Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: a randomised controlled trial

Abstract

Tongue thrust, which is an oral reflex associated with sucking behaviour, may cause problems in swallowing, speech, oro-facial development and also drooling. We aimed to examine the effect of Functional Chewing Training (FuCT) on tongue thrust and drooling in children with cerebral palsy. The study included 32 children with a mean age of 58·25 ± 9·58 months who had tongue thrust. Children were divided into two groups: the FuCT group and control group receiving classical oral motor exercises. Each group received training for 12 weeks. Oral motor assessment was performed. Chewing performance level was determined with the Karaduman Chewing Performance Scale. Tongue thrust severity was evaluated with the Tongue Thrust Rating Scale. The Drooling Severity and Frequency Scale was used to evaluate drooling severity and frequency. The evaluations were performed before and after treatment. Groups were well matched in age, gender and oral motor assessment. No significant difference was found between groups in terms of pre-treatment chewing function, tongue thrust severity, drooling severity and frequency (P > 0·05). The FuCT group showed improvement in chewing performance (P = 0·001), tongue thrust severity (P = 0·046) and drooling severity (P = 0·002), but no improvement was found in terms of drooling frequency (P = 0·082) after treatment. There was no improvement in chewing performance, tongue thrust, drooling severity and frequency in the control group. A significant difference was found between groups in favour of FuCT group in tongue thrust severity (P = 0·043). This study showed that the FuCT is an effective approach on the severity of tongue thrust and drooling in children with CP.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

“…This decline in severity is encouraging. Children with cerebral palsy may be more likely than ever to be treatment responsive to motor [20,21], bimanual training [54][55][56], constraintinduced movement therapy [46,[62][63][64][65][66][67], functional chewing training [137], goal-directed training [98], home programs using goal-directed training [112], mobility training [123,127], treadmill training [65,123,127], partial body weight support treadmill training [123,127,169], and occupational therapy post botulinum toxin [190] (green lights). Moreover, environmental enrichment to promote task performance is effective (green light) [95] and adapting the environment and task to enable task performance via context-focused therapy (yellow light) [77] is a potent modulator of effective care.…”

“…As such, given that this intervention approach yields only modest benefits above and beyond oral sensorimotor therapy alone, a considered approach is warranted within a pediatric population. (b) A new motor learning-based oral sensorimotor intervention called functional chewing training (FuCT) appeared to improve chewing and reduce tongue thrust and sialorrhea better than traditional oral sensorimotor treatment alone [137] (yellow light), suggesting the direct training component was important. The FuCT findings are consistent with current thinking about motor learning.…”

A systematic review of noninvasive and invasive sialorrhoea management

“…And there was no significant change in the frequency of drooling among those children who completed the study, although the drooling severity scores were improved greatly (Johnson et al, ). One study tried to increase tongue movement to reduce sialorrhoea (Inal, Serel Arslan, Demir, Tunca Yilmaz, & Karaduman, ); again, however, no improvement was found in the frequency of sialorrhoea.…”

“…0.5% sublingual atropine sulphate There was statistically significant reduction in the DIS (drooling impact score) score. Side effects were found in four out of the 33 patients who started the study (12.1%) and their respective frequency occurred as follows: fever and flush (n = 1); irritability (n = 1); flush and irritability (n = 1); flush and angioedema (n = 1) 75% increase tongue movement to reduce sialorrhoea (Inal, Serel Arslan, Demir, Tunca Yilmaz, & Karaduman, 2017); again, however, no improvement was found in the frequency of sialorrhoea.…”

Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review

“…Do not bite forward Keep the lips apart and swallow while keeping your lips apart and teeth closed Two sets of 30 swallow practices are recommended every day. 17 …”