Next Article in Journal
Behavioral and Sleep Disorders in Children and Adolescents following COVID-19 Disease: A Case-Control Study
Next Article in Special Issue
Exploring the Prognosis: A Longitudinal Follow-Up Study of Children with Sensory Processing Challenges 8–32 Years Later
Previous Article in Journal
Becoming Dad: Expectant Fathers’ Attachment Style and Prenatal Representations of the Unborn Child
Previous Article in Special Issue
Spanish Cultural Adaptation and Inter-Rater Reliability of the Revised Knox Preschool Play Scale
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 10
Issue 7
10.3390/children10071188
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3–6 Years with Cerebral Palsy with Cerebral Visual Impairment

by
Mustafa Cemali
1,*,
Özge Cemali
2,
Ayla Günal
3 and
Serkan Pekçetin
4
1
Department of Occupational Therapy, Faculty of Health Sciences, Lokman Hekim University, 06510 Ankara, Turkey
2
Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
3
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, 60250 Tokat, Turkey
4
Department of Occupational Therapy, Faculty of Gülhane Health Sciences, University of Health Sciences, 06010 Ankara, Turkey
*
Author to whom correspondence should be addressed.
Children 2023, 10(7), 1188; https://doi.org/10.3390/children10071188
Submission received: 12 June 2023 / Revised: 4 July 2023 / Accepted: 8 July 2023 / Published: 9 July 2023
(This article belongs to the Special Issue Occupational Therapy, Physiotherapy, Rehabilitation for Children and Adolescents)
Review Reports Versions Notes

Abstract

:
The current study aimed to examine the relationship between sensory processing skills and feeding behavior in cerebral palsy (CP) children aged 3–6 years with cerebral visual impairment (CVI). A total of ninety mothers participated in the study in three groups: thirty mothers of children with CP with CVI, thirty mothers of children with CP without CVI, and thirty mothers of children with typical development (TD). The sensory processing skill of the children was evaluated with the Sensory Profile (SP), and feeding behavior was evaluated with the the Behavioral Pediatric Feeding Assessment Scale (BPFAS). In the triple comparison, a significant difference was found between the groups in all SP parameter and BPFAS scores (p < 0.001). Post hoc analysis revealed statistically significant differences between the groups in all parameters (p < 0.001). Feeding problems were detected in 65% of all groups. In the correlation analysis, a significant relationship was found between all parameters of the SP and the BPFAS (p < 0.05). In terms of sensory processing skills and feeding status, it was determined that children with CVI with CP had more problems than children with CP without CVI, and children with CP without CVI had more problems than children with TD. With these results, it was concluded that sensory processing problems affect feeding status, and visual impairment causes both sensory problems and feeding problems.

1. Introduction

Cerebral palsy (CP) is a non-progressive motor function, posture, and movement disability that occurs as a result of prenatal, natal, and postnatal harm to the developing brain [1]. The main expression of the disease is motor dysfunction, but since the existing pathology affects other parts of the brain, motor disorder is often accompanied by epilepsy, sensory processing problems, visual and hearing disorders, oral–motor insufficiency and related feeding problems, orthopedic disorders, mental retardation, behavioral disorders, language–speech disorders, chronic lung problems, and sleep problems [2,3].
It is known that problems in children with CP might differ depending on the location of brain damage. Feeding problems are said to be more important than other problems since they are directly tied to growth and development [4,5]. Feeding problems in children with cerebral palsy vary depending on impaired motor coordination, structural anatomical pathologies, spasticity or hypotonic posture, sensory processing problems, motor involvement severity, whether the swallowing reflex is developed to a normal level or not, trunk control deficiencies, and deficiencies in tongue, lip, jaw, and mouth functions [6].
Feeding problems affect 60–90% of children with CP and can begin in infancy and last throughout life [7]. Feeding problems that affect physical growth can be seen in children with CP due to reasons such as difficulty in sucking, chewing, and swallowing, loss of appetite, rejection of new foods, taking a long time to eat. If these feeding problems are not treated, they can cause growth and developmental retardation, which negatively affect morbidity and mortality [8,9].
There have been many studies in the literature on the factors that cause feeding problems in children with CP [10,11,12]. Taş revealed that feeding behavior problems increased with worsening gross motor skills in children with CP aged 2–15 years [10]. Kürklü, in his study on children with CP aged 3–18, concluded that swallowing and chewing difficulties are associated with oral–motor insufficiency and that this is the most important cause of feeding problems [11]. Kangalgil, on the other hand, stated that behaviors such as keeping food in the mouth, choking while feeding, and food refusal are factors that cause feeding problems in children with CP aged 7–17 [12]. Although studies have shown that motor, swallowing, and chewing issues are the most common causes of feeding problems [4,13,14], research has also shown that sensory processing impairments can induce feeding problems related to the manipulation of solid foods in the mouth [15]. It has been reported that eating problems due to sensory reasons may result in oral intolerance, primarily due to the flavor, texture, and hardness of the meal, and that this circumstance also prolongs feeding times [16].
It is known that loss of function may occur as a result of brain damage due to CP due to motor, cognitive, behavioral, speech, auditory, and visual areas being affected. Although motor involvement is prominent in the loss of function in children with CP, cerebral visual impairment (CVI), damage to the part of the cerebral cortex that governs vision, is also indicated to cause serious problems for the functional independence of children [17]. CVI is defined as a functional visual impairment that occurs due to damage to the visual center. CVI occurs in 40 to 48% of children with CP and occurs in addition to CP symptoms [18]. Around 70–80% of the receptors in our body are in our eyes, and the sense of sight is of great importance to the integration of visual stimuli and environmental orientation [19]. Sensory processing, which is the reception of stimuli from the environment, their interpretation in the cerebral cortex, and the formation of an appropriate response, is impaired in these children with CVI and CP due to the involvement of sensory areas [20].
In studies examining the parameters associated with sensory processing skills in children with CP with and without CVI, it is seen that mostly motor skills are evaluated [19,20,21,22]. Cemali found that the vestibular, tactile, and proprioception senses of children with CVI and CP were more problematic than children with CP without CVI in his study of 10–18-month-old children with and without CVI, stating that vision loss may prevent children from perceiving sensory stimuli and that children may perceive stimuli to be dangerous [19]. Pavao evaluated the sensory parameters of children with CP with the Dunn Sensory Profile questionnaire, which included oral assessment of sub-parameters, and partially examined feeding status through feeding questions in the oral assessment and revealed that the children had feeding problems [23]. Apart from these studies, studies with children with CP are mostly related to the relationship between feeding and motor skills, swallowing, and chewing. [24,25]. It is known that the characteristics of foods, such as texture, taste, smell, and appearance, constitute the sensory parameters of feeding [26]. We could not identify a study that looked at the association between sensory processing skills and feeding status in children with CP, either with or without CVI, in our examination of the literature. From this point of view, we aimed to compare the sensory processing skills and feeding status of children with CVI with CP, children without CVI with CP, and children with TD to reveal how sensory processing skills and feeding status are related in each group.

