Use of Substitute Food
Textures for Standard
Eating Assessment in
Children With Cerebral
Palsy and Children
Without Disabilities
Alexandra R. Tcheremenska,
Erika G. Gisel
Key Words: eating and feeding evaluation.
oral motor assessment
Objective. Eating assessment is theji'rst step toward
amelioration 0/ eating problems in children. A quantitative evaluation tool with three standard textures of
food has been developed to determine the severi~y 0/
an eatinB problem. Howeue~ children occasionally
refuse some of the standard textures. J1!Iuch time a'nd
effort could be saved if substitute textures could be
usedfor testing The purpose of this study was to examine the feasibili~y of using substitute food textures.
Method. Twenty children (10 without disabilities,
10 with cerebral pal~y and eating impairments) with
a mean age of 8.2 years (SO = 4.1) years were tested
with three standard and three substitute textures of
food (solid, viscous, puree). Eating time (in seconds)
and chewing cycles were compared between standard
and substitute textures as well as between children
without disabilities and children with eating
impairments.
Results. Substitutes for pureed and uiscous, but
not solid textures could be used for children without
disabilities; in children with eating impairments, suhstitutes for uiscous and solid, but not pureed textures
could be used.
Conclusion. Children with eating impairments
may be more sensitive than children without disabilities to small changes in food consistencies or other
characteristics of the food. Thus, in standardized testing, food textures should not be arbitrarily
interchanged.
ating difficulties are common in children with neuromotordysfunctions (Bax, 1989; Denhoff, 1981;
Gisel, 1993, in press), those who are failing to
thrive (Mathisen, Skuse, Wolke, & Reilly, 1989; Ramsay,
Gisel, & Boutry, 1993), and those with severe emotional
disturbances and mental retardation (Riordan, Iwata, Finney, Wohl, & Stanley, 1984; Riordan, Iwata, Wohl, & Finney, 1980; Stroh, Robinson, & Stroh, 1986). Severe eating
difficulties may lead to inadequate nutrient intake and
malnutrition, which is known to affect brain size and central nervous system function (Galler, Ramsey, & Solimano, 1984; Galler, Ramsey, & Solimano, 1985; Galler,
Ramsey, Solimano, Kucharski, & Harrison, 1984), impair
cognitive and rsychomoror develorment (Reilly & Skuse,
1992), and retard growth (Orren bacher, Scoggins, & Wayland, 1981; Stallings, Charney, Davies, & Cronk, 1993;
Sterling, 1960; Thomessen, Kase, Riis, & Heiberg, 1991;
Tobis, Saturen, Larios, & Posniak, 1961). Bax (1989)
found that among 100 young persons with severe disabilities, 40% had major feeding rroblems. Patrick, Boland,
Stoski, and Murray (1986) noted that malnutrition has
been almost accepted in the past as part of the disability.
In the develoring human, ingestion proceeds from
suckling to mature feeding, which requires the graduation from an exclusively liquid diet to physically varied
E
Alexandra R. Tchcremcnska is an occupalional lhcrapy SIUdenr, Schoo] of Physical and Occupaliona] Therapy, McGill
Universily, Monrreal, Quebec, Canada.
Erika G. Gisel, PhD. on. is A'isocialC Professor, School of Physical and Occupalional Thcrapy, McGill Universily, 3654 Drummond Slrecl, Monrrcal, Quebec, Canada H3G 1Y5.
Tbis article was accepted fur puhlicatiol1 Novemher 23, 199,).
