Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy

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 manage...

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Bibliographic Details
Published in:Dysphagia 1994, Vol.9 (3), p.174-179
Main Authors: Mirrett, P L, Riski, J E, Glascott, J, Johnson, V
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Barium
Cerebral Palsy - complications
Child
Child, Preschool
Deglutition Disorders - complications
Deglutition Disorders - diagnosis
Deglutition Disorders - diagnostic imaging
Dentistry
Female
Fluoroscopy
Humans
Infant
Male
Muscle Spasticity - complications
Nutrition Disorders - etiology
Nutrition Disorders - prevention & control
Pneumonia, Aspiration - prevention & control
Severity of Illness Index
Videotape Recording
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Summary: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 suggest 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.
ISSN:0179-051X
1432-0460
DOI:10.1007/BF00341262