2. Materials and Methods

2.1. Study Design

The study was approved by the Tokat Gaziosmanpasa University Clinical Research Ethics Committee (Registration Number: 01-08/Approval Date: 21 March 2023) and was carried out in accordance with the ethical rules established according to the Declaration of Helsinki. Research was carried out between March 2023 and May 2023 in a special education and rehabilitation center in Ankara where children with visual, physical, and mental disabilities receive special education and rehabilitation services.

2.2. Procedure

Three independent groups consisting of mothers of children aged 3–6 years with CVI with CP, mothers of children without CVI with CP, and mothers of children with TD were formed for the study. After the purpose of the study was explained to the mothers who voluntarily agreed to participate in the study, they were asked to sign a consent form. The interviews were made face-to-face and evaluation forms were filled using paper and pencils. The demographic information form, the Sensory Profile (SP), and the Behavioral Pediatric Evaluation Scale (BPFAS) were used in the evaluations made in the presence of a physiotherapist and feeding and dietetics specialist with 10 years of experience. Each participant’s evaluation session lasted an average of 30 min. After calculating the evaluation scores for each group, the SP and BPFAS scores of the groups were compared. Correlation analysis was used separately for each group to examine the relationship between the SP and the BPFAS.

2.3. Participant

The sample size of the study was calculated with an a priori type of power analysis by selecting the ANOVA fixed effect, omnibus, and one-way test parameter under the F test family using the Gpower 3.1.9.7 program. In order to determine the difference between the 3 different groups, the Behavioral Pediatric Feeding Assessment Scale (BPFAS) was determined for 30 individuals in each group with a medium effect size, a 95% confidence interval, and 80% power, and the required number for the total sample size was 90.
Children with CP with and without visual impairment who participated in the study were selected according to the Special Needs Report for Children Report (SNRCR). This report is a report that states the diagnosis and training needs of children, which is required to receive special education and rehabilitation services in Turkey and given by a multidisciplinary team.
The inclusion criteria for the children with CP whose mothers were included were as follows: (1) age from 36 to 72 months and (2) diagnosed with CP according to the SNRCR (for the group of children with CP with CVI, a diagnosis of CVI according to the SNRCR and no ocular problems was also required). The inclusion criteria for children with TD were as follows: (1) age of 36 to 72 months and (2) the absence of any ocular or neurological disorders. Exclusion criteria for the study were as follows: (1) the mother’s refusal to participate in the study and (2) the child being affected by deafness, blindness, or deaf-blindness. Inclusion criteria for mothers were the ability to read and write, being at a cognitive level capable of perceiving and answering the survey questions, and agreeing to answer the survey questions completely.

2.4. Measure

2.4.1. Demographic Information Form

This is an information form that contains information such as the age and gender of the child.

2.4.2. Sensory Profile (SP)

The Sensory Profile was developed by Dunn et al. in 1999 [27].to evaluate responses to possible sensory experiences in daily life in children with different diagnoses. This profile allows for evaluation of the effect of the sensory processes of individuals on functional performance in their daily lives. The profile reveals the sensory appearance of the individual in terms of sensory seeking, emotional response, low endurance, oral sensitivity, distraction, poor perception, sensory sensitivity, activity level, and fine motor/perceptual differences. The profile is filled by caregivers. A five-point Likert scale is used to evaluate the profile consisting of 125 items, with “Always” as 1; “Often” as 2; “Sometimes” as 3; “Rarely” scored as 4; and “Never” scored as 5. After the scores are calculated, a result is obtained about the child’s sensory system processing problem, how they interpret the sense, how they adapt to the surrounding sensory stimuli, how they participate in the activities of daily living, or how they react to them according to the reference score table. In addition, it evaluates the child’s ability to receive the senses (sensory processing), adjust (modulation), and create behavioral and emotional responses according to the reference scoretable. Typical performance, potential difference, and precise difference score ranges were determined for each parameter. The overall score for each parameter improves from the exact difference score range to the typical performance score range. The Sensory Profile is a frequently used questionnaire to evaluate sensory processing skills in children with CP [23]. The Turkish version of this study was conducted by Kayihan et al. in 2015, and the total cronbach α value was 0.99 [27,28].

