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Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy

  • Katherine A. Benfer
    Correspondence
    Corresponding author Katherine A. Benfer, PhD, Queensland Cerebral Palsy and Rehabilitation Research Centre, Level 6 Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101.
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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  • Kelly A. Weir
    Affiliations
    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
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  • Kristie L. Bell
    Affiliations
    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
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  • Robert S. Ware
    Affiliations
    Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia

    School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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  • Peter S. Davies
    Affiliations
    Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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  • Roslyn N. Boyd
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Published:December 18, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.016

      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±2.9mo 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

      List of abbreviations:

      BMI (body mass index), CP (cerebral palsy), DDS (Dysphagia Disorders Survey), GMFCS (Gross Motor Function Classification System), OPD (oropharyngeal dysphagia)
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