The development of an observation assessment tool concerning mastication in children with cerebral palsy.

These partial studies are a part of a PhD project. The aim of the PhD project
is to improve the assessment and intervention of chewing of CP-children. The
project concerns the clinical assessment tools and the intervention to improve
the chewing process. CP-children suffer with disabilities in coordination and
controlling the muscles. This leads to disabilities in gross motor function but
also in decreased oral movements (Rosenbaum, 2007). One of the consequences is
a decreased mastication function. These CP-children have;
- a limited mastication speed, whereby consuming lumpy food takes more time
- a limited mastication coordination, whereby the food processing is less
- an improved risk on choking or aspiration

CP-children are less good in managing solid and lumpy food compared with aged
matched peers. (Bell et al., 2010, Matsuo et al., 2008).

In the clinical setting of speech therapists responsible for these children, is
a need for an observation assessment tool to determine the oral motor ability
in mastication and to objectify the development of mastication. Until now, an
observational assessment tool lacks. In international literature some
observation instrument concerning feeding abilities are described, but were not
focussed on chewing or were not available in the Netherlands.
This observational list for mastication is developed with the Delphi method
among 15 specialized speech therapists. In 3 rounds (1 oral and 2 in written
form) 15 items were selected and there was agreement on the definition and the
4-point answer options. The name of the instrument is Mastication Observation
and Evaluation (MOE).
The inter and intra observer agreement of the MOE for educated speech
therapists was good, calculated with the intraclasscorrelation coefficient
(ICC). The ICC of the intra-observer agreement varied from .73 to.98. The ICC
of the inter-observer agreement varied from .56 to 1.0.

1. Discribe the normal development of mastication in healthy children aged
between 6 and 48 months by using the Mastication Observation and Evaluation
(MOE). Which oral motor behaviours occurs?
2. Determine the differences in mastication between healthy young children and
CP-children aged between 2 and 6 years. Determine the usefulness of the MOE in
this comparison.

This study concerns the observation of oral motor behaviour during mastication
of (1) healthy children and of (2) CP-children.

Both groups of children eat the same food; five pieces of wheat bread with
chocolate butter or pate (depends of the preference of the child) and five
bites of a biscuit. This feeding session is recorded on a digital video tape.
The video-tapes will be analysed post-hoc with the MOE without any information
of age, gender or diagnosis. The parents were asked to fill in a questionnaire
about the mastication of their child.

As soon as parents are informed, agree with participation of their child and
signed the informed consent, appointments will be made for a feeding session by
telephone or email.
Parents or nurses are able to feed the child. They will get some instructions
concerning the position towards the child and the position of their arm/ hand
during feeding for the optimal video view.
The bread and biscuit is supplied by the researchers.
The questionnaire for parents will take 10 minutes to fill in.
The study is performed by students of the University of Applied Sciences (HAN)
by supervision of Mrs. L. Remijn, speech therapist researcher of Sint
Maartenskliniek

The impact for the child is limited. the observaton of the feeding session
happens only once. It is a regular feeding session in a familiar setting.The
child eats familiar and tasty food. The chiolds eats five pieces of wheat bread
and five bites of a biscuit. The whole feeding session will take 15 minutes.
When the child refuses, the session will stop.
The feeding session is at the child's home, in the kindergarten, preschool of
classroom. The time will be adapted to the possibilities of the child, parents
or classroom.
Parents and child do not need to make costs for travelling. If they do so,
travel expenses are compensated.