2.4.3. The Behavioral Pediatric Feeding Assessment Scale (BPFAS)

The scale, which was developed by Crist et al. [29] and adapted into Turkish by Önal et al. [30], consists of 35 items. In total, “25 of the expressions in the 5-point Likert-type scale are related to the feeding status of the child and 10 of them are related to the person responsible for the feeding of the child”. Of the 25 items of the BPFAS related to children, 6 of them (items 1, 3, 5, 6, 9, and 16) have a negative meaning. Items that are expressed positively are scored in the opposite way. The lowest score that can be obtained from the BPFAS is 35, and the highest score is 175. A total score of more than 84 indicates that there is an eating problem. There are four subheadings in the scale, namely food selectivity, early food rejection, early grainy food rejection, and late food rejection. An increase in the score obtained from the scale indicates a high level of problematic eating behavior and eating habits. The scale is a tool used to evaluate eating behavior in children with CP [10]. The total Cronbach α value of the scale is 0.87 [31].

2.5. Statistical Analysis

Data were analyzed using the SPSS 25.0 program (SPSS Inc. Chicago, IL, USA). Descriptive statistics of data were given as number and percentage for categorical variables and mean and standard deviation for numerical variables. The conformity of continuous variables to normal distribution was tested using the Shapiro–Wilk test. It was determined that SP and BPFAS scores did not show normal distribution; therefore, non-parametric tests were used. The differences between the outcome measures of the groups were analyzed with the chi-square test for categorical variables and the Kruskal–Wallis test for numerical variables. The Kruskal–Wallis test was used to compare the SP and BPFAS scores between the groups. Multiple comparisons were then made with the Mann–Whitney U test with Bonferroni correction [32]. The relationship between SP and BPFAS scores was also analyzed with the Spearman correlation test. A significance level of 0.05 was accepted for the p-value.

3. Result

The groups were comparable in term of gender and age (p > 0.05) (Table 1).
It was observed that there was a statistically significant difference between the BPFAS scores between the groups (p < 0.001). It was concluded that the feeding status of children with CVI with CP was more problematic than those with CP without CVI, and the feeding status of children with CP without CVI was more problematic than those with TD (Table 2).
In the assessment of sensory processing skills, a significant difference was found between the groups in all areas of the SP (p < 0.001). It was concluded that in all sub-areas of the SP, the sensory processing skills of children with CP with CVI were lower than those of children with CP without CVI, and the sensory processing skills of children with CP without CVI were lower than those of children with TD (Table 2).
As a result of post hoc analysis, there was a significant difference in all pairwise comparisons of the three groups in all parameters. Children with CP with CVI and CP without CVI were found to exhibit differences in all sub-areas of the BPFAS and SP (Table 3).
According to BPFAS, feeding behavior problems were detected in 10 children with TD, 22 children with CP without CVI, and 27 children with CP with CVI. There was a significant difference between the groups (p < 0.001) (Table 4).
There was a statistically negative correlation between all sub-parameters of the SP and BPFAS for each group (p < 0.05). It was concluded that with the increase in sensory processing skill problems, feeding behavior problems increased (Table 5).

