Cerebral palsy (CP) is a disorder of movement and/or posture caused by a non-progressive
brain lesion that persists through the lifespan and has a prevalence of more than 2 per
1000 live births (Oskoui et al., 2013). It comprises a heterogeneous group of impairments
that may also affect the oral motor functions needed for eating, drinking, swallowing,
and articulation (Romano et al., 2017). Dysphagia is a swallowing problem that can
influence the safety and efficiency of feeding. This may lead to inadequate nutritional
status due to prolonged feeding times (Mishra et al., 2018), stress during mealtimes for
the caregiver and/or the child, and impaired growth (Cousino and Hazen, 2013; Stevenson
et al, 2006). Estimates of the prevalence of dysphagia in children with CP vary widely
due to the different definitions and tools used, variability in severity of CP, and motor
type. The prevalence ranges from 21% in a group of 1357 children with CP (Parkes et al.,
2010), to 99% in a group of 166 severely affected children with intellectual impairment
(Calis et al., 2008). Children with CP commonly have feeding disorders and dysphagia that
in many instances place them at risk for aspiration with oral feeding, with potential
pulmonary consequences. They also commonly have reduced nutrition/ hydration status and
prolonged stressful mealtimes. The specific nature and severity of the swallowing
problems may differ, at least to some degree, in relation to sensorimotor impairment,
gross and fine motor limitations, and cognitive/ communication deficits. Children with
generalized severe motor impairment (for 2
example, spastic quadriplegia) are likely to experience greater swallowing deficits
(Calis et al., 2008; Parkes et al., 2010). Oropharyngeal dysphagia may be characterized
by problems in any or all phases of swallowing (Arvedson et al., 2019). The oral cavity
and pharynx are anatomically separate but functionally integrated, the two regions are
involved in complex motor responses that include feeding, chewing, swallowing, speech,
and respiration. The multiple sensory receptors that innervate these two regions provide
the first link in reflexes that control muscles of the entire head, upper
gastrointestinal tract, and airway. Most of the reflexes affect the diversity of muscles
that compose the tongue, which is vital to all stages of feeding, and which continually
affects the patency of the airway (Miller, 2002). The types of oral and pharyngeal
problems that children with CP have include reduced lip closure, poor tongue function,
tongue thrust, exaggerated bite reflex, tactile hypersensitivity, delayed swallow
initiation, reduced pharyngeal motility and drooling. Impaired oral sensorimotor function
can result in drooling that in turn results in impaired hydration (Santos et al., 2012).
The Schedule for Oral Motor Assessment (SOMA) is an assessment tool developed for the
objective assessment of oral motor function in infants, with proven reliability and
validity clinical setting. The SOMA is an assessment tool designed for the objective
evaluation of oral-motor functions in children, with proven reliability and validity in
infants aged 8-24 months. For the 5 types of test diet, based on the cutting score after
assessment in each category, subjects are classified into normal or abnormal oral-motor
function groups (Reilly et al., 1995). Oral motor rehabilitation therapy in children with
CP aims at reducing or eliminating swallowing disorders and promoting functional feeding
(Novak et al., 2020). Some studies suggest that intervention with oral motor therapy
(OMT) or oro-motor exercise (OME) has a beneficial effect on functional independence
levels and improves the quality of life of patients with feeding and swallowing 3
disorder (FSD) (Sığan et al., 2013; Howe and Wang, 2013). The Masgutova Neurosensorimotor
reflex integration (MNRI) Facial Reflex Integration course is directed to the specific
primary reaction of facial reflexes and their integration with whole movement development
and learning. It arises from the basic Neurosensorimotor Reflex Integration concept that
addresses the enhancement of learning through developing movement