Oral Sensorimotor Therapy in the Treatment of Pediatric Dysphagia

Mariam

(pseudonym)

Client Background

Christie Schulz, B.S., Graduate Clinician in SpeechLanguage Pathology

National Dysphagia Diet (NDD) Levels

Age: 2;5 at the time of evaluation

Diagnosis: Oropharyngeal dysphagia that presents as both motor and

The Treatment

sensory based.

Characterized By:

National dysphagia diet (NDD) level 1 at the initiation of treatment and level 2 at
3rd month of treatment.

-Decreased labial seal

-Anterior labial loss of liquids
-Abnormal mastication and piecemeal deglutition
-Anterior pocketing of liquids and solids
-Decreased anterior-posterior transit
-Oral stasis
-Clinical signs and symptoms of aspiration with wet voice quality
and cough
-Dysmorphic features including high forehead and square
cranium
-Macrocephaly, hydrocephalus, porencephaly
-Ventriculoperitoneal shunt placement and revision
-Significant for seizure activity

Increased tongue lateralization with intra-oral stimulation.

Utilized p-chewy to increase chewing strength and textured tools for increased
sensory input.

Outcomes

Demonstration of variability due to reported seizure activity

during first month of therapy.

Tools Utilized

By third month of therapy, her skills had increased drastically:

Increase in ability to masticate.
Decrease in holding liquids.
Decrease in signs and symptoms of aspiration.

The efficacy of oral sensorimotor interventions was shown to be 15% above the level of maturation
in children with cerebral palsy and moderate dysphagia (Gisel, 2008).

o Oral stimulation in treatment should be viewed as preparation for

eating and should not be done in isolation (Manno, Eicher, & Kerwin,
2005).
o Oral-motor practice with food should follow oral stimulation so that
movements can be coordinated to practice food management,
transport, and swallow. (Manno , Eicher, & Kerwin, 2005).
o Oral-motor treatments range from passive such as tapping, stroking,
vibration, and/or stimulation, to the more active such as range-ofmotion activities, stretching, resistance exercises, and/or chewing
and swallowing exercises (Arvedson, Clark, Lazarus, Schooling, &
Frymark, 2010).

Implications/Further Research:
o Clinicians need to evaluate the effects within a controlled treatment
design to determine the efficacy of the treatment because the EBP
results are mixed.
o Sensorimotor treatment should not be implemented in isolation and a
team approach is strongly recommended.
o Most of the research has been on children with cerebral palsy and
more research is needed on a variety of populations such as on
children with cranial facial anomalies and various genetic syndromes.

What Does the Research Say?

Pro

o The goal is to improve oral-motor skills by modifying specific

abnormalities in the movement patterns and providing structured
sensory and movement experiences (Gisel, 2008; Sheppard, 2005).

No restrictions: All foods allowed

Visual, verbal, and tactile cues were utilized to decrease holding of liquids and solids.

1. Pt. will demonstrate bilateral chewing strength of 20/20 from a

baseline of 6/20 bilaterally on a nonnutritive stimuli (p-chewy).
2. Pt. will demonstrate the ability to masticate a 1/2 tsp bite of a
level 2 solid and complete the cycle of deglutition in less than 10
seconds for 3 consecutive trials.
3. Pt. will demonstrate the ability to consume thin liquids without
holding in 10 trials in a 30 minute session without the signs and
symptoms of aspiration.

o The first exercise system proposed for treating pediatric dysphagia

in children with disability to facilitate acquisition of oral-motor skills
needed to improve feeding function (Roche, et al., 2011; Sheppard,
2005).

Regular

A lip blocker was used to prevent the insertion of the straw too far into the mouth
to discourage tongue thrust.

Goals of Therapy:

What is Oral Sensorimotor Therapy?

NDD Level 3

Advanced: Soft foods that require more

chewing ability.

NDD Level 1

2;6-2;9 during treatment

Patient History:

NDD Level 2

Puree Consistency: Homogenous, very

cohesive, pudding-like, requiring very little
chewing ability.
Mechanical Altered: Cohesive, moist,
semisolid foods, requiring some chewing.

Mixed
Arvedson, Clark, Lazarus, Schooling, & Frymark made a systematic search of relevant peer-reviewed
literature and they found there was insufficient evidence to determine the effects of oral-motor exercises
on children with sensorimotor dysphagia (2010).
Sheppard found that the research suggests that oral preparation, oral initiation, and the pharyngeal
phase may be improved by oral sensorimotor therapy, but the treatment affects appear to be specific
for individual strategies. Improved treatment outcomes can occur when considering the structure and
relevance of the practice activity in advancing the childs skills (2005; 2008).
The majority of published studies support the use of oral-motor therapy for children with neuromotor
difficulties, however, few case studies have investigated the use of oral-motor treatment techniques for
children with low muscle tone, autism, or cognitive impairment (Manno, Eicher, & Kerwin, 2005).
An interdisciplinary team approach that incorporates an oral, motor, medical, and behavioral approach
is a necessity to treat children with dysphagia (Roche, 2011).

References
Arvedson, J., Clark, H., Lazarus, C., Schooling, T., & Frymark, T. (2010). The effects of
oral-motor exercises on swallowing in children: An evidence-based systematic
review. Developmental Medicine & Child Neurology, 52(11), 1000-1013.
doi: 10.1111/j.1469-8749.2010.03707.x
Gisel, E. (2008). Interventions and outcomes for children with dysphagia.
Developmental Disabilities Research Reviews, 14(2), 165-173.
doi: 10.1002/ddrr.21
Manno, C.J., Fox, C., Eicher, P. S., & Kerwin, M. E. (2005). Early oral-motor interventions
for pediatric feeding problems: What, when and how. Journal of Early and
Intensive Behavior Intervention, 2(3), 145-159. Retrieved from
http://files.eric.ed.gov/fulltext/EJ846764.pdf
Roche, W. J., Eicher, P. S., Martorana, P., Berkowitz, M., Petronchak, J., Dzioba, J., &
Vitello, L. (2011). An oral, motor, medical, and behavioral approach to pediatric
feeding and swallowing disorders: An interdisciplinary model. SIG 13 Perspectives
on Swallowing and Swallowing Disorders (Dysphagia), 20(3), 65-74.
doi: 10.1044/sasd20.3.65
Sheppard, J. J. (2005). The role of oral sensorimotor therapy in the treatment of
pediatricdysphagia. Perspectives on Swallowing and Swallowing Disorders
(Dysphagia), 14(2), 6-10. doi: 10.1044/0161-1461(2008/022)
Sheppard, J. J. (2008). Using motor learning approaches for treating swallowing and
feeding disorders: A review. Language, Speech, and Hearing Services in Schools,
39(2), 227-236. doi: 10.1044/sasd14.2.6