803963

research-article2018
AORXXX10.1177/0003489418803963Annals of Otology, Rhinology & LaryngologySjögreen et al

Review Article
Annals of Otology, Rhinology & Laryngology

Oral Sensory-Motor Intervention for

2018, Vol. 127(12) 978­–985
© The Author(s) 2018
Article reuse guidelines:
Children and Adolescents (3-18 Years) sagepub.com/journals-permissions
DOI: 10.1177/0003489418803963
https://doi.org/10.1177/0003489418803963

With Dysphagia or Impaired Saliva journals.sagepub.com/home/aor

Control Secondary to Congenital or

Early-Acquired Disabilities: A Review
of the Literature, 2000 to 2016

Lotta Sjögreen, PhD1 , Margareta Gonzalez Lindh2,

Madeleine Brodén, MS3, Corinna Krüssenberg, MS4, Irvina Ristic, MS5,
Agneta Rubensson, MS6, and Anita McAllister, PhD7

Abstract
Objectives: Dysphagia and impaired saliva control are common in children and adolescents with congenital and
developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor
interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-
acquired disabilities and to make recommendations regarding methods for intervention.
Methods: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children
and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired
disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC,
Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of
Recommendations Assessment, Development and Evaluation.
Results: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment
of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic
reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on
the basis of the grading results from the primary studies. The studies reported good results, but study design was often
insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral
sensory-motor interventions in children and adolescents with congenital and developmental disabilities.
Conclusions: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations
relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control.

Keywords
deglutition, deglutition disorders, children, intervention, drooling, dysphagia

