Behavioural Interventions to Treat Oropharyngeal Dysphagia in Children with Cerebral Palsy: A Systematic Review of Randomised Controlled Trials.

Background/Objectives: Swallowing disorder(s), or oropharyngeal dysphagia (OPD), are very common in children with cerebral palsy (CP) and pose a significant risk to their health. Behavioural interventions are frequently recommended when targeting OPD in children with CP; however, their efficacy has yet to be determined. This systematic review aimed to synthesise the current evidence for behavioural interventions in the treatment of OPD in children with CP. Methods: A comprehensive search in six databases in October 2024 sought studies that (1) included participants aged 0-18 years with a diagnosis of CP and OPD; (2) utilised and described a behavioural intervention for OPD; and (3) used a randomised controlled trial (RCT) experimental design. Three reviewers independently extracted the data, and results were tabulated. The Revised Cochrane Risk of Bias (ROB-2) tool was used to determine the methodological quality of eligible articles. Results: From an initial yield of 2083 papers, 99 full-text studies were screened for eligibility. Seven RCTs involving 329 participants aged 9.5 months (SD = 2.03) to 10.6 yrs were included. CP description varied. Most studies used a combination of behavioural interventions to treat OPD (n = 6), and oral sensorimotor treatment was the most frequently utilised treatment (n = 4). Positive outcomes were reported in all (n = 7); however, there was high risk of bias in five studies. Conclusions: The use of behavioural interventions to treat OPD in children with CP continues to be supported by low-level evidence. Rigorously designed RCTs with larger samples of children with CP and OPD are needed to evaluate the true effects of behavioural interventions across the developmental phase of childhood. Importantly, consistency in describing and reporting baseline analysis of swallowing and OPD; together with treatment-component data, is a priority in future research.