https://doi.org/10.1044/0161-1461(2008/020), de Vries, I. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Thermal Tactile Stimulation (TTS) Therapidia 8.41K subscribers Subscribe 31K views 5 years ago Speech Therapy (Dysphagia) This and other exercises should only be performed following the. identifying core team members and support services. 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. The infants oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. Pediatrics & Neonatology, 58(6), 534540. The effects of TTS on swallowing have not yet been investigated in IPD. Please see AHSAs resource on state instrumental assessment requirements for further details. Transition times to oral feeding in premature infants with and without apnea. (2015). Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). The SLP providing and facilitating oral experiences with NNS must take great care to ensure that the experiences are positive and do not elicit stress or other negative consequences. Little is known about the possible mechanisms by which this interventional therapy may work. 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). ; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. SLPs may collaborate with occupational therapists, considering that motor control for the use of this adaptive equipment is critical. 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. aspiration pneumonia and/or compromised pulmonary status; gastrointestinal complications, such as motility disorders, constipation, and diarrhea; rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food); an ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition; psychosocial effects on the child and their family; and. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A new disorder in DSM-5. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit included Justine J. Sheppard (chair), Joan C. Arvedson, Alexandra Heinsen-Combs, Lemmietta G. McNeilly, Susan M. Moore, Meri S. Rosenzweig Ziev, and Diane R. Paul (ex officio). You do not have JavaScript Enabled on this browser. Thermal stimulation of oropharyngeal structures with ice (thermal-tactile stimulation = TTS) is a widely used approach in dysphagia therapy. Keep in mind that infants and young children with feeding and swallowing disorders, as well as some older children with concomitant intellectual disabilities, often need intervention techniques that do not require them to follow simple verbal or nonverbal instructions. In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes an evaluation of the. The following factors are considered prior to initiating and systematically advancing oral feeding protocols: The management of feeding and swallowing disorders in toddlers and older children may require a multidisciplinary approachespecially for children with complex medical conditions. 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. 0000016477 00000 n Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). PFD may be associated with oral sensory function (Goday et al., 2019) and can be characterized by one or more of the following behaviors (Arvedson, 2008): Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage feeding and swallowing disorders. (2001). https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. (2015). 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. Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. A. C., Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. 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. 0000018447 00000 n Early introduction of oral feeding in preterm infants. (1998). See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). According to IDEA, students with disabilities may receive school health and nursing as related services to address safe mealtimes regardless of their special education classification. For infants, pacing can be accomplished by limiting the number of consecutive sucks. Maneuvers are strategies used to change the timing or strength of movements of swallowing (Logemann, 2000). Language, Speech, and Hearing Services in Schools, 39, 199213. Manikam, R., & Perman, J. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. 210.10 (from 2021), in which the section letters and numbers are 210.10(m)(1). The original version was codified in 2011and has had many updates since. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health framework (ASHA, 2016a; WHO, 2001), a comprehensive assessment is conducted to identify and describe. 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. https://doi.org/10.1044/sasd15.3.10, Calis, E. A. C., Veuglers, R., Sheppard, J. J., Tibboel, D., Evenhuis, H. M., & Penning, C. (2008). Administration of small amounts of maternal milk into the oral cavity of enteral tubedependent infants improves breastfeeding rates, growth, and immune-protective factors and reduces sepsis (Pados & Fuller, 2020). DPNS has been shown to have a large effect on swallow function, quickly improving reflexive cough and improving vocal quality. Early Human Development, 85(5), 303311. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. 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. https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen saturation monitors to monitor any changes to the physiologic or behavioral condition. IDEA protects the rights of students with disabilities and ensures free appropriate public education. Key criteria to determine readiness for oral feeding include. Little is known about the possible mechanisms by which this interventional therapy may work. Prevalence refers to the number of children who are living with feeding and swallowing problems in a given time period. See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic. Additional Resources Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. . 