Introduction 1
Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public
Dental Service, Gothenburg, Sweden
Oral sensory-motor dysfunction in children and adolescents 2
Department of Speech and Language Pathology, Gävle Hospital, Gävle,
with congenital and developmental disabilities often affects Sweden
3
swallowing and causes dysphagia and impaired saliva con- Child and Adolescent Habilitation Services, Kronoberg County, Växjö,
Sweden
trol (sialorrhea). Feeding difficulties in infants can be 4
Child and Adolescent Habilitation Services, Skåne County, Malmö,
caused by abnormality of the organs or failure of the appro- Sweden
priate maturation of functions and reflexes. Furthermore, 5
Habilitation Services, Adults, Gothenburg, Sweden
6
the cause of swallowing problems can be either organic or The Queen Silvia Children’s Hospital, Regional Rehabilitation Centre,
behavioral or both, but, regardless of the cause, feeding Gothenburg, Sweden
7
Division of Speech and Language Pathology, CLINTEC, Karolinska
development will probably be influenced.1,2 Institutet, Functional Area Speech and Language Pathology, Karolinska
Dysphagia can occur with solids and/or liquids and is University Hospital, Stockholm, Sweden
categorized as oropharyngeal or esophageal. In young or
Corresponding Author:
developmentally disabled children, the symptoms can be Lotta Sjögreen, PhD, Mun-H-Center Odontologen, Public Dental
subtle, manifesting only as slow eating, multiple swal- Service, Medicinaregatan 12A, Gothenburg, SE-413 90, Sweden.
lowing attempts, or aspiration pneumonia, or obvious, Email: lotta.sjogreen@vgregion.se
Sjögreen et al 979
manifesting as coughing, choking, or vomiting. In cases
of severe dysphagia, there is an increased risk for life-
threatening events such as choking, aspiration, and
malnutrition.3
Impaired saliva control is often a consequence of either
poor oral muscle tone or dysphagia. Some studies suggest a
correlation between decreased oral sensation and saliva
leakage.4 Saliva leakage, chewing with an open mouth, and
coughing during meals are often stigmatizing and can
exclude individuals from participating in meals and social
interaction.
Oral sensory-motor therapy uses a variety of exercises to
develop awareness, strength, coordination and the move-
ment and endurance of the lips, cheeks, tongue, and jaw.
They include active muscle exercise, muscle stretching,
passive exercise, and sensory stimulation and aim to influ-
ence the physiology of the oropharyngeal mechanism.5,6
The ways parents of children with disabilities experi-
ence their children’s oral sensory-motor dysfunction have
been identified through interviews and questionnaires, and
guardians often say that these dysfunctions have a consid-
erable influence on quality of life.7-9 In a study (the
Feeding/Swallowing Impact Survey), Lefton-Greif et al10
identified 3 main problem areas reported by the parents of
children with dysphagia: daily activities, anxiety, and eat-
ing difficulties. On the basis of the health-related and
social effects of dysphagia and impaired saliva control, it
is important to make evidence-based interventions avail-
able to this patient group.
Before any intervention can be recommended, many
questions need to be considered and discussed with the
patient and caregiver: Is it likely that the recommended
intervention will lead to the intended result? Is the recom-
mended intervention better and more effective than other
methods? Does the patient have the necessary resources
(including support) and enough motivation and strength to
carry out the intervention? To be able to answer these and
similar questions, the clinician needs knowledge of the evi-
dence base for different and alternative interventions for a
specific dysfunction in a certain patient group. The final
decision on the method that is best suited to the individual
patient is made by the patient or a caregiver after having
been informed of the possible alternatives.
The implementation of new research often takes time
because of a variety of personal and administrative obsta-
cles, such as a lack of researchers in an organization, a lack
of resources, or an inborn resistance to reorganization.11
Introducing new methods for intervention is expensive and
takes time and resources from ordinary clinical work. It is
therefore of great importance that the chosen intervention
be the most effective for the specific patient group.
The aim of the present review was to investigate the evi-
dence base for oral sensory-motor interventions in children
and adolescents aged 3 to 18 years with dysphagia or
impaired saliva control secondary to congenital or early-
acquired disabilities. On the basis of the literature review,
another aim was to make recommendations regarding dif-
ferent therapy methods for improving or preserving oral
sensory-motor functions in children and adolescents with
dysphagia or impaired saliva control secondary to congeni-
tal or early-acquired disabilities.
Methods
The inclusion criteria were as follows: (1) articles published
in scientific peer-reviewed journals between January 1,
