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Malandraki GA, Kantarcigil Ç, Craig BA, Zhang Y, Gordon AM. Day-to-Day Variability of Clinical Feeding and Swallowing Performance in School-Age Self-Feeding Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:190-200. [PMID: 36492292 DOI: 10.1044/2022_ajslp-22-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE We aimed to examine the day-to-day variability of feeding and swallowing performance and mealtime duration in school-age self-feeding children with spastic cerebral palsy (SCP) across 15 days. METHOD Thirteen children with SCP (ages 5;10 [years;months]-17;6) participated. Children were divided into unilateral (UCP, n = 6) and bilateral (BCP, n = 7) SCP groups. Feeding/swallowing assessments using the Dysphagia Disorder Survey (DDS) were conducted and total mealtime durations (TMDs) were calculated for all days. DDS Part 1 (factors related to feeding) and DDS Part 2 (signs of oropharyngeal difficulties) components were rated. Mixed-effects models were used to compare group means and estimate between- and within-subject variances in each group. Likelihood ratio tests were used to determine best covariance structure and compare variance types across groups. RESULTS Within-subject variance for all three variables, DDS Part 1, 2, and TMD, across days was larger in the BCP group than the UCP group (Part 1: p = .0036, Part 2: p = .0002, and TMD: p = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (p = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: p = .0160; Part 2: p = .0141) and shorter TMD (p = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (p < .0001). CONCLUSION These preliminary results emphasize the need to account for day-to-day variability when evaluating swallowing especially in children with BCP and provide preliminary ranges of performance that could be useful for clinical prognosis and future treatment research. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21669611.
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Affiliation(s)
- Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Çagla Kantarcigil
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Bruce A Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Yumin Zhang
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Costa A, Martin A, Arreola V, Riera SA, Pizarro A, Carol C, Serras L, Clavé P. Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy. Nutrients 2021; 13:2413. [PMID: 34371923 PMCID: PMC8308512 DOI: 10.3390/nu13072413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. METHODS A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). RESULTS A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. CONCLUSION MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.
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Affiliation(s)
- Alicia Costa
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Unitat de Dietètica i Nutrició, Hospital de Mataró, 08304 Mataró, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Cerdanyola del Vallès, Spain
| | - Alberto Martin
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
| | - Viridiana Arreola
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
| | - Stephanie A. Riera
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
| | - Ana Pizarro
- Departament de Periodòncia, Facultat d’Odontologia de Barcelona UIC, 08195 Sant Cugat del Vallès, Spain;
| | - Cristina Carol
- Escola l’Arboç, Fundació El Maresme, 08301 Mataró, Spain;
| | - Laia Serras
- Unitat de Suport Tècnic, Fundació El Maresme, 08301 Mataró, Spain;
| | - Pere Clavé
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
- Fundació de Recerca en Gastroenterologia (Furega), 08008 Barcelona, Spain
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Mohamadi O, Torabinezhad F, Ebadi A. Psychometric properties of the Persian version of the oral motor assessment scale in children and adolescents with cerebral palsy. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:511-517. [PMID: 35937163 PMCID: PMC9351576 DOI: 10.1080/20473869.2020.1819944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 06/15/2023]
Abstract
The Oral Motor Assessment Scale (OMAS) is a diagnostic tool used to assess the oral motor skills in individuals with neurological and neuromuscular disorders. This assessment was developed by Brazilian researchers and for the first time, its validity and reliability was examined in Brazil. The purpose of the present study was to examine the validity and reliability of the adopted Persian version of the OMAS (OMAS-P) to assess the oral skills of Iranian individuals with cerebral palsy (CP). In this non-experimental descriptive-analytical study 120 people (60 children and adolescents with CP) aged 3 to 15 years and 60 healthy subjects) participated. The research was carried out in number of stages including translation and adaptation of the OMAS to Persian (OMAS-P) in a forward-backward way. The oral motor skills functionality of the 120 people was examined using the OMAS-P. To assess the repeatability and reliability of the OMAS-P the assessments was repeated on the participants with CP disorder after two weeks. Results corresponding to this study indicated a reasonable agreement (Kappa >0.7) for all the OMAS-P items. The mean values of the OMAS-P items were appreciably different between the two groups (p < 0.001). The Persian version of the OMAS (OMAS-P) indicated consistent psychometric properties and can be used as a reliable tool for oral motor skills assessment in people with CP. However, it seems that by specifying factors such as the time frame for the OMAS, the position of the child during assessment, and whether or not parents use facilitating techniques, the comprehensiveness and efficiency of the OMAS data will also upgrade.
