Tongue movements in normal 2- to 8-year-old children: extended profile of an eating assessment

In this study tongue movements of 103 normal 5-, 6-, 7-, and 8-year-old children were measured and compared. The 5-year-olds were compared with children of an earlier study and data were combined for 2- to 8-year-old children. Two different tongue positions were measured as three standard textures of food were presented: first, the position of the tongue as the food was 5 cm away from the lips, and second, the position of the tongue or other oral characteristics as the food was swallowed. For the anticipation of food a significant age-texture (p less than .001) as well as an age-sex-texture interaction was noted (p less than .035). For swallowing, significant age (p less than .0001), texture (p less than .0001), and sex-age interactions (p less than .0001) were found. Although food is anticipated in a similar fashion by both sexes, age and texture differences must be taken into account when swallowing is evaluated. A preliminary developmental curve for the two eating behaviors is presented for children 2 to 8 years old.     

Lateralization of tongue movements during eating in children 2 to 5 years old

Normative data on skills of the tongue used in eating are presented. Normal children 2 to 5 years old were studied regarding their preference of placing food either on the right or left side when eating, and they were compared with age-matched Down's syndrome children. In addition, the ability to move food from the right to the left side of the mouth was studied. Normal children underwent a transition from predominantly placing food on the right side at 2 years of age to predominantly placing it on the left side at 4 years of age. Among Down's syndrome children females preferred the right side, and males preferred the left side. The ability to move food from right to left (lateralizing) undergoes a developmental progression from tilting the head to rolling, followed by slow and eventually by smooth movement from one side to the other. Only 15% of the 5-year-olds were able to move food smoothly from side to side. These data provide a baseline against which children with eating problems can be compared.     

Tongue movements in normal 2-, 3-, and 4-year-old children: a continuation study

In this study, tongue movements of normal 2-, 3-, and 4-year-old children were measured and compared. The 4-year-olds were also compared with 4-year-old children in a previous study (Schwartz J: Observation of Tongue and Jaw Movement in Normal Four- and Five-Year-Old Children, master's thesis. Washington University, School of Occupational Therapy, St. Louis, MO, 1982). Measures were taken on 56 children: 17 two-year-olds (8 females, 9 males), 19 three-year-olds (10 females, 9 males), and 20 four-year-olds (10 females, 10 males). Two different tongue positions were quantified: First, the position of the tongue as the food was presented to the child at the moment when the food was 5 cm away from the lips and second, the position of the tongue as the food was swallowed. Younger children held their tongues in a more forward position when the food was presented, although the predominant tongue position was behind the teeth in all three age groups. During swallowing there was also a progression, as age increased, from pursing the lips to puckering at the corners of the mouth. Many children kept their mouth open during swallowing. These results provide further normative data for the assessment of eating-impaired children.     

Reducing fear in preschool children during clinical examinations

In the author's hospital, pre-intervention observations showed that almost three-quarters (73%) of all pre-school aged children visiting a clinic showed signs of fear, which affected the attitudes of other children, disturbed the general environment, created tense relationships between doctors and patients, and affected the quality of medical treatment. Primary reasons for fear among these young patients include lack of child-friendly settings, the attitudes of nursing personnel, nurses' appearance, a lack of tools and techniques especially designed to attract children and hold their attention, and the frightening appearance of examining tools. An action team was formed to respond to the perceived needs identified during these observations. Changes that were recommended and accepted were redecorating all pediatric clinics, changing the uniforms of pediatric nurses, purchasing special toys for use during examinations, changing the external appearance of examining tools, and offering inservice classes on reducing fear among visiting children. As a result of these changes, the percentage of pre-school aged patients exhibiting signs of fear in the hospital's outpatient clinics fell to 37%.     

Application of an ATNR rating scale to normal preschool children

An Asymmetrical Tonic Neck Reflex Rating Scale was applied to data from 40 normal 3- and 5-year-old children. Raw scores representing degrees of elbow flexion in response to passive head rotation were converted using a four-point scale, and the results of eight trials in quadrupedal posture were summed. These results reinforce those of previous studies: the mean inhibition scores increased with age, whereas the variance decreased. Results also support further development of normative data for clinical use of the scale.     

Insulin and normal eating

Sarah Bloor critiques a research paper about a randomised control trial, which examined the use of training in flexible, intensive insulin management to enable dietary freedom for people with type 1 diabetes. (Dose Adjustment for Normal Eating Study Group, 2002).     

Tongue–palate contact during selected vowels in children with speech sound disorders

Abstract

There is evidence that complete tongue–palate contact across the palate during production of vowels can be observed in some children with speech disorders associated with cleft palate in the English-speaking and Japanese-speaking populations. Although it has been shown that this is not a feature of typical vowel articulation in English-speaking adults, tongue-palate contact during vowel production in typical children and English-speaking children with speech sound disorders (SSD) have not been reported in detail. Therefore, this study sought to determine whether complete tongue–palate contact occurs during production of five selected vowels in 10 children with SSD and eight typically-developing children. The results showed that none of the typical children had complete contact across the palate during any of the vowels. However, of the 119 vowels produced by the children with SSD, 24% showed complete contact across the palate during at least a portion of the vowel segment. The results from the typically-developing children suggest that complete tongue–palate contact is an atypical articulatory feature. However, the evidence suggests that this pattern occurs relatively frequently in children with SSD. Further research is needed to determine the prevalence, cause, and perceptual consequence of complete tongue–palate contact.     

Eyelid movements in normal human fetuses

PURPOSE: We undertook this study to investigate the characteristics of blinking activity in healthy human fetuses. METHODS: Blinking activity was studied sonographically in healthy fetuses between 33 and 42 weeks' menstrual age. Horizontal and coronal sonographic views of the eye were obtained and videotaped. Fetal blinking movements were analyzed by reviewing the videotape in slow motion. Fetal vibroacoustic stimulation was also used when clinically indicated. RESULTS: We examined a total of 18 healthy fetuses. Fetal blinking was detected in 89% of cases, with a mean frequency of 6.2 movements per 60-minute observation period. Vibroacoustic stimulation was associated with increased fetal blinking in the 6 fetuses in which it was applied (mean, 15.3 movements per 60-minute observation period). CONCLUSIONS: Blinking is a normal fetal activity. The increased frequency of blinking activity associated with vibroacoustic stimulation may be considered a part of the normal startle reflex.     

Segmental movements of the spine during treadmill walking with normal speed.

OBJECTIVE: The aim of the present work is to investigate the segmental movement patterns of the spine during normal treadmill gait.DESIGN: The spine movement during treadmill gait of ten healthy subjects (five men and five women) has been investigated using an optoelectronic measuring system.METHODS: The spine was divided into seven segments, from C(7) to S(2). The subjects walked with their normal speed. All data were normalized to per cent of the gait cycle. The normal patterns of the spine segment movements were found in the sagittal and the frontal planes.RESULTS: The behaviour of the spine can be described as the motion of a stiff element with superimposed small, inter-segmental movements. These small inter-segmental movements were found both in the sagittal and the frontal planes.CONCLUSIONS: The small inter-segmental movements could play an important role in the reduction of the energy consumption during gait and in maintenance of the equilibrium. RELEVANCE: Any disability affecting the spine should result in changing spine movement pattern during gait, thus changing the overall gait pattern. Therefore, treatment and rehabilitation should not discard the influence of the spine malfunctioning, regardless of its nature.     

Chewing cycles in 4- and 5-year-old normal children: an index of eating efficacy

Eating movements in the preschool child undergo change between the ages of 2 and 5 years. There is a lack of objective clinical data from normal children against which eating movements of feeding-impaired children can be compared. In this study, chewing movements were measured to complement tongue movements described in an earlier study. The movements were monitored in 40 children: 20 were four years old and 20 were five years old. Each group had ten boys and ten girls. Chewing movements were measured by time (sec), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. Age and sex did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. These findings suggest that the texture of food strongly influences both the number of chewing cycles performed and the time used for chewing. The occupational therapist administering eating evaluations to children should carefully choose the foods offered for initial evaluations and use the same food consistently during re-evaluations.     

Co-contraction during passive movements of the knee joint in children with cerebral palsy

BACKGROUND: Co-contraction is an impairment commonly reported in children with cerebral palsy. However, co-contraction has not been investigated during passive movements which may be used to assess spasticity in children with cerebral palsy. The purpose of this study was to examine the frequency of co-contraction and the relationship between reflex activity and co-contraction during passive movements of the knee joint in children with cerebral palsy. METHODS: Twenty children with cerebral palsy participated in this study. One set of ten continuous passive movements from 90 degrees of knee flexion to 25 degrees of knee flexion and from 25 degrees of knee flexion to 90 degrees of knee flexion was completed at 15 degrees /s, 90 degrees /s, and 180 degrees /s. The mean percentage of the range of motion of each movement and mean percentage of the number of movements which exhibited electromyographic activity of the vastus lateralis, medial hamstrings, and co-contraction were calculated for each set of movements. FINDINGS: The number of the movement repetitions and the percentage of the range of motion which exhibited co-contraction were considerable regardless of the direction and speed of motion. Significant positive correlations were found between the percentage of the passive range of motion with medial hamstrings activation, vastus lateralis activation, and co-contraction during passive movements into both knee flexion and knee extension at a velocity of 15 degrees /s, 90 degrees /s, and 180 degrees /s (P<0.001). INTERPRETATION: Co-contraction commonly occurs during passive movements of the knee in children with cerebral palsy. The presence of co-contraction may influence measurements of spasticity which use passive movements to assess spasticity.     

中文版饮食能力分级系统在学龄前脑性瘫痪儿童中的信度与效度研究

摘要 目的：确定中文版脑瘫（CP）患儿饮食能力分级系统（EDACS）在学龄前脑瘫儿童中的信度与效度。 方法：通过分析现场评估和录像评估结果之间的一致性确定中文版EDACS及协助水平的重测信度;分析不同评估者间（照顾者,熟悉患儿情况的言语治疗师ST1和对患儿熟悉度一般的言语治疗师ST2）的评估结果确定中文版EDACS的评估者间信度;以吞咽障碍调查表（DDS）的分值为效标确定EDACS的平行效度。 结果：ST1的现场评估与录像评估结果显示, EDACS具有良好的重测信度,Kw=0.762（95%CI：0.590—0.884）,协助水平的评估结果Kw=0.807（95%CI：0.656—0.9035）。同时EDACS具有良好的评估者间信度,2名言语治疗师间的中文版EDACS评估结果Kw=0.741（95%CI：0.553—0.879）,协助水平的评估结果Kw=0.808（95%CI：0.696—0.935）。ST1与家长间的中文版EDACS评估结果Kw=0.590（95%CI：0.457—0.732）,协助水平评估结果Kw=0.635（95%CI：0.509—0.754）。EDACS与DDS分值间具有良好的平行效度, Spearman相关系数为0.889。 结论：中文版EDACS在学龄前脑瘫患儿中具有良好的评估者间信度和平行效度, 可以有效的对学龄前脑瘫患儿进行饮食功能分级。