Innovative Evidence-Based Assessment and Treatment of Oropharyngeal Dysphagia and Communication Disorders in Infants and Young Children at High Risk of Cerebral Palsy

Abstract

Infants with cerebral palsy (CP) have concomitant feeding and communication disorders with lifelong detrimental consequences, including premature death. Early detection and intervention for these deficits is under-researched. This thesis investigates evidence, current practice, innovative assessment, and novel intervention for these domains.

To critically appraise evidence for all interventions for children with CP, a large-scale systematic review was conducted. There is high level evidence to support the use of electrical stimulation alongside oral sensory motor interventions, and Functional Chewing Training. Low positive evidence exists supporting direct intervention for literacy, parent training and augmentative alternative communication for language and communication disorders.

An international survey of dysphagia practice revealed lack of alignment with evidence, with few patients receiving gold standard assessments, adaptation over direct treatment, and children receiving less-intensive treatment than adults.

Ultrasound and Fibreoptic Endoscopic Evaluation of Swallowing were piloted as novel instrumental assessments of OPD in infants with CP. These tools show promise for safe early detection of OPD and warrant more research to establish psychometrics.

A second systematic review was undertaken to determine evidence for OPD interventions specifically for infants with CP. Results found that neuroplasticity and motor learning-based interventions are most promising.

The Baby Intensive Early Active Treatment (BabiEAT) program was then designed to harness plasticity and was tested against standard care in a pilot randomised control trial. Results showed that BabiEAT was feasible and acceptable, and conferred superior gains in feeding and parental quality of life while maintaining health and safety.

To limit preventable death and optimise outcomes, speech pathologists must keep abreast of evidence, upskill, and implement new successful approaches.