626
Jul)' 1994, Vulume 48, Number 7
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foods (Bosma, 1992: Stevenson & AJlaire, 1991) 'l'he complex oral skills needed to deal with different food textures
(liquid, pur'ee, viscous, solid) are acqUired bv children
over a number of years (Gibbs et ai, 1982: Gisel, 1988,
1991). With the introduction of solid foods during weaning, the rhythmic anteroposterior movem<:nts of tongue
and jaw give wav to munching, up-and,down movements
(Stolovitz & Gisel, 1991) that arc later I'cfined \vith rotary
movements (Gibbs et ai, 1982; Morris, 1982). During the
same time, the tongue anc! jaw become functionally dissociated, rermirting lateralization movements essential for
placing food between the teeth for cheWing (Stolovitz &
Gisel, 1991). Ingestion of liqUids through drinking is distiner from suckling in that it requires the stabili7arion of
the jaw in a semiopen position (Gisel, in [lress), the drawing up of liquid with the lips from an open conwiner, anrl
the simultaneous coordination of respiration and swallOWing (McPherson et ai, 1992)
Eating imrainnents are characterized b\' the arresl
or delayed maturation of oral morc)!' skills in eal'liel' stages
of developmelll. Primitive reflexc.s .such :IS the biting ami
suckling reflex ma\' persist (Campbell, 1979) 01' tongue
lateralization and lip control fur drinking mm'nevel- develop (Gisel, in pl'ess). Immature oral motor patterns ma\'
prevent a child from ingesting age-apl)mpriate food textun~s. Thus, ingestion of a I'egular table eliu reqUires a
ma[Ure set of 01',11 motor skills to core with the demJnds
of different textures of foocl EJting imp:lirments mm'
further be aggrav;l[ed by J developmenralh inadequate
diet. creating an increasing discrepancv between the
child's growing energy needs and actual nutritiun,l! imake
(Patrick & Gisel, 1990: Reilly & Skusc, 1992). Because
liquid <lnd pureed substances generallv h~lve a lower' Glloric density than solid food~ (Walkel', 1990). chilclren
with oral motor pmblems will have to spend pmgressiveIy more time eating to ascertain ail ,lc!cquate enngv intake. Thus, energy demancL mav eventuallv exceed the
available time for feeding, and malnutrition will result.
Because of the extensivc efforts and time spent feeding
childr'en with eating impairments, it is nor surprising that
caregivers perceive meal times as frustrating and exhausting (Reilly & Skuse, 1992; Thomessen et ,11.,1991). Therefore, the first ster t( )ward the amelioration of eating problems is comprehensive assessment, which mUSI conSider
the severity of the problem as well as thc child's oral
motor capacity and nutritional needs.
Recent wllJ'k has indicated that chi ldreil 's I'esponses
to different food textures dming Cjuantitative evalu,ltion
permits the separatiun uf children with pore Ilti,lI for oral
motor therapy from those who LlL'k skills fUI' mlequate
oral ingestion (Gisel & P,mick, 198H). Evaluation is based
un the oral rnorm development of healthy chiklren ,lnd
the diagnosis of mild, moderate, or severe eating difficulty is made by comparison with estJhlished norms (AJphonce-Schweizer & Gisel, 1994). Nonnative <.lara exist
for children from 6 months to 8 years of age using differ-
enrly textureel foods (puree, viscous, ancl solid) (Gisel,
1988, 1991). Whercas a child with severe eating impairments will have diffkulty eating pureed and solid food
textures within two standard deviations of the time
norms, a child with moderate eating impairmenrs is able
to eat a soliel food texture at m below one standard deviation and a pureed texture at or below two standard deviatjons of established time norms (AJ phonceSchweizer & Gisel, 1994; Gisel & Patrick, 1988)
A problem encountered in testing children with eating impairments is that they will occasionally refuse to eat
our standard textures, not because they are unable to
ingest them, but because of idiosyncratic taste r refe 1'ences. To allow testing to proceed, it would be useful to
havc specific alternative foods available for such children.
However, the arbitrary change to similar food textures
during testing might altcr the significance or the results
(Gisel, 1991). It is unknown whether substitutes fur the
slandardi/.ed textures would be eaten within the same
time limits as the standardized textures, or whether chilelt'en \\-ith and without eating impaimlents respond to
substitute textures in the same manner Thel'efore, the
IJurpo.,Se of the present study W,lS to detcrrnine the feasilJilitv of using substitute food textures while maintaining
the validitv of the diagnustic too!'
Method
Subjects
Twcntv children, 10 withoul disabilities and 10 with cerebral palsy and eating impairments, participated in the
stuck Subjects' ages r,lngecl f-rom 5.8 to 15 '5 years. The 10
children without disahilitics (7 girls and 3 boys) attended
J special school in l'v!olltreal that integrates children Without disabilities and chi1clren with moror and cognitive
impaimlents. Their mean age was 1).1 years (SD = 1.8).
