Annie Aloysius

Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic–ischaemic injury

BACKGROUNDnBasal ganglia and thalamic (BGT) injury is common after acute perinatal hypoxia-ischaemia. Cerebral palsy is the most obvious consequence of BGT injury affecting 70-75% of survivors and is predictable from neonatal magnetic resonance imaging (MRI). However there is no equivalent predictive data for other specific outcomes. Feeding and communication impairments are also common in children following hypoxic-ischaemic encephalopathy (HIE) and BGT injury.nnnAIMSnTo describe, in infants with HIE and BGT injury, the prevalence of feeding and communication impairments; and to evaluate the accuracy of early MRI for predicting these outcomes.nnnMETHODSn175 term infants with HIE and BGT injury were studied. Brain lesions were classified by site and severity from the MRI scans. Motor, feeding and communication impairments were documented at 2 years.nnnRESULTSnFeeding and communication impairments occurred in 65% and 82% of 126 survivors respectively and related strongly to the severity of motor impairment. Forty-one children had a gastrostomy or long-term nasogastric tube. Injury severity in all brain regions was significantly associated with feeding and communication impairment on univariate analysis. On logistic regression analysis BGT (OR 10.9) and mesencephalic lesions (OR 3.7) were independently associated with feeding impairment; BGT (OR 10.5) and pontine lesions (OR 3.8) were associated with gastrostomy; the severity of BGT lesions (OR 20.1) was related to the severity of communication impairment.nnnCONCLUSIONSnFeeding and communication impairment are very common in children with BGT and brainstem injury of neonatal origin and can be well predicted from early MRI scans.

Drinking speed using a valved Pat Saunders straw, wide bore straw and a narrow bore straw in school-age children.

BACKGROUNDnTo understand the nature of straw drinking in relation to a group of children with specific eating and drinking difficulties, it is first necessary to ascertain the range of normal function. Straw drinking is often recommended as a method that can support children with eating and drinking difficulties.nnnMETHODnThis study looked at straw drinking performance in a normal population of 125 children aged between 6 and 11 years of age. Three types of straws were used: a valved Pat Saunders straw, a wide bore straw and a narrow bore straw. Children drank 40 mL of water for each straw tested.nnnRESULTSnChildren increased their speed of intake significantly for all straw types as they matured. Drinking speed was quickest for the wide bore straw followed by the narrow bore and slowest for the valved Pat Saunders straw. This was supported by qualitative feedback from the children with most finding the wide bore straw the easiest one to use and the valved Pat Saunders straw the hardest. There were significant differences in speed of flow between the valved Pat Saunders straw and wide bore straw, between the valved Pat Saunders straw and the narrow bore straw and between the wide bore straw and the narrow bore straw. There were no significant differences between straw flow or straw type and gender.nnnCONCLUSIONSnThis normative data for straw drinking in a paediatric population can be used to develop baseline measures for clinical assessment.

Drinking speed using a Pat Saunders valved straw, wide-bore straw and a narrow-bore straw in a normal adult population

Background:Straw drinking is often recommended as a strategy for managing swallowing difficulties in adult clinical populations. This study presents a range of normal adult straw drinking speeds and discusses clinical applications. Method:Straw drinking speed in a normal healthy population of 70 adults from 18 to 95 years of age was measured. Three types of straws were used: a Pat Saunders valved straw (PSVS), a wide-bore straw and a narrow-bore straw (NBS). Participants drank 40u200aml of water for each straw tested. All participants were asked to comment on the straws used. A mixed-method design was used wherein both quantitative and simple structured qualitative data were collected. Results:Drinking speed was quickest for the wide-bore straw, followed by the NBS and slowest for the PSVS. This was supported by qualitative comments from the adults who reported that the PSVS was the most difficult straw to use. There were no significant differences between straw flow or straw type and sex of the participants. There were significant changes with aging and a decrease in flow speed with the NBS. Weight and height had some effect on straw drinking speeds. There was a slight correlation between age and sex and age and height, but not between age and weight. Conclusion:This article presents data for a normal range of straw drinking speeds in a healthy adult population. It can be used in the assessment and monitoring of straw drinking in acquired disorders of swallowing.