Interventions For Feeding And Nutrition In Cerebral Palsy

Cerebral palsy (CP) is a “group of disorders of the development of movement and posture, causing activity limitation, that is attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.” This group of syndromes ranges in severity and is the result of a variety of etiologies occurring in the prenatal, perinatal, or postnatal period. Though the disorder is nonprogressive, the clinical manifestations may change over time as the brain develops, with other neurologic impairments frequently co-occurring. CP includes a spectrum of disorders of movement, posture, and coordination with heterogeneous etiologies. The diversity of the clinical features is reflected in multiple classification systems that include reference to type of motor dysfunction, body parts affected, severity, and functional abilities. Further classification is by severity level (mild, moderate, severe), and gross motor function, which reflects the functional capabilities of the affected. Developed in the late 1990s, the Gross Motor Function Classification System (GMFCS) outlines a standardized system for classifying motor function based on constructs of disability and functional limitation. The GMFCS includes levels that reflect abilities ranging from walking without limitations (level I) to severe head and trunk control limitations requiring extensive use of assisted technology, physical assistance, and a wheelchair (level V). We have synthesized evidence in the published literature to address these Key Questions: KQ1a. When compared with other nonsurgical interventions or no intervention, how effective are behavioral interventions, including positioning, oral appliances, oral stimulation, sensorimotor facilitation, and caregiver training, for improving nutritional state/growth, health outcomes, health care/resource utilization, and quality of life in individuals with CP and feeding difficulties? KQ1b. Is the effectiveness of behavioral interventions modified by age, race, severity, functional status (e.g., GMFCS level), or initial nutritional status? KQ2a. When compared with other nonsurgical interventions (e.g., positioning, oral appliances or stimulation) or no intervention, how effective are nutritional interventions (food thickeners, caloric supplementation with formulas, vitamin supplementation, and altering food consistency [e.g., pureeing]) for improving nutritional state/growth, health outcomes, health care/resource utilization, and quality of life in individuals with CP and feeding difficulties? KQ2b. Is the effectiveness of nutritional interventions modified by age, race, severity, functional status (e.g., GMFCS level), or initial nutritional status? KQ3a. What is the comparative effectiveness of tube feeding when compared with oral feeding or with nutritional and behavioral interventions in individuals with CP who present with feeding difficulties, including malnourishment, failure to thrive, aspiration, and excessive caregiver burden? KQ3b. Among individuals with CP and feeding difficulties with significant reflux, what is the effectiveness of g-tube placement with fundoplication versus oral feeding for reducing reflux and for improving nutritional state/growth, health outcomes, health care/resource utilization, and quality of life? KQ3c. Among individuals who develop reflux after gastrostomy, what is the comparative effectiveness of j-tube versus fundoplication for reducing reflux in the short term and achieving improvements in nutritional state/growth, health outcomes, health care/resource utilization, and quality of life? KQ3d. Is the effectiveness of tube feeding modified by tube placement, age, race, severity, functional status (e.g., GMFCS level), initial nutritional status, or continuous versus bolus feeding?

When a child has a health problem, parents want answers. But when a child has cerebral palsy, the answers don't come quickly. A diagnosis of this complex group of chronic conditions affecting movement and coordination is difficult to make and is typically delayed until the child is eighteen months old. Although the condition may be mild or severe, even general predictions about long-term prognosis seldom come before the child's second birthday. Written by a team of experts associated with the Cerebral Palsy Program at the Alfred I. duPont Hospital for Children, this authoritative resource provides parents and families with vital information that can help them cope with uncertainty. Thoroughly updated and revised to incorporate the latest medical advances, the second edition is a comprehensive guide to cerebral palsy. The book is organized into three parts. In the first, the authors describe specific patterns of involvement (hemiplegia, diplegia, quadriplegia), explain the medical and psychosocial implications of these conditions, and tell parents how to be effective advocates for their child. In the second part, the authors provide a wealth of practical advice about caregiving from nutrition to mobility. Part three features an extensive alphabetically arranged encyclopedia that defines and describes medical terms and diagnoses, medical and surgical procedures, and orthopedic and other assistive devices. Also included are lists of resources and recommended reading.

