Effects of consistent food presentation on oral-motor skill acquisition in children with severe neurological impairment.

The purpose of this study was to evaluate systematically the effect of presenting food consistently, in a position regarded as optimal, to children with severe neurological impairment who have associated oral-motor dysfunction. We tested the validity of some recommendations often made in the literature regarding good feeding practices. The trial used an ABA within-subjects design and extended over a 9-month period. Sixteen children between 7 and 17 years of age with severe neurological impairment and associated eating difficulties were studied. Six subjects had some speech. The effects of the intervention were compared by detailed analysis of standard feeding assessments carried out and video-recorded under control and experimental conditions. Statistically significant differences in components of oral-motor behavior were found when a consistent method of food presentation was employed and significant improvements, which could not be attributed to maturation alone, were found between assessment periods. There were also significant differences in the degree of oral-motor learning achieved by children who had some speech and those who had none. Newly acquired skills were not always evident at followup, however, nor in control assessments of feeding. We conclude that some children, even those with severe neurological impairment, can acquire mastery over latent or previously undeveloped oral-motor skills when feeding strategies are modified to allow appropriate opportunities for learning to occur.