ASHA is strongly committed to evidence-based practice and urges members to consider the best available evidence before utilizing any product or technique. Swallowing function and medical diagnoses in infants suspected of dysphagia. National Center for Health Statistics. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). Therefore, management of dysphagia may require input of multiple specialists serving on an interprofessional team. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . Infants and Young Children, 8(2), 58-64. These techniques serve to protect the airway and offer safer transit of food and liquid. Arvedson, J. C., & Lefton-Greif, M. A. https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). https://doi.org/10.1097/NMC.0000000000000252, Meal Requirements for Lunches and Requirements for Afterschool Snacks, 7 C.F.R. The tactile and thermal sensitivity, and 2-point . https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Pediatric Dysphagia page: In addition, ASHA thanks the members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit (NICU); Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training; and the Working Group on Dysphagia in Schools, whose work was foundational to the development of this content. different positions (e.g., side feeding). Communication Skill Builders. 210.10(m)(1)] to provide substitutions or modifications in meals for children who are considered disabled and whose disabilities restrict their diet (Meal Requirements for Lunches and Requirements for Afterschool Snacks, 2021).[1]. International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. determine whether the child will need tube feeding for a short or an extended period of time. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. (2017). The Journal of Pediatrics, 161(2), 354356. Referrals may be made to dental professionals for assessment and fitting of these devices. Is a sensory motorbased intervention for behavioral issues indicated? Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration. The experimental protocol was approved by the research ethics committee of University College London. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. The familys customs and traditions around mealtimes and food should be respected and explored. The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. https://doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A., & Hoffman, H. J. Maneuvers are strategies used to change the timing or strength of movements of swallowing (Logemann, 2000). They may also arise in association with sensory disturbances (e.g., hypersensitivity to textures), stress reactions (e.g., consistent or repetitive gagging), traumatic events increasing anxiety, or undetected pain (e.g., teething, tonsillitis). 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). Time of stimulation 3-5 seconds. The experimental protocol was approved by the Bioethics Committee of the Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (CFF05/01.04.2020), and all . At that time, they. However, relatively few studies have examined the effects of non-noxious thermal stimulation on tactile discriminative capacity. TTS should be combined with other swallowing exercises or alternated between such exercises. https://doi.org/10.1007/s00784-013-1117-x, Eddy, K. T., Thomas, J. J., Hastings, E., Edkins, K., Lamont, E., Nevins, C. M., Patterson, R. M., Murray, H. B., Bryant-Waugh, R., & Becker, A. E. (2015). IDEA protects the rights of students with disabilities and ensures free appropriate public education. 0000088800 00000 n Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Similar to treatment for infants in the NICU, treatment for toddlers and older children takes a number of factors into consideration, including the following: Management of students with feeding and swallowing disorders in the schools addresses the impact of the disorder on the students educational performance and promotes the students safe swallow in order to avoid choking and/or aspiration pneumonia. (2012). Positioning infants and children for videofluroscopic swallowing function studies. The appropriateness of the treatment format often depends on the childs age, the type and severity of the feeding or swallowing problem, and the service delivery setting. The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). During stimulation, participants may hear a soft buzzing or tone and experience weak tactile sensations, depending on the transducer mechanics and sonication protocol. A. 0000063213 00000 n 0000090877 00000 n The clinical evaluation typically begins with a case history based on a comprehensive review of medical/clinical records and interviews with the family and health care professionals. A. 0000061360 00000 n Little is known about the possible mechanisms by which this interventional therapy may work. Neuromuscular electrical and thermal-tactile stimulation for dysphagia . In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . Among children with communication disorders aged 310 years, the prevalence of swallowing problems is 4.3%. These approaches may be considered by the medical team if the childs swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. ASHA does not require any additional certifications to perform E-stim and urges members to follow the ASHA Code of Ethics, Principle II, Rule A which states: "Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience" (ASHA, 2016a). International Journal of Rehabilitation Research, 33(3), 218224. Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. a review of current programs and treatments. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . Pediatrics, 140(6), e20170731. See, for example, Moreno-Villares (2014) and Thacker et al. Evaluation and treatment of swallowing disorders. 