Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Karen van Hulst (Donders series 401)

14 November 2019

Promotor: prof. dr. S. Geurts
Co-promotors: dr. C. Erasmus, dr. P. Jongerius (Sint Maartenskliniek, Nijmegen)

Oral motor Perfomance in children with neurodevelopmental disabilities; about dysphagia and drooling

This thesis focuses on the assessment and treatment of complex oral motor activities in seriously impaired children with dysphagia and drooling. Insight has been gained that drooling still exists in 3-15% of preschoolers at the age of four and  invasive treatment of saliva loss under that age is not advisable. Knowledge of the determinants of dysphagia in children with Cerebral Palsy has been increased and children can be classified reliably by the EDACS (Eating and Drinking Ability Classification System). The assessment of disabling saliva loss has been further refined and there is proof that saliva loss can be measured in 5 minutes (DQ5) instead of 10, which can serve as a cut-off point for decision making in drooling treatment. To personalize drooling intervention, adverse effects (AEs) on oral motor performance after Botulinum Toxin-A in salivary glands have been identified as well as independent predictors of AEs. Evidence has been found that a combination of objective and subjective drooling outcome measurements, both regarding severity as well as impact on the child and family, is preferable to decide whether treatment is necessary and to evaluate the effects. Finally, Global similarities and differences in drooling treatment became apparent in an international collaboration resulting in a narrative review.