Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated?

Santos, Maria Teresa Botti Rodrigues; Batista, Renato; Previtali, Elisangela Fernandez; Ortega, Adriana; Nascimento, Oliver Augusto; Jardim, José Roberto

doi:10.1111/j.1600-0714.2011.01074.x

Cited by 21 publications

(23 citation statements)

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“…Impaired oral sensorimotor function can result in drooling that in turn results in impaired hydration. 11 Problems with liquids are common and usually relate to a timing deficit with delayed pharyngeal swallow initiation. Problems with thick smooth, lumpy or mashed foods relate to residue in the pharynx when pharyngeal motility is reduced.…”

Section: Types Of Swallowing and Feeding Problems In Children With Cpmentioning

confidence: 99%

Feeding children with cerebral palsy and swallowing difficulties

2013

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Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.European Journal of Clinical Nutrition (2013) 67, S9-S12; doi:10.1038/ejcn.2013.224Keywords: cerebral palsy; dysphagia; pediatrics; feeding; swallowing INTRODUCTIONChildren with cerebral palsy (CP) commonly have feeding disorders and swallowing problems (dysphagia) that in many instances place them at risk for aspiration with oral feeding, with potential pulmonary consequences. They also commonly have reduced nutrition/hydration status and prolonged stressful meal times. The specific nature and severity of the swallowing problems may differ, at least to some degree, in relation to sensorimotor impairment, gross and fine motor limitations, and cognitive/ communication deficits. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits 1,2 than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. 3 Concerns are multifactorial and include issues of reduced volume of food and liquid consumed orally, nutrition deficits, inadequate hydration and limited range of textures with slow advance of oral skills.Children with moderate-to-severe dysphagia usually are managed most effectively with an interdisciplinary team that allows for multiple factors to be addressed in a coordinated way. These factors include, but are not limited to, gastrointestinal issues, pulmonary status, nutrition/hydration, oral sensorimotor skills, behavioral issues and family interactions. The importance of a structured approach is stressed to handle these multiple problems. 4 It is critical that all decisions for the management of feeding and swallowing problems are made in consideration of the primary needs of the child that is, a stable airway with adequate nutrition and hydration. In addition, any feeding/ swallowing intervention should be pleasurable and non-stressful for patients and care givers. In some instances, tube feeding may be needed either temporarily or long term. [5][6][7][8] It is expected, with rare exceptions, that these children can cope with at least minimal tastes for pleasure, a practice that may have a positive impact on management of saliva/secretions while maintaining oral function and swallowing.This review paper is focused on dysphagia: types of deficit...

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Section: Types Of Swallowing and Feeding Problems In Children With Cpmentioning

confidence: 99%

Feeding children with cerebral palsy and swallowing difficulties

2013

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“…18 Children with greater oral and motor impairment present greater problems of deglutition, use a liquid diet, 19 and may more often use medications in the form of a solution, which predisposes them to a greater risk of oral diseases, thereby requiring more attention from their dentists and caregivers.…”

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Oral hygiene orientation and caries experience for cerebral palsy patients using oral medication

Silva¹,

Lopes²,

Ikeda³

et al. 2014

Acta Fisiátrica

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The presence of damage associated with cerebral palsy (CP) often requires the long-term continuous use of prescription drugs. Among the adverse side effects of these drugs are decreased salivary flow and increased risk for caries. Objective: To determine whether those responsible for CP patients received orientation regarding the necessity of oral hygiene after the administration of drugs of continuous oral use and the caries experience in patients with CP. Method: Participating in this study were 205 children with medical diagnosis of CP, of both genders, aged 0-12 years (6.6 ± 2.9) attending a preventive program in dentistry in a reference institution of rehabilitation in São Paulo-SP. The data regarding gender, movement disorder and clinical types of CP were collected from medical records. In an interview format, the caregivers reported whether there was use of any continuous medicine. They were asked what form it took, whether the caregivers had received prior guidance on the importance of oral hygiene after the use of medicines, who performed the oral child's hygiene, and how often it was done. Their caries experience was recorded based on whether a given tooth was decayed (D, d) missing (M, m) or filled (F, f) (DMFT). The sample was divided into two groups according to whether they used continuous drugs (group 1: G1) or did not (group 2: G2). The Chi-square test and Student's t test were used, with the level of significance set up at 5%. Results: G1 (n = 110) and G2 (n = 95) were similar in terms of gender (p = 0.343) and age (p = 0.514). However, they differed significantly in relation to the clinical pattern, with G1 presenting significantly higher percentages of patients with tetraparesis (p < 0.001). Considering only the G1, it was observed that the subgroup that used medicine in oral solution form (solution, n = 65) differed significantly from that using tablets (tablets, n = 45) in relation to their previous orientation for hygiene oral (p = 0.013), in that the solution subgroup had been better oriented. With regard to oral hygiene, the solution subgroup had significantly higher percentages (p = 0.044) of children requiring supervision and completion of the oral hygiene when compared to the tablet group. The comparison of caries experience between G1 and G2 showed that the G1 had significantly higher values for their DMF index (p = 0.048), and fewer caries-free patients (p = 0.016) when compared to G2. Conclusion: Although those responsible for the patients receiving medication in the form of oral solution were better oriented, these patients presented higher values of caries experience.

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“…Há um estudo entre indivíduos jovens com paralisia cerebral espástica que investiga a influência do desempenho oromotor, dada pelo OMAS, sobre o estado nutricional e os parâmetros salivares (Santos et al, 2012).…”

Section: Discussionunclassified

“…A motricidade oral está diretamente relacionada com a lesão cerebral causada pela PC, mais do que associada a mudanças de desenvolvimento que são modificadas por hormônios e na puberdade (Santos et al, 2012). Em crianças com PC, o limitado desempenho motor da mastigação e deglutição associado à deficiência no desenvolvimento neurológico (Rosenbaum et al, 2007), resulta em disfunções alimentares que incluem diversas variáveis que se interagem, incluindo disfunção no controle oromotor (sucção fraca, deglutição atípica persistente e pobre selamento labial), maturação neurológica anormal (presença de reflexos patológicos orais), e pobre postura durante a alimentação (Troughton;Hill, 2001;Fung et al, 2002;Santos et al, 2005;Sullivan, 2008;Calis et al, 2010).…”

Section: Função Oromotoraunclassified

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Influência do comprometimento funcional orofacial no estado nutricional de crianças e adolescentes com paralisia cerebral

Pinto¹

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Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated?

Abstract: Cerebral palsy individuals appear to present impaired adequate hydration due to compromised oral motor performance.

Cited by 21 publications

References 20 publications

Feeding children with cerebral palsy and swallowing difficulties

Feeding children with cerebral palsy and swallowing difficulties

Oral hygiene orientation and caries experience for cerebral palsy patients using oral medication

Influência do comprometimento funcional orofacial no estado nutricional de crianças e adolescentes com paralisia cerebral

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