4. Discussion

The current study studied the association between sensory integration and feeding behavior in children with CVI with CP, children without CVI with CP, and children with TD and compared these parameters between groups. In conclusion, it has been observed that children with CP with CVI have significant sensory and feeding problems compared to both children with CP without CVI and children with TD. It has been found that feeding problems increase with an increased level of sensory processing disorder.
In a study evaluating sensory processing in children with visual impairment, it was found that children have low sensory thresholds and exhibit sensitivity avoidance behavior to stimuli [33]. Although our results were similar, we found that in addition to low sensory threshold, avoidance, and sensitivity behavior, sensory seeking response also improved in children with CP with CVI. It is known that children with CP with CVI and children with CP without CVI due to neural involvement have lower sensory, motor, and cognitive skills than children with TD, and their functional independence levels are lower accordingly [34,35]. Children with functional disabilities may exhibit sensory seeking because they do not have adequate access to sensory stimuli. On the contrary, those with CP who cannot adequately access sensory stimuli may exhibit behaviors such as sensitivity and avoidance due to insufficient sensory experience [36]. It is known that vision is an important sense for environmental orientation, and it is predicted that CP symptoms may be more severe in those with vision deficiencies [17,37,38]. Therefore, it can be inferred that the response of children with CP and CVI to sensory stimuli may be variable and may produce different types of responses depending on the sensory threshold [19].
It is recognized that motor, cognitive, visual, speech, and hearing parts of the cerebral cortex, as well as the somatosensory area and sensory pathways, may be damaged in CP. In CP, the injured central nervous system not only causes aberrant muscle tone, but may also lead to sensory processing disorders arising in addition to these symptoms [39]. In a study conducted in children with CP, it was stated that 90% of the children had vestibular and proprioceptive sensory dysfunctions, and vestibular sense and motor function development were correlated bidirectionally [40]. In the current study, the vestibular sensory evaluation results of children with CP without CVI were similar to those in the literature, but this loss was much higher in children with CP and CVI. Cemali concluded that children with CP with CVI had lower motor skills and vestibular sensory development than children with CP without CVI, and revealed that this situation resulted from limitations on independent movement and environmental orientation as a consequence of visual impairment [20]. It can be said that visual and vestibular senses are related to each other and vision is an important parameter for movement [41]. Recognition of objects occurs with the cooperation of vision and tactile senses [42]. In a study conducted with children with CP, it was stated that children have sensory modulation disorders due to neural activity, and it was concluded that this disorder causes children to form a defensive response to tactile stimuli [43]. When tactile stimuli do not integrate with vision in children with visual impairment, stimuli from the environment may be regarded as dangerous, and children may avoid tactile stimuli and objects as a result. The same is true for auditory stimuli. In cases where the visual sense is insufficient, sounds of different types and intensities from the environment can be defined as a danger for children [19]. Similar to the literature, we concluded that children with CP with CVI have problems in tactile and auditory sensory processing. These results clearly show that sensory problems can be experienced in the absence of the visual sense required to perceive the environment and objects [44].
Studies have shown that the sensory integration system is linked to the limbic system, where the emotional state is controlled [45]. For this reason, after the age of three, the sensory need is more pronounced and this deficiency may cause emotional, behavioral, and social problems in a disease group such as those with CP who have a low level of independence [23]. In a study conducted with children with CP, it was concluded that children who do not experience enough sensory satisfaction are more aggressive, experience emotional problems, and engage in self-harming behaviors [36]. Another study found that sensory processing impairment limits children’s activity and participation [46]. In current research, we found that children have problems in behavioral, sensory, and social participation areas related to sensory integration. It can be said that children with neurodevelopmental disorders who cannot experience sensory stimuli adequately and experience sensory satisfaction may exhibit different behaviors, be aggressive, and experience limitations in their level of activity [21,23].
Behavioral, emotional, and social areas of sensory processing are as important as the vision, hearing, touch, and vestibular sensory areas, and these areas interact with each other [47]. Feeding behavior is another significant indicator that demonstrates the relationship between feeding’s tactile and behavioral characteristics. Although tactile stimuli function in the mouth as they do throughout the body, they are more sensitive in the mouth [16]. It has been stated that children with CP may create a disorganized response to tactile stimuli, with tactile stimuli in the oral region thus possibly being affected by this situation, which may affect food intake for foods with different textures and flavors [48]. It has been reported that 25–45% of infants and children with TD and 80% of children with neurodevelopmental disorders have feeding problems such as eating less, refusal to eat, choosing food, avoiding food, and prolonged eating times [49]. Yilmaz stated in his study that children with TD had moderate eating disorders, and Aydin stated that infants with TD had a low level of eating problems. İnan reported that 39.5% of children with learning difficulties had feeding problems, with Crasta finding that 61% of children with autism had feeding problems. Studies have emphasized that the most important cause of feeding disorders in children with TD is being picky with food due to the taste, texture, and smell of food, while children with neurodevelopmental disorders also have a lack of sensory tolerance [50,51,52,53]. In the current study, we found that one-third of the children with TD had eating disorders, and this was much higher in children with CP with and without CVI; with the increase in sensory problems in the groups, the eating problems increased. In a study conducted with children with CP, it was revealed that children have problems in chewing and tolerating solid foods [48]. In another study investigating feeding problems in children with CP, it was stated that oral sensory problems in addition to oromotor and neurological swallowing and chewing problems affect children’s feeding [4]. Similar to prior studies, it was established in a study of infants with a history of premature birth that the feeding status of children with sensory integration disorder was worse [54]. In the current study, we concluded that the feeding attitudes of children with CVI and CP were worse and that this was related to sensory processing skills. We think that this situation is related to the inability to tolerate the type, taste, and texture of foods, together with sensory reasons [55]. Although we focused on the relationship of feeding with sensory processing skills and oral and tactile stimuli in our study [56,57], it should be considered that motor, oral motor, swallowing, and chewing disorders also affect feeding in children with CP with and without CVI. With this perspective, it is thought that the multidimensional evaluation of feeding will be an important step in determining the feeding problem and that our findings will guide further studies to be conducted more comprehensively.
This study was limited in that it could not directly analyze sensory status or feeding behavior, as assessments were made using standard caregiver-filled questionnaires. In addition, other limitations of the study are that other factors that may affect feeding behavior were not evaluated, such as the motor, swallowing, and cognitive states of the children and the ability of the parents to feed the children.

5. Conclusions

It was observed that children with CP with CVI had more problematic sensory processing skills and feeding behavior attitudes than children with CP without CVI, and children with CP without CVI had more problematic experiences than children with TD. In addition, it was concluded that as the problems in sensory processing skills increased in each group, the feeding behavior problems also increased. As a result, it was observed that the sensory processing skills and feeding behaviors of children with CP were affected, and with the addition of a CVI diagnosis to the diagnosis of CP, the sensory and feeding status of children became worse.

Author Contributions

Conceptualization, M.C., Ö.C. and S.P.; data curation, A.G.; formal analysis Ö.C. and M.C.; investigation, M.C., S.P. and A.G.; supervision, S.P.; writing—original draft, M.C., Ö.C., A.G. and S.P.; editing, S.P. and A.G. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was approved by the Tokat Gaziosmanpasa University Clinical Research Ethics Committee (Registration Number: 01-08/Approval Date: 21 March 2023) and was carried out in accordance with the ethical rules established according to the Declaration of Helsinki.

Informed Consent Statement

Parents were given a consent form for each infant participant in accordance with the study protocol.

Data Availability Statement

The dataset analysed in this study can be requested from Mustafa Cemali (muscemali@hotmail.com) on reasonable request.

