Article

OBJECTIVES: To determine changes in prevalence and severity of oropharyngeal
dysphagia (OPD) in children with cerebral palsy (CP) and the relationship to
health outcomes. DESIGN: Longitudinal cohort study. SETTING: Community and
tertiary institutions. PARTICIPANTS: Children (N=53, 33 boys) with a confirmed
diagnosis of CP assessed first at 18 to 24 months (Assessment 1: mean age +/- SD,
22.9+/-2.9mo corrected age; Gross Motor Function Classification System [GMFCS]:
I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at 36 months (Assessment 2).
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: OPD was classified using
the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal
dysphagia. Nutritional status was measured using Z scores for weight, height, and
body mass index (BMI). Gross motor skills were classified on GMFCS and motor
type/distribution. RESULTS: Prevalence of OPD decreased from 62% to 59% between
the ages of 18 to 24 months and 36 months. Thirty percent of children had an
improvement in severity of OPD (greater than smallest detectable change), and 4%
had worse OPD. Gross motor function was strongly associated with OPD at both
assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3, P=.011; Assessment
2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment
2: OR=15.8, P=.003), and OPD severity (Assessment 1: beta=6.1, P<.001; Assessment
2: beta=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36
months: low Z scores for weight (adjusted beta=1.2, P=.03) and BMI (adjusted
beta=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049).
CONCLUSIONS: Classification and severity of OPD remained relatively stable
between 18 to 24 months and 36 months. Gross motor function was the best
predictor of OPD. These findings contribute to developing more effective
screening processes that consider critical developmental transitions that are
anticipated to present challenges for children from each of the GMFCS levels.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS