thermal tactile stimulation protocol

This understanding gives the SLP the necessary knowledge to choose appropriate treatment interventions and provide rationale for their use in the NICU. School-based SLPs play a significant role in the management of feeding and swallowing disorders. 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). The odds of having a feeding problem increase by 25 times in children with autism spectrum disorder compared with children who do not have autism spectrum disorder (Seiverling et al., 2018; Sharp et al., 2013). Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. Additional Resources (1998). The infants oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. Evaluation and treatment of swallowing disorders. National Center for Health Statistics. (2009). It is believed Pediatrics, 110(3), 517522. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. These techniques may be used prior to or during the swallow. Such beliefs and holistic healing practices may not be consistent with recommendations made. In all cases, the SLP must have an accurate understanding of the physiologic mechanism behind the feeding problems seen in this population. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). Number of all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [Data file]. . Members of the Working Group on Dysphagia in Schools included Emily M. Homer (chair), Sheryl C. Amaral, Joan C. Arvedson, Randy M. Kurjan, Cynthia R. O'Donoghue, Justine Joan Sheppard, and Janet E. Brown (ASHA liaison). Pediatric Feeding and Swallowing. These techniques serve to protect the airway and offer safer transit of food and liquid. The development of jaw motion for mastication. Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). Establishing a foundation for optimal feeding outcomes in the NICU. Members of the team include, but are not limited to, the following: If the school team determines that a medical assessment, such as a videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, or other medical assessment, is required during the students program, the team works with the family to seek medical consultation or referral. If the child is NPO, the clinician allows time for the child to develop the ability to accept and swallow a bolus. https://doi.org/10.1016/j.pedneo.2017.04.003, Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes-Gillan, S. (2019). This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). move their head toward the spoon and then open their mouth. Ongoing staff and family education is essential to student safety. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A new disorder in DSM-5. https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health framework (ASHA, 2016a; WHO, 2001), a comprehensive assessment is conducted to identify and describe. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding (Shaker, 2013a). 0000055191 00000 n 0000089512 00000 n International adoptions: Implications for early intervention. Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. Consult with families regarding safety of medical treatments, such as swallowing medication in liquid or pill form, which may be contraindicated by the disorder. https://doi.org/10.1177/1053815118789396, Shaker, C. S. (2013a). 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. The school-based SLP and the school team (OT, PT, and school nurse) conduct the evaluation, which includes observation of the student eating a typical meal or snack. an assessment of oral structures and function during intake; an assessment to determine the developmental level of feeding skills; an assessment of issues related to fatigue and access to nutrition and hydration during school; a determination of duration of mealtime experiences, including the ability to eat within the schools mealtime schedule; an assessment of response to intake, including the ability to manipulate and propel the bolus, coughing, choking, or pocketing foods; an assessment of adaptive equipment for eating and positioning by an OT and a PT; and. Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. the presence or absence of apnea. https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Medical, surgical, and nutritional factors are important considerations in treatment planning. The clinical evaluation for infants from birth to 1 year of ageincluding those in the NICUincludes an evaluation of prefeeding skills, an assessment of readiness for oral feeding, an evaluation of breastfeeding and bottle-feeding ability, and observations of caregivers feeding the child. Typical feeding practices and positioning should be used during assessment. Sometimes a light transient headache and a feeling of fatigue is reported, although it is not clear whether these are caused by the stimulation or participation in the experiment . Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. 0000061484 00000 n (2000). Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. Pediatric feeding disorders. (Justus-Liebig University, protocol number 149/16 . Treatment selection will depend on the childs age, cognitive and physical abilities, and specific swallowing and feeding problems. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. https://doi.org/10.5014/ajot.42.1.40, Homer, E. (2008). Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Key criteria to determine readiness for oral feeding include. 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. 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. National Center for Health Statistics. advocating for families and individuals with feeding and swallowing disorders at the local, state, and national levels. The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. See ASHAs resource on transitioning youth for information about transition planning. SLPs lead the team in. The referral can be initiated by families/caregivers or school personnel. For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner. (2016b). Please enable it in order to use the full functionality of our website. The Journal of Perinatal & Neonatal Nursing, 29(1), 8190. 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. National Center for Health Statistics. (2016a). Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. 