McInerney Michelle, Moran Sarah, Molloy Sophie, Murphy Carol-Anne, McAndrew Bríd
Department of Language & Cognition, Faculty of Brain Sciences, University College London (UCL), London WC1N 1PF, UK.
Heart Centre for Children, Westmead Children's Hospital, Sydney Children's Hospital Network (SCHN), Sydney, NSW 2145, Australia.
J Clin Med. 2025 Aug 25;14(17):6005. doi: 10.3390/jcm14176005.
: Swallowing disorder(s), or oropharyngeal dysphagia (OPD), are very common in children with cerebral palsy (CP) and pose a significant risk to their health. Behavioural interventions are frequently recommended when targeting OPD in children with CP; however, their efficacy has yet to be determined. This systematic review aimed to synthesise the current evidence for behavioural interventions in the treatment of OPD in children with CP. : A comprehensive search in six databases in October 2024 sought studies that (1) included participants aged 0-18 years with a diagnosis of CP and OPD; (2) utilised and described a behavioural intervention for OPD; and (3) used a randomised controlled trial (RCT) experimental design. Three reviewers independently extracted the data, and results were tabulated. The Revised Cochrane Risk of Bias (ROB-2) tool was used to determine the methodological quality of eligible articles. : From an initial yield of 2083 papers, 99 full-text studies were screened for eligibility. Seven RCTs involving 329 participants aged 9.5 months (SD = 2.03) to 10.6 yrs were included. CP description varied. Most studies used a combination of behavioural interventions to treat OPD ( = 6), and oral sensorimotor treatment was the most frequently utilised treatment ( = 4). Positive outcomes were reported in all ( = 7); however, there was high risk of bias in five studies. The use of behavioural interventions to treat OPD in children with CP continues to be supported by low-level evidence. Rigorously designed RCTs with larger samples of children with CP and OPD are needed to evaluate the true effects of behavioural interventions across the developmental phase of childhood. Importantly, consistency in describing and reporting baseline analysis of swallowing and OPD; together with treatment-component data, is a priority in future research.
吞咽障碍，即口咽吞咽困难（OPD），在脑瘫（CP）患儿中非常常见，对他们的健康构成重大风险。针对脑瘫患儿的口咽吞咽困难，行为干预是常用的推荐方法；然而，其疗效尚未确定。本系统评价旨在综合目前关于行为干预治疗脑瘫患儿口咽吞咽困难的证据。2024年10月，在六个数据库中进行了全面检索，寻找符合以下条件的研究：（1）纳入年龄在0至18岁、诊断为脑瘫和口咽吞咽困难的参与者；（2）采用并描述了针对口咽吞咽困难的行为干预；（3）采用随机对照试验（RCT）的实验设计。三名评审员独立提取数据，并将结果制成表格。使用修订后的Cochrane偏倚风险（ROB - 2）工具来确定符合条件的文章的方法学质量。从最初的2083篇论文中，筛选出99篇全文研究以确定其是否符合条件。纳入了7项随机对照试验，涉及329名年龄在9.5个月（标准差 = 2.03）至10.6岁的参与者。脑瘫的描述各不相同。大多数研究使用多种行为干预措施来治疗口咽吞咽困难（n = 6），口腔感觉运动治疗是最常用的治疗方法（n = 4）。所有7项研究均报告了积极结果；然而，5项研究存在高偏倚风险。行为干预用于治疗脑瘫患儿口咽吞咽困难仍然得到低水平证据的支持。需要设计更严格、样本量更大的随机对照试验，纳入更多脑瘫和口咽吞咽困难患儿，以评估行为干预在儿童发育阶段的真实效果。重要的是，在描述和报告吞咽及口咽吞咽困难的基线分析以及治疗成分数据时保持一致，是未来研究的重点。