2000, and February 29, 2016; (2) children from the age of 3
years to adulthood; (3) a diagnosis of congenital or develop-
mental disability; and (4) reported speech and oral sensory-
motor dysfunction, including swallowing dysfunction,
drooling, and oral habits. The present review was part of a
larger project that also included an evaluation of oral sen-
sory-motor interventions for speech.12
A literature search was performed using the PubMed,
CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane,
and Google Scholar databases. The search was limited to
intervention studies published in English, Swedish, or
German between January 1, 2000, and February 29, 2016.
Articles that fulfilled the inclusion criteria and were identi-
fied during the reading process were added to the project.
The Grading of Recommendations Assessment,
Development and Evaluation (GRADE) was used to make
a qualitative evaluation of the primary studies that were
reviewed.13 The grading system uses a 4-grade scale for
an intervention method: 4 = high, 3 = moderate, 2 =
limited, and 1 = insufficient quality. The study design
was crucial to the grading. Highly ranked study designs
were randomized controlled trials, meta-analyses, and
systematic reviews (GRADE 4). Controlled trials were
evaluated as being of moderate quality (GRADE 3).
Observational studies without controls and studies with
multiple single-subject designs were considered to be of
limited quality (GRADE 2), and case reports were judged
to be of insufficient quality (GRADE 1). In addition, a
study could be upgraded or downgraded depending on
how it was performed and reported and the representa-
tiveness of the study population.14
The final recommendations for an intervention method
for a specific patient population were based on the results of
the GRADE evaluation. The following recommendations
were used:
High scientific support: The method was used in several
studies with high or medium to high quality and no or
few diminishing factors.
Medium to high scientific support: Methods with high or
medium to high quality with diminishing factors in the
overall assessment of the assessed studies.
980 Annals of Otology, Rhinology & Laryngology 127(12)
Figure 1.  Results of the literature search.
Limited scientific support: Methods with high or medium
to high quality and substantial diminishing factors in the
overall assessment of the assessed studies.
Insufficient scientific support: Methods for which the
number of studies was few or of low quality or the avail-
able studies reported conflicting results.
Results
Initially, 3,555 articles were found, 1,131 about dysphagia
and 2,424 about saliva leakage (Figure 1). After the deletion
of all duplicates and obviously irrelevant articles, abstracts
from the remaining articles were read and categorized
according to participants, diagnosis groups, and types of
interventions. Only studies that related to oral sensory-
motor interventions and included participants with congeni-
tal and early-acquired disabilities were finally selected for
the review. Five systematic reviews, 16 narrative reviews,
and 26 primary studies, of which 3 were randomized con-
trolled trials, were finally included in the analysis. A variety
of methods for the treatment of dysphagia (Table 1) and
saliva leakage (Table 2) were found.
In the original project (including also interventions for
speech), a total of 28 articles (28.5%) were randomly
selected for interrater reliability testing. The selected stud-
ies were independently graded by 2 investigators. The
interrater reliability proved to be very good (Cronbach
α = .986).
Interventions for Children and Adolescents With
Dysphagia Secondary to Congenital or Early-
Acquired Disabilities
Primary Studies.  Twenty primary studies of oral sensory-
motor interventions for children and adolescents with
dysphagia secondary to congenital or early-acquired dis-
abilities fulfilled the inclusion criteria (Table 1). In all,
556 children and adolescents aged 0.4 to 17 years partici-
pated in these studies. Twenty children with Down syn-
drome were involved in 2 studies.15,16 The included
diagnoses were cerebral palsy (n = 86),17-20 Down syn-
drome (n = 50),15,16,21-23 myotonic dystrophy type 1 (n =
8),24 Goldenhar syndrome (n = 3),25 food refusal (n =
45),26 deviant swallowing pattern (n = 157),27-29 oromo-
tor dysfunction (n = 45),30 and dysphagia of unspecified
etiology (n = 157).31-34 Oral sensory-motor stimulation
was often part of a more holistic treatment program also
including feeding and swallowing therapy, mealtime
adaptations, and behavior management.
Twenty children with cerebral palsy and moderate dys-
phagia were treated with the Innsbruck Sensorimotor
Activator and Regulator (ISMAR) for 1 year. Ten of the
children were randomly chosen to act as control subjects
and entered the therapy program at a later stage. The abili-
ties to spoon-feed, bite, chew, and drink from a cup
improved during the intervention period. The improve-
ments were significant compared with what could be
expected from spontaneous development only.17 In a
Sjögreen et al 981

Table 1.  Intervention Studies Including Individuals With Dysphagia Caused by Congenital or Early-Acquired Disabilities, Type of
Intervention, Number of Participants, and Grading.

Participants  

Reference Intervention Sample Size Age, y Diagnosis/Dysfunction GRADE

Haberfellner et al (2001)17 ISMAR 20 4.2-13.1 Cerebral palsy 4
Carlstedt et al (2003)16 Palatal platea 20 5.5 ± 1.5 Down syndrome 4
Carlstedt et al (2001)15 Palatal platea 20 9.5 ± 1.5 Down syndrome 4
Gisel et al (2001)18 ISMAR 17 6-15 Cerebral palsy 3
Sjögreen et al (2010)24 Oral screena 8 7-17 Myotonic dystrophy 3
Schwarz et al (2001)34 Swallowing therapy 79 5.8 ± 3.7 Dysphagia 2
Lamm et al (2005)26 Oral stimulation 45 0.4-9.2 Food refusal 2
Gibbons et al (2007)21 Oral stimulation 1 6 Down syndrome 2
Korbmacher et al (2004)22 Palatal platea 20 Children Down syndrome 2
Alacam and Kolcuoǧlu (2007)19 Palatal plate or oral screena 50 3-7 Cerebral palsy, Down syndrome 2
Korbmacher et al (2004)30 FaceFormera 45 3-16 Oromotor dysfunction 2
Smithpeter and Covell (2010)31 OMT and orthodonticsa 76 Adolescents Frontal open bite 2
Eckman et al (2008)23 Masticatory traininga 2 5-9 Down syndrome, multiple disabilities 2
Clawson et al (2007)20 Swallowing therapy and 18 1.5-4.7 Cerebral palsy 1
oral stimulation
Bailey and Angell (2005)32 Oral stimulation 3 11-15 Intellectual disability 1
Tamura et al (2011)33 Oral stimulation 67 6.5 ± 6.0 Disability 1
Clawson et al (2006)25 Oral stimulation 3 3 (mean) Goldenhar syndrome 1
Saccomanno et al (2012)27 OMT and orthodonticsa 23 5-17 Deviant swallowing 1
Green (2013)28 OMT and orthodonticsa 1 9 Deviant swallowing 1
Giuca et al (2008)29 OMTa 57 5-13 Deviant swallowing 1

Abbreviations: GRADE = Grading of Recommendations Assessment, Development and Evaluation; ISMAR = Innsbruck Sensorimotor Activator and
Regulator; OMT = oral myofunctional therapy.
a
Part of function as outcome.