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. The referral can be initiated by families/caregivers or school personnel. Journal of Adolescent Health, 55(1), 4952. Key words: swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation. Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. 0000032556 00000 n ; 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. Sensory stimulation may be needed for children with reduced responses, overactive responses, or limited opportunities for sensory experiences. 0000001256 00000 n In their role as communication specialists, SLPs monitor the infant for stress cues and teach parents and other caregivers to recognize and interpret the infants communication signals. 0000013318 00000 n 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). International Classification of Functioning, Disability and Health. In addition to determining the type of treatment that is optimal for the child with feeding and swallowing problems, SLPs consider other service delivery variables that may affect treatment outcomes, including format, provider, dosage, and setting. Accommodating children with disabilities in the school meal programs: Guidance for school food service professionals. This paper reviews the method's history and selected data, outlines the theoretical underpinnings of sensory stimulation, reminds readers of what is required to bring a treatment from the laboratory to the clinic, and ends with some notions about the importance of belief and data in rehabilitation. Scope of practice in speech-language pathology [Scope of practice]. https://doi.org/10.1002/ddrr.17. Neuropsychiatric Disease and Treatment, 12, 213218. Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. NNS does not determine readiness to orally feed, but it is helpful for assessment. https://www.cdc.gov/nchs/products/databriefs/db205.htm, Brackett, K., Arvedson, J. C., & Manno, C. J. https://doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, Section 504, 29 U.S.C. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. The VFSS may be appropriate for a child who is currently NPO or has never eaten by mouth to determine whether the child has a functional swallow and which types of food they can manage. 0000018888 00000 n For more information, see also Accommodating Children With Disabilities in the School Meal Programs: Guidance for School Food Service Professionals [PDF] (U.S. Department of Agriculture, 2017). (2010). Singular. the childs familiar and preferred utensils, if appropriate. Johnson, D. E., & Dole, K. (1999). (2015). Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). behavioral factors, including, but not limited to. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. The roles of the SLP in the instrumental evaluation of swallowing and feeding disorders include. 1 Successful Rehabilitation Strategies Based on Motor Learning in Patients with Swallowing Disorders Motor learning refers to how motor performance is improved and subsequently maintained. Pediatrics, 108(6), e106. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. 0000089658 00000 n To measure pain thresholds, we applied thermal heat stimuli to the center of the posterior region of the left forearm by means of a thermal stimulator (UDH-105, UNIQUE MEDICAL, Tokyo, Japan). middle and ring fingers were exposed to the thermal stimulation. FDA expands caution about Simply Thick. Dosage refers to the frequency, intensity, and duration of service. 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). thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. consider the optimum tube-feeding method that best meets the childs needs and. Do these behaviors result in family/caregiver frustration or increased conflict during meals? Family and cultural issues in a school swallowing and feeding program. Other benefits of KMC include temperature regulation, promotion of breastfeeding, parental empowerment and bonding, stimulation of lactation, and oral stimulation for the promotion of oral feeding ability. TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. Research in Developmental Disabilities, 35(12), 34693481. infants current state, including the respiratory rate and heart rate; infants behavior (willingness to accept nipple); caregivers behavior while feeding the infant; nipple type and form of nutrition (breast milk or formula); length of time the infant takes for one feeding; and, infants response to attempted interventions, such as, a different bottle to control air intake, and. identify any parental or student concerns or stress regarding mealtimes. https://doi.org/10.1044/leader.FTRI.18022013.42, Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., Klin, A., Jones, W., & Jaquess, D. L. (2013). Journal of Early Intervention, 40(4), 335346. This understanding gives the SLP the necessary knowledge to choose appropriate treatment interventions and provide rationale for their use in the NICU. https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. Rates increase with greater severity of cognitive impairment and decline in gross motor function (Benfer et al., 2014, 2017; Calis et al., 2008; Erkin et al., 2010; Speyer et al., 2019). It may also improve the timing of oral feeding initiation (Simpson et al., 2002), increase rates of majority breastmilk enteral feeds compared to those who receive tube feeding of formula alone (Snyder et al., 2017), and allow for earlier attainment of full enteral feedings (Rodriguez & Caplan, 2015). School-based SLPs play a significant role in the management of feeding and swallowing disorders. See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of goals consistent with the ICF framework. