Drooling in children with cerebral palsy: Impact and behavioural treatment
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RU Radboud Universiteit Nijmegen, 30 mei 2008
Promotor : Rotteveel, J.J. Co-promotores : Jongerius, P.H., Didden, H.C.M.
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SW OZ BSI OLO
SW OZ BSI OLO
SubjectLearning and Plasticity
Severe drooling negatively affects many aspects of daily life, social interactions, and the development of self-esteem. The impact of salivary flow reduction following medication (scopolamine and intraglandular Botulinum Toxin Type A injection in the submandibular glands) on daily life and provision of care, and on social interaction and self-esteem was evaluated in 45 children with Cerebral Palsy (3-16 years) who suffered from severe drooling. Drooling diminished substantially and this was accompanied by a significant reduction in care needs. The amount of reported damage to communication devices and computers decreased. The reduction of drooling was also related to increased social interactions with peers. However, parents perceived that the impact of drooling had increased on the level of the child's satisfaction on physical appearance, relations within the extended family, and life in general. This may reflect their disappointment as the treatment effect decreased during the 24 weeks following injection, leading to a gradual increase in drooling. Unfortunately, many social and emotional consequences of drooling remained unchanged. Behavioural intervention is another option for the treatment of drooling. Although effective behavioural procedures are reported, the evidence-base of behavioural intervention in terms of number of studies and their quality is limited. The effectiveness of a self-management procedure for drooling was evaluated in a center-based case-series study (n=10). After intervention, all participants (7;0-19;9 years) remained dry for intervals of 30-60 minutes while being engaged in daily activities. For all participants generalization to the classroom occurred. For three participants maintenance of treatment effect was established at 6 and 24 weeks. However, seven participants failed to maintain self-management skills at follow-up. Parental and teachers' judgment of drooling severity during the day showed positive results up to 24 weeks follow-up. Positive changes in the impact of drooling on daily care, social interactions, and self esteem were reported as well.
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