Table 2.  Intervention Studies Using Intra-Oral Appliances Including Children and Adolescents With Impaired Saliva Control
(Drooling) Caused by Congenital or Early-Acquired Disabilities, Number of Included Participants, Diagnoses, and Grading.

Participants  

Reference Intervention Sample Size Age, y Diagnosis/Dysfunction GRADE

Zavaglia et al (2003)50 Palatal plate 68 Children Down syndrome 3
Alacam and Kolcuoǧlu (2007)19 Palatal plate or oral screen 50 3-7 Cerebral palsy, Down syndrome 2
Gerek & Çiyiltepe (2005)51 Palatal plate 7 8-17 Cerebral palsy 2
Koskimies et al (2011)49 Palatal plate 168 4-14 Oromotor dysfunction, speech 1
impairment
Pani and Hegde (2007)53 Palatal plate 1 12 Intellectual disability 1
Johnson et al (2004)52 ISMAR 18 4-13 Cerebral palsy 1

Abbreviations: GRADE = Grading of Recommendations Assessment, Development and Evaluation; ISMAR = Innsbruck Sensorimotor Activator and
Regulator.

follow-up study, no difference was found between the group
of children who were treated for 2 years and the control
group, which finished the treatment after 1 year.18
Five intervention studies for children with food refusal
problems comprised a total of 119 children, aged 4 months
to 15 years. The therapy focused on oral tactile stimulation,
but it was often combined with other interventions, such as
swallowing therapy and behavior modification.21,25,26,32,33
In 1 of the studies, 45 children with severe dysphagia were
treated with intraoral tactile stimulation.26 Before therapy,
they were all dependent on artificial nutrition. At follow-
up, 1 to 2 years later, nearly all of them (93%) were able to
eat complete meals orally. In all studies in which the inter-
vention of oral tactile stimulation was included, the chil-
dren made significant improvements. None of the studies
included controls, but the concurrent results point in the
982 Annals of Otology, Rhinology & Laryngology 127(12)
same positive direction, thereby constituting the basis for a
limited recommendation.
Studies With Part of Function as an Outcome.  Eleven stud-
ies with a total of 321 participants evaluated the effect on
motor function in muscles or muscle groups involved in
swallowing rather than direct effects on swallowing. The
oral sensory-motor stimulation was performed with or
without specific therapy tools. The focus for the interven-
tion could be to affect the swallowing pattern, the resting
position of lips and tongue, bite force, or occlusion. These
studies comprised children and adolescents with different
degrees of orofacial dysfunction. The most common diag-
nosis represented was Down syndrome. Palatal plates
were used for the intra-oral sensory-motor treatment of
children and adolescents with Down syndrome in 3 stud-
ies with moderately strong scientific evidence.15,16,22 All 3
studies showed positive effects on lip and tongue function
compared with control subjects. In 3 intervention studies,
lip-force training was performed with an oral screen or a
FaceFormer (a variant of an oral screen).19,24,29 Four of
eight school-aged children with myotonic dystrophy type
1 improved their lip force significantly compared with
baseline in a study with moderately strong scientific evi-
dence.24 Forty-five children and adolescents with oral
motor dysfunction received oral sensory-motor treatment
(unspecified), and 26 of these also used a FaceFormer. All
the participants improved their orofacial function, but
those who had the additional therapy with a FaceFormer
improved more rapidly.30 In an observation study without
a control group, 50 children with cerebral palsy, Down
syndrome, or intellectual disability used either oral
screens or palatal plates.19 Positive effects on orofacial
function were reported for both therapy tools. A relation-
ship was found between the time spent on training and the
effect of training. The results were stable for 44.6% of the
participants 3 months after the intervention ended. Chil-
dren who participated in a multiple single-study design
improved their masticatory function and were able to eat
a more varied diet after chewing exercises.28 Seventy-six
children and adolescents who had received orthodontic
treatment for frontal open bite participated in an observa-
tion study with controls.31 Of these, 27 also received
myofunctional therapy aimed at correcting the orofacial
resting position or swallowing pattern. The risk for
relapse after completing the orthodontic treatment
decreased in the group of patients who had received myo-
functional therapy.
In all included primary studies of interventions for dys-
phagia, treatment outcomes were based on clinical registra-
tions such as functional feeding skills, food acceptance, and
weight. In some studies, electromyography and force mea-
surements were used.17,24,27
Three systematic reviews35-37 and 11 narrative revi
ews38-48 were identified within the area of dysphagia. In a
Cochrane review, Morgan et al36 expressed an urgent need
for large-scale randomized studies to evaluate interven-
tions for the treatment of oropharyngeal dysphagia in chil-
dren and adolescents. Durvasula et al40 pointed to the
importance of a multidisciplinary approach in the assess-
ment and treatment of children with dysphagia. Faulks
et al42 emphasized the role of the dental team in the treat-
ment of chewing difficulties in patients with Down syn-
drome. Dusick41 identified 6 different areas that require
attention in the management of children with dysphagia:
“normalization of posture and positioning, adaptation of
foods and feeding equipment, oromotor therapy, feeding
therapy, nutritional support and management of associated
disorders.” Manikam and Perman43 explained that the
causes of pediatric dysphagia are on a continuum between
psychosocial and organic factors and believe that, in most
cases, they could improve significantly with medical treat-
ment, oral motor training and behavioral therapy. The
authors also emphasized that feeding problems are rarely
limited to the children but involve the whole family.
Recommendations Relating to Oral Sensory-Motor Interven-
tions for Children and Adults With Dysphagia Secondary to
Congenital or Early-Acquired Disabilities.  The following rec-
ommendations are based on 20 primary intervention stud-
ies (Table 1):
•• Limited recommendation for intervention with a
combination of swallowing therapy and oral sensory-
motor stimulation in children with dysphagia sec-
ondary to congenital or early-acquired disabilities.
The scientific evidence is limited because of a lack
of control groups, but congruent, significant positive
results constitute the basis of this recommendation.
•• Limited recommendation for oral myofunctional
therapy after orthodontic treatment of an open bite to
prevent a relapse.
•• Limited to moderately strong recommendation for
oral sensory-motor stimulation (with or without ther-
apy tools) aiming at activating and strengthening the
lips, tongue, and chewing muscles in children with
orofacial dysfunction.
•• Moderately strong recommendation to use ISMAR
for the treatment of moderate dysphagia in children
with cerebral palsy. The maximum effect of the ther-
apy could be expected within 1 year, and it is proba-
bly due to improved jaw stability.
•• Moderately strong recommendation to use a palatal
plate for the treatment of impaired lip and tongue
function in children and adolescents with Down
syndrome.
Sjögreen et al 983
Interventions for Children and Adolescents With
Impaired Saliva Control Secondary to Congenital
or Early-Acquired Disabilities
Primary Studies.  Six primary studies of oral sensory-motor
interventions for the treatment of impaired saliva control
were evaluated (Table 2). These studies comprised 312
children and adolescents aged 3 to 17 years. The diagno-
ses that were represented were orofacial dysfunctions (n
= 168),49 Down syndrome (n = 74),19,50 cerebral palsy (n
= 56)19,51,52 and intellectual disability (n = 14). In all
studies, treatment with an intra-oral appliance, most often
a palatal plate, was used. A palatal plate, in isolation or
together with other types of oral sensory-motor stimula-
tion, was used for the treatment of impaired saliva control
in 5 intervention studies.19,49,50,52,53 They all reported that
the intervention resulted in improved saliva control. In an
observation study with a control group comprising 68
children with Down syndrome, a clear improvement in
saliva control was found compared with the situation
before therapy.50 The treatment of impaired saliva control
in children and adolescents with cerebral palsy using a
palatal plate was evaluated in 2 observation studies with-
out control subjects.19,53 Both studies revealed a positive
effect. Improved saliva control was also found in studies
including children and adolescents with other disabilities,
such as intellectual disability or orofacial dysfunction,
but these studies offer insufficient scientific evidence
because of the study design.49,51 Treatment with ISMAR
had a good effect on 6 children and adolescents with cere-
bral palsy who participated in an observation study with-
out control subjects. The study had a significant dropout
(n = 12), and 1 of the authors is the creator of ISMAR
therapy.52 The outcome results in the included studies
were based on a clinical evaluation of saliva control.
Systematic and Narrative Reviews.  Intervention studies for
the treatment of saliva leakage were evaluated in 2 sys-
tematic reviews35,54 and 5 narrative reviews.55-59 Arved-
son et al35 concluded that evaluations were often
complicated because of heterogeneous, poorly described
patient groups and that many studies included a combi-
nation of interventions. Haberfellner58 and Gisel44
described many years’ experience of treatment with
ISMAR and an oral screen. The authors emphasized the
importance of improving postural control of the lower
jaw, hyoid bone, and tongue and stimulating movements
of the lips and tongue to improve salivary control. Crys-
dale et al59 reported on the results of treatment in 1,487
patients with impaired saliva control. Oral motor therapy
was presented as the primary intervention but was often
combined with medication or surgery to decrease saliva
production.
Recommendations Regarding Oral Sensory-Motor Interventions
for Children and Adolescents With Impaired Saliva Control Sec-
ondary to Congenital or Early-Acquired Disabilities. The fol-
lowing recommendations are based on 6 primary
intervention studies (Table 2):
Moderately strong recommendation to use a palatal plate
for the treatment of impaired saliva control in children
and adolescents with Down syndrome, cerebral palsy,
and/or orofacial dysfunction. Good agreement between
available studies strengthens the evidence base.
No recommendation is given regarding the treatment of
impaired saliva control with ISMAR, because of insuf-
ficient scientific evidence.
Discussion
We evaluated the scientific evidence relating to oral sen-
sory-motor interventions for children and adolescents with
dysphagia or impaired saliva control secondary to congeni-
tal or early-acquired disabilities. On the basis of the grading
of the intervention studies that were included, no strong rec-
ommendations could be made. Many of the intervention
studies lacked control groups and had other serious limita-
tions relating to study design. The systematic reviews con-
firmed the insufficient scientific basis for strong
recommendations.35-37,54 The literature search ended in
February 2016. To our knowledge, no systematic reviews of
oral sensory-motor interventions for this patient group were
published between March 2016 and August 2018.
Nearly all the identified studies reported good results.
However, the study design was often insufficient, and study
groups were small. Only a few studies evaluated the effect
of oral sensory-motor treatment on saliva leakage, and all
these studies included the use of palatal plates or other
intra-oral appliances.
In the clinical setting, oral sensory-motor interventions
for children with dysphagia or impaired saliva control are
often part of a more extensive therapy program involving
different team members, such as a physician, a nurse, a
physiotherapist, an occupational therapist, a dietician, and a
dentist. The management also includes support and practi-
cal advice for parents and personnel. The care offered by
different team members and cooperation among these pro-
viders are often prerequisites for successful interventions.60
The combined and often necessary support of many profes-
sionals and the implementation of extensive therapy pro-
grams are challenging for clinical research. Other challenges
are small, heterogenous patient groups and the ethical
aspects of randomized controlled trials.
Each clinician and each clinic can contribute to the com-
mon evidence base through the systematic collection and
reporting of therapy results. As a professional, the clinician
984 Annals of Otology, Rhinology & Laryngology 127(12)
is expected to learn about each patient’s unique situation
and expectations. A detailed knowledge of available inter-
ventions and specific knowledge relating to the patient
should be integrated and evaluated before any recommen-
dation on clinical management can be presented. The rec-
ommendations made from the gradings performed in the
present review offer a comprehensive view of a variety of
methods available for oral sensory-motor interventions.
Individual clinicians will have to determine the applicabil-
ity of the recommendations to individual patients.61
Conclusion
There is an urgent need for high-quality studies that could
serve as the basis for strong recommendations relating to
oral sensory-motor interventions for children with dyspha-
gia and impaired saliva control.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
work was supported by Föreningen för Sveriges Habiliteringschefer
(http://habiliteringisverige.se).
ORCID iD
Lotta Sjögreen https://orcid.org/0000-0001-9551-8686
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