Feeding Skills and Growth After One Year of Intraoral Appliance Therapy in Moderately Dysphagic Children with Cerebral Palsy

Abstract

We determined changes in functional feeding skills and growth after one year of intraoral appliance therapy in dysphagic children. Twenty children, 4.2-13.1 years of age (average 8.3 +/- 0.9 years), participated in this study. Children wore the appliance daily. Phase I of treatment (6 months) aimed primarily at stabilizing the mandible and phase II aimed at facilitating ingestive skills. A control period of 6 months preceded treatment. Functional feeding skills improved significantly during phase I beyond changes seen during the control period. Further significant improvement occurred in chewing during phase II. All children significantly gained weight (kg) during the control period, as well as during the two treatment phases. This weight gain was sufficient for children to maintain their growth trajectory. There was also significant growth in height (cm). This growth spurt was characterized by marginal catch-up. Jaw stabilization was a major contributor to the significant improvement in functional feeding skills. Weight gain cannot be attributed to intervention because it occurred during the control period and was the same in magnitude through both treatment phases. However, it permitted a period of growth in stature which previously had been described only after tube feeding.

Impact of Oral Appliance Therapy: Are Oral Skills and Growth Maintained One Year after Termination of Therapy?

“…More recent studies show a variety of designs that aim at restoration of speci®c oral skills [24±28]. We have shown that functional feeding skills, as measured by spoon-feeding, biting, chewing, cup drinking, and swallowing (less food and liquid loss), improve signi®cantly after one year of intraoral appliance therapy with an ISMAR [15]. These changes were above the level achieved during a comparable control period.…”

“…We report results from a two-year study with the following goals: (1) During the ®rst year, the eects of the appliance on jaw stabilization, oral-motor skills, and growth were examined [15]. (2) During the second year, the impact of such therapy on the same outcome measures was to be examined and is the focus of this article.…”

“…During the course of one year of ISMAR treatment, children signi®cantly gained weight (kg) during the control as well as the 12-month treatment period. This weight gain was sucient for children to maintain their growth trajectory, but there was no catch-up in weight [15]. There was also signi®cant growth in height (cm).…”

“…It could not be attributed to our intervention because it occurred during the control period and was of the same magnitude through the treatment period. However, it permitted a period of growth in stature [15] that previously has been described only after tube feeding [35]. The moderately eating impaired child will require continuous careful monitoring of his/her nutritional state [19].…”

“…The moderately eating impaired child will require continuous careful monitoring of his/her nutritional state [19]. The purported eects of therapy with ISMARs, namely increased tongue mobility, improved resting posture of the lips, and marked improvement of oral-motor transport, have been veri®ed [15,34]. However, questions important to the treating clinician remained.…”