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Umay E, Cankurtaran D, Tezel N, Uz C, Tombak Y, Karaahmet O, Aykin Yigman Z, Celik G, Unlu Akyuz E. Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy. Clin Pediatr (Phila) 2024:99228241241901. [PMID: 38591868 DOI: 10.1177/00099228241241901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Nihal Tezel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Yasemin Tombak
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Ozgur Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Gulnur Celik
- Physical Medicine and Rehabilitation Clinic, Mamak State Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
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Boyd RN, Novak I, Morgan C, Bora S, Sakzewski L, Ware RS, Comans T, Fahey MC, Whittingham K, Trost S, Pannek K, Pagnozzi A, Mcintyre S, Badawi N, Smithers Sheedy H, Palmer KR, Burgess A, Keramat A, Bell K, Hines A, Benfer K, Gascoigne-Pees L, Leishman S, Oftedal S. School readiness of children at high risk of cerebral palsy randomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials. BMJ Open 2023; 13:e068675. [PMID: 36849209 PMCID: PMC9972445 DOI: 10.1136/bmjopen-2022-068675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION School readiness includes cognitive, socio-emotional, language and physical growth and development domains which share strong associations with life-course opportunities. Children with cerebral palsy (CP) are at increased risk of poor school readiness compared with their typically developing peers. Recently, earlier diagnosis of CP has allowed interventions to commence sooner, harnessing neuroplasticity. First, we hypothesise that early referral to intervention for children at-risk of CP will lead to improved school readiness at 4-6 years relative to placebo or care as usual. Second, we hypothesise that receipt of early diagnosis and early intervention will lead to cost-savings in the form of reduced healthcare utilisation. METHODS AND ANALYSIS Infants identified as at-risk of CP ≤6 months corrected age (n=425) recruited to four randomised trials of neuroprotectants (n=1), early neurorehabilitation (n=2) or early parenting support (n=1) will be re-recruited to one overarching follow-up study at age 4-6 years 3 months. A comprehensive battery of standardised assessments and questionnaires will be administered to assess all domains of school readiness and associated risk factors. Participants will be compared with a historical control group of children (n=245) who were diagnosed with CP in their second year of life. Mixed-effects regression models will be used to compare school readiness outcomes between those referred for early intervention versus placebo/care-as-usual. We will also compare health-resource use associated with early diagnosis and intervention versus later diagnosis and intervention. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland, University of Sydney, Monash University and Curtin University Human Research Ethics Committees have approved this study. Informed consent will be sought from the parent or legal guardian of every child invited to participate. Results will be disseminated in peer-reviewed journals, scientific conferences and professional organisations, and to people with lived experience of CP and their families. TRIAL REGISTRATION NUMBER ACTRN12621001253897.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samudragupta Bora
- Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Faculty of Medicine, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Collingwood Fahey
- Paediatric Neurology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Alex Pagnozzi
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Rebecca Palmer
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Afroz Keramat
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Laura Gascoigne-Pees
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
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Parr J, Pennington L, Taylor H, Craig D, Morris C, McConachie H, Cadwgan J, Sellers D, Andrew M, Smith J, Garland D, McColl E, Buswell C, Thomas J, Colver A. Parent-delivered interventions used at home to improve eating, drinking and swallowing in children with neurodisability: the FEEDS mixed-methods study. Health Technol Assess 2021; 25:1-208. [PMID: 33769272 PMCID: PMC8020453 DOI: 10.3310/hta25220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Eating, drinking and swallowing difficulties are common in young children with neurodisability. These difficulties may lead to inadequate calorie intake, which affects a child's nutrition, growth and general physical health. OBJECTIVE To examine which interventions are available that can be delivered at home by parents to improve eating, drinking and swallowing in young children with neurodisability and are suitable for investigation in pragmatic trials. DESIGN This was a mixed-methods study that included focus groups, surveys, an update of published systematic reviews of interventions, a systematic review of measurement properties of existing tools, evidence mapping, evidence synthesis, a Delphi survey and stakeholder workshops. SETTING The study was carried out in NHS hospitals, community services, family homes and schools. PARTICIPANTS Parents of children who had neurodisability and eating, drinking and swallowing difficulties. Professionals from health and education. Young people with eating, drinking and swallowing difficulties or young people who had previously experienced eating, drinking and swallowing difficulties. DATA SOURCES Literature reviews; national surveys of parents and professionals; focus groups with parents, young people and professionals; and stakeholder consultation workshops. REVIEW METHODS An update of published systematic reviews of interventions (searched