Feeding intervention in children with cerebral palsy over an 18-month period in rural Eastern Cape

Abstract

The incidence of cerebral palsy (CP) is significantly higher in South Africa compared to international statistics. Feeding and swallowing difficulties associated with CP are of great concern in impoverished communities. There is a dearth of research regarding appropriate feeding interventions for children with CP in South Africa.

The aims of this study were to (i) determine if there was a change in the anthropometric measurements of children with CP, (ii) in the feeding performance of children with CP and (iii) in the caregiver awareness of and concerns about their children’s feeding difficulties and weight over an 18-month period, following intervention and caregiver training, in a rural South African community.

A simple time-series experiment was employed. An intensive five-day intervention block of neurodevelopmental therapy (NDT) and caregiver training was provided in August 2007 and August 2008. Pre-intervention, post-intervention and follow-up data were collected. Participants were purposively selected. Children (aged one to 18 years) with a confirmed diagnosis of CP and their caregivers were included. Data collected included anthropometric measurements of the child participants, and extracted questions from the Pediatric Evaluation of Disability Inventory (PEDI) and the Feeding Profile (Kenny et al. 1989).

Statistically significant differences were observed in the mean weight, length/height and mid-upper arm circumference measurements of the child participants over the 18-month period. There was also a significant increase in the number of child participants able to tolerate ground/lumpy foods, instead of pureed foods, over the 18-month period. Individual participants demonstrated improvement in and maintenance of certain feeding skills over time. No significant differences were observed in the number of caregivers aware of and concerned about their children’s feeding difficulties and weight over the 18-month period.

Although not classified as an effective intervention in the systematic review by Novak et al. (2013), NDT appeared to be a cost-effective and easily accessible approach for the purposes of the current study. As the caregivers, who lived far from healthcare facilities and services, received training, they could continue suggested activities at home. As no control group was used in the current study, it is not possible to say whether individual improvements in anthropometric measurements and feeding performance were as a result of intervention and caregiver training.

KEY WORDS: Cerebral palsy (CP), feeding, swallowing, neurogenic dysphagia, neurodevelopmental therapy (NDT) nutrition, anthropometry, caregiver concerns, rural South Africa, poverty, CP intervention.