Telepractice for Pediatric Dysphagia: A Case Study
A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger’s Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia.
American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders [knowledge and skills]. Retrieved from www.asha.org/policy.
Belafsky, P.C., Mouadeb, D.A., Rees, C.J., Pryor, J.C., Postma, G.N., Allen, J., & Leonard, R.J. (2008). Validity and reliability of the eating assessment tool (EAT-10). Annals of Otology, Rhinology, and Laryngology, 117, 919-924.
Burklow, K.A., Phelps, A.N., Schultz, J.R., McConnell, K., & Rudolph, C. (1998). Classifying complex pediatric feeding disorders. Journal of Pediatric Gastroenterology and Nutrition, 27, 143-147.
Buschmann, A., Jooss, B., Feldhusen, F., Pietz, J., & Philippi, H. (2009). Parent based language intervention for 2-year-old children with specific expressive language delay: A randomised controlled trial. Archives of Disease in Childhood, 94, 110 -116.
Coyle, J. (2012). Tele-dysphagia management: An opportunity for prevention, cost-savings and advanced training. International Journal of Telerehabilitation, 4(1), 37-39.
Cranen, K., Veld, R.H., Ijzerman, M., & Vollenbroek-Hutten, M. (2011). Change of patients’ perceptions of telemedicine after brief use. Telemedicine Journal and e-Health, 17, 530-535.
Davies, W.H., Satter, E., Berlin, K.S., Sato, A.H., Silverman, A.H., Fischer, E.A., ... Rudolph, C.D. (2006). Reconceptualizing feeding and feeding disorders in interpersonal context: The case for a relational disorder. Journal of Family Psychology, 20, 409–417.
Demiris, G., Speedie, S. M., & Finkelstein, S. (2001). Change of patients’ perceptions of TeleHomeCare. Telemedicine Journal and e-Health, 7, 241-248.
Field, D., Garland, M., & Williams, K.E. (2003). Correlates of specific childhood feeding problems. Journal of Paediatric Child Health, 39, 299-304.
Georges, J., Belz, N., & Potter, K. (2006, November 07). Telepractice program for dysphagia: Urban and rural perspectives from Kansas. ASHA Leader, 11(15).
Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvarex, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3(1), 31-42.
Kirsch, C.M., & Sanders, A. (1988). Aspiration pneumonia: Medical management. Otolaryngology Clinics of North America, 21, 677–689.
Kleim, J.A., & Jones, T.A. (2008) Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51, S225–S239.
Lefton-Greif, M.A., & Arvedson, J.C. (2007). Pediatric feeding and swallowing disorders: State of health, population trends, and application of the international classification of functioning, disability, and health. Seminars in Speech and Language, 28, 161-165.
Lewis, C., Packman, A., Onslow, M., Simpson, J., & Jones, M. (2008). A Phase II trial of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention. American Journal of Speech-Language Pathology, 17, 139-149.
Linscheid, T.R. (2006). Behavioral treatments for pediatric feeding disorders. Behavior Modification, 30(1), 6-23.
Logemann, J. (1998). Evaluation and Treatment of Swallowing Disorders (2nd ed.). Austin, TX: Pro-Ed.
Magoon, M.A., & Critchfield, T.S. (2008). Concurrent schedules of positive and negative reinforcement: differential-impact and differential-outcomes hypotheses. Journal of the Experimental Analysis of Behavior, 90(1), 1-22.
Malandraki, G.A., Markaki, V., Georgopoulos, V.C., Bauer, J.L., Kalogeropoulos, I., & Nanas, S. (2013). An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia. Journal of Telemedicine and Telecare, 19, 75-79.
Malandraki, G.A., McCullough, G., He, X., McWeeny, E., & Perlman, A.L. (2011). Teledynamic evaluation of oropharyngeal swallowing. Journal of Speech Language and Hearing Research, 54, 1485-1496.
McKirdy, L.S., Sheppard, J.J., Osborne, M.L., & Payne, P. (2008). Transition from tube to oral feeding in the school setting. Language, Speech, and Hearing Services in Schools, 39, 249-260.
Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Is parent child interaction therapy effective in reducing stuttering? Journal of Speech, Language & Hearing Research, 51, 636-650.
Mion, L.C., McDowell, J.A., & Heaney, L.K. (1994). Nutritional assessment of the elderly in the ambulatory care setting. Nurse Practitioner Forum, 5(1), 46–51.