July-August 2017), a mapping review (searched October 2017) and a systematic review of measurement properties using COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) methodology (searched May 2018). RESULTS Significant limitations of the available research evidence regarding interventions and tools to measure outcomes were identified. A total of 947 people participated: 400 parents, 475 health professionals, 62 education professionals and 10 young people. The survey showed the wide range of interventions recommended by NHS health professionals, with parents and professionals reporting variability in the provision of these interventions. Parents and professionals considered 19 interventions as relevant because they modified eating, drinking and swallowing difficulties. Parents and professionals considered 10 outcomes as important to measure (including Nutrition, Growth and Health/safety); young people agreed that these were important outcomes. Stakeholder consultation workshops identified that project conclusions and recommendations made sense, were meaningful and were valued by parents and professionals. Parents and health professionals were positive about a proposed Focus on Early Eating, Drinking and Swallowing (FEEDS) toolkit of interventions that, through shared decision-making, could be recommended by health professionals and delivered by families. LIMITATIONS The national surveys included large numbers of parents and professionals but, as expected, these were not representative of the UK population of parents of children with eating, drinking and swallowing difficulties. Owing to the limitations of research evidence, pragmatic decisions were made about interventions that might be included in future research and outcomes that might be measured. For instance, the reviews of research found only weak or poor evidence to support the effectiveness of interventions. The review of outcome measures found only limited low-level evidence about their psychometric properties. CONCLUSIONS Opportunities and challenges for conducting clinical trials of the effectiveness of the FEEDS toolkit of interventions are described. Parents and professionals thought that implementation of the toolkit as part of usual NHS practice was appropriate. However, this would first require the toolkit to be operationalised through development as a complex intervention, taking account of constituent interventions, delivery strategies, implementation and manualisation. Subsequently, an evaluation of its clinical effectiveness and cost-effectiveness could be undertaken using appropriate research methods. FUTURE WORK Initial steps include FEEDS toolkit development and evaluation of its use in clinical practice, and identification of the most robust methods to measure valued outcomes, such as Nutrition and Growth. TRIAL REGISTRATION Current Controlled Trials ISRCTN10454425. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Cadwgan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Diane Sellers
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Lewes, UK
| | - Morag Andrew
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Johanna Smith
- Patient and Public Involvement, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Buswell
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian Thomas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Allan Colver
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bell KL, Benfer KA, Ware RS, Patrao TA, Garvey JJ, Arvedson JC, Boyd RN, Davies PSW, Weir KA. Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Dev Med Child Neurol 2019; 61:1175-1181. [PMID: 30937885 PMCID: PMC6850582 DOI: 10.1111/dmcn.14220] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/18/2022]
Abstract
AIM To develop and validate a screening tool for feeding/swallowing difficulties and/or undernutrition in children with cerebral palsy (CP). METHOD This cross-sectional, observational study included 89 children with CP (63 males, 26 females; median age 6y 0mo; interquartile range 4y 0mo-8y 11mo), across all Gross Motor Function Classification System levels. Children with feeding tubes were excluded. Children were classified as well-nourished or moderately to severely undernourished, using the paediatric Subjective Global Nutrition Assessment. Eating and drinking abilities were classified using the Eating and Drinking Ability Classification System (EDACS) from mealtime observation and videofluoroscopic swallow studies when indicated. Parents/caregivers answered 33 screening questions regarding their child's feeding/swallowing abilities and nutritional status. The diagnostic ability of each question for identifying children with feeding/swallowing difficulties and undernutrition was calculated and the combination of questions with the highest sensitivity and specificity identified. RESULTS Feeding difficulties impacted on swallow safety in 26 children (29%) and 26 children (29%) were moderately or severely undernourished. The 4-item final tool had high sensitivity and specificity for identifying children with feeding/swallowing difficulties (81% and 79% respectively) and undernutrition (72% and 75% respectively). The tool successfully identified 100 per cent of children with severe undernutrition and 100 per cent of those classified as EDACS level IV or V. INTERPRETATION Screening for feeding/swallowing difficulties and undernutrition will enable early identification, assessment, and management for those children in need. WHAT THIS PAPER ADDS A screening tool with high sensitivities and specificities for identifying children with feeding/swallowing difficulties and undernutrition. The tool identified 100 per cent of children with severe undernutrition. The tool identified 100 per cent of children in Eating and Drinking Ability Classification System levels IV or V.
