thermal tactile stimulation protocol
Positioning infants and children for videofluroscopic swallowing function studies. Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). an assessment of behaviors that relate to the childs response to food. Feeding and gastrointestinal problems in children with cerebral palsy. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. https://doi.org/10.1016/j.ijom.2015.02.014, Centers for Disease Control and Prevention. https://doi.org/10.1016/j.earlhumdev.2008.12.003. The control group was given thermal-tactile stimulation treatment only, while in the experimental group neuromuscular electrical stimulation and thermal-tactile stimulation treatments were applied simultaneously. Pediatrics, 110(3), 517522. Huckabee, M. L., & Pelletier, C. A. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. 0000001256 00000 n 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. 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. https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). https://doi.org/10.1177/1053815118789396, Shaker, C. S. (2013a). 0000051615 00000 n How can the childs quality of life be preserved and/or enhanced? middle and ring fingers were exposed to the thermal stimulation. Pro-Ed. Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. The pup while on its back is allowed to sleep. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. sometimes also called fiber-optic endoscopic evaluation of swallowing, the inclusion of orally fed supplements in the childs diet, Pediatric Feeding and Swallowing Evidence Map, preferred providers of dysphagia services, Scope of Practice in Speech-Language Pathology, interprofessional education/interprofessional practice [IPE/IPP], Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004), U.S. Department of Agriculture Food and Nutrition Service Program, https://www.govinfo.gov/content/pkg/CFR-2011-title7-vol4/pdf/CFR-2011-title7-vol4-sec210-10.pdf, interprofessional education/interprofessional practice (IPE/IPP), state instrumental assessment requirements, videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), International Dysphagia Diet Standardisation Initiative (IDDSI), alternative nutrition and hydration in dysphagia care, ASHA Guidance to SLPs Regarding Aerosol Generating Procedures, Dysphagia Management for School Children: Dealing With Ethical Dilemmas, Feeding and Swallowing Disorders in Children, Flexible Endoscopic Evaluation of Swallowing (FEES), Interprofessional Education/Interprofessional Practice (IPE/IPP), Pediatric Feeding Assessments and Interventions, Pick the Right Code for Pediatric Dysphagia, State Instrumental Assessment Requirements, International Commission on Radiological Protection (ICRP), Management of Swallowing and Feeding Disorders in Schools, National Foundation of Swallowing Disorders, RadiologyInfo.org: Video Fluoroscopic Swallowing Exam (VFSE), https://doi.org/10.1016/j.jpeds.2012.03.054, https://doi.org/10.1016/j.ridd.2014.08.029, https://www.cdc.gov/nchs/products/databriefs/db205.htm, https://doi.org/10.1111/j.1469-8749.2008.03047.x, https://doi.org/10.1016/j.ijom.2015.02.014, https://doi.org/10.1044/0161-1461(2008/020), https://doi.org/10.1007/s00784-013-1117-x, https://doi.org/10.1097/MRR.0b013e3283375e10, https://doi.org/10.1016/j.jadohealth.2013.11.013, https://doi.org/10.1044/0161-1461(2008/018), https://doi.org/10.1016/j.ijporl.2020.110464, https://doi.org/10.1017/S0007114513002699, https://doi.org/10.1016/j.pmr.2008.05.007, https://doi.org/10.1007/s00455-017-9834-y, https://doi.org/10.1044/0161-1461.3101.50, https://doi.org/10.1111/j.1552-6909.1996.tb01493.x, https://doi.org/10.1097/NMC.0000000000000252, https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10, https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf, https://www.nationaleatingdisorders.org/warning-signs-and-symptoms, https://doi.org/10.1016/j.nwh.2020.03.007, https://www.ada.gov/regs2016/504_nprm.html, https://doi.org/10.1097/JPN.0000000000000082, https://doi.org/10.1891/0730-0832.32.6.404, https://doi.org/10.1044/leader.FTRI.18022013.42, https://doi.org/10.1007/s10803-013-1771-5, https://doi.org/10.1016/j.pedneo.2017.04.003, https://doi.org/10.1080/09638280701461625, https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, https://wayback.archive-it.org/7993/20170722060115/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm, https://doi.org/10.1016/j.ijporl.2013.03.008, https://doi.org/10.1016/j.earlhumdev.2008.12.003, www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/, Connect with your colleagues in the ASHA Community, refusing age-appropriate or developmentally appropriate foods or liquids, accepting a restricted variety or quantity of foods or liquids, displaying disruptive or inappropriate mealtime behaviors for developmental levels, failing to master self-feeding skills expected for developmental levels, failing to use developmentally appropriate feeding devices and utensils, significant weight loss (or failure to achieve expected weight gain or faltering growth in children), dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning. 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). Number of all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [Data file]. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. Johnson, D. E., & Dole, K. (1999). Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. A significant number of studies that evaluated tactile-pain interactions employed heat to evoke nociceptive responses. Celia Hooper, vice president for professional practices in speech-language pathology (20032005), served as monitoring vice president. Anxiety and crying may be expected reactions to any instrumental procedure. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). consider the optimum tube-feeding method that best meets the childs needs and. 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. A. Consider the childs pulmonary status, nutritional status, overall medical condition, mobility, swallowing abilities, and cognition, in addition to the childs swallowing function and how these factors affect feeding efficiency and safety. 0000023632 00000 n 0000089331 00000 n When treatment incorporates accommodations, modifications, and supports in everyday settings, SLPs often provide training and education in how to use strategies to facilitate safe swallowing. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A new disorder in DSM-5. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. 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. School-based SLPs play a significant role in the management of feeding and swallowing disorders. Treatment selection will depend on the childs age, cognitive and physical abilities, and specific swallowing and feeding problems. Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. As a result, intake is improved (Shaker, 2013a). The clinical evaluation of infants typically involves. 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. The pharyngeal muscles are stimulated through neural pathways. 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. No single posture will provide improvement to all individuals. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). The tactile and thermal sensitivity, and 2-point . 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). The space between the tongue and the palate increases, and the larynx and the hyoid bone lower, elongating and enlarging the pharynx (Logemann, 1998). The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. Code of ethics [Ethics]. 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. Interdisciplinary feeding team: A medical, motor, behavioral approach to complex pediatric feeding problems. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Understanding adult anatomy and physiology of the swallow provides a basis for understanding dysphagia in children, but SLPs require knowledge and skills specific to pediatric populations. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. The experimental protocol was approved by the research ethics committee of University College London. Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). Disability and Rehabilitation, 30(15), 11311138. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes The referral can be initiated by families/caregivers or school personnel. International Journal of Pediatric Otorhinolaryngology, 77(5), 635646. The prevalence of pediatric voice and swallowing problems in the United States. 0000004839 00000 n 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. National Health Interview Survey. Language, Speech, and Hearing Services in Schools, 39(2), 177191. Feeding and swallowing challenges can persist well into adolescence and adulthood. has recently been hospitalized with aspiration pneumonia. 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. 0000016477 00000 n https://doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Foods given during the assessment should be consistent with the childs current level of chewing skills. the use of intervention probes to identify strategies that might improve function. Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. Format refers to the structure of the treatment session (e.g., group and/or individual). Accommodating children with disabilities in the school meal programs: Guidance for school food service professionals. In infants, the tongue fills the oral cavity, and the velum hangs lower. See, for example, Manikam and Perman (2000). Singular. 1997- American Speech-Language-Hearing Association. The development of jaw motion for mastication. Pediatrics, 135(6), e1458e1466. (2008). NNS patterns can typically be evaluated with skilled observation and without the use of instrumental assessment. trailer <<2AADF4957C534E2585366F6E9BD5386B>]/Prev 440546/XRefStm 1525>> startxref 0 %%EOF 175 0 obj <>stream Apnea is strongly correlated with longer transition time to full oral feeding (Mandich et al., 1996). https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). Infants under 6 months of age typically require head, neck, and trunk support. See the Assessment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. the presence or absence of apnea. 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). The effects of TTS on swallowing have not yet been investigated in IPD. an assessment of current skills and limitations at home and in other day settings. https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). Behavioral state activity during nipple feedings for preterm infants. 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. Alternative feeding does not preclude the need for feeding-related treatment. Please enable it in order to use the full functionality of our website. 