Authors (including presenting author) :
Yuen KMW (1), Wong AHY (1), Louie FTM (1)
Affiliation :
(1) Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital
Introduction :
Anterior sialorrhea, commonly called anterior drooling, is unintentional and visible spillage of saliva from mouth onto lips, chin, neck, hands, clothes, and even objects. It is common in normal babies but usually subsides by 18-month-old. Anterior sialorrhea after 4-year-old is generally considered pathologic. Due to impaired neuromuscular control of orofacial tissues and oral sensory processing, anterior sialorrhea is a common problem in clients with neurological diseases.
Persistent anterior sialorrhea could result in significant complications. Physical complications include skin maceration with secondary bacterial infection, bad odour and dehydration. Psychosocial complications include decreased self-esteem, social interaction difficulties, increased burden of care, and increased caregiver stress. Visible anterior sialorrhea may cause a significant negative impact on the quality of life for both clients and caregivers.
Orofacial Myofunctional Therapy (OMT) is a conservative intervention that focuses on neuro-muscular re-education of orofacial muscles. OMT aims to improve resting position and coordination of orofacial muscles, and could be a therapy to manage anterior sialorrhea.
Objectives :
To evaluate effectiveness of OMT for an adult with anterior sialorrhea.
Methodology :
A middle-aged adult with cerebral palsy and moderate intellectual disability was referred from the Drooling Clinic. He received 8 sessions for drooling assessment and OMT at the out-patient clinic in 6 months. After each session, he was requested to daily practice the educated OMT activities.
Result & Outcome :
Physically, posterior tongue strength improved from 10 kilopascal to 12 kilopascal after treatment.
Drooling Quotient (5 minutes), and Drooling Severity and Frequency Scale were used to assess the severity and frequency of anterior sialorrhea. After treatment, the severity was reduced from moderate (wet lips and chin) to dry (never drools) when sitting, and from severe (damp clothes) to mild (wet lips only) when talking and in bed. Also, the frequency reduced from occasionally to never when sitting, from frequently to occasionally when in bed, and also reduced from 5 percent to 0 percent in active situation.
More importantly, there was improvement in quality to life in both client and carer. Lower score in Drooling Rating Scale indicating less impact to quality of life and carer stress, and the score reduced from 26 to 17.
To conclude, OMT could be an effective intervention modalities to tackle anterior sialorrhea problem in adults.