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Affiliation(s)
- Kristie L Bell
- Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
- Dietetics and Food ServicesChildren's Health QueenslandBrisbaneQueenslandAustralia
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research CentreChild Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Robert S Ware
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Tania A Patrao
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Josephine J Garvey
- Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Joan C Arvedson
- Children's Hospital of Wisconsin‐MilwaukeeMedical College of Wisconsin‐MilwaukeeMilwaukeeWisconsinUSA
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research CentreChild Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Peter S W Davies
- Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Kelly A Weir
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast University HospitalGold Coast HealthSouthportQueenslandAustralia
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Claßen M, Schmidt-Choudhury A. Ernährungsprobleme und Unterernährung bei schwer neurologisch beeinträchtigten Kindern und Jugendlichen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0726-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Prendeville N, Sell D. Tongue Reduction Surgery and Feeding Difficulties in Infants With Beckwith Wiedemann Syndrome: A Case Series. Cleft Palate Craniofac J 2018; 56:679-689. [DOI: 10.1177/1055665618794070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To profile the pre- and post-operative feeding difficulties in infants with macroglossia in Beckwith Wiedemann Syndrome (m-BWS) who have had tongue reduction surgery (TRS) and to pilot a bespoke feeding rating scale. Design: Retrospective consecutive case series designed with two pre-operative and one 3-month post-operative feeding assessments. A 4-point Likert-type scale was developed and applied retrospectively to describe the feeding behaviors for liquids, purées, and solids. Descriptive and non-parametric statistics were used. Setting: National service for children with m-BWS at a pediatric hospital. Patients: Twenty-five infants, age range 4 to 12 months at initial assessment, underwent TRS (median age = 16 months). Intervention: Tongue reduction surgery. Outcome Measure: Oral and selected pharyngeal stage feeding behaviors on liquids, purées, and solids. Results: Pre-operative profile: Most feeding difficulties arose at the oral stage due to the macroglossia impacting important lingual movements. Difficulties were found with lip seal formation, biting, bolus manipulation and tongue lateralization. Aspiration risk was found in >75%. Texture modification was indicated for purées and solids. Post-operative profile: There were statistically significant differences for each consistency pre- and post-operatively. Eighty-four percent of infants had age-appropriate drinking and eating skills. Mild residual difficulties with biting, tongue lateralization, and bolus manipulation remained for solids in four infants. Conclusions: Feeding difficulties are common pre-operatively in m-BWS, putting infants at risk of aspiration if left unmanaged. TRS was effective in reducing or eliminating them. This is the first systematic report of infant feeding in m-BWS pre- and post-TRS.
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Affiliation(s)
- Nicole Prendeville
- Speech and Language Therapy Department, Great Ormond Street Hospital, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, United Kingdom
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Oropharyngeal Dysphagia and Cerebral Palsy. Pediatrics 2017; 140:peds.2017-0731. [PMID: 29167377 DOI: 10.1542/peds.2017-0731] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the progression of oropharyngeal dysphagia (OPD) in preschool-aged children with cerebral palsy (CP) according to gross motor function. It was hypothesized that fewer children would have OPD at 60 months compared with 18 to 24 months (predominately Gross Motor Function Classification System [GMFCS] I-II). METHODS Longitudinal population-based cohort of 179 children (confirmed CP diagnosis, born in Queensland in 2006-2009, aged 18-60 months at study entry [mean = 34.1 months ± 11.9; 111 boys; GMFCS I = 46.6%, II = 12.9%, III = 15.7%, IV = 10.1%, and V = 14.6%]). Children had a maximum of 3 assessments (median = 3, total n = 423 assessments). OPD was classified by using the Dysphagia Disorders Survey part 2 and rated from video by a certified pediatric speech pathologist. GMFCS was used to classify children's gross motor function. RESULTS OPD prevalence reduced from 79.7% at 18 to 24 months to 43.5% at 60 months. There were decreasing odds of OPD with increasing age (odds ratio [OR] = 0.92 [95% confidence interval (CI) 0.90 to 0.95]; P < .001) and increasing odds with poorer gross motor function (OR = 6.2 [95% CI 3.6 to 10.6]; P < .001). This reduction was significant for children with ambulatory CP (GMFCS I-II, OR = 0.93 [95% CI 0.90 to 0.96]; P < .001) but not significant for children from GMFCS III to V (OR [III] = 1.0 [95% CI 0.9 to 1.1]; P = .897; OR [IV-V] = 1.0 [95% CI 1.0 to 1.1]; P = .366). CONCLUSIONS Half of the OPD present in children with CP between 18 and 24 months resolved by 60 months, with improvement most common in GMFCS I to II. To more accurately detect and target intervention at children with persisting OPD at 60 months, we suggest using a more conservative cut point of 6 out of 22 on the Dysphagia Disorders Survey for assessments between 18 and 48 months.
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Affiliation(s)
| | - Kelly A Weir
- Menzies Health Institute of Queensland, Griffith University, Queensland, Australia; and.,Gold Coast University Hospital, Gold Coast Health, Queensland, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre and.,Children's Nutrition Research Centre, Child Health Research Centre, Faculty of Medicine and
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Queensland, Australