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Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy

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Abstract

Very little has been published about the characteristics and sequelae of dysphagia in children with neurological impairment. The swallowing difficulties encountered by children with spastic cerebral palsy are particularly debilitating and potentially lethal. However, aggressive evaluation and management of their feeding is typically deferred until they are medically or nutritionally compromised. Reports of the use of videofluoroscopy to analyze the swallowing patterns and presence or absence of aspiration in such children are rare. This paper describes the histories and analyzes the videofluorographic swallow studies of 22 patients with the primary diagnosis of severe spastic cerebral palsy. The ages of the subjects ranged from 7 months to 19 years. All had severe dysphagia and were slow, inefficient eaters. Fifteen patients (68.2%) demonstrated significant silent aspiration during their swallow study. Analysis of specific features of their swallowing patterns indicated that decreased or poorly coordinated pharyngeal motility was predictive of silent aspiration. Moderately to severely impaired oral-motor coordination was indicative of severity of feeding complications. Our data suggeest that early diagnostic workup, including baseline and comparative videofluoroscopic swallow studies, could be helpful in managing the feeding difficulties in these children and preventing chronic aspiration, malnutrition, and unpleasant lengthy mealtimes.

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References

  1. Batshaw ML, Perret YM: Children with Handicaps: A Medical Primer. Baltimore: Paul H Brooks, 1988, pp 299–321

    Google Scholar 

  2. Logemann JA: Evaluation and Treatment of Swallowing Disorders. San Diego: College Hill Press, 1983, pp 28–29

    Google Scholar 

  3. Christensen JR: Developmental approach to pediatric neurogenic dysphagia. Dysphagia 3:131–134, 1989

    Google Scholar 

  4. Griggs CA, Jones PM, Lee RE: Videofluoroscopic investigation of feeding disorders in children with multiple handicap. Dev Med Child Neurol 31:303–308, 1989

    Google Scholar 

  5. Kramer SS: Radiologic examination of the swallowing-impaired child. Dysphagia 3:117–125, 1989

    Google Scholar 

  6. Tuchman DN: Dysfunctional swallowing in the pediatric patient: clinical considerations. Dysphagia 2:203–208, 1988

    Google Scholar 

  7. Tuchman DN: Cough, choke, sputter: the evaluation of the child with dysfunctional swallowing. Dysphagia 3:111–116, 1989

    Google Scholar 

  8. Morris SE: Development of oral-motor skills in the neurologically impaired child receiving non-oral feedings. Dysphagia 3:135–154, 1989

    Google Scholar 

  9. Stallings VA, Charney EB, Davies JC, Cronk CE: Nutrition-related growth failure of children with quadriplegic cerebral palsy. Dev Med Child Neurol 35:126–138, 1993

    Google Scholar 

  10. Haberfellner H, Rosiwall B: Treatment of oral sensorimotor disorders in cerebral palsied children: preliminary report. Dev Med Child Neurol 19:350–352, 1977

    Google Scholar 

  11. Morris SE, Wever SS: Problems of cerebral palsy and oral-motor functions. In: Wilson JM (ed.). Oral-Motor Function and Dysfunction in Children. Chapel Hill, NC: Division of Physical Therapy, 1978, pp 163–166

    Google Scholar 

  12. Scherzer AL, Tscharnuter: Early Diagnosis and Therapy in Cerebral Palsy. New York: Marcel Dekker, Inc., 1990, pp 44–46

    Google Scholar 

  13. Rempel GR, Colwell SO, Nelson RP: Growth in children with cerebral palsy fed via gastrostomy tube. Pediatrics 82857–862, 1988

    Google Scholar 

  14. Reeves G: Editorial: growth and nutrition in children with cerebral palsy. Lancet, May:1253–1254, 1990

  15. Kenny DJ, Casas MJ, McPherson KA: Correlation of ultrasound imaging of oral swallow with ventilatory alterations in cerebral palsied and normal children: preliminary observations. Dysphagia 3:112–117, 1989

    Google Scholar 

  16. Parrott LC, Selley WG, Brooks WA, Lethbridge PC, Cole JJ, Flack FC, Ellis RE, Tripp JH: Dysphagia in cerebral palsy: a comparative study of the Exeter Dysphagia Assessment Technique and a multidisciplinary assessment. Dysphagia 7:209–219, 1992

    Google Scholar 

  17. Rogers BT, Arvedson J, Msall M, Demerath RR: Hypoxemia during oral feeding of children with severe cerebral palsy. Dev Med Child Neurol 35:3–10, 1993

    Google Scholar 

  18. Helfrich-Miller KR, Rector KL, Straka JA: Dysphagia: its treatment in the profoundly retarded patient with cerebral palsy. Arch Phys Med Rehabil 67:520–525, 1986

    Google Scholar 

  19. Gisel EG, Patrick J: Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet, Feb:282–285, 1988

  20. Fisher SE, Painter M, Milmoe G: Swallowing disorders in infancy. Pediatr Clin North Am 28:845–853, 1981

    Google Scholar 

  21. Morris SE: Developmental implications for the management of feeding problems in neurologically impaired infants. Semin Speech Language 6:293–315, 1985

    Google Scholar 

  22. McCullagh P, Nelder J: Generalized Linear Models, 2nd ed. London: Chapman and Hall, 1989

    Google Scholar 

  23. Ottenbacher K, Short MA: The development and treatment of oral-motor dysfunction: a review of clinical research. Phys Occup Ther Pediatr 3:1–13, 1983

    Google Scholar 

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Mirrett, P.L., Riski, J.E., Glascott, J. et al. Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy. Dysphagia 9, 174–179 (1994). https://doi.org/10.1007/BF00341262

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  • DOI: https://doi.org/10.1007/BF00341262

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