Thev had no neuromotor impairments, were ambulatoly,
could feeel themselves, and could unclerstand and follow
verbal instructions. The 10 children with cerebral palsy ('5
girl:-- and 5 hoys) had motor imp:.linnents ranging from
mild to moder;lte. They arrendecl one of two special
schools in Nlontreal. Thcir mean age was to.7 years (SD
= 3.1), Five of these children (2 boys and 3 girLs) had
moclerate elting impairments and had a mean age of 8.4
(.')D = 1.5) years. They used wheelchairs fm ambulation:
needed assistance with activities of daily living. including
caring; and manifesteel a range of hvp()[onicity to hypertonicity in their twnk and all extremities. The severit\' of
spasticity varied between upper and Jower extremities 01'
between the right ancl left bod~T sides. The other' five
children (3 boys and2 girls) had mild eating impairments
and a mean age of 131 (Sf) = 22) years. They had mild
quadriplegia, <.liplegia, or hemiplegia, but were ambulatory and able to feed themselves. AJI children were able to
voluntarily coopel'Jtc during testing. Stratification into
mild and moderate eating impairment groups was based
The American journal uf Occupaliunal Therapl'
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627
on earlier established criteria that considered measures
of growth, eating efficiency, and eating and drinking performance (Alphonce-Schweizer & Gisel, 1994).
All children without disabilities ate the three standard food texwres within the limits of the established
time norms (Gisel, 1988). Children with cerebral palsy ate
a solid texture within one standard deviation of the time
norms but were at or below two standard deviations of
the time norms for a pureed texture. Children were not
persuaded to eat any food that they refused. None of the
children in the study was allergic to the foods offered. We
have shown earlier that gender does not inAuence our
eating measures (Gisel, 1988). Written institutional and
parental consent and verbal consent of the child were
obtained before testing.
Procedures
Children were tested in their respective schools, in a
quiet, well-lit room, free from distractions. The time interval between testing and the subjects' last meal was at least
1 V2 hr. Ambulatory children were seated on a chair with
their feet Aat on the Aoor. The rest of the children were
tested in their custom-fitted wheelchairs. Sitting position
was checked and the following posture aimed for: trunk
in the upright position (90° flexion at the hips or slightly
inclined forward), with the head positioned in midline
and in a slight chin tuck position (30° head Aexion). Children with head rests were aligned with their head support systems. A lap tray was placed on the wheelchair and
the arms were positioned on the lap board. Arms were
flexed at 90° and feet were placed flat on the foot rests. A
videocamera was placed 1.8 m from the child to obtain a
semiprofile view. The feeder was sitting directly in front of
the child. Before testing, the feeder introduced all children to the goal and proceedings of the testing. The
feeding session started as soon as the child felt comfortable with the set-up and lasted no more than 15 to 20 min.
The same tester fed the children throughout the study. All
children were told what food was going to be offered,
although some subjects could not speak. The camera
operator followed the children's movements so that the
semiprofile view was maintained. Children were offered 5
spoonfuls or '5 bites of each standard texture (solid, puree, viscous) followed by the new textures, in random
order. This order of presentation was reversed in approximately half of the children.
Instrument
CheWing duration (in seconds) was measured between
placement of food in the mouth and completion of the
first swaJlow. A cheWing cycle was defined as one downand-up movement of the mandible. The mean from 5
bites of food (both time and cycles) was used for statistical comparisons. The interobserver reliability of our mo-
628
tor measures has been established and ranges from 0.94
to 0.97 for the time and cycles measures of the solid and
viscous textures, and from 0.69 to 072 for the pureed
texture (Alphonce-Schweizer & Gisel, 1993). Measures of
the group of normal and children with eating impairments consisted of the standard as well as the substitute
foods.
Data Analysis
Differences between standard and substitute textures
were computed in each group and a Wilcoxon signed
rank test was used to determine significance. Group comparisons between normal subjects and subjects with eating impairments were made for each texture with a f-test
for independent samples. Eating impairment was classified as either mild or moderate (Alphonce-Schweizer &
Gisel, 1994) and these two groups were compared to
determine differences in time and cycles for each texture
with a (-test for independent samples.
Results
The first question raised was whether food textures similar to our standard textures could be used as substitutes
when children refuse our standard textures. Differences
in the group without disabilities were not significant for
time or cycles between the standard and substitute textures of either pureed or viscous foods (see Table 1).
However, there was a significant difference in time for the
solid food (z = 2.446, P <007). In the group without
disabilities, 7 children ate the arrowroot biscuit in less
time than the graham biscuit, 2 children took the same
amount of time to eat either biscuit, and 1 child took
longer to eat the arrowroot biscuit than to eat the graham
biscuit. Five children of the group without disabilities ate
applesauce in a shorter time than pudding, 1 child took
the same amount of time for both purees, 2 children took
longer to eat applesauce than pudding, 1 child refused
applesauce, and another refused pudding. All other children accepted all food textures offered.