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Affiliation(s)
- Omid Mohamadi
- School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Ebadi
- Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Nakamura Y, Nakajima T, Sasakawa Y, Tsukuno S, Sakurai R, Kurosawa M, Iwase Y, Saitoh I, Hori K, Hayashi T, Hayasaki H. Influence of food adhesivity and quantity in lip closing pressure. Physiol Behav 2020; 214:112743. [DOI: 10.1016/j.physbeh.2019.112743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/24/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
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Taylor T, Kozlowski AM, Girolami PA. Comparing behavioral treatment of feeding difficulties and tube dependence in children with cerebral palsy and autism spectrum disorder. NeuroRehabilitation 2017; 41:395-402. [DOI: 10.3233/nre-162071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tessa Taylor
- Paediatric Feeding International, Sydney, NSW, Australia
| | - Alison M. Kozlowski
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter A. Girolami
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nip ISB, Wilson EM, Kearney L. Spatial Characteristics of Jaw Movements During Chewing in Children with Cerebral Palsy: A Pilot Study. Dysphagia 2017; 33:33-40. [PMID: 28795229 DOI: 10.1007/s00455-017-9830-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 07/29/2017] [Indexed: 11/26/2022]
Abstract
This study compared jaw motion between children with cerebral palsy (CP) and their typically-developing (TD) peers during chewing. The jaw movements of 11 children with spastic CP (GMFCS levels II-V) all of whom were exclusively oral feeders with no reported clinical issues with feeding [mean age = 7.49 (2.30) years; 7 males, 4 females] and 11 age- and sex-matched TD peers [mean age = 7.54 (2.35) years] were recorded using optical motion capture. Participants chewed five trials of three different consistencies, including puree, mechanical soft, and solid. For each chewing sequence, the path distance (total amount of distance traveled by the jaw), average jaw speed, and working space (total 3-dimensional size of the jaw movements during chewing) were calculated. The CP group had greater path distances for mechanical soft and solids (p < 0.001) and larger working spaces (p < 0.001) than the TD group. Consistency differences were also found with path distances increasing for both groups with increased bolus consistency (p < 0.001). Puree was chewed most slowly for both groups (p = 0.05) and was associated with smaller working space than the other consistencies for both groups (p < 0.001). The TD group demonstrated slower speeds for mechanical soft as compared to solids (p = 0.05), a finding which was not observed in the CP group. The results suggest children with CP showed jaw movement differences during chewing despite being exclusive oral eaters with no reports of clinical feeding or deglutition disorders. Food consistency also influenced jaw movements in both children with CP and their TD peers.
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Affiliation(s)
- Ignatius S B Nip
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA, USA.
| | - Erin M Wilson
- Speech and Feeding Disorders Laboratoray, MGH Institute of Health Professions, Boston, MA, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucia Kearney
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA, USA
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc02. [PMID: 26770277 PMCID: PMC4702052 DOI: 10.3205/cto000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Swallowing disorders are frequent. The main concern is mortality due to aspiration-induced pneumonia and malnutrition. In addition, quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract, and sequelae of tumor treatment in the head and neck region are the main pathologic entities. Predominantly ENT physicians and phoniatricians are asked for diagnostics and therapy, and will coordinate the interdisciplinary treatment according to the endoscopic findings. A differentiated approach in history, diagnostics, and symptom-oriented treatment is necessary for these mostly complex disorders. Integration of non-medical staff such as speech therapists, physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over in close cooperation. In particular, an interdisciplinary cooperation with the staff of intensive care medicine is essential. The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists. Endoscopy is a medical service that is basically not delegable. Consequently, substitution of the physician is excluded.
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Affiliation(s)
- Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | | | - Saskia Rohrbach
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
| | - Cornelia Schwemmle
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
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Taş SA, Çankaya T. An investigation of the relationship of drooling with nutrition and head control in individuals with quadriparetic cerebral palsy. J Phys Ther Sci 2015; 27:3487-92. [PMID: 26696723 PMCID: PMC4681930 DOI: 10.1589/jpts.27.3487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to investigate the relationship of drooling,
nutrition, and head control in individuals with quadriparetic cerebral palsy. [Subjects
and Methods] Fifty-six individuals between the ages 2 and 15 diagnosed with spastic
quadriparetic cerebral palsy and their families/caretakers were included in the study.