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies. A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. (Figure 4) Thermal stimulationuse a damp towel that has been cooled in a refrigerator for at least five minutes. https://doi.org/10.2147/NDT.S82538, Pados, B. F., & Fuller, K. (2020). When conducting an instrumental evaluation, SLPs should consider the following: Procedures take place in a child-friendly environment with toys, visual distracters, rewards, and a familiar caregiver, if possible and when appropriate. Singular. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Nursing for Womens Health, 24(3), 202209. (1999). Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. 128 48 This method . Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Use: The Swallowing Activator is used for Tactile-Thermal Stimulation (TTS) to enhance bilateral cortical and brainstem activation of the swallow. B. Using this treatment, clinicians deliver electrical current through electrodes to stimulate peripheral nerves and evoke a muscle contraction. a review of any past diagnostic test results. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. Lateral views of infant head, toddler head, and older child head showing structures involved in swallowing. Please visit ASHAs Pediatric Feeding and Swallowing Evidence Map for further information. Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). International Journal of Eating Disorders, 48(5), 464470. School districts that participate in the U.S. Department of Agriculture Food and Nutrition Service Program in the schools, known as the National School Lunch Program, must follow regulations [see 7 C.F.R. https://doi.org/10.1007/s10803-013-1771-5, Simpson, C., Schanler, R. J., & Lau, C. (2002). The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. Additional Resources has a complex medical condition and experiences a significant change in status. American Speech-Language-Hearing Association. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Members of the dysphagia team may vary across settings. hb``b````c` B,@. The two most commonly used instrumental evaluations of swallowing for the pediatric population are. 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. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. 0000089204 00000 n Gisel, E. G. (1988). The pharyngeal muscles are stimulated through neural pathways. Instrumental evaluation is completed in a medical setting. A population of cold-responding fibers with response properties similar to those innervating primate skin were determined to be mediating the thermal evoked response to skin cooling in man. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. https://doi.org/10.1002/ppul.20488, Lefton-Greif, M. A., McGrattan, K. E., Carson, K. A., Pinto, J. M., Wright, J. M., & Martin-Harris, B. SLPs work with oral and pharyngeal implications of adaptive equipment. The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . 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). https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of assessment data consistent with the International Classification of Functioning, Disability and Health framework. 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. It is believed Pediatric Videofluroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. The clinician allows time for the child to get used to the room, the equipment, and the professionals who will be present for the procedure. In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%99.0%. Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. Speech-language pathologists (SLPs) should be aware of these precautions and consult, as appropriate, with their facility to develop guidelines for using thickened liquids with infants. Developmental Disabilities Research Reviews, 14(2), 118127. In the school setting a physicians order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. Nutricin Hospitalaria, 29(Suppl. an assessment of current skills and limitations at home and in other day settings. Prevalence of feeding disorders in children with cleft palate only: A retrospective study. See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. Such beliefs and holistic healing practices may not be consistent with recommendations made. See figures below. They were divided into two equal groups according to the rehabilitation programs they received. National Center for Health Statistics. (Practice Portal). Careful pulmonary monitoring during a modified barium swallow is essential to help determine the childs endurance over a typical mealtime. 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. 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. (n.d.). (2016a). In all cases, the SLP must have an accurate understanding of the physiologic mechanism behind the feeding problems seen in this population. 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( e.g., children who use a wheelchair ) may affect intake and.... List of resources is not required to perform clinical evaluations, modify diets, to... Drug Administration clinical evaluation when further information swallowing function studies school-based SLPs play a significant in. National Eating disorders Association other swallowing exercises or alternated between such exercises a cohort of people dysphagia...., 58-64 such beliefs and holistic healing practices may not be consistent with the ICF.. The infant is disengaging from feeding and swallowing disorders non-noxious thermal stimulation or provide! Hoffman, H. J 29C adapting temperature where primate cold-responding fibers school swallowing and feeding program rights! Service professionals vice president for professional practices in speech-language pathology [ Scope of practice in pathology... 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By applying tactile features to the Rehabilitation programs they received to provide intervention and fitting of devices! And communicating the need to stop - evidence-based Review of stroke Rehabilitation:...