Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy

This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at...

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Main Authors: Benfer, K., Weir, K., Bell, K., Ware, R., Davies, P., Boyd, Roslyn
Format: Journal Article
Published: 2015
Online Access:http://hdl.handle.net/20.500.11937/40987
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author Benfer, K.
Weir, K.
Bell, K.
Ware, R.
Davies, P.
Boyd, Roslyn
author_facet Benfer, K.
Weir, K.
Bell, K.
Ware, R.
Davies, P.
Boyd, Roslyn
author_sort Benfer, K.
building Curtin Institutional Repository
collection Online Access
description This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18–36 months (mean = 27.4, 81 males) and 40 children with typical development (TD, mean = 26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR = 1.7, p < 0.01). Parents reported clinical signs in 46.2% of children, with 60% agreement with direct clinical mealtime assessment (kappa = 0.2, p < 0.01). The most common signs on direct assessment were coughing (44.7%), multiple swallows (25.2%), gurgly voice (20.3%), wet breathing (18.7%) and gagging (11.4%). 37.5% of children with TD had clinical signs, mostly observed on fluids. Dysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18–36 months.
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spelling curtin-20.500.11937-409872017-09-13T14:28:46Z Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy Benfer, K. Weir, K. Bell, K. Ware, R. Davies, P. Boyd, Roslyn This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18–36 months (mean = 27.4, 81 males) and 40 children with typical development (TD, mean = 26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR = 1.7, p < 0.01). Parents reported clinical signs in 46.2% of children, with 60% agreement with direct clinical mealtime assessment (kappa = 0.2, p < 0.01). The most common signs on direct assessment were coughing (44.7%), multiple swallows (25.2%), gurgly voice (20.3%), wet breathing (18.7%) and gagging (11.4%). 37.5% of children with TD had clinical signs, mostly observed on fluids. Dysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18–36 months. 2015 Journal Article http://hdl.handle.net/20.500.11937/40987 10.1016/j.ridd.2014.12.021 restricted
spellingShingle Benfer, K.
Weir, K.
Bell, K.
Ware, R.
Davies, P.
Boyd, Roslyn
Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title_full Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title_fullStr Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title_full_unstemmed Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title_short Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
title_sort clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy
url http://hdl.handle.net/20.500.11937/40987