This book is a practical guide to the effective treatment of cerebral palsy in children. It provides a set of principles by which to observe and analyze individual patients' problems and then plan treatment. With the help of this book, non-specialists working with children with cerebral palsy can make decisions and choose the appropriate therapeutic activities for each child. It includes examples of how to apply these principles to real-life situations, using easy-to-follow descriptions and illustrations. New to this revised edition is a chapter on sensory integration problems with children with cerebral palsy, which looks at ways of evaluating and then dealing with these problems. The author also integrates theory with practical skills more closely.

This handbook provides easily accessible information on the aetiology, assessment and management of nutritional disorders in children with neurodisability.

Pediatric Swallowing and Feeding: Assessment and Management, Third Edition provides information to practitioners interested in and involved with children who demonstrate swallowing and feeding disorders. Since the 2002 publication of the second edition, there has been an exponential increase in the number of medically fragile and complex children with swallowing/feeding disorders. A corresponding proliferation in the related basic and clinical research has resulted in the increased appreciation of the complicated inter-relationships between structures and systems that contribute to swallowing/feeding development, function, and disorders. Case studies throughout the book provide examples for decision making and highlight salient points. New to the Third Edition: * Maureen A. Lefton-Greif, PhD, CCC-SLP, BCS-S, is welcomed as co-editor. She brings extensive research expertise and clinical practice in pediatric dysphagia and feeding. * All chapters contain significant updated evidence-based research and clinical information. * New chapters focus on the genetic testing and conditions associated with swallowing and feeding disorders, and the pulmonary manifestations and management of aspiration. * World Health Organization (WHO) description of an International Classification of Functioning, Disability, and Health (ICF) sets the stage for an in-depth discussion of clinical feeding evaluation procedures, interpretation, and management decision making. Pediatric Swallowing and Feeding continues to be the leading text on pediatric dysphagia that provides practical information for clinicians seeing children with swallowing and feeding disorders. The overall importance of an appropriate fund of knowledge and shared experience employing team approaches is emphasized throughout this third edition as in the earlier editions of this book. From the Foreword: "The Editors have recognized the advances and changes in the understanding in the information now available for the care of pediatric swallowing and feeding challenges. They have recruited an outstanding group of contributors for this newest edition. There are numerous critically important updates and additions in the third edition. They have included World Health Organizations International Classification of Functioning, Disability and Health is the functional basis in all areas of the book. This text has its importance as there has been an increased number of children with complex medical and healthcare conditions which are risk for feeding and swallowing disorders. This edition stresses the need for team approaches and also documents the use of “virtual” teams ...Pediatric Swallowing and Feeding: Assessment and Management, Third Edition is the fundamental holistic source for all healthcare providers providing the care for swallowing and feeding in children. This book will be utilized by all caring for children with feeding and swallowing problems throughout the world. The previous editions have been and now this updated third edition continues to be the standard source for the information concerning diagnosis and care of these children." —Robert J. Ruben, MD, FAAP, FACS Distinguished University Professor Departments of Otorhinolaryngology – Head and Neck Surgery and Pediatrics Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York

This third edition systematically reviews recent developments in the diagnosis and evidence-based treatment of cerebral palsy, a consequence of foetal and early infant brain damage resulting in lifelong disabilities with a range of clinical characteristics. The first part discusses the definition, aetiology, classification, imaging and neuropathology, while the second focuses on the management of the individual challenges that children with cerebral palsy face, such as spasticity, dyskinesia, feeding problems and scoliosis. Based on the diverse characteristics of cerebral palsy, children require care from various specialists, including neuro-paediatricians, orthopaedists, psychologists, epidemiologists, physiotherapists and occupational therapists. This work was written by an international team of such specialists, providing a comprehensive mix of perspectives and expertise.

This book is written to assist those who have responsibility for the nutritional and gastrointestinal care of children with neurodisability. The emphasis throughout is on the importance of multidisciplinary care. It is concerned with the problems surrounding the nutritional management of children with neurological impairment who have difficulty swallowing and feeding. Written from a multidisciplinary perspective by a group of authors with considerable clinical and research experience in this area, it covers: ? The epidemiology of feeding disorders in children with cerebral palsy ? Nutritional assessment ? Evaluation of oral-motor function ? Dietetic management ? Nursing issues in the nutritional care of the disabled child ? Tube feeding ? Gastrointestinal problems and their investigation