Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa.
Int J Lang Commun Disord. 2011 Sep-Oct;46(5):550-63. doi: 10.1111/j.1460-6984.2011.00010.x. Epub 2011 Mar 7.
The treatment of drooling in a paediatric population with neurological impairments is clinically challenging. Surgery is considered invasive, while behaviour modification techniques, correction of situational factors and oral-motor therapy do not always produce sustained improvement. In recent years the use of Botox® to decrease drooling has been investigated.
To review the clinical data from a Drooling Treatment Project for children with neurological impairments and to establish the validity of the drooling severity and frequency rating scales, establishing Phase I-level information about the therapeutic use of submandibular salivary gland injections of Botox® in various contexts.
METHOD & PROCEDURES: A retrospective, explanatory design was used to review the data. Nine children, seven with cerebral palsy and two with operculum syndrome, ranging in age from 5 to 17 years (mean = 9;3 years) were included. Drooling was assessed by qualified speech-language therapists using drooling rating scales, in five different situations and at different time points pre- and post-Botox® injection up to 6 months. Quantitative and qualitative analyses were computed. Parents'/primary caregivers' perceptions of drooling and treatment with Botox® were also considered using an interview form and a quality of life questionnaire.
OUTCOMES & RESULTS: Statistically significant reductions in drooling with large effect sizes were obtained in the communicating and general appearance situations. There was a difference in the pattern of response between the children with cerebral palsy and those with operculum syndrome. Discrepancies between the parents and the speech-language therapists regarding the context of drooling reduction were found. Most parents/primary caregivers felt their children's lives and their own had improved following the Botox® injection and would repeat the treatment. The drooling rating scales were a valid method to assess drooling in a clinical situation.
CONCLUSIONS & IMPLICATIONS: In the clinical setting of the Drooling Treatment Project, the results indicated that the context in which drooling occurs is an important factor and suggested the value of considering the situational context when making drooling judgments. Further, there was a difference in the pattern of response between the children with cerebral palsy and those with operculum syndrome, suggesting that aetiology may be involved in the response to Botox®.
治疗有神经损伤的儿科患者流口水具有临床挑战性。手术被认为具有侵入性，而行为矫正技术、情境因素纠正和口腔运动疗法并不总是产生持续的改善。近年来，已经研究了使用肉毒杆菌毒素®来减少流口水。
回顾神经损伤儿童流口水治疗项目的临床数据，并确定流口水严重程度和频率评定量表的有效性，确定下颌下唾液腺注射肉毒杆菌毒素®在各种情况下治疗用途的 I 期信息。
采用回顾性、解释性设计来回顾数据。共纳入 9 名儿童，其中 7 名患有脑瘫，2 名患有岛盖综合征，年龄 5 至 17 岁（平均年龄=9 岁；3 岁）。流口水由合格的言语治疗师使用流口水评定量表在五个不同的情况下进行评估，并在肉毒杆菌毒素®注射前和注射后 6 个月的不同时间点进行评估。计算了定量和定性分析。还使用访谈表和生活质量问卷考虑了父母/主要照顾者对流口水和肉毒杆菌毒素®治疗的看法。
在交流和一般外观情况下，流口水显著减少，具有大的效应量。脑瘫儿童和岛盖综合征儿童的反应模式存在差异。发现父母和言语治疗师对减少流口水的情况存在差异。大多数父母/主要照顾者认为，他们的孩子和自己的生活在接受肉毒杆菌毒素®注射后得到了改善，并愿意重复治疗。流口水评定量表是在临床情况下评估流口水的有效方法。
在流口水治疗项目的临床环境中，结果表明流口水发生的情况是一个重要因素，并表明在做出流口水判断时考虑情境因素的价值。此外，脑瘫儿童和岛盖综合征儿童的反应模式存在差异，这表明病因可能与肉毒杆菌毒素®的反应有关。
