Voluntary Cough and Clinical Swallow Function in Children with Spastic Cerebral Palsy and Healthy Controls

Dysphagia and resulting pulmonary sequelae are frequently observed in children with spastic cerebral palsy (SCP). However, physiological evidence regarding airway protective behaviors (specifically swallowing and cough function) in these children is sparse. The aim of this investigation was to quantify specific feeding, swallowing, and cough impairments in children with SCP compared to controls. Eleven children with SCP (mean age: 7 ± 2 years; GMFCS: I-V; MACS: I-V) and 10 age-matched controls participated. Clinical feeding and swallowing performance was evaluated with the dysphagia disorder survey (DDS) using standardized liquid, puree, and chewable solid consistencies. Suprahyoid muscle activity and respiratory-swallow patterns were assessed with simultaneous surface electromyography and respiratory inductance plethysmography as children swallowed the various consistencies. Voluntary cough airflow measures were also obtained. Nonparametric tests were used for group comparisons and correlational analyses. Compared to controls, children with SCP demonstrated more signs of clinical feeding and swallowing impairment (p < 0.0001, η² = 0.771), heightened suprahyoid muscle activity for puree (p = 0.014, η² = 0.305) and chewable solids (p = 0.001, η² = 0.528), more frequent post-swallow inhalation across liquid (p = 0.005, η² = 0.401), puree (p = 0.014, η² = 0.304), and chewable solids (p = 0.035, η² = 0.223), and lower cough volume acceleration (p = 0.019, η² = 0.289). Post-swallow inhalation for chewable solids was correlated with the DDS Part 1 (r_s = 0.734, p = 0.010), DDS Part 2 (r_s = 0.610, p = 0.046) and the DDS Total scores (r_s = 0.673, p = 0.023). This study is the first to provide evidence of specific physiological deficits of both swallowing and voluntary cough in children with SCP. Potential hypotheses explaining these deficits and implications for physiologically driven management are explored.