Acknowledgments

The authors thank all the children and their mothers who participated in the study at the special education centre.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Kantor, J.; Hlaváčková, L.; Du, J.; Dvořáková, P.; Svobodová, Z.; Karasová, K.; Kantorová, L. The effects of Ayres Sensory Integration and related sensory based interventions in children with cerebral palsy: A scoping review. Children 2022, 9, 483. [Google Scholar] [CrossRef] [PubMed]
  2. Jahan, I.; Muhit, M.; Hardianto, D.; Laryea, F.; Chhetri, A.B.; Smithers-Sheedy, H.; McIntyre, S.; Badawi, N.; Khandaker, G. Epidemiology of cerebral palsy in low-and middle-income countries: Preliminary findings from an international multi-centre cerebral palsy register. Dev. Med. Child Neurol. 2021, 63, 1327–1336. [Google Scholar] [CrossRef]
  3. De Guindos-Sanchez, L.; Lucena-Anton, D.; Moral-Munoz, J.A.; Salazar, A.; Carmona-Barrientos, I. The effectiveness of hippotherapy to recover gross motor function in children with cerebral palsy: A systematic review and meta-analysis. Children 2020, 7, 106. [Google Scholar] [CrossRef]
  4. Speyer, R.; Cordier, R.; Kim, J.H.; Cocks, N.; Michou, E.; Wilkes-Gillan, S. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. Dev. Med. Child Neurol. 2019, 61, 1249–1258. [Google Scholar] [CrossRef] [Green Version]
  5. Jahan, I.; Sultana, R.; Muhit, M.; Akbar, D.; Karim, T.; Al Imam, M.H.; Das, M.C.; Smithers-Sheedy, H.; McIntyre, S.; Badawi, N.; et al. Nutrition interventions for children with cerebral palsy in low-and middle-income countries: A scoping review. Nutrients 2022, 14, 1211. [Google Scholar] [CrossRef] [PubMed]
  6. Boudokhane, S.; Migaou, H.; Kalai, A.; Dhahri, A.; Jellad, A.; ben Salah Frih, Z. Feeding problems and malnutrition associated factors in a North African sample of multidisabled children with cerebral palsy. Res. Dev. Disabil. 2021, 118, 104084. [Google Scholar] [CrossRef] [PubMed]
  7. Min, K.-C.; Seo, S.-M.; Woo, H.-S. Effect of oral motor facilitation technique on oral motor and feeding skills in children with cerebral palsy: A case study. BMC Pediatr. 2022, 22, 1–7. [Google Scholar] [CrossRef]
  8. Acar, G.; Ejraei, N.; Turkdoğan, D.; Enver, N.; Öztürk, G.; Aktaş, G. The effects of neurodevelopmental therapy on feeding and swallowing activities in children with cerebral palsy. Dysphagia 2022, 37, 800–811. [Google Scholar] [CrossRef]
  9. Mouilly, M.; El Midaoui, A.; El Hessni, A. The Effects of Swallowing Disorders and Oral Malformations on Nutritional Status in Children with Cerebral Palsy. Nutrients 2022, 14, 3658. [Google Scholar] [CrossRef]
  10. Ayaz, S.; Çankaya, T. Investigation of the relationship between feeding behaviors and nutritional levels of children with spastic quadriparetic cerebral palsy. J. Health Sci. Prof. 2017, 5, 281–287. [Google Scholar]
  11. Seremet, K.N.; Kaya, K.Ö.; Karaçil, E.M.Ş.; Kamarli, A.H.; Şen, E. Evaluation of the relationship between oral motor functions and malnutrition in children with cerebral palsy. J. Phys. Med. Rehabil. Sci. 2022, 25, 362–368. [Google Scholar]
  12. Kangalgil, M.; Özçelik, A.Ö. Evaluation of nutritional status of children with cerebral palsy. Curr. Pediatr. 2018, 16, 69–84. [Google Scholar]
  13. Sherman, V.; Greco, E.; Moharir, M.; Beal, D.; Thorpe, K.; Martino, R. Feeding and swallowing impairment in children with stroke and unilateral cerebral palsy: A systematic review. Dev. Med. Child Neurol. 2019, 61, 761–769. [Google Scholar] [CrossRef] [PubMed]
  14. Szuflak, K.; Malak, R.; Fechner, B.; Sikorska, D.; Samborski, W.; Mojs, E.; Gerreth, K. The Masticatory Structure and Function in Children with Cerebral Palsy—A Pilot Study. Healthcare 2023, 11, 1029. [Google Scholar] [CrossRef] [PubMed]
  15. Addison, L.R.; Piazza, C.C.; Patel, M.R.; Bachmeyer, M.H.; Rivas, K.M.; Milnes, S.M.; Oddo, J. A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. J. Appl. Behav. Anal. 2012, 45, 455–471. [Google Scholar] [CrossRef] [Green Version]
  16. Seiverling, L.; Anderson, K.; Rogan, C.; Alaimo, C.; Argott, P.; Panora, J. A comparison of a behavioral feeding intervention with and without pre-meal sensory integration therapy. J. Autism Dev. Disord. 2018, 48, 3344–3353. [Google Scholar] [CrossRef]
  17. Philip, S.S.; Guzzetta, A.; Chorna, O.; Gole, G.; Boyd, R.N. Relationship between brain structure and cerebral visual impairment in children with cerebral palsy: A systematic review. Res. Dev. Disabil. 2020, 99, 103580. [Google Scholar] [CrossRef]
  18. Gorrie, F.; Goodall, K.; Rush, R.; Ravenscroft, J. Towards population screening for cerebral visual impairment: Validity of the five questions and the CVI questionnaire. PLoS ONE 2019, 14, e0214290. [Google Scholar] [CrossRef] [Green Version]
  19. Cemali, M.; Pekçetin, S.; Aki, E. The Effectiveness of Sensory Integration Interventions on Motor and Sensory Functions in Infants with Cortical Vision Impairment and Cerebral Palsy: A Single Blind Randomized Controlled Trial. Children 2022, 9, 1123. [Google Scholar] [CrossRef]