Drooling severity and frequency of individuals was evaluated by using the scale developed
by Thomas-Stonell and Greenberg (Drooling Severity and Frequency Scale). Individuals
having a drooling severity value of 1 were included in the not drooling group (group 2)
(n=27). Individuals having a drooling severity of 2, 3, 4, or 5 were included in the
drooling group (group 1) (n=29). The evaluations were applied to both groups. [Results]
There were significant differences between the two groups in terms of gestational age,
nutrition behavior, eating abilities, head control, gagging, nutritional status
(inadequate nutrition, normal nutrition, over weight-obese), and low weight. It was
established that as head control increased, drooling severity diminished, and as drooling
severity increased, BMI index decreased. Independence of eating ability was found to be
greater in the group having better drooling control. [Conclusion] In the present study, it
was determined that drooling control affected nutritional functions and that drooling
control was affected by head control.
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Affiliation(s)
- Seda Ayaz Taş
- Private 75th Year Special Education and Rehabilitation Centre, Turkey
| | - Tamer Çankaya
- School of Physical Therapy and Rehabilitation, Abant İzzet Baysal University: 14280 Bolu, Turkey
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Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients 2015; 7:9400-15. [PMID: 26580646 PMCID: PMC4663597 DOI: 10.3390/nu7115469] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022] Open
Abstract
Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children.
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. [Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children and adults]. Laryngorhinootologie 2015; 94 Suppl 1:S306-S354. [PMID: 25860495 DOI: 10.1055/s-0035-1545298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.
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Affiliation(s)
- C Arens
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | | | - S Rohrbach
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
| | - C Schwemmle
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | - T Nawka
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:192-201. [PMID: 25562439 DOI: 10.1016/j.ridd.2014.12.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
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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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7 Block 6, Herston 4029, Queensland, Australia.
| | - Kelly A Weir
- Speech Pathology Department, Royal Children's Hospital, Herston 4029, Queensland, Australia; Queensland Children's Medical Research Institute, The University of Queensland, Herston 4029, Queensland, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7 Block 6, Herston 4029, Queensland, Australia; Children's Nutrition Research Centre, QCMRI, The University of Queensland, Herston 4029, Queensland, Australia
| | - Robert S Ware
- Queensland Children's Medical Research Institute, The University of Queensland, Herston 4029, Queensland, Australia; School of Population Health, The University of Queensland, Herston 4029, Queensland, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, QCMRI, The University of Queensland, Herston 4029, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7 Block 6, Herston 4029, Queensland, Australia
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3469-3481. [PMID: 25213472 DOI: 10.1016/j.ridd.2014.08.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/20/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE This study aimed to document the prevalence and patterns of oral phase oropharyngeal dysphagia (OPD) in preschool children with cerebral palsy (CP), and its association with mealtime duration, frequency and efficiency. METHODS Cross-sectional population-based cohort study of 130 children diagnosed with CP at 18-36 months ca (mean = 27.4 months, 81 males) and 40 children with typical development (mean = 26.2, 18 males). Functional abilities of children with CP were representative of a population sample (GMFCS I = 57, II = 15, III = 23, IV = 12, V = 23). Oral phase impairment was rated from video using the Dyspahgia Disorders Survey, Schedule for Oral Motor Impairment, and Pre-Speech Assessment Scale. Parent-report was collected on a feeding questionnaire. Mealtime frequency, duration and efficiency were calculated from a three day weighed food record completed by parents. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS). RESULTS Overall, 93.8% of children had directly assessed oral phase impairments during eating or drinking, or in controlling saliva (78.5% with modified cut-points). Directly assessed oral phase impairments were associated with declining gross motor function, with children from GMFCS I having a 2-fold increased likelihood of oral phase impairment compared to the children with TD (OR = 2.0, p = 0.18), and all children from GMFCS II-V having oral phase impairments. Difficulty biting (70%), cleaning behaviours (70%) and chewing (65%) were the most common impairments on solids, and difficulty sipping from a cup (60%) for fluids. OPD severity and GMFCS were not related to mealtime frequency, duration or efficiency, although children on partial tube feeds had significantly reduced mealtime efficiency. CONCLUSIONS Oral phase impairments were common in preschool children with CP, with severity increasing stepwise with declining gross motor function. The prevalence and severity of oral phase impairments were significantly greater for most tasks when compared to children with typical development, even for those with mild CP. Children who were partially tube fed had significantly lower feeding efficiency, so this could be a useful early indicator of children needing supplementation to their nutrition (through increasing energy density of foods/fluids, or tube feeds).
