Donna Scarborough

Sonographically measured hyoid bone displacement during swallow in preschool children: A preliminary study

This study explored normative parameters regarding maximum displacement of hyoid bone movement during spontaneous swallows using ultrasound (US) in a sample of healthy preschool children. We hypothesized that consistency and bolus size would influence hyoid movement, but gender would not be a factor.

The Incidence of Oropharyngeal Dysphagia in Infants With GERD-Like Symptoms

BACKGROUND Symptoms of infantile gastroesophageal reflux disease (GERD) may overlap with oropharyngeal dysphagia, but the evaluation and treatment of these conditions vary greatly. In this investigation, the incidence of oropharyngeal dysphagia in infants with GERD-like symptoms is determined. MATERIALS AND METHODS A retrospective chart review was performed on infants referred to a pediatric gastroenterology clinic for GERD-like symptoms. A feeding screen was performed in all infants. Standardized bedside swallow evaluation and modified barium swallow (MBS) studies were then performed when clinically indicated. A similarly aged cohort of normal participants also underwent a standard bedside swallow evaluation for group comparison. RESULTS Study population included 67 infants. A swallow evaluation was recommended in 39 of 67 infants with abnormalities noted in all. Swallowing abnormalities were more frequent and clustered in infants with GERD-like symptoms vs controls. MBS was abnormal in 16 of 17 qualifying infants. Characteristics of at-risk infants included extreme prematurity, developmental delay, or symptoms refractory to antireflux medications. CONCLUSION Oropharyngeal dysphagia is prominent in infants with GERD-like symptoms.

Mechatronic applications in pediatric therapy devices

Mechatronic devices can provide solutions in pediatric physical and occupational therapy that improve the level of care, improve patient comfort, and explore new therapy methods. A family of mechatronic devices based on thin film sensors is discussed. Thin film force sensitive resistors (FSR) provide a low cost component for force based inputs. Pediatric applications in manual muscle testing, walking therapy, and feeding therapy are presented. Design considerations characterizing the needs of each pediatric device are summarized. System components including the actuators, sensors and controllers are presented

The Role of Chemosenses in Swallowing Disorders Across the Lifespan

IntroductionThe act of swallowing saliva or food/liquid is a complex motor-sensory event that occurs for most people without any thought or concern. However, for individuals who are born with or acquire dysphagia (swallowing impairment), swallowing can be frightening, painful, difficult, and/or life-threatening.MethodsWhile it is well known that the physical and chemical composition of food and liquids can alter its acceptance and consumption, the role that these properties play in dysphagia is just beginning to be studied.ResultsTaste, smell, and oral touch are integral sensory systems of deglutition. These inputs are crucial for infants/children who are learning to safely chew and swallow increasingly more complex food textures. These sensory inputs are equally important for adults who may have acquired sensorimotor impairments due to trauma, cancer, or neurologic disease. This article describes how swallowing physiology and anatomy change from infancy to adulthood and how the attributes of food and liquids influence swallowing safety.ConclusionsThe manipulation of the taste/smell and physical properties of food and liquids in the treatment of dysphagia is an intriguing area of new research currently underway.

Activation of Neurons in the Rat Medulla Following a Gag Reflex Stimulus

Despite the fact that a number of individuals present with a hypersensitive gag reflex, research in this area has been limited to clinical applications. An animal model that describes the neurologic underpinnings of the gag reflex has not been reported. Thus, the objective of the current study was to localize activated neurons in the rat medulla and to investigate their neurochemistry following mechanostimulation to the posterior pharyngeal wall eliciting a gag reflex response. Activated neurons, determined using c-fos immunohistochemistry, were observed in subnuclei of the nucleus tractus solitarius (NTS) and motor regions such as dorsal motor vagus, hypoglossal, and nucleus ambiguus. The lateral and dorsal paragigantocellular nuclei and the medial rostral ventrolateral nucleus involved in bitter taste processing, also showed robust activation. Tyrosine hydroxylase and/or choline acetyltransferase immunoreactivity was localized in many activated neurons. The results of the present study provide the first documentation of activated neurons and preliminary neurochemistry in brainstem nuclei that are unique to mechanostimulation to the posterior pharyngeal wall. Our results support postulated medullary structures involved with the gag reflex and propose new regions to be added to the circuitry model. Further, our results reveal an activation pattern within the NTS unique to the gag reflex.

Clinical implications of design characteristics, flow rates, and suction pressure attributes in commercially available training cups

OBJECTIVE Transitioning from a bottle to open cup drinking can be a lengthy process in typical development. Children are often introduced to training cups during this period. Due to a lack of standardization in commercially available training cups, differences in design and performance characteristics may potentially create medical complications in developmentally delayed individuals. Our purpose is to report commercially available training cup design characteristics, residual fluid, flow rates, and suction pressures and discuss the potential clinical implications. DESIGN A testing apparatus was developed to determine suction pressure and flow rate. Nine commercially available training cups were tested by two independent research teams. Experimental data were filtered and then fit with a linear approximation determined by a least squares method. RESULTS Commercially available cups exhibited extensive variability in design parameters, suction pressure, rate of flow, and residual fluid. CONCLUSION The extensive variability of design and function within current commercially available cups has clinical implications for children with development delays such as the ingestion of air and aspiration. Studying the variability of existing training cup performance identifies characteristics that impact cup function which can influence future cup design.

Open-Cup Drinking Development: A Review of the Literature

To date, a lack of published research studies exist that systematically analyze the factors involved with the progression of open-cup drinking in typically developing infants and toddlers. As a result, clinicians who are working with children that have delays in open-cup drinking development have a limited framework from which to base clinical decisions. The purpose of this review is to collate works from disparate and related fields to provide a brief review of the literature of pertinent sensorimotor and cognitive components necessary for successful open-cup drinking development.

Correction to: A Comparison of Measurements of a Pediatric Supplement

The original version of this article unfortunately contained mistakes.

Abnormal Physiologic Responses to Touch in Feeding Difficulties

The ability of a child to process tactile input is critical for feeding development. Early touch processing involves generalized autonomic responses, which may include state behavior changes or gagging. Over time with neurological maturation during the first 3 months of life in healthy infants, these autonomic responses modulate to more appropriate behavioral patterns. However, a recent report found that full-term infants who have been orally deprived (i.e., received alternative tube feedings) during this critical time period have been found to have persistent aberrant autonomic behaviors to graded tactile input that was not observed in a normal control group. Further, these behaviors were found to persist well beyond the first year of life. These findings are supported by other areas of development, such as behavioral and emotional regulation, which also appear to have a critical connection to successful regulation of autonomic processing early in life and may persist into adolescence and adulthood. As a result, assessment of feeding behaviors related to touch processing should include a comprehensive past medical history of the child to best determine the root cause of the behavior. Further, clinicians who are treating chronic negative feeding behaviors should have a thorough understanding of the type of behaviors that may persist if early developmental levels are interrupted. This broader understanding of feeding behaviors, particularly when observed in children over 3 months of age, will, in turn, promote appropriate treatment techniques to remediate the root cause of the behavior.

The role of mechatronics in a pediatric training cup design process

This paper applies new experimental systems to support research for children with swallowing disorders. Specifically, the transition to cup drinking will be explored. A user centered approach is utilized to determine a foundation for the design criteria. Further criteria are established using a novel experimental set up. Experimental equipment and methods are presented. Flow rate and suction pressure results for state of practice training cups are presented and show a wide degree of variability. The concept for an adjustable cup designed for transition to open cup drinking is presented.