  20. Cemali, M. Investigation of the Effect of Sensory Integration Therapy on Sensory, Motor and Oculomotor Skills in Infants with Cortical Visual Impairment. Ph.D. Thesis, Hacettepe University Institute of Health Sciences, Ankara, Turkey, 2022. [Google Scholar]
  21. Warutkar, V.B.; Kovela, R.K.; Warutkar, V. Review of sensory integration therapy for children with cerebral palsy. Cureus 2022, 14, e30714. [Google Scholar] [CrossRef]
  22. Olfatian, Y.; Hemayattalab, R.; Bagherzadeh, F. Examine the effectiveness of sensory integration therapy approach on fine motor skills in children with spastic cerebral palsy. J. Sports Mot. Dev. Learn. 2021. [Google Scholar] [CrossRef]
  23. Pavão, S.L.; Lima, C.R.G.; Rocha, N.A.C.F. Association between sensory processing and activity performance in children with cerebral palsy levels I-II on the gross motor function classification system. Braz. J. Phys. Ther. 2021, 25, 194–202. [Google Scholar] [CrossRef] [PubMed]
  24. Dehghan, L.; Dalvand, H.; Bayani, M.; Shamsoddini, A. Frequency of oral motor dysfunction during feeding and some of its effective factors in children with cerebral palsy. J. Arak Univ. Med. Sci. 2019, 22, 47–56. [Google Scholar]
  25. Sousa, K.T.D.; Ferreira, G.B.; Santos, A.T.; Nomelini, Q.S.S.; Minussi, L.O.D.A.; Rezende, É.R.M.D.A.; Nonato, I.L. Assessment of nutritional status and frequency of complications associated to feeding in patients with spastic quadriplegic cerebral palsy. Rev. Paul. Pediatr. 2020, 38, e2018410. [Google Scholar] [CrossRef]
  26. Alaçam, A.; Çalik Yilmaz, B.C.; Incioğlu, A.S. Assessment of orofacial dysfunction using the NOT-S method in a group of Turkish children with cerebral palsy. Eur. Arch. Paediatr. Dent. 2020, 21, 215–221. [Google Scholar] [CrossRef]
  27. Brown, C.; Tollefson, N.; Dunn, W.; Cromwell, R.; Filion, D. The adult sensory profile: Measuring patterns of sensory processing. Am. J. Occup. Ther. 2001, 55, 75–82. [Google Scholar] [CrossRef] [Green Version]
  28. Kayihan, H.; Akel, B.S.; Salar, S.; Huri, M.; Karahan, S.; Turker, D.; Korkem, D. Development of a Turkish version of the sensory profile: Translation, cross-cultural adaptation, and psychometric validation. Percept. Mot. Ski. 2015, 120, 971–986. [Google Scholar] [CrossRef]
  29. Crist, W.; Dobbelsteyn, C.; Brousseau, A.M.; Napier-Phillips, A. Pediatric assessment scale for severe feeding problems: Validity and reliability of a new scale for tube-fed children. Nutr. Clin. Pract. 2004, 19, 403–408. [Google Scholar] [CrossRef] [PubMed]
  30. Önal, S.; Var, E.Ç.; Uçar, A. A study of adapting the Behavioral Pediatric Feeding Assessment Scale (BPFAS) into Turkish. Nevşehir Sci. Technol. J. 2017, 6, 93–101. [Google Scholar]
  31. Dovey, T.M.; Aldridge, V.K.; Martin, C.I.; Wilken, M.; Meyer, C. Screening Avoidant/Restrictive Food Intake Disorder (ARFID) in children: Outcomes from utilitarian versus specialist psychometrics. Eat. Behav. 2016, 23, 162–167. [Google Scholar] [CrossRef] [Green Version]
  32. Armstrong, R.A. When to use the B onferroni correction. Ophthalmic Physiol. Opt. 2014, 34, 502–508. [Google Scholar] [CrossRef]
  33. Houwen, S.; Cox, R.F.; Roza, M.; Lansink, F.O.; van Wolferen, J.; Rietman, A.B. Sensory processing in young children with visual impairments: Use and extension of the Sensory Profile. Res. Dev. Disabil. 2022, 127, 104251. [Google Scholar] [CrossRef] [PubMed]
  34. Clark, C.; Sliker, L.; Sandstrum, J.; Burne, B.; Haggett, V.; Bodine, C. Development and preliminary investigation of a semiautonomous Socially Assistive Robot (SAR) designed to elicit communication, motor skills, emotion, and visual regard (engagement) from young children with complex cerebral palsy: A pilot comparative trial. Adv. Hum. Comput. Interact. 2019, 2019. [Google Scholar] [CrossRef]
  35. Chokron, S.; Kovarski, K.; Dutton, G.N. Cortical visual impairments and learning disabilities. Front. Hum. Neurosci. 2021, 15, 713316. [Google Scholar] [CrossRef] [PubMed]
  36. Jovellar-Isiegas, P.; Resa Collados, I.; Jaén-Carrillo, D.; Roche-Seruendo, L.E.; Cuesta García, C. Sensory processing, functional performance and quality of life in unilateral cerebral palsy children: A cross-sectional study. Int. J. Environ. Res. Public Health 2020, 17, 7116. [Google Scholar] [CrossRef]
  37. Tran, H.-T.; Li, Y.-C.; Lin, H.-Y.; Lee, S.-D.; Wang, P.-J. Sensory Processing Impairments in Children with Developmental Coordination Disorder. Children 2022, 9, 1443. [Google Scholar] [CrossRef]
  38. Morelli, F.; Aprile, G.; Martolini, C.; Ballante, E.; Olivier, L.; Ercolino, E.; Perotto, E.; Signorini, S. Visual function and neuropsychological profile in children with cerebral visual impairment. Children 2022, 9, 921. [Google Scholar] [CrossRef]
  39. Seyam, M.; Sherief, A.; Waly, M.I.; Kashoo, F.Z.; Elfakharany, M.S. Effect of sensory integration on gait for children with mild hemiplegic cerebral palsy. Egypt. J. Phys. Ther. 2021, 7, 1–6. [Google Scholar] [CrossRef]
