Viaeofluoroscopic Evaluation of Dysphagia in Patients with Severe Cerebral Palsy

Viaeofluoroscopic Evaluation of Dysphagia in Patients with Severe Cerebral Palsy

Dysphagia usually accompanies other major impairments in subjects with severe cerebral palsy (CP) and should be of major concern to physiatrists, as such patients are at risk of aspiration, malnutrition, failure to thrive and lengthened meal times. Early identification of oropharyngeal dysphagia and adequate management are crucial for the prevention of these complications. Patients with severe tetraplegia and suspected aspiration were enrolled in videofluoroscopic swallowing study (VFSS). Oral phase and pharyngeal phase functions, as well as the presence of silent or overt aspiration, were evaluated. Factors on VFSS associated with risk of aspiration were analyzed. A total of 16 males and 5 females with ages ranging from 6.0 to 30.0 yrs completed the study. Fourteen subjects (66.7%) were found to be aspirators and 71.4 % showed no overt symptoms during aspiration (silent aspiration). The most common oral and pharyngeal impairments were retention over oral cavity (100%) and retention over vallecula (95.2%). Despite these severe impairments and high rate of aspiration, only three patients received nasogastric tube insertion. Aspirators were more likely to have pharyngeal wall coating (p＜ 0.005) and delayed swallowing reflex (p = 0.026). Oral dysphagia factors did not differ between aspirators and nonaspirators. Aspiration is common in children with severe CP and is mostly silent. It is associated with pharyngeal dysfunction which is difficult to detect on bedside swallowing tests. VFSS remains the most important asses sment tool for determining deglutition problems and should be performed early in CP with severe motor dysfunction.