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CriticaIIy Appraised
Topic
Does OraI Sensorimotor Therapy Improve OraI
SkiIIs in Feeding in ChiIdren with a DisabiIity?
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1. Defined our questions
2. Refined our questions - PCO
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Corpar|sor |rlerverl|or Corpar|sor |rlerverl|or
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. Completed searches + hand searched additional
references
4. Selected articles from title, abstract information and
ordered them
5. Reviewed the articles re: level of evidence, points of
interest to allied health professionals
6. Developed a clinical bottom line
The Spastic Centre 2006
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!opuIatio
n
Intervention Comparis
on
Outcome
Children
with a
disability
Oral motor/
Sensorimotor
therapy
None mprove
oral
motor
skills in
feeding
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The Spastic Centre 2006
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The Paediatric Feeding nterest Group
(PFG) members who worked in
disability were interested in determining
the efficacy of oral motor therapy in this
population, as it is a widely used
therapy.
The Spastic Centre 2006
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7
evel of Evidence # Source of
Evidence
evel 1 evidence
evel 2 evidence 2
evel evidence
Medline,
PubMED,
OVD,
CNAH
evel 4 evidence 1


The Spastic Centre 2006
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imited (but not significant) improvements in the
eating domains (spoon feeding, biting, chewing)
but not in drinking.
As a group children maintained their weight but did
not have catch up growth.
Most improvements seen over a 20 week period
No significant treatment difference between
chewing only therapy vs sensorimotor therapy
Type of sensorimotor therapy was tailored to the
individual therefore not consistent approach.
The Spastic Centre 2006 eveI 2
:.:/ (177( :.:/ (177(
No significant changes in feeding times or mealtime
duration across the group no significant difference
in any group because of large variations within each
group.
All children maintained weight but no catch-up growth.
Many confounding variables noted eg. Health status,
degree of disability and ambulatory status
The Spastic Centre 2006
eveI 2
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Mixed results 4 subjects: 2 subjects improved their
oral motor evaluation score, 2 subjects declined
slightly. 2 subjects increased their weight and 2
subjects showed decreased weight.
ack of homogeneity between subjects (in regards to
age / weight) several variables.
Results are mixed and the study is unclear about which
changes are statistically significant
The Spastic Centre 2006
eveI 3
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No significant changes in eating efficiency (eating time)
in response to treatment. Children maintained their
weight: age and skinfold:age measurements but
there was no catch up growth.
Articles suggested that increased texture may not
improve eating time or growth but may improve oral
skills (as occurred in a small number of subjects).
The Spastic Centre 2006
eveI
3
:.:/ :i / (177( :.:/ :i / (177(
Some significant improvements noted in spoon feeding,
normal chewing and swallowing but no control group
to compare results (cohort study). Non-aspiration
group did better than aspiration group.
No significant improvements in weight gain.
Study had too many variables, large age range.
Compliance with daily treatment was 68%.
The Spastic Centre 2006
eveI
3
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Articles reviewed varied. imited evidence to suggest
that children with moderate feeding difficulties
improved oral motor skills with oromotor treatment.
No significant evidence to suggest that oral motor
therapy results in decreased mealtime duration or
increased weight gain.
No evidence to support that oral motor treatment
results in improved clearance from the pharynx.
The Spastic Centre 2006
eveI 4 -
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The search results gave insufficient high
quality evidence available to suggest that
oral motor treatment improves eating skills /
weight gain growth / time taken to eat a
meal / oral motor skills.
Studies showed small but not significant
changes across these domains and factors
such as health status, disability and
ambulatory status may have influenced
treatment outcomes.
The Spastic Centre 2006
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n clinical practice, clinicians need to be n clinical practice, clinicians need to be
aware that the evidence for oral motor aware that the evidence for oral motor
treatment is limited however it may be treatment is limited however it may be
used in conjunction with other treatment used in conjunction with other treatment
programs and in conjunction with programs and in conjunction with
feeding. feeding.
The Spastic Centre 2006
/-/:J2:i. /-/:J2:i.
enny Wood
Dorothea Gray
Sudi
Veerabangsa
enore Scali
iora Ballin
Helen Mcaren
Harriet Korner
Hayley Smithers-
Sheedy
Alison Wu
isa Hanley
enny ee
The Spastic Centre 2006
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1. Gisel, E.G. (1994) "Oral Motor Skills Following Sensorimotor ntervention in the
Moderately Eating mpaired Child with Cerebral Palsy Dysphagia 9: 180-192.
2. Gisel, E.G. (1996) "Effect of Oral Sensorimotor Treatment on measures of Growth
and Efficiency of Eating in the Moderately Eating mpaired Child with Cerebral Palsy.
Dysphagia 11: 48-58.
. Ottenbacher, K., Hicks, ., Roark, A. & Swinea, . (198) "Oral Sensorimotor
Therapy in the Developmentally Disabled: A Multiple baseline study. The American
Journal of Occupational Therapy 37:8, 541-547.
4. Gisel, EG., Applegate-Ferrante, T., Benson, E. & Bosma, F. (1995) "Effect of Oral
Sensorimotor Trreatment on Measures of Growth, Eating Efficiency and Aspiration in
the Dysphagic Child with Cerebral Palsy. Developmental Medicine and Child
Neurology 37, 528-543.
5. Gisel, EG., Applegate-Ferrante, T., Benson, E. & Bosma, F. (1996) "Oral-motor
skills following Sensorimotor Therapy in two groups of moderately Dysphagic
Children with Cerebral Palsy: Aspiration vs Nonaspiration. Dysphagia11, 59-71.
6. Davies, F. (200) "Does the end justify the means? A critique of oromotor treatment
in children with cerebral palsy. Asia Pacific Journal of Speech, Language and
Hearing 8,146-152
The Spastic Centre 2006
||| f| |:J:. ||| f| |:J:.
AIana um
aIum@tscnsw.org.au
Anna Bech
abech@tscnsw.org.a
u
The Spastic Centre 2006