Ventilation and swallowing interactions of normal children and children with cerebral palsy.

The respiratory inductance plethysmograph was used to analyse the ventilatory cycle during drinking, chewing and swallowing of normal and cerebral-palsied children aged between five and 12 years. 33 children were divided equally into three groups: normal, spastic CP and athetoid CP. A few of the children with spastic CP and over half of those with athetoid CP were unable to perform the 'big breath' task. In the remaining trials, the children with CP held their breath for a shorter time than normal children. Many children with CP required multiple swallows to consume 5mL of liquid. In the majority of trials, normal children swallowed liquids at or near the peak of inspiration, whereas the children with CP did not. Supplementary swallows and solid-bolus swallows occurred at any point in the ventilatory cycle in all groups. The children with CP had a greater need to inspire at the end of liquid tasks, especially during the 75mL task.

Dynamic monitoring of sitting posture for children with spastic cerebral palsy.

A dynamic postural monitoring technique was developed and implemented to determine the effects of a forward-inclined seat base on the sitting posture of both normal children and children with mild spastic cerebal palsy. With the seat base tilted forward there was a significant increase in the distance between the top of head and the seat base, and an increase in the normalized erector spinae muscle activity for both the normal and cerebral palsy subjects. This increase represents a longitudinal straightening of the spine and consequent reduction in kyphotic posture. Sitting stability was significantly lower for children with cerebral palsy than for the normals. Data from this study reveal that an approximately 10° anterior seat tilt may be beneficial for children with cerebral palsy, affecting spinal elongation, reducing dynamic curvatures, and improving sitting stability.

Biofeedback techniques and behaviour modification in the conservative remediation of drooling by children with cerebral palsy.

In an attempt to decrease the rates of drooling of 12 children with cerebral palsy, the authors investigated the effectiveness of EMG auditory feedback training of the orbicularis oris, of making the act of swallowing a conscious one, and of providing an auditory signal to cue swallowing by means of an Accularm interval timer. After biofeedback training there was a significant decrease in drooling rates and a small increase in swallowing rates. After the Accularm was used the children maintained the decreased drooling rates and there was a further small improvement in swallowing rates. One month after treatment stopped there was a non-significant regression in the rates of both drooling and swallowing. The marked decrease in drooling after biofeedback training must be attributed to more effective swallowing as a result of improved oral motor control, rather than to increased rates of swallowing.

Oral motor functioning, frequency of swallowing and drooling in normal children and in children with cerebral palsy.

Attempts to eliminate drooling in children with cerebral palsy have ranged from speech therapy to radical surgery. Drooling primarily results from an overflow of saliva from the mouth due to dysfunctional voluntary oral motor activity, improper swallowing, or oral sphincter deficits and rarely from hypersalivation. A study was undertaken to determine typical orofacial electromyographic patterns and swallowing frequencies of normal children and children with cerebral palsy with oral involvement who do, and who do not drool, as well as to determine the correlation between swallowing frequency and drooling rate. Results suggest that drooling in the pediatric cerebral palsy population is caused by both inefficient and infrequent swallowing.