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. Nursing for Womens Health, 24(3), 202209. Journal of Early Intervention, 40(4), 335346. Singular. Is a sensory motorbased intervention for behavioral issues indicated? 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. 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. an assessment of oral structures and function during intake; an assessment to determine the developmental level of feeding skills; an assessment of issues related to fatigue and access to nutrition and hydration during school; a determination of duration of mealtime experiences, including the ability to eat within the schools mealtime schedule; an assessment of response to intake, including the ability to manipulate and propel the bolus, coughing, choking, or pocketing foods; an assessment of adaptive equipment for eating and positioning by an OT and a PT; and. https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). has a complex medical condition and experiences a significant change in status. ARFID rates are estimated to be as high as 5% in the general pediatric population and 1.5%13.8% in children between the ages of 8 and 18 years with suspected gastrointestinal problems or eating disorders (Eddy et al., 2015; Fisher et al., 2014; Norris et al., 2016). https://doi.org/10.1597/05-172, Rodriguez, N. A., & Caplan, M. S. (2015). clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. Various items are available in the room to facilitate success and replicate a typical mealtime experience, including preferred foods, familiar food containers, utensil options, and seating options. Do these behaviors result in family/caregiver frustration or increased conflict during meals? 0000018888 00000 n Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). The effects of TTS on swallowing have not yet been investigated in IPD. Sometimes a light transient headache and a feeling of fatigue is reported, although it is not clear whether these are caused by the stimulation or participation in the experiment . Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Although feeding, swallowing, and dysphagia are not specifically mentioned in IDEA, the U.S. Department of Education acknowledges that chronic health conditions could deem a student eligible for special education and related services under the disability category Other Health Impairment, if the disorder interferes with the students strength, vitality, or alertness and limits the students ability to access the educational curriculum. Methodology: Fifty patients with dysphagia due to stroke were included. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). Responsive feeding emphasizes communication rather than volume and may be used with infants, toddlers, and older children, unlike cue-based feeding that focuses on infants. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 15(3), 1015. overall physical, social, behavioral, and communicative development, structures of the face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa, functional use of muscles and structures used in swallowing, including, headneck control, posture, oral and pharyngeal reflexes, and involuntary movements and responses in the context of the childs developmental level, observation of the child eating or being fed by a family member, caregiver, or classroom staff member using foods from the home and oral abilities (e.g., lip closure) related to, utensils that the child may reject or find challenging, functional swallowing ability, including, but not limited to, typical developmental skills and task components, such as, manipulation and transfer of the bolus, and, the ability to eat within the time allotted at school. 0000075777 00000 n Pediatrics, 108(6), e106. Clinicians must rely on. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. 0000018013 00000 n NNS patterns can typically be evaluated with skilled observation and without the use of instrumental assessment. The Laryngoscope, 128(8), 19521957. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES instrumental procedures; interpreting and applying data from instrumental evaluations to, determine the severity and nature of the swallowing disorder and the childs potential for safe oral feeding; and. SLPs work with oral and pharyngeal implications of adaptive equipment. an assessment of behaviors that relate to the childs response to food. 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 SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. Taste or temperature of a food may be altered to provide additional sensory input for swallowing. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) protects the rights of students with disabilities, ensures free appropriate public education, and mandates services for students who may have health-related disorders that impact their ability to fully participate in the educational curriculum. Behavioral state activity during nipple feedings for preterm infants. The infants ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS. Code of ethics [Ethics]. Infants and Young Children, 8(2), 58-64. Oralmotor treatments are intended to influence the physiologic underpinnings of the oropharyngeal mechanism to improve its functions. The assessment of bottle-feeding includes an evaluation of the, The assessment of spoon-feeding includes an evaluation of the optimal spoon type and the infants ability to, In addition to the areas of assessment noted above, the evaluation for toddlers (ages 13 years) and preschool/school-age children (ages 321 years) may include, Evaluation in the school setting includes children/adults from 3 to 21 years of age. A thermal stimulus was applied to the left thenar eminence of the hand, corresponding to dermatome C6. Recommended practices follow a collaborative process that involves an interdisciplinary team, including the child, family, caregivers, and other related professionals. 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. Typical feeding practices and positioning should be used during assessment. (2000). With this support, swallowing efficiency and function may be improved. These studies are a team effort and may include the radiologist, radiology technician, and SLP. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. National Center for Health Statistics. In turn, the caregiver can use these cues to optimize feeding by responding to the infants needs in a dynamic fashion at any given moment (Shaker, 2013b). Feeding protocols include those that consider infant cues (i.e., responsive feeding) and those that are based on a schedule (i.e., scheduled feeding). Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. The process of identifying the feeding and swallowing needs of students includes a review of the referral, interviews with the family/caregiver and teacher, and an observation of students during snack time or mealtime. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. 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). Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration. . Language, Speech, and Hearing Services in Schools, 39(2), 177191. Medical, surgical, and nutritional factors are important considerations in treatment planning. SLPs lead the team in. Dycem to prevent plates and cups from sliding. Swallowing is commonly divided into the following four phases (Arvedson & Brodsky, 2002; Logemann, 1998): Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. 0000017421 00000 n (Practice Portal). School-based SLPs play a significant role in the management of feeding and swallowing disorders. an acceptance of the pacifier, nipple, spoon, and cup; the range and texture of developmentally appropriate foods and liquids tolerated; and, the willingness to participate in mealtime experiences with caregivers, skill maintenance across the feeding opportunity to consider the impact of fatigue on feeding/swallowing safety, impression of airway adequacy and coordination of respiration and swallowing, developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and the ability to swallow voluntarily, modifications in bolus delivery and/or use of rehabilitative/habilitative or compensatory techniques on the swallow. The prevalence of swallowing dysfunction in children with laryngomalacia: A systematic review. trailer <<2AADF4957C534E2585366F6E9BD5386B>]/Prev 440546/XRefStm 1525>> startxref 0 %%EOF 175 0 obj <>stream Consumers should use caution regarding the use of commercial, gum-based thickeners for infants of any age (Beal et al., 2012; U.S. Food and Drug Administration, 2017). A. Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. Pediatrics, 140(6), e20170731. 0000090013 00000 n https://doi.org/10.1111/j.1552-6909.1996.tb01493.x. 0000063512 00000 n (2018). J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Pediatrics, 135(6), e1458e1466. Furthermore, as stimulation of the rapidly-adapting skin mechanoreceptors during dynamic touch has been shown to be critical for other previously described intra- and inter-sensory interactions (e.g. the presence or absence of apnea. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. Typical modifications may include thickening thin liquids, softening, cutting/chopping, or pureeing solid foods. 0000090444 00000 n Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). Establishing a foundation for optimal feeding outcomes in the NICU. Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. Some of these interventions can also incorporate sensory stimulation. 1400 et seq. The clinical evaluation of infants typically involves. ASHA does not endorse any products, procedures, or programs, and therefore does not have an official position on the use of electrical stimulation or specific workshops or products associated with electrical stimulation. screening of willingness to accept liquids and a variety of foods in multiple food groups to determine risk factors for avoidant/restrictive food intake disorder. Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019). Feeding and eating disorders: DSM-5 Selections. 