Nadon, G., Feldman, D., & Gisel, E. (2013). Feeding issues associated with autism spectrum disorders, In M. Fitzgerald (Ed.). Recent advances in autism spectrum disorders – Volume 1 (pp. 559-632). Rijeka, Croatia: InTech.
Nilsson, H., Ekberg, O., Olsson, R., Kjellin, O., & Hindfelt, B. (1996). Quantitative assessment of swallowing in healthy adults. Dysphagia, 11, 110-116. 26.
Park, J. H., Wilde, H., & Shea, C. H. (2004). Part-whole practice of movement sequences. Journal of Motor Behavior, 36(1), 51–61.
Perlman, A.L., & Witthawaskul, W. (2002). Real-time remote telefluoroscopic assessment of patients with dysphagia. Dysphagia, 17, 162–167.
Pitts, T., Bolser, D., Rosenbek, J., Troche, M., Okun, M.S., & Sapienza, C. (2009). Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest, 135, 1301-1308.
Ramig, L.O., Sapir, S., Fox, C., & Countryman, S. (2001). Changes in vocal loudness following intensive voice treatment (LSVT®) in individuals with Parkinson’s disease: A comparison with untreated patients and normal age-matched controls. Movement Disorders, 16(1), 79–83.
Robbins, J., Gangnon, R.E., Theis, S.M., Kays, S. A., Hewitt, A.L., & Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53, 1483–1489.
Robbins, J., Kays, S.A., Gangnon, R.E., Hind, J. A., Hewitt, A.L., Gentry, L.R., & Taylor, A.J. (2007). The effects of lingual exercise in stroke patients with dysphagia. Archives of Physical Medicine and Rehabilitation, 88, 150 –158.
Roberts, M.Y., & Kaiser, A.P. (2011). The effectiveness of parent-implemented language intervention: A meta-analysis. American Journal of Speech-Language Pathology, 20, 180-199.
Sapienza, C.M. (2008). Respiratory muscle strength training applications. Current Opinion in Otolaryngology & Head and Neck Surgery, 16, 216-220.
Schmidt, R., & Lee, T. (2005). Motor Control and Learning: (5th ed.). Champaign, IL: Human Kinetics.
Schmidt, R., & Wrisberg, C.A. (2004). Motor learning and performance: A situation-based learning approach (4th ed.). Champaign, IL: Human Kinetics.
Schopler, E., Brehm, S.S., Kinsbourne, M., & Reichler, R.J. (1971). Effect of treatment structure on development in autistic children. Archives of General Psychiatry. 24, 415-421.
Sharma, S., Ward, E.C., Burns, C., Theodoros, D., & Russell, T. (2013). Assessing dysphagia via telerehabilitation: patient perceptions and satisfaction. International Journal of Speech-Language Pathology, 15, 176-183.
Sheppard, J.J. (1994). Clinical evaluation and treatment. In S.R. Rosenthal, J.J. Sheppard, & M. Lotze (Eds.), Dysphagia and the child with developmental disabilities: Medical, clinical and family interventions (pp. 37–76). San Diego, CA: Singular.
Sheppard, J.J. (2013). Management of oral pharyngeal dysphagia in pediatrics: Rehabilitative maneuvers and exercise. In R. Shaker, C. Easterling, P.C. Belafsky, &
G.N. Postma (Eds.). Manual of diagnostic and therapeutic techniques for disorders of deglutition (pp. 319-348). New York, NY: Springer. 40.
Spielman, J., Ramig, L.O., Mahler, L., Halpern, A., & Galvin W.J. (2007). Effects of an extended version of the Lee Silverman Voice Treatment on voice and speech in Parkinson’s disease. American Journal of Speech-Language Pathology, 16, 95-107.
Waite, M., Theodoros, D., Russell, T., & Cahill, L. (2010). Internet-based telehealth assessment of language using the CELF-4. Language, Speech, and Hearing Services in Schools, 41, 445-448.
Ward, E.C., Sharma, S., Burns, C., Theodoros, D., & Russell, T. (2012). Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation, Dysphagia, 27, 460-472.
Ward, L., White, J., Russell, T., Theodoros, D., Kuhl, M., Nelson, K., & Peters, I. (2009). Assessment of communication and swallowing function post laryngectomy: A telerehabilitation trial. Journal of Telemedicine and Telecare, 13, 88-91.
Wessa, P. (2012). Pearson correlation (v1.0.6) in free statistics software (v1.1.23-r7). Office for Research Development and Education. Retrieved from http://www.wessa.net/rwasp_correlation.wasp/
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