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7, Block 6, Herston 4029, Queensland, Australia.
| | - Kelly A Weir
- Speech Pathology Department, Royal Children's Hospital, Herston 4029, Queensland, Australia; Queensland Children's Medical Research Institute, The University of Queensland, Herston 4029, Queensland, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7, Block 6, Herston 4029, Queensland, Australia; Children's Nutrition Research Centre, QCMRI, The University of Queensland, Herston 4029, Queensland, Australia
| | - Robert S Ware
- Queensland Children's Medical Research Institute, The University of Queensland, Herston 4029, Queensland, Australia; School of Population Health, The University of Queensland, Herston 4029, Queensland, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, QCMRI, The University of Queensland, Herston 4029, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Level 7, Block 6, Herston 4029, Queensland, Australia
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Remijn L, Speyer R, Groen BE, van Limbeek J, Nijhuis-van der Sanden MWG. Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1551-1561. [PMID: 24770467 DOI: 10.1016/j.ridd.2014.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used. Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects. The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.
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Affiliation(s)
- Lianne Remijn
- Department of Child Rehabilitation, Rehabilitation Centre, Sint Maartenskliniek, Postbox 9011, 6500 GM Nijmegen, The Netherlands; Institute of Health Studies, HAN University of Applied Sciences, Postbox 6960, 6503 GL Nijmegen, The Netherlands.
| | - Renée Speyer
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville City, Queensland 4811, Australia; Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, The Netherlands
| | - Brenda E Groen
- Sint Maartenskliniek Research, Postbox 9011, 6500 GM Nijmegen, The Netherlands
| | - Jacques van Limbeek
- Achmea Health Insurance Company, Postbox 1717, 3800 BS Amersfoort, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Postbox 9101, 6500 HB Nijmegen, The Netherlands
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Sığan SN, Uzunhan TA, Aydınlı N, Eraslan E, Ekici B, Calışkan M. Effects of oral motor therapy in children with cerebral palsy. Ann Indian Acad Neurol 2013; 16:342-6. [PMID: 24101813 PMCID: PMC3788277 DOI: 10.4103/0972-2327.116923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/09/2012] [Accepted: 01/28/2013] [Indexed: 11/04/2022] Open
Abstract
AIM Oral motor dysfunction is a common issue in children with cerebral palsy (CP). Drooling, difficulties with sucking, swallowing, and chewing are some of the problems often seen. In this study, we aimed to research the effect of oral motor therapy on pediatric CP patients with feeding problems. MATERIALS AND METHODS Included in this single centered, randomized, prospective study were 81 children aged 12-42 months who had been diagnosed with CP, had oral motor dysfunction and were observed at the Pediatric Neurology outpatient clinic of the Children's Health and Diseases Department, Istanbul Medical Faculty, Istanbul University. Patients were randomized into two groups: The training group and the control group. One patient from the training group dropped out of the study because of not participating regularly. Following initial evaluation of all patients by a blinded physiotherapist and pedagogue, patients in the training group participated in 1 h oral motor training sessions with a different physiotherapist once a week for 6 months. All patients kept on routine physiotherapy by their own physiotherapists. Oral motor assessment form, functional feeding assessment (FFA) subscale of the multidisciplinary feeding profile (MFP) and the Bayley scales of infant development (BSID-II) were used to evaluate oral motor function, swallowing, chewing, the gag reflex, the asymmetrical tonic neck reflex, tongue, jaw, and mouth function, severity of drooling, aspiration, choking, independent feeding and tolerated food texture during the initial examination and 6 months later. RESULTS When the initial and post-therapy FFA and BSID-II scores received by patients in the training and the study group were compared, the training group showed a statistically significant improvement (P < 0.05). CONCLUSION Oral motor therapy has a beneficial effect on feeding problems in children with CP.