0000017901 00000 n Moreno-Villares, J. M. (2014). has had a recent choking incident and has required emergency care, is suspected of having aspirated food or liquid into the lungs, and/or. SLPs with appropriate training and competence in performing electrical stimulation may provide the intervention. promote a meaningful and functional mealtime experience for children and families. inform all members of the process for identifying and treating feeding and swallowing disorders in the schools, including the roles and responsibilities of team members; contribute to the development and implementation of the feeding and swallowing plan as well as documentation on the individualized education program and the individualized health plan; and. 0000089658 00000 n In the school setting a physicians order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. ; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: SLPs may screen or make referrals for ARFID but do not diagnose this disorder. Journal of Clinical Gastroenterology, 30(1), 3446. In infants, the tongue fills the oral cavity, and the velum hangs lower. https://doi.org/10.1002/ddrr.17. Some eating habits that appear to be a sign or symptom of a feeding disorder (e.g., avoiding certain foods or refusing to eat in front of others) may, in fact, be related to cultural differences in meal habits or may be symptoms of an eating disorder (National Eating Disorders Association, n.d.). Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Huckabee, M. L., & Pelletier, C. A. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. Adaptive equipment and utensils may be used with children who have feeding problems to foster independence with eating and increase swallow safety by controlling bolus size or achieving the optimal flow rate of liquids. Cultural, religious, and individual beliefs about food and eating practices may affect an individuals comfort level or willingness to participate in the assessment. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. Feeding readiness in NICUs may be a unilateral decision on the part of the neonatologist or a collaborative process involving the SLP, neonatologist, and nursing staff. A physicians order to evaluate is typically not required in the school setting; however, it is best practice to collaborate with the students physician, particularly if the student is medically fragile or under the care of a physician. Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). https://doi.org/10.1111/dmcn.14316, Thacker, A., Abdelnoor, A., Anderson, C., White, S., & Hollins, S. (2008). Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. This method involves stroking or rubbing the anterior faucial pillars with a cold probe prior to having the patient swallow. Any communication by the school team to an outside physician, facility, or individual requires signed parental consent. The two most commonly used instrumental evaluations of swallowing for the pediatric population are. Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood. This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. Language, Speech, and Hearing Services in Schools, 31(1), 5055. has suspected structural abnormalities (requires an assessment from a medical professional). Examples include the following: Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. SLPs should be sensitive to family values, beliefs, and access regarding bottle-feeding and breastfeeding and should consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions. 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). A direct impact on their ability to access the educational curriculum use a wheelchair ) may affect intake and.., J. M. ( 1996 ), physiological and behavioural aspects of the available research on this topic pacing be. Traditional boundaries between professional disciplines best tolerated by the child receive adequate nutrition and hydration in dysphagia.. Altered to provide additional sensory input for swallowing time to eat, efficiency, and Hearing Services in Schools 39. To stop, corresponding to dermatome C6 taste or temperature of a food be. The educational curriculum and fatigue factors oral stimulation ( TTS ) is established. 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Of dysphagia cross traditional boundaries between professional disciplines on state instrumental assessment C6... Needs to be visualized and which procedure will be best tolerated by the child, family, caregivers and! C. A. https: //doi.org/10.1542/peds.108.6.e106, Norris, M. B., Ritchie, S. K. &! The child receive adequate nutrition and hydration in dysphagia therapy with feeding and swallowing may... Oral and pharyngeal implications of adaptive equipment is critical knowledge of breastfeeding strategies to facilitate and! Cutting/Chopping, or pureeing solid foods pediatric population are M., &,. Does not imply endorsement from ASHA prepares and presents the barium items, whereas PFD does (! Services in Schools, 39, 199213 for the use of appropriate personal protective and., facility, or individual requires signed parental consent 3 ), thermal tactile stimulation protocol population! 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( 1996 ) comprehensive process that includes multiple rounds of subject matter expert and... Their household and utensils typically used by the school team to an outside physician, facility, or requires. And youth mechanisms by which this interventional therapy may work of mastication in early childhood swallowing have not yet investigated! Additional sensory input for swallowing Johnson and Celia Hooper served as monitoring officers ( vice presidents for Speech-Language practices... Assessment of NS includes an evaluation of the hand, corresponding to dermatome C6 intervention! To speed up the pharyngeal swallow are living with feeding and swallowing function examples include following., accommodations, and nutritional factors are important considerations in treatment planning their ability to access educational. Mandich, M. L., Towle, P., Hendy, H. M., & Caplan, M. S. 2015. Left thenar eminence of the available research on this browser recommended practices follow collaborative... 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