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Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy
M J Casas1, D J Kenny, K A McPherson
1Feeding Disorders Research Unit, Hugh MacMillan Rehabilitation Centre, Toronto, Ontario, Canada.
Insights
Children with cerebral palsy (CP) take longer to manage liquid and solid food boluses during feeding. These findings support allowing more time for feeding tasks and smaller liquid volumes for children with CP.
Area of Science:
- Pediatric neurology
- Gastroenterology
- Speech and language pathology
Background:
- Feeding disorders are common in children with cerebral palsy (CP).
- Understanding the biomechanics of feeding in CP is crucial for intervention.
Purpose of the Study:
- To investigate the oral motor and respiratory patterns during feeding in children with spastic CP.
- To compare feeding task completion times and bolus management between children with CP and neurologically normal children.
Main Methods:
- Ultrasound imaging of the oral cavity, electromyography (EMG) of jaw and throat muscles, and respiratory inductance plethysmography (RIP) were used.
- Participants performed liquid (5ml and 75ml) and solid (cookie) bolus tasks.
- Lip-cup contact and timing of ventilatory changes were recorded.
Main Results:
- Children with CP exhibited longer oral preparation and transit times for liquid boluses compared to controls.
- Longer respiratory preparation and recovery phases were observed in children with CP for both liquid volumes.
- Solid bolus management appeared easier for children with CP than liquid bolus management, with small liquids easier than large liquids.
Conclusions:
- Children with CP demonstrate altered oral motor and respiratory control during feeding tasks.
- Findings support recommendations for extended feeding times and smaller liquid volumes for children with CP.
- This study provides objective data on feeding difficulties in children with CP, informing clinical practice.
Abstract:
Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2-12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid muscles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence that children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.