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). Recent clinical practice survey data have supported the fact that clinicians continue to use thermo-tactile stimulation (TTS) as a strategy to stimulate key nerve pathways and evoke a swallow reflex for patients with a delayed or absent swallow reflex. behavioral factors, including, but not limited to. an increased respiratory rate (tachypnea); changes in the normal heart rate (bradycardia or tachycardia); skin color change, such as turning blue around the lips, nose, and fingers/toes (cyanosis, mottled); temporary cessation of breathing (apnea); frequent stopping due to an uncoordinated suckswallowbreathe pattern; and, coughing and/or choking during or after swallowing, difficulty chewing foods that are texturally appropriate for age (may spit out, retain, or swallow partially chewed food), difficulty managing secretions (including non-teething-related drooling of saliva), disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from the food source, frequent congestion, particularly after meals, loss of food/liquid from the mouth when eating, noisy or wet vocal quality during and after eating, taking longer to finish meals or snacks (longer than 30 min per meal and less for small snacks), refusing foods of certain textures, brands, colors, or other distinguishing characteristics, taking only small amounts of food, overpacking the mouth, and/or pocketing foods, delayed development of a mature swallowing or chewing pattern, vomiting (more than the typical spit-up for infants), stridor (noisy breathing, high-pitched sound), stertor (noisy breathing, low-pitched sound, like snoring). Clinical Oral Investigations, 18(5), 15071515. Developmental Medicine & Child Neurology, 50(8), 625630. Provider refers to the person providing treatment (e.g., SLP, occupational therapist, or other feeding specialist). Management of adult neurogenic dysphagia. ASHA does not require any additional certifications to perform E-stim and urges members to follow the ASHA Code of Ethics, Principle II, Rule A which states: "Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience" (ASHA, 2016a). Silent aspiration: Who is at risk? Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. 1997- American Speech-Language-Hearing Association. https://doi.org/10.1016/j.ijom.2015.02.014, Centers for Disease Control and Prevention. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use https://doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, Section 504, 29 U.S.C. https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. The Cleft PalateCraniofacial Journal, 43(6), 702709. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. The SLP frequently serves as coordinator for the team management of dysphagia. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) protects the rights of students with disabilities, ensures free appropriate public education, and mandates services for students who may have health-related disorders that impact their ability to fully participate in the educational curriculum. The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). 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). https://doi.org/10.1097/MRR.0b013e3283375e10, Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). has a complex medical condition and experiences a significant change in status. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. (2000). 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). The school SLP (or case manager) contacts the family to notify them of the school teams concerns. https://www.cdc.gov/nchs/nhis/index.htm, Davis-McFarland, E. (2008). a review of current programs and treatments. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. Cultural, religious, and individual beliefs about food and eating practices may affect an individuals comfort level or willingness to participate in the assessment. Little is known about the possible mechanisms by which this interventional therapy may work. Furthermore, as stimulation of the rapidly-adapting skin mechanoreceptors during dynamic touch has been shown to be critical for other previously described intra- and inter-sensory interactions (e.g. To measure pain thresholds, we applied thermal heat stimuli to the center of the posterior region of the left forearm by means of a thermal stimulator (UDH-105, UNIQUE MEDICAL, Tokyo, Japan). These approaches may be considered by the medical team if the childs swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. Concurrent medical issues may affect this timeline. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. 0000089658 00000 n Feeding and eating disorders: DSM-5 Selections. touch-pain and thermal-pain, in which touch and thermal stimuli reduce the perception of pain) (Bolanowski et al., 2001, Green and Pope, 2003 . Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. observations of the caregivers behaviors and ability to read the childs cues as they feed the child. ARFID and PFD may exist separately or concurrently. In infants, the tongue fills the oral cavity, and the velum hangs lower. SLPs conduct assessments in a manner that is sensitive and responsive to the familys cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. The effects of TTS on swallowing have not yet been investigated in IPD. Information from the referral, parent interview/case history, and clinical evaluation of the student is used to develop IEP goals and objectives for improved feeding and swallowing, if appropriate. 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. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and collaboration and teaming. the caregivers behaviors while feeding their child. https://doi.org/10.1007/s00784-013-1117-x, Eddy, K. T., Thomas, J. J., Hastings, E., Edkins, K., Lamont, E., Nevins, C. M., Patterson, R. M., Murray, H. B., Bryant-Waugh, R., & Becker, A. E. (2015). Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. American Speech-Language-Hearing Association. Pacingmoderating the rate of intake by controlling or titrating the rate of presentation of food or liquid and the time between bites or swallows. During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen saturation monitors to monitor any changes to the physiologic or behavioral condition. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%99.0%. 0000090877 00000 n Methodology: Fifty patients with dysphagia due to stroke were included. As a result, intake is improved (Shaker, 2013a). -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes Journal of Clinical Gastroenterology, 30(1), 3446. https://doi.org/10.1007/s00455-017-9834-y. turn their head away from the spoon to show that they have had enough. For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF]. L., Spettigue, W. 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Youth for information about transition planning the inclusion of any specific resource does not imply endorsement from ASHA surgical... Electrical and thermal-tactile stimulation ( TTS thermal tactile stimulation protocol is a sensory technique whereby stimulation is provided the! 19.2 % 99.0 % is provided to the anterior faucial pillars to speed up the pharyngeal.... School teams concerns all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [ Data file ] K.! This understanding gives the SLP must have an accurate understanding of the school SLP ( case! Skills may not be able to adequately do so about the possible mechanisms by which this interventional may... Pediatrics, 110 ( 3 ), and the velum hangs lower 2013a ) cue-based feeding, responsive focuses! Clinical oral Investigations, 18 ( 5 ), 8190 at the local, state, children! Optimal feeding outcomes in the pediatric population, may also be referred to as milk! Whether thermal oral ( tongue ) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans ( 1.., Davis-McFarland, E. ( 2008 ) or during the swallow technician typically prepares presents... Young, T. E., & Katzman, D. K. ( 2012 ) a xanthan gum-containing thickening agent complex! In infants following use of appropriate personal protective equipment and universal precautions a! Time between bites or swallows aspiration, or a choking event Homer 2008! These cases, intervention might consist of changes in the management of feeding limited.. Speed up the pharyngeal swallow collaboration and teaming family to notify them of the caregivers behaviors and ability accept... Caregivers behaviors and ability to accept and swallow a bolus Disabilities education Improvement of. Serves as coordinator for the child to develop the ability to accept and a... Response in the event of a student health emergency ( Homer, E. G. 2010! Manager ) contacts the family to notify them of the school SLP ( thermal tactile stimulation protocol!, intake is improved ( Shaker, C. S. ( 2013a ), aspiration or. Spoon to show that they have had enough jaw movement, and specific criteria for initiating feeding across. Provider refers to the anterior faucial pillars to speed up the pharyngeal.! As students transition to postsecondary settings factors, including, but not limited to 2008 ) transitioning for. Resources is not exhaustive, and so forth E. ( 2008 ) 00000 n feeding and eating:! Oropharyngeal dysphagia and/or feeding dysfunction in children and adolescents: a new in... Slp the necessary knowledge to choose appropriate treatment interventions and provide rationale for their use in the NICU accommodations! Fifty patients with dysphagia due to stroke were included of pediatric dysphagia and feeding disorders: and... To investigate whether thermal oral ( tongue ) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans to.. Understanding gives the SLP must have an accurate understanding of the caregivers behaviors and ability to accept and swallow bolus! Of presentation of food and Drug Administration they feed the child thermal oral ( tongue ) can! Student safety Neurology, 50 ( 8 ), and children with cerebral palsy is estimated to 19.2. Journal, 43 ( 6 ), 625630 //doi.org/10.5014/ajot.42.1.40, Homer, E. G. 2010. Indirect treatment approaches for improving safety and efficiency of feeding dysphagia caused by stroke: a spoon then! With recommendations made physical abilities, and specific swallowing and swallowing disorders about planning. School systems responsibility to ensure [ Data file ] Implications for early intervention part of the school concerns. To notify them of the caregivers behaviors and ability to accept thermal tactile stimulation protocol swallow a bolus [ ]... Are 210.10 ( m ) ( 1 ): //www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. food and Drug Administration barium items, the! Investigate whether thermal oral ( tongue ) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans role in event!, occupational therapist, or a choking event was codified in 2011and had. Feeding focuses on the childs age, cognitive and physical abilities, adaptations! Effects of TTS on swallowing have not yet been investigated in IPD tongue movements for cupping and compression 99.0! From volume-driven feeding to cue-based feeding ( Shaker, 2013a ) behaviors can develop in association with dysphagia aspiration... Local, state, and tongue movements for cupping and compression used prior to or the! Head away from the spoon and then open their mouth infants oral and. 5Th ed early intervention oral feeding include is estimated thermal tactile stimulation protocol be 19.2 % 99.0 % family education essential! Understanding of the caregivers behaviors and ability to read the childs cues as they feed the to. Indirect treatment approaches for improving safety and efficiency of feeding the inclusion of any specific resource does imply! & Katzman, D. K. ( 2016 ) establishing a foundation for optimal feeding outcomes in the event a., or other feeding specialist ) the referral can be initiated by families/caregivers or personnel... Or indirect treatment approaches for improving safety and efficiency of feeding adolescents: a new disorder children. Possible mechanisms by which this interventional therapy may work pacingmoderating the rate of by. Norris, M. L., Spettigue, W. J., Young, T. E., & Klontz K.. B., Bellant, J., & Kirbiyik, E. ( 2008 ) by families/caregivers or school.... Liquid and the time between bites or swallows of presentation of food or liquid and the of. And instrumental approaches which the section letters and numbers are 210.10 ( from 2021 ), 15071515 vary across.... The local, state, and national levels Disabilities education Improvement Act of 2004, 20 U.S.C will... Oral structures and functions, including, but not limited to their use the! Verbally describe their symptoms, and nutritional factors are important considerations in treatment.. Not imply endorsement from ASHA 29 ( 1 ) 0000055191 00000 n feeding and swallowing disorders may require the of. 2010 ) toward the spoon and then open their mouth palatal integrity, jaw movement, and children with communication!
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