In the group of children with cerebral palsy, 7 children took less time to eat the graham biscuit than the
arrowroot biscuit, whereas 3 took more time. There were
no significant differences in time or cycles in the viscous
and solid textures, but a significant difference was found
in the time measure of the puree (z = -1.784,p < .037)
Seven of the 10 children took Jess time to eat applesauce
than pudding, whereas 3 took more time.
Our second question was whether there were differences in time or cycles in the standard and substitute
textures between a group of children with and a group
without eating impairments and cerebral palsy. There
were no significant differences between the two groups
for the pureed textures, but significant differences were
found for both the viscous and solid textures (see Table
July 1994, Volume 48, Number 7
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Table 1
Substitute Textures for Standard Testing in Children With Cerebral Palsy and Normal Age Mates Without Disabilitles a
Time
Group
Puree
Applesauce h - Pudding
Viscous
Orange geJatin b - Strawberry
Solid
Graham biscuit b - Arrowroot
Puree
Applesauce h - Pudding
Viscous
Orange gelatin h - Strawberry
Solid
Graham biscuit b - Arrowroot
With cerebral palsy (n = 10)
p
z
Texture Difference
Without disabilities (n = 10)
Cycles
z
p
-0910
.181
-1.260
.104
gelatin
0.051
480
0663
.254
biscuit
2446
<.007
0561
.287
-1784
<037
-0306
380
gelatin
-1.172
.121
-1580
.057
biscuit
-1580
057
-1529
063
Nole. Statistics are derived from difTerences in time (seconds) and cycles between the standard and substitute texture.
'Wilcoxon signed rank teSI
hStandard textures
2). There was a difference in cycles for the orange gelatin
(t = 2.908, df = I8.0,p < .009). A significant difference in
time was found for hoth solid textures: graham biscuit (l
= 2.665, dJ = 127,p < .020) and arrowroot hiscuit (l =
3.304, d{ = 10.1, P <008).
The third question addressed was whether there
were differences when the group of children with cere-
Table 2
Comparison of Time and Cycles of Standard and
Substitute Food Textures in Children With
Cerebral Palsy and Children Without Disabilities
Without
Disabilities
(n = 10)
Texture
kl
SD
Puree
Applesauce'
Time (sec)
256 095
247 1.29
Cycles
Time/cycles
1.23 048
Pudding
273 1.12
Time
Cycles
249 1.22
1.46 0.42
Timelcycles
Viscous
Orange gelatin'
Time (sec)
556 201
8.06 318
Cycles
Time/cycles
0.70 0.11
Strawberry gelatin
Time (sec)
5.11 1.44
7.11 2.68
Cycles
Time/cycles
094 0.46
Solid
Graham biscuit'
Time (sec)
946 302
1187 329
Cycles
Time/cycles
074 014
Arrowroot biscuit
Time (sec)
818 211
11.74 320
Cycles
Time/cycles
0.71 011
Mild
(n= 5)
d/
SD
P
328 194
2.72 2.43
160 108
1051 134
0288 14.0
312
778
4.26 291
322 258
155 0.95
1536 11.8
0.801 13.1
.437
5.19 29';
4';0 2.21
1.19 040
- 0.328 180
2908 180
747
<009
663 3.86
640 337
1.13 032
1.167 11.5
-0521 180
.267
609
1549 6.49
1453 'i88
1.30 104
2665 12.7
1249 141
<.020
232
1735 852
1643 6.64
107 040
3304 10.1
2.012 130
<.008
066
lSI
Texture
Puree
Applesauce"
Time (sec)
Cycles
Time/cycles
Pudding
Time (sec)
Cvcles
Ti me/cycles
Viscous
Orange gelatin'
Time (sec)
Cycles
Time/cycles
Strawberry gelatin
Time (sec)
Cvcles
Time/cycles
Solid
Graham biSCUit'
Time (sec)
Cycles
Time/cycles
Arrowroot biscuit
Time (sec)
Cycles
Time/cycles
Moderate
(n = 5)
dI
P
-1.455
- 0.780
51
5.2
20';
509
303
332
127
- 2.429
-1';56
8.0
43
<.041
190
680
5.48
134
328
2.72
0.40
- 1990
-1498
8.0
53
082
192
856
776
1.28
448
4.04
0.41
- 1.756
- 1.327
80
80
.117
.221
1452 57';
15.58 323
091 0.21
1646 769
13.48 8.04
1.68 1.41
-0452
0542
80
5.3
.664
14.68 667
1628 435
0.88 0.10
20.02 10.04
16.58 7.68
1.26 051
-0990
- 0.067
80
80
351
.948
M
SD
2.44 090
216 1.28
136 052
4.12
328
183
2.42
329
148
2.46 134
2.04 0.68
1.26 0.46
6.06
4.40
1.84
358 152
3.52 109
104 0.38
4.70 201
';04 216
0.98 0.08
M
SD
.610
'Standard textures
"Standard textures
The American journal
Table 3
Comparison of Time and Cycles of Standard and
Substitute Food Textures in Children With
Mild or Moderate Cerebral Palsy
Cerebral
Palsy
(n = 10)
M
bral pals)' was stratified into groups with mild and with
moderate eating impairments (see Table 3). These findings must be regarded as preliminaly hecause of the small
sample size. A significant difference was found with puree
(pudding) in the measure of time (l = - 2.429, d/ =
8.0, P < .041). None of the other textures reached
significance.