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Affiliation(s)
- Seray Nural Sığan
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Weir KA, Bell KL, Caristo F, Ware RS, Davies PS, Fahey M, Rawicki B, Boyd RN. Reported Eating Ability of Young Children With Cerebral Palsy: Is There an Association With Gross Motor Function? Arch Phys Med Rehabil 2013; 94:495-502. [DOI: 10.1016/j.apmr.2012.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 09/04/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
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Remijn L, Speyer R, Groen BE, Holtus PCM, van Limbeek J, Nijhuis-van der Sanden MWG. Assessment of mastication in healthy children and children with cerebral palsy: a validity and consistency study. J Oral Rehabil 2013; 40:336-47. [DOI: 10.1111/joor.12040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Remijn
- Department of Child Rehabilitation; Rehabilitation Centre; Sint Maartenskliniek; Nijmegen the Netherlands
- Institute of Health Studies; HAN University of Applied Sciences; Nijmegen the Netherlands
| | - R. Speyer
- Institute of Health Studies; HAN University of Applied Sciences; Nijmegen the Netherlands
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; James Cook University; Townsville Qld Australia
| | - B. E. Groen
- Department of Research; Development & Education; Sint Maartenskliniek; Nijmegen the Netherlands
| | - P. C. M. Holtus
- Department of Research; Development & Education; Sint Maartenskliniek; Nijmegen the Netherlands
| | - J. van Limbeek
- Department of Research; Development & Education; De Viersprong; Halsteren the Netherlands
| | - M. W. G. Nijhuis-van der Sanden
- Scientific Institute for Quality of Healthcare; Department of Rehabilitation; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motor attainment, growth and nutritional status in preschool children with cerebral palsy. BMJ Open 2012; 2:bmjopen-2012-001460. [PMID: 22893668 PMCID: PMC3425902 DOI: 10.1136/bmjopen-2012-001460] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The prevalence of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) is estimated to be between 19% and 99%. OPD can impact on children's growth, nutrition and overall health. Despite the growing recognition of the extent and significance of health issues relating to OPD in children with CP, lack of knowledge of its profile in this subpopulation remains. This study aims to investigate the relationship between OPD, attainment of gross motor skills, growth and nutritional status in young children with CP at and between two crucial age points, 18-24 and 36 months, corrected age. METHODS AND ANALYSIS This prospective longitudinal population-based study aims to recruit a total of 200 children with CP born in Queensland, Australia between 1 September 2006 and 31 December 2009 (60 per birth-year). Outcomes include clinically assessed OPD (Schedule for Oral Motor Assessment, Dysphagia Disorders Survey, Pre-Speech Assessment Scale, signs suggestive of pharyngeal phase impairment, Thomas-Stonell and Greenberg Saliva Severity Scale), parent-reported OPD on a feeding questionnaire, gross motor skills (Gross Motor Function Measure, Gross Motor Function Classification System and motor type), growth and nutritional status (linear growth and body composition) and dietary intake (3 day food record). The strength of relationship between outcome and exposure variables will be analysed using regression modelling with ORs and relative risk ratios. ETHICS AND DISSEMINATION This protocol describes a study that provides the first large population-based study of OPD in a representative sample of preschool children with CP, using direct clinical assessment. Ethics has been obtained through the University of Queensland Medical Research Ethics Committee, the Children's Health Services District Ethics Committee, and at other regional and organisational ethics committees. Results are planned to be disseminated in six papers submitted to peer reviewed journals, and presentations at relevant international conferences.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia
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Abstract
OBJECTIVE To examine differences in feeding among children with cerebral palsy (CP) who varied in the severity of their oral motor involvement; to examine longitudinal change in feeding behaviours for different severity groups. METHOD Twenty-three children with CP participated (mean age = 4.53 years at the first time point). Feeding data were collected from parent questionnaires at 6 month intervals over 30 months. RESULTS Significant differences were observed among severity groups for all feeding variables except coughing and choking during meals. Only one variable, coughing, showed significant change over time. CONCLUSIONS Children with CP who had severe oral-motor involvement had marked and pervasive feeding difficulties which showed some fluctuation with time, but generally were stable. Children with CP who did not have oral motor involvement and those who had mild-moderate involvement also showed little-to-no change over time and had fewer problems than those in the severe group.
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KAYANAKA-SEKINE H, SAIKI C, TAMURA F, KIKUTANI T, MATSUMOTO S. Lip closing pressure and spoon management in passive spoon feeding. J Oral Rehabil 2010; 38:423-8. [DOI: 10.1111/j.1365-2842.2010.02171.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Furkim AM, Duarte ST, Sacco ADFB, Sória FS. O uso da ausculta cervical na inferência de aspiração traqueal em crianças com paralisia cerebral. REVISTA CEFAC 2009. [DOI: 10.1590/s1516-18462009000800011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: comparar a detectabilidade da ausculta cervical na avaliação clínica com a comprovação da aspiração na videofluoroscopia da deglutição em crianças com paralisia cerebral tetraparética espástica com disfagia orofaríngea. MÉTODOS: estudo retrospectivo com análise de 101 prontuários de crianças, na faixa etária de 1 a 12 anos, pertencentes a uma instituição, com diagnóstico de paralisia cerebral tetraparética espástica e que foram encaminhadas e avaliadas por equipe interdisciplinar. Foi realizada anamnese com avaliação clínica da alimentação com ausculta cervical e videofluoroscopia da deglutição. RESULTADOS: os resultados estatísticos mostraram que há relação significante entre a ausculta cervical positiva e a penetração ou aspiração laríngea constatada na videofluoroscopia da deglutição e que a ausculta cervical negativa está mais associada à não penetração/aspiração. CONCLUSÃO: concluiu-se que a ausculta cervical pode ser utilizada para inferência do risco de aspiração e, portanto, como alerta para atuação precoce nessa população, além da vantagem de ser um método não invasivo.
