Article

The aim of the study was to determine the best measure to discriminate
between those with oropharyngeal dysphagia (OPD) and those without OPD, among
young children with cerebral palsy (CP). METHOD: We carried out a cross-sectional
population-based study involving 130 children with CP aged between 18 months and
36 months (mean 27.4mo; 81 males, 49 females) classified according to the Gross
Motor Function Classification Scale (GMFCS) as level I (n=57), II (n=15), III
(n=23), IV (n=12), or V (n=23). Forty children with CP (mean 28.5mo; 21 males,19
females, eight for each GMFCS level) were included in the reproducibility
sub-study, and 40 children with typical development (mean 26.2mo; 18 males, 22
females) were included in the validity sub-study. OPD was assessed using the
Dysphagia Disorders Survey (DDS), Pre-Speech Assessment Scale (PSAS), and
Schedule for Oral Motor Assessment (SOMA). We analysed reproducibility using
inter- and intrarater agreement (percentage) and reliability (kappa values and
intraclass correlation coefficients). Construct validity was assessed as
concordance between measures (SOMA, DDS, and PSAS). In the absence of a criterion
standard measure for OPD, prevalence was estimated using latent class variable
analysis. Data from the children with typical development were used to propose
modified OPD cut-points for discriminative validity. RESULTS: All measures had
strong agreement (>85%) for inter- and intrarater reliability. The SOMA had the
best specificity (100.0%), but lacked sensitivity (53.0%), whereas the DDS and
PSAS had high sensitivity (each 100.0%) but lacked specificity (47.1% and 70.6%
respectively). OPD prevalence when calculated using the web-based estimation was
65.4%, which was similar to the estimate from the modified cut-points.
INTERPRETATION: Using the sample of children with typical development and
modified cut-points, OPD prevalence was lower than estimates with standard
scoring. We propose using these modified cut-points when administering the DDS,
PSAS or SOMA in young children with CP.
CI - (c) 2014 Mac Keith Press.

Langue : ANGLAIS