Format

Send to

Choose Destination
Arch Phys Med Rehabil. 2016 Apr;97(4):552-560.e9. doi: 10.1016/j.apmr.2015.11.016. Epub 2015 Dec 18.

Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy.

Author information

1
Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: katherine.benfer@uqconnect.edu.au.
2
Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Speech Pathology, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
3
Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
4
Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
5
Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
6
Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

Abstract

OBJECTIVES:

To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and the relationship to health outcomes.

DESIGN:

Longitudinal cohort study.

SETTING:

Community and tertiary institutions.

PARTICIPANTS:

Children (N=53, 33 boys) with a confirmed diagnosis of CP assessed first at 18 to 24 months (Assessment 1: mean age ± SD, 22.9±2.9 mo corrected age; Gross Motor Function Classification System [GMFCS]: I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at 36 months (Assessment 2).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/distribution.

RESULTS:

Prevalence of OPD decreased from 62% to 59% between the ages of 18 to 24 months and 36 months. Thirty percent of children had an improvement in severity of OPD (greater than smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3, P=.011; Assessment 2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment 2: OR=15.8, P=.003), and OPD severity (Assessment 1: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049).

CONCLUSIONS:

Classification and severity of OPD remained relatively stable between 18 to 24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes that consider critical developmental transitions that are anticipated to present challenges for children from each of the GMFCS levels.

KEYWORDS:

Cerebral palsy; Deglutition disorders; Longitudinal studies; Rehabilitation

PMID:
26707458
DOI:
10.1016/j.apmr.2015.11.016
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center