  40. Arslan, C.; Ünsal, E.; Sezer, K.Ş.; Tarakci, D. Investigation of the Effect of Structured Neurodevelopmental Therapy and Sensory Integration Approaches on Sitting Balance in Children with Cerebral Palsy. Haliç Univ. J. Health Sci. 2020, 3, 107–116. [Google Scholar]
  41. Tramontano, M.; Medici, A.; Iosa, M.; Chiariotti, A.; Fusillo, G.; Manzari, L.; Morelli, D. The effect of vestibular stimulation on motor functions of children with cerebral palsy. Mot. Control 2017, 21, 299–311. [Google Scholar] [CrossRef]
  42. Chokron, S.; Dutton, G.N. Impact of cerebral visual impairments on motor skills: Implications for developmental coordination disorders. Front. Psychol. 2016, 7, 1471. [Google Scholar] [CrossRef] [Green Version]
  43. Pavão, S.L.; Rocha, N.A.C.F. Sensory processing disorders in children with cerebral palsy. Infant Behav. Dev. 2017, 46, 1–6. [Google Scholar] [CrossRef] [PubMed]
  44. Özyazici, K.; Ebru, B.; Alagöz, N.; Varlikliöz, K.; Arslan, Z.; Semra, A.; Sağlam, M. Development of the Senses and Sensory Integration. J. Dev. Psychol. 2021, 2, 209–226. [Google Scholar]
  45. Abdel Ghafar, M.A.; Abdelraouf, O.R.; Abdelgalil, A.A.; Seyam, M.K.; Radwan, R.E.; El-Bagalaty, A.E. Quantitative assessment of sensory integration and balance in children with autism spectrum disorders: Cross-sectional study. Children 2022, 9, 353. [Google Scholar] [CrossRef]
  46. Mishra, D.; Mishra, G.; Das, S.; Senapati, A.; Mohakud, K. Sensory Processing/Integration Dysfunction Affects Functional Mobility of Children with Cerebral Palsy. J. Neonatol. Clin. Pediatr. 2020, 7, 043. [Google Scholar]
  47. Mc Gill, C.; Breen, C.J. Can sensory integration have a role in multi-element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services. Br. J. Learn. Disabil. 2020, 48, 142–153. [Google Scholar] [CrossRef]
  48. Koca, R.B. Investigation of the Relationship Between Nutritional Problems and Cognitive and Sensory Functions of Children with a History of Premature Birth. Master’s Thesis, Hacettepe University Institute of Health Sciences, Ankara, Turkey, 2021. [Google Scholar]
  49. Esra, K.; Emel, Ö. Approach to the child with an eating disorder. Curr. Pediatr. 2016, 14, 129–135. [Google Scholar]
  50. Crasta, J.E.; Benjamin, T.E.; Suresh, A.P.C.; Alwinesh, M.T.J.; Kanniappan, G.; Padankatti, S.M.; Russell, P.S.S.; Nair, M.K.C. Feeding problems among children with autism in a clinical population in India. Indian J. Pediatr. 2014, 81, 169–172. [Google Scholar] [CrossRef] [PubMed]
  51. Yilmaz, G. Feeding behavior in children and feeding attitudes of mothers. Eurasian J. Fam. Med. 2020, 9, 109–116. [Google Scholar] [CrossRef]
  52. Aydin, B. The Role of the Father in the Transition to Complementary Feeding and Nutritional Problems in Early Infancy. Ph.D. Thesis, Hacettepe University Institute of Health Sciences, Ankara, Turkey, 2021. [Google Scholar]
  53. İnan, C.M.; Özçelik, A.Ö. Nutritional Status and Feeding Behavior Problems of Turkish Children with Special Learning Disabilities. 2022; Preprint Version. [Google Scholar] [CrossRef]
  54. Bookser, B.A. Food for Thought: Early Childhood Food Refusal, Maternal Caregiving, and Child Sensory Processing. Ph.D. Thesis, Mills College, Oakland, CA, USA, 2014. [Google Scholar]
  55. Kamal, S.; Kamaralzaman, S.; Sharma, S.; Jaafar, N.H.; Chern, P.M.; Hassan, N.I.; Toran, H.; Ismail, N.A.S.; Yusri, G.; Hamzaid, N.H. A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families. Nutrients 2022, 14, 5241. [Google Scholar] [CrossRef] [PubMed]
  56. Descrettes-Demey, V.; Demey, B.; Crovetto, C.; Simonnot, A.; Berquin, P.; Djeddi, D.D.; Bury, V.; Lahaye, H.; Rey, N.; Guilé, J.M.; et al. Relation Between Sensory Processing Difficulties and Feeding Problems in Youths with Autistic Spectrum Disorders: A Comprehensive Systematic Review and Meta-analysis. Rev. J. Autism Dev. Disord. 2023, 1–13. [Google Scholar] [CrossRef]
  57. Murphy, C.; Byrd, N.; Bordelon, S.; Hilburn, S.; Henderson, J.; Razon, S. Effective Treatment for Pediatric Feeding Difficulties: Multimodal Approach Compared to Sensory Integration Intervention. Am. J. Occup. Ther. 2019, 73 (Suppl. 1), 7311520416p1-p1. [Google Scholar] [CrossRef]
Table
Table 1. Descriptive characteristics of the groups.
Table 1. Descriptive characteristics of the groups.
TDCP without CVICP with CVI
(n = 30)(n = 30)(n = 30)
Gendern (%)n (%)n (%)p
Boy16 (53.3)16 (53.3)18 (60)0.0837 a
Girl14 (46.7)14 (46.7)12 (40)
M (SD)M (SD)M (SD)p
Age (month)44.97 (7.68)44.80 (7.51)47.62 (9.57)0.378 b
CVI: cerebral visual impairment; CP: cerebral palsy; TD: yypical development. a The p-value of the chi-qquare test. b The p-value of the Kruskal–Wallis test.
Table
Table 2. Comparison of groups in terms of BPFAS and SP scores.
Table 2. Comparison of groups in terms of BPFAS and SP scores.
TDCP without CVICP with CVI
(n = 30)(n = 30)(n = 30)
M (SD)M (SD)M (SD)p
