Dysphagia: its treatment in the profoundly retarded patient with cerebral palsy

Oral motor and swallowing patterns of six profoundly retarded cerebral palsied patients were examined with videofluoroscopy. All subjects had delayed swallow reflexes and lingual dysfunction. Two subjects aspirated 10% or more of the bolus. Based upon patterns observed in x-ray evaluations, treatment programs were designed to remediate deviant areas. These programs consisted of dietary modifications, oral motor treatment, and thermal stimulation. Therapy was implemented seven days a week and a minimum of three times per day. X-rays were repeated at two four-month intervals following initiation of treatment procedures. Results showed significant gains in pharyngeal transit times, amount of material aspirated, amount of residue in the valleculae and pyriform sinuses, and number of swallows required to clear the oropharynx. Thermal stimulation was withdrawn on three of the subjects and after four months, when the x-rays were repeated. Withdrawal patients regressed in pharyngeal transit times but continued to make gains in other areas. Treatment patients showed minimal regression and substantial continued gains. Results suggest that the profoundly retarded cerebral palsied patient is capable of making gains in swallowing function based upon a passive treatment paradigm. The swallowing mechanism was felt to operate more quickly, more efficiently, and with fewer swallows at the end of the 18-month study.