To: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit

Abstract

The special article presented by Johnston et al., entitled “First Brazilian recommendation of physical therapy for sensorimotor stimulation of newborns and infants in an intensive care unit”,(1) aimed to provide guidelines for sensorimotor stimulation. However, caution should be used when analyzing and interpreting the results of the included studies and developing guidelines for the recommendations. To recommend the modalities of therapeutic massage, i.e., tactile-kinesthetic stimulation and multisensory stimulation to improve sucking, the results were aggregated for two different outcomes: weight and sucking. For a better interpretation of the results of the studies, it should be noted in tables 5S, 6S and 8S of the commented article that only in the latter, there is a a single publication that evaluated suction.(2) According to the analysis of the authors of this recommendation, the study has a moderate level of evidence, which we agree with. However, the results and conclusions should be interpreted with caution due to the limitations of the study, as noted by the authors themselves: the small sample size; the heterogeneous sample of infants with and without medical complications; and the lack of daily collection of data on sucking, which hinders the understanding of the variability of daily behaviors. All these findings limit the ability to generalize a recommendation. When analyzing the multisensory approach, this study did not control for confounding factors, thus leading to a risk of measurement bias. Therefore, there is no way to isolate the effect of multisensory stimulation as the only factor favoring the sucking performance of newborns subjected to auditory, tactile, visual and vestibular stimulation.(2) The authors of this document, which integrates and represents the 20202022 management of the Department of Dysphagia of the Sociedade Brasileira de Fonoaudiologia (SBFa), also highlight the role of the speech therapist as responsible and qualified for prevention, evaluation, diagnosis, functional/functional rehabilitation and management of sucking and swallowing disorders, acting in units of low, medium and high complexity, hospitals (including neonatal intensive care units), rehabilitation centers, among others.(3) Thus, specialized literature in this area may provide more robust evidence focused on the functions of sucking, swallowing and feeding. For example, a double-blinded randomized clinical trial using an oral stimulation program (applied by speech therapists) before the first attempt at oral assessment showed promising results. The intervention group reached level 4 of oral feeding ability 8 days before the control group, and 75.7% of participants reached level 4in the first oral attempt. The control group had a lower probability of reaching 100% of the diet when compared to the intervention in the same Sheila Tamanini de Almeida1 , Deborah Salle Levy2 , Carla Lucchi Pagliaro3 , Carolina Castelli Silvério4