Table 7Key findings summarized in Snider et al.34 systematic review*

Author, Year
Study Design
InterventionCP Type/Severity
Participants
Age Range
Key Findings
Oral sensorimotor facilitation*Helfrich-Miller et al., 198672
Case series
Dietary modification, oral program during feeding, thermal stimulationSevere CP
n=6
10–13 years
  • Improvements in swallowing efficiency and speed
  • Reductions in aspirations and incidence of upper respiratory tract infections for those remaining on thermal stimulations program
Ganz 198773
Single-subject ABA design
Neuromotor and sensory facilitationSevere CP
n=1
8 years
  • Decreased tongue thrust and positive changes in tongue and jaw movements
  • Poorer elevation of tongue with jaw separation for liquids and solids
*Gisel et al., 199574
Prospective cohort study comparing outcomes in aspirators and nonaspiratorsa
Tailored sensorimotor treatment with emphasis on tongue lateralization, lip control, chewingModerate to severe motor impairment
n=27
2–10 years
  • Limited change in eating efficiency in non aspirators; improvements with purees in aspirating group but declines with solids
  • Rank in weight- and skin fold-or-age measurements maintained
  • Eating efficiency may be related to severity of eating impairment
*Gisel et al., 199675
Prospective cohort study comparing outcomes in aspirators and nonaspiratorsa
Tailored sensorimotor treatment with emphasis on tongue lateralization, lip control, chewingModerate to severe motor impairment
n=27
2–10 years
  • Significant improvements in spoon feeding, chewing (lateralization of the tongue), and swallowing
  • No significant changes in rotary chewing or drinking skills
  • No catch-up growth reported
*Gisel et al., 199661
RCT
Tailored sensorimotor treatment with emphasis on tongue lateralization, lip control, chewingModerate to severe motor impairment
n=35
4.3–13.3 years
  • Eating time of standard food textures did not decrease significantly
  • No significant changes in clearing time or ability to advance to more solid foods between groups
  • No differences between groups regarding weight gain
*Clawson et al., 200771
Case series
Beckman oral-motor exercise, parent trainingSpastic diplegia
n=8
1.6–4.7 years
  • Chewing and swallowing improved
  • Number of calories increased (less need for supplementation)
  • Height and weight gain
  • Improvements in caregiver ability to feed
Food consistencyCroft et al., 199279
Prospective cohort study
Mashed vs. nonmashed foodHemiplegia, athetoid, spastic quadriplegia plus athetoid
n=67
3–18 years
  • Children without speech took significantly longer to eat nonmashed than mashed food
  • Children with CP more likely to cough or choke while eating more solid foods
PositioningBanerdt et al., 197870
Case report
Self-feeding skills program, positioningSpastic CP
n=1
2.5 years
  • Number of independent responses from the child increased throughout treatment. New self feeding behaviors at 5 months followup
Morton et al., 199376
Case series
Feeding assessment with videofluoroscopy, positioning recommendationsMajority CP with malnourishment
n=14
4–16 years
  • Children with difficulties mainly in oral phase fed best in the reclined position
  • Children with difficulties mainly in pharyngeal phase fed best in the erect position
  • Parents found seating recommendations helpful
  • No changes in weight gain reported
*Larnert et al., 199577
Case series
PositioningTetraplegia with dystonia (aspiration, recurrent pneumonia)
n=5
3–10 years
  • Aspiration decreased for all participants in reclined position with neck flexed
  • Oral leak diminished in 2 children
  • Retention of puree improved in 1 child
*Vekerdy et al., 200778
Case series
Thoracic-lumbar-sacral orthosisCP, nonambulatory
n=24
1.7–11.2 years
  • Improvement in meal textures tolerated
  • Decreases in feeding time
  • Improvements in mouth opening, food leakage, tongue protrusion
Oral applianceHaberfellner et al.,197780
Case series
Oral appliance (oral shield, vestibular pads)Mixed forms of spasticity, athetosis, and /or ataxia
n=9
6–12 years
  • Sensibility, lip seal, saliva transport, and nasal breathing improved
  • Speech articulation improved
*Fischer-Brandies et al.,198781
Case series
Oral appliance (upper palate plates), physical therapyCP, majority spastic diplegia, majority severe dysfunction
n=71
4–14 years
  • Improvements in spontaneous tongue position and coordination of tongue movement, food intake, speech development and drooling in at least half of participants
  • Treatment discontinued in 5 children due to lack of improvement
  • Unclear if positive effects due to physical therapy or appliance
Gisel et al., 199982
Case report
ISMARModerate spastic quadriplegia
n=1
2 years, 10 months
  • Improved functional feeding skills and visible aspects of the swallow
  • Improved eating efficiency of three standard textures
  • Catch-up of weight during treatment phase, improvements in ambulation and upper extremity function
  • Child became able to self-feed
*Gisel, et al., 2000b69
RCT
ISMARTetraparesis with moderate motor impairment
n=20
4–13 years
  • Improvement in sitting postural control and upper extremity control
  • Improvements in jaw stabilization and oral-motor control
  • Improvement in oral posture but not tongue position in half of participants
*Gisel et al., 2001b83
RCT
ISMARTetraparesis with moderate motor impairment
n=17
6–15 years
  • ISMAR tolerated without complications
  • No significant differences in 7 domains of functional feeding or weight gain 18–24 month followup
  • Maturation equally effective as ISMAR therapy after the first year of use
*Haberfellner et al., 2001b84
RCT
ISMARTetraparesis with moderate motor impairment
n=20
4.2–13.1 years
  • Improvements in oral-motor and chewing skills
*Johnson et al., 200485
Case series
ISMARCP, majority with moderate to sever dysphagia
n=18
4–13 years
  • Clinically important and statistically significant changes in chewing, cup drinking, straw drinking, and swallowing at various points of study
*Gerek et al., 200568
Case series
Castillo-Morales deviceCP, majority with moderate to severe dysphagia
n=7
8–17 years
  • Changes noted in deglutition skills with higher consistency in food intake, decreased risk of aspiration, better saliva control
Parental satisfaction with treatment results
Adapted equipmentPinnington et al., 1999c86
ABA within-subjects design
Electric feeder (Handy 1 Robotic Aid to Eating)Majority CP, moderate-very severe motor disorder
n=16
7–17 years
  • Food intake and weight gain maintained using feeder
  • Eating efficiency reduced; energy and protein intake unchanged using feeder
Pinnington et al., 2000c67
ABA within-subjects design
Electric feeder (Handy 1 Robotic Aid to Eating)Majority CP, moderate-very severe motor disorder
n=16
7–17 years
  • Improvements in oral-motor behaviors using feeder but not always sustained
  • Children with more limited speech appeared to have greater benefit

CP = cerebral palsy; ISMAR = Innsbruck Sensorimotor Activator and Regulator; n = number; RCT = randomized controlled trial

*

Study meets inclusion criteria for current comparative effectiveness review.

a

Same study population.

b

Same study population.

c

Same study population.

From: Results

Cover of Interventions for Feeding and Nutrition in Cerebral Palsy
Interventions for Feeding and Nutrition in Cerebral Palsy [Internet].
Comparative Effectiveness Reviews, No. 94.
Ferluga ED, Archer KR, Sathe NA, et al.

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