Vol.:(0123456789) 1 3 Dysphagia https://doi.org/10.1007/s00455-019-10016-x REVIEW Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review Amanda Khamis 1  · Iona Novak 1  · Catherine Morgan 1  · Gloria Tzannes 2  · Jane Pettigrew 2  · Jeanette Cowell 2  · Nadia Badawi 1,2 Received: 24 January 2018 / Accepted: 23 April 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Feeding difculties and dysphagia are common in cerebral palsy (CP) and can lead to defciencies of development and aspi- ration pneumonia; a leading cause of death in CP. Motor learning interventions have shown positive results in other clinical areas and may be benefcial for this population. This systematic review appraises research that addresses the question: are motor learning-based interventions more efective than compensatory strategies alone in treating dysphagia in infants with, or at risk of, CP?. Systematic searches were conducted in nine electronic databases. All levels of evidence, with at least one infant between 37 weeks post-menstrual age and 12 months corrected age who were at risk of, or diagnosed with CP, implemented interventions which aimed to improve oropharyngeal function for feeding, and aligned with at least two motor learning principles, were included. Studies were appraised by two independent reviewers using the Cho & Bero Instrument and GRADE. One historical case–control study and four case series met inclusion criteria. All involved a combination of motor learning interventions and compensatory strategies, which do not traditionally align with motor learning principles. All studies reported improvements in oral feeding outcomes, however, only three reported statistical analysis. The best available evidence collectively demonstrated a very weak positive efect for motor learning-based interventions for feeding difculties in infants with, or at risk of, CP. Keywords Feeding · Swallowing · Dysphagia · Deglutition · Deglutition disorders · Infant · Cerebral palsy · Motor Learning · Intervention Introduction Cerebral palsy (CP) is a group of permanent disorders of muscle control and coordination, caused by damage to the developing brain [1]. It is the most common physical dis- ability in childhood; afecting 2.1/1000 live births worldwide [2]. CP is commonly accompanied by associated impair- ments including epilepsy, intellectual disability, vision impairment, chronic pain and oropharyngeal dysphagia [3]. Dysphagia afects up to 99% of individuals with CP, the severity and prevalence increasing with the severity of CP [4–10]. Dysphagia can cause poor nutrition, faltering growth, and aspiration pneumonia, which is a leading cause of death in CP [8, 9, 11]. Feeding interventions can be grouped into two categories; those that align with motor learning principles (Table 1), which aim to improve skills, and those that primarily aim to immediately improve safety by compensating for impair- ments. Motor learning interventions for infant feeding and swallowing typically aim to improve suck-swallow-breathe coordination, oral skills for bolus formation or control, and swallowing skills while minimizing safety risks [12–15]. Motor learning interventions include: biting or chewing practice with transitional foods which quickly dissolve to puree, increasing oral awareness by altering taste, tempera- ture or tactile quality of food, or refning bolus control and swallow through small controlled sips of water which has minimal chance of causing infection if aspirated [16]. Interventions that do not align with motor learning prin- ciples are typically those which compensate for impairments * Amanda Khamis akhamis@cerebralpalsy.org.au 1 Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia 2 The Children’s Hospital at Westmead, The Sydney Children’s Hospitals Network, Sydney, Australia