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Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy
P L Mirrett1, J E Riski, J Glascott
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Children with spastic cerebral palsy often have severe dysphagia and silent aspiration. Early videofluoroscopic swallow studies can help manage feeding issues and prevent complications.
Area of Science:
- Pediatric Neurology
- Gastroenterology
- Speech-Language Pathology
Background:
- Dysphagia in children with neurological impairment, particularly spastic cerebral palsy, is under-researched.
- Feeding difficulties in these children are often severe, potentially life-threatening, and typically addressed late.
Purpose of the Study:
- To analyze swallowing patterns and identify predictors of aspiration in children with severe spastic cerebral palsy.
- To evaluate the utility of videofluoroscopic swallow studies (VFSS) in this population.
Main Methods:
- Retrospective analysis of VFSS in 22 patients (7 months–19 years) with severe spastic cerebral palsy.
- Assessment of oral-motor coordination and pharyngeal motility during swallowing.
Main Results:
- 15 patients (68.2%) exhibited silent aspiration.
- Decreased pharyngeal motility predicted silent aspiration.
- Impaired oral-motor coordination correlated with feeding complication severity.
Conclusions:
- Early VFSS is crucial for diagnosing dysphagia and aspiration in children with spastic cerebral palsy.
- Proactive management can prevent malnutrition, aspiration pneumonia, and prolonged mealtimes.
Abstract:
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.