0/ Occupational Therapy
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629
Discussion
S'ubs!iluliu17 of Siandard Te.X"lures
Our most im[)ortant qucstion was whether substitute
food textures could he used during standard testing when
children refuse standard food textures. Our clinical impression was that foods of similar texture could be readilv
interchanged, but findings showed otheLwise Children
without disabilities responded differently to substitutes
than children with cerebral palsy (see Table 4). In childrcn without disabilities, the rureed and viscous textures
can be replaced by the srecific substitute, whereas the
solid texture, the graham biscuit, should not be replaced
bv an arrowroot biscuit. Thus, a baseline may fluctuate
\:hen substitutes for established standards are used, so
foods should not be arbitrarily exchanged unless their
suitabilitv has been tested. Among children without disabilities, '62.'5% ate the standard ruree texture and 60%
ate the standard viscous texture in a shorter amount of
time than the substitute texture, whereas 70% ate the
'olid substitute texture (arrowroot biscuit) in a significantly shorter amount of time than the standard texture
(graham biscuit).
During standard assessment of children with cerebral palsy, pudding should not be used to rerlace arrlesauce. However, the viscous and solid textures that were
used in this study may be interchanged. Seventy percent
of the children with cerebral palsy ate all three standard
textures in a shorter amount of time than the substitute
food textures. Therefore, the percentage of children who
ate the standard texture in a shorter time than the substitute texture was similar in the two groups, except that the
direction of difference for the solid textures was exactly
reversed (i.e., time for eating the graham biscuit was less
for children with cerebral ralsy, but it was more for children without disabilities). These findings suggest that
results established for norms should not be assumed to
Table 4
.
Food Substitutes That Can be Used for Standard Testing
in Children With Cerebral Palsy and Children
Without Disabilities
Texture
Without disahilities
Puree
Applesauce" - Pudding
Viscous
Orange gelatin a - Strawberry gelalin
Solid
Graham biscuit a -ArrowrOOt biscuit
With cerebral palsy
Puree
Applesauce" - Pudding
Viscous
Orange gelatin' - Strawberry gelatin
Solid
Graham biscuitd-ArrowrOOt biscuit
"Slandard lextures
630
Yes
()
x
x
x
x
x
x
be generalizable to children with eating impairments. AJtho'ugh the difference in time for eating both solid textures in children without disahilities was small (see Tahle
2), this difference was significant because the variation in
each group also proved to be very small. The robustness
of the eating measures is consistent with earlier data by
Schwartz, liman, and Gisel (1984) and Schwaab, liman,
and Giscl (1986). AJthough certain qualities such as taste
(sweetness) an.d hardness secmed similar in the two biscuirs, there may still be a difference in ~avor or granularity
of the texture that might have contrihuted to how long
each bite was chewed and savored. Thus, our findin.gs
strongly suggest that under conditions of standardized
testing, foods should not be arbitrarily interchanged unless an objective detcrmination of their suitability has
been made. Orher food substitutions may lead to differApplesauce and pudding can be interchanged for
eating assessment standards with children without disabilities, but they should not be exchanged in children
with eating imrairments. The time data suggest thar arplesauce may be less viscous and so can be eaten in a
shoneI' time than rudding, which may be more viscous.
In addition, the cycle data suggest that pudding is eaten
with greater effort (more cycles) than arplesauce, particularlv in the child with moderate impairments. Thus,
childre~ with eating impairments may be more sensitive
than children without disabilities to small changes in food
consistencies, othcr characteristics of the food, or both. A
rroblem of accurately assessing ingcstion of rurees is
that children usually savor and swallow a spoonful of
puree in approximately two cycles. Thus, if one rater
scores 1 cycle and the second rater scores 2 cycles, the
error of this measurement is '50%. If, however, twO raters
disagree on 1 cycle out of 20 cycles chewed on a bite of
graham hiscuit, the error rate is only '5%. The problem of
attaining accuracy at the lower end of a defined behavior
no doubt contributes to the lower reliability score for
rurces than the other textures. However, this problem is
not unique to our assessment method; it has been described by other investigators dealing with eating assessment (Reilly, Skuse, Mathisen, & Wolke, 1993).