0000089204 00000 n 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. Careful pulmonary monitoring during a modified barium swallow is essential to help determine the childs endurance over a typical mealtime. SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional. Silent aspiration is estimated at 41% of children with laryngeal cleft, 41%49% of children with laryngomalacia, and 54% of children with unilateral vocal fold paralysis (Jaffal et al., 2020; Velayutham et al., 2018). 0000018447 00000 n National Center for Health Statistics. Examples include the following: Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. Dycem to prevent plates and cups from sliding. 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. skill development for eating and drinking efficiently during meals and snack times so that students can complete these activities with their peers safely and in a timely manner. Pediatric Pulmonology, 41(11), 10401048. Developmental Disabilities Research Reviews, 14(2), 118127. breathing difficulties when feeding, which might be signaled by. https://sites.ed.gov/idea/, Jaffal, H., Isaac, A., Johannsen, W., Campbell, S., & El-Hakim, H. G. (2020). Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. 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. A feeding and swallowing plan may include but not be limited to. 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. (2017). Swallowing function and medical diagnoses in infants suspected of dysphagia. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. Medical, surgical, and nutritional factors are important considerations in treatment planning. If the child is NPO, the clinician allows time for the child to develop the ability to accept and swallow a bolus. formulate feeding and swallowing treatment plans, including recommendations for optimal feeding techniques; being familiar with and using information from diagnostic procedures performed by different medical specialists that yield information about swallowing function, which include. Members of the Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training included Caryn Easterling, Maureen Lefton-Greif, Paula Sullivan, Nancy Swigert, and Janet Brown (ASHA staff liaison). (2010). 128 48 Tactile and thermal hypersensitivity were assessed using von Frey filaments and the tail flick test initially, at 24 h and 48 h after administration. https://doi.org/10.1044/0161-1461(2008/020), de Vries, I. American Journal of Occupational Therapy, 42(1), 4046. Warning signs and symptoms. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(9), 771776. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. turn their head away from the spoon to show that they have had enough. Behaviors can include changes in the following: Readiness for oral feeding in the preterm or acutely ill, full-term infant is associated with. Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Methods: Thirty-six subjects were randomized into experimental and control groups. (Figure 4) Thermal stimulationuse a damp towel that has been cooled in a refrigerator for at least five minutes. 0000018013 00000 n (2009). Cases of ARFID are reported to have a greater likelihood in males and children with gastrointestinal symptoms, a history of vomiting/choking, and a comorbid medical condition (Fisher et al., 2014). Families are encouraged to bring food and drink common to their household and utensils typically used by the child. https://doi.org/10.1002/ddrr.17. Singular. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. Additional components of the evaluation include. TSTP (traditional therapy using tactile thermal stimulus [group A]) Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. 0000001525 00000 n Anxiety may be reduced by using distractions (e.g., videos), allowing the child to sit on the parents or the caregivers lap (for FEES procedures), and decreasing the number of observers in the room. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation (1998). 0000057570 00000 n 0000018888 00000 n The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). Dosage refers to the frequency, intensity, and duration of service. Among children with communication disorders aged 310 years, the prevalence of swallowing problems is 4.3%. Manikam, R., & Perman, J. See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1542/peds.2015-0658. Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. 0000055191 00000 n World Health Organization. Journal of Developmental & Behavioral Pediatrics, 23(5), 297303. Strategies that slow the feeding rate may allow for more time between swallows to clear the bolus and may support more timely breaths. The participants in the experimental group underwent five consecutive sessions of tactile-thermal stimulation for 30 minutes each time. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. B. The long-term consequences of feeding and swallowing disorders can include. 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). effect of neuromuscular and thermal tactile stimulation on its rehabilitation. If certain practices are contraindicated, the clinician can work with the family to determine alternatives that allow the child to safely participate as fully as possible. Prevalence of feeding disorders in children with cleft palate only: A retrospective study. 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.