questions
• Refined our questions - PICO
• Population - the client group
• Intervention
• Comparison intervention
• Outcome
• Completed searches hand searched additional
  references
• Selected articles from title, abstract
  information and ordered them
• Reviewed the articles re level of evidence,
  points of interest to allied health professionals
• Developed a clinical bottom line

3
answerable question
Population Intervention Comparison Outcome
Children with a disability Oral motor/ Sensorimotor therapy None Improve oral motor skills in feeding
PubMED, CINAHL, OVID, Medline
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
7
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.

Level 2
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

Level 2
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

Level 3
9
Gisel et al (1995)

• No significant changes in eating efficiency
  (eating time) in response to treatment. Children
  maintained their weight age and skinfoldage
  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).

Level 3
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.

Level 3
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.

Level 4
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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

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references

1. Gisel, E.G. (1994) Oral Motor Skills Following
   Sensorimotor Intervention in the Moderately
   Eating Impaired Child with Cerebral Palsy
   Dysphagia 9 180-192.
2. 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.
3. 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 378, 541-547.
4. 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.
5. 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.
6. 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

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PFIG EBP Leaders

• Alana Lum
• alum_at_tscnsw.org.au
• Anna Bech
• abech_at_tscnsw.org.au