On Iv one of the texture comrarisons was significant
(time-r~dding) when children with cerebral palsy were
categorized as having mild or moderate eating imrairments. In general, children with moderatc eating impairments take longer than those with mild impairments to
eat pureed and viscous textures ancl, although the time
needed for eating a solid texture is also longer, the proportional increase is shortest in solid texturCs and longest
in the viscous and purced textures. These findings support our earJiu contention that the thinner and more
liquid a food substance becomes, the more difficult it is to
control motorically (Gisel, 1988). The therapeutic implication for children with eating impairments is that cohesive (tacky) food textures will be easier to manirulatc
orally than thinner food textures.
Jul), 1994, Volume 48, Number 7
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Chewing vigor for viscous and solid textures in gen-
textures interchangeably during standard testing have
eral is markedly reduced in children with eating impair-
been defined in this study. The standard viscous and solid
ments, as re~eeted by a ratio of time to cycles (t :c) that is
greater than one. The t: c ratio is less than 1 in children
textures m3Y be interchanged, whereas applesauce, the
standard puree, should not be replaced with pudding.
without disabilities. Clinically, children with more severe
eating problems show higher t: c ratios than children with
milder problems (see Table 3). The usefulness of this
ratio in determining a cutoff point when children's nutri-
The specific use of certain food textures in oral motor
therapy is also much better understood (Gisel, 1993, in
tional status will be compromised due to their inability to
chew with adequate vigor merits further investigation.
Some authors have argued that children with severe oral
motor deficits should be given mashed food because it
can be eaten more effiCiently. However, children's ability
to sustain age-appropriate weights when given mashed
foods has not been addressed (Croft, 1992; jones, 1989).
Sign~ficance
of Food Textures in Other Domains
Early attempts at rating mechanical parameters of food
textures were made for commercial purfloses (Szczesniak, Brandt, & Friedman, 1963), but their use was not
pursued in other domains until recently. AJthough clinicians have long used various food textures therapeutically
to elicit specific oral motor behaviors, the use of food
textures for diagnostic purposes in conjunction with videOflhotograflhy is a more recent develoflment (AJphonceSchweizer & Gisel, 1994; GiseJ & Patrick, 1988) Other
technologies, such as video~uoroscopy, also use different
food textures for diagnostic purposes. Videotluoroscopy
offers the advantage of visualizing and identifying the
anatomic region and phase of ingestion related to a specific eating problem (Gisc1, Applegate-Ferrante, Benson,
& Bosma, 1993; Griggs,jones, & Lee, 19H9: Kramer, 198'1;
Rogers, Arvedson, Buck, Smart, & !Visall, in rress) However, a disadvantage of vicleotluoroscopy is the exposure
of young children to radiation (Logcmann, 1986) Nevertheless, some authors base their choice of food texture
on video~uoroscopic examination to determine which
texture is safest to swallow without aspiration (Griggs et
aI., 1989; Helfrich-Miller, Rector, & Straka, 1986).
The goal of using various food textures therapeutically is to achieve more mature feeding skills. Of equal
importance should be the monitoring of children's
weight to determine whether ingestive skills are adequate
to meet growth demands. Recent work in our laboratOly
has indicated that children with moderate eating imflairments make some progress in eating after sensorimotor
thcrarY that cmr10yed srecific food textures therapeutically. However, children showed no catch-ur growth; that
is, their weight did not rise above their pretreatment
growth trajectory (Gisel, 1993, in press) The therareutic
effect of sensorimotor treatment with children with mild
eating impairments still needs to be determined.
In summary, the use of different food textures for
diagnostic purposes is now well described (AJphonceSchweizer & Gisel, 1993). The limitations I'm using food
press), but the purported benefits of oral motor therapy
must always be judged against a child's progress in
growth .•
Acknowledgments
We thank Anne[(e Majnemer, PhD. and Nicolina ~akova-Pavlova,
Phil. for GH'eful reading and comments on this manuscript. This
scudy was supported in part by a McGill University Faculty of
Medicine student bursary to Alexandra R. Tcheremenska and in
part by a grant from the American Occupational Therapy
Foundation.
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