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Santos MTBR, Guare RO, Celiberti P, Siqueira WL. Caries experience in individuals with cerebral palsy in relation to oromotor dysfunction and dietary consistency. SPECIAL CARE IN DENTISTRY 2009; 29:198-203. [DOI: 10.1111/j.1754-4505.2009.00092.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Soylu OB, Unalp A, Uran N, Dizdarer G, Ozgonul FO, Conku A, Ataman H, Ozturk AA. Effect of nutritional support in children with spastic quadriplegia. Pediatr Neurol 2008; 39:330-4. [PMID: 18940556 DOI: 10.1016/j.pediatrneurol.2008.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 07/28/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
Malnutrition is a common problem in patients with cerebral palsy. We evaluated the effect of nutritional support on clinical findings in children with spastic quadriplegia. Feeding history, numbers of lower respiratory tract infections, and gastrointestinal and neurologic findings were evaluated via questionnaire. Weight, height, head circumference, midarm circumference, and triceps skinfold thickness were measured. Height for age, weight for age, weight for height, body mass index, and weight and height z-scores were calculated. Clinical findings and anthropometric parameters were re-evaluated after nutritional support for 6 months. Forty-five patients were enrolled. No difference was evident between the first and the last height z-scores of 31 patients who completed the follow-up. Weight, height, weight z-scores, weight for age, weight for height, body mass index, midarm circumference, and triceps skinfold thickness exhibited improvement. Moreover, a significant decrease in number of infections was evident. Frequency of seizures and Gross Motor Function Classification System status did not change. Constipation decreased significantly. Nutritional therapy revealed improvements in some anthropometric findings and a decrease in number of infections. Although there was no difference regarding motor development or seizure frequency, further studies with a longer follow-up are required.
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Affiliation(s)
- Ozlem Bekem Soylu
- Department of Pediatrics, Dr. Behcet Uz Children's Disease and Pediatric Surgery Training and Research Hospital, Alsancak, Izmir, Turkey.
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Marchand V, Motil KJ. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:123-35. [PMID: 16819391 DOI: 10.1097/01.mpg.0000228124.93841.ea] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Undernutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that affect the neurologically impaired child. Monitoring neurologically impaired children for nutritional comorbidities is an integral part of their care. Early involvement by a multidisciplinary team of physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is essential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status. Careful evaluation and monitoring of severely disabled children for nutritional problems are warranted because of the increased risk of nutrition-related morbidity and mortality.
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Affiliation(s)
- Valerie Marchand
- Department of Pediatrics, University of Montreal, Montreal, Canada
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Lamey PJ, Clifford TJ, El-Karim IA, Cooper C. Personality analysis of patients complaining of sialorrhoea. J Oral Pathol Med 2006; 35:307-10. [PMID: 16630295 DOI: 10.1111/j.1600-0714.2006.00417.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sialorrhoea, the symptom of apparent excessive secretion of saliva is a relatively uncommon complaint. Some authors consider that in the absence of clinical findings, then these patients have a psychiatric disorder masquerading as a physical illness. However, there is little evidence in the literature to support this conclusion and a detailed psychological assessment of this population has not previously been reported. METHODS In total, 18 patients and 18 age- and sex-matched controls were studied. All had a history of a complaint of excess salivation in the absence of any oral mucosal or systemic abnormality. All patients completed an Eysenck Personality Questionnaire. RESULTS There were no differences in the extroversion of psychoticism scores between the study and control group. However, the result showed significant increases in the neuroticism and Lie Scale score in the patient group. CONCLUSIONS The overall results of this study indicate that the complaint of sialorrhoea in otherwise healthy individuals does not have an organic basis and suggest that sialorrhoea is associated with high levels of neuroticism and a tendency to dissimulate.
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Affiliation(s)
- P-J Lamey
- Oral Science Research Centre, School of Dentistry, Queen's University Belfast, Belfast, Northern Ireland, UK.
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