BPFAS74.90 (24.4)92.56 (19.01)109.96 (22.26)<0.001
SP
Sensation seeking97.50 (21.43)81.63 (18.44)66.70 (10.45)<0.001
Sensation avoidance112.56 (24.83)91.36 (17.77)78.26 (14.57)<0.001
Sensory sensitivity74 (17.78)61.13 (12.11)49.63 (8.18)<0.001
Low registration57.16 (11.98)46.53 (10.22)36.83 (7.24)<0.001
Auditory processing28.46 (7.68)24.40 (6.40)18.76 (4.56)<0.001
Visual processing32.36 (9.18)27.63 (7.42)23.80 (5.28)<0.001
Vestibular processing39.66 (9.78)34.70 (7.43)28.96 (4.74)<0.001
Touch processing65.30 (16.62)56.3 (11.53)48.93 (8.07)<0.001
Oral sensory44.53 (11.33)35.9 (8.15)30.4 (6.37)<0.001
Sensory inputs that influence
emotional responses		25.50 (3.88)15.53 (3.54)13.53 (2.93)<0.001
Regulation of visual stimuli affecting emotional responses and activity level15.16 (3.39)18.60 (4.27)10.86 (2.33)<0.001
Emotional–social responses56.13 (12.11)43.9 (9.52)36.26 (8.32)<0.001
Behavioral consequences of
sensory processing		23.16 (5.27)18.7 (4.16)15.8 (3.92)<0.001
Response threshold results11.63 (2.74)9.46 (2.11)7.63 (2.10)<0.001
CVI: cerebral visual impairment; CP: cerebral palsy; TD: typical development. The p-values are taken from the Kruskal–Wallis test.
Table
Table 3. Pairwise comparisons of outcome measures between groups.
Table 3. Pairwise comparisons of outcome measures between groups.
TD
CP without CVI		TD
CP with CVI		CP without CVI
CP with CVI
n = 30n = 30n = 30
ppp
BPFAS0.006 *<0.001<0.001
SP
Sensation seeking<0.001<0.001<0.001
Sensation avoidance<0.001<0.001<0.001
Sensory sensitivity0.001 *<0.001<0.001
Low registration<0.001<0.001<0.001
Auditory processing0.045 *<0.001<0.001
Visual processing0.024 *<0.001<0.001
Vestibular processing0.034 *<0.001<0.001
Touch processing0.019 *<0.001<0.001
Oral sensory0.001 *<0.001<0.001
Sensory inputs that influence emotional responses0.002 *<0.001<0.001
Regulation of visual stimuli affecting emotional responses and activity level0.001 *<0.001<0.001
Emotional–social responses<0.001<0.001<0.001
Behavioral consequences of sensory processing<0.001<0.001<0.001
Response threshold results<0.001<0.001<0.001
CVI: cerebral visual impairment; CP: cerebral palsy; TD: typical development. All significance values have been adjusted by the Bonferroni correction. * p < 0.05.
Table
Table 4. Number of children with behavioral feeding problems according to BPFAS score.
Table 4. Number of children with behavioral feeding problems according to BPFAS score.
TDCP without CVICP with CVITotalp
n%n%n%n%
Has a feeding behavior problem1033.3227327905965p < 0.001
No feeding behavior problems2066.78273103135
CVI: cerebral visual impairment; CP: cerebral palsy; TD: typical development. BPFAS > 84: has a feeding behavior problem.
Table
Table 5. Examining the relationship between the SP and BPFAS.
Table 5. Examining the relationship between the SP and BPFAS.
BPFAS
TDCP without CVICP with CVITotal
rprprprp
SP
Sensation seeking−881p < 0.001−735p < 0.001−4020.020 *–0.813p < 0.001
Sensation avoidance−882p < 0.001−761p < 0.001−4750.008 *–0.723p < 0.001
Sensory sensitivity−915p < 0.001−811p < 0.001−5610.001 *–0.717p < 0.001
Low registration−864p < 0.001−756p < 0.001−4400.015 *–0.698p < 0.001
Auditory processing−932p < 0.001−879p < 0.001−5930.001 *–0.840p < 0.001
Visual processing−901p < 0.001−832p < 0.001−6010.001 *–0.811p < 0.001
Vestibular processing −934p < 0.001−634p < 0.001−4540.012 *−737p < 0.001
Touch processing−913p < 0.001−699p < 0.001−5040.004 *–0.759p < 0.001
Oral sensory−818p < 0.001−732p < 0.001−5070.003 *–0.724p < 0.001
Sensory inputs that influence emotional responses−816p < 0.001−628p < 0.001−4630.001 *0.706p < 0.001
Regulation of visual stimuli affecting emotional responses and activity level−805p < 0.001−692p < 0.001−3750.038 *–0.704p < 0.001
Emotional–social responses−700p < 0.001−626p < 0.001−3900.035 *–0.718p < 0.001
Behavioral consequences of sensory processing−840p < 0.001−630p < 0.001−3640.042 *–0.718p < 0.001
Response threshold results−806p < 0.001−625p < 0.001−4100.018*–0.689p < 0.001
SP: Sensory Profile; BPFAS: Behavioral Pediatric Feeding Assessment Scale; Spearman correlation analysis, * p < 0.05.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Cemali, M.; Cemali, Ö.; Günal, A.; Pekçetin, S. Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3–6 Years with Cerebral Palsy with Cerebral Visual Impairment. Children 2023, 10, 1188. https://doi.org/10.3390/children10071188

AMA Style

Cemali M, Cemali Ö, Günal A, Pekçetin S. Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3–6 Years with Cerebral Palsy with Cerebral Visual Impairment. Children. 2023; 10(7):1188. https://doi.org/10.3390/children10071188

Chicago/Turabian Style

Cemali, Mustafa, Özge Cemali, Ayla Günal, and Serkan Pekçetin. 2023. "Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3–6 Years with Cerebral Palsy with Cerebral Visual Impairment" Children 10, no. 7: 1188. https://doi.org/10.3390/children10071188

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop