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

2. The Spastic Centre 2006 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. The Spastic Centre 2006 answerable question PubMED, CINAHL, OVID, Medline

4. The Spastic Centre 2006 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. 7 The Spastic Centre 2006 results

6. The Spastic Centre 2006 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. The Spastic Centre 2006 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. The Spastic Centre 2006 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. The Spastic Centre 2006 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). Level 3

10. The Spastic Centre 2006 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. The Spastic Centre 2006 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 –

12. The Spastic Centre 2006 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. The Spastic Centre 2006 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. Jenny Wood Dorothea Gray Sudi Veerabangsa Lenore Scali Liora Ballin Helen McLaren Harriet Korner Hayley Smithers- Sheedy Alison Wu Lisa Hanley Jenny Lee The Spastic Centre 2006 acknowledgments

15. The Spastic Centre 2006 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. The Spastic Centre 2006 PFIG EBP Leaders Alana Lum alum@tscnsw.org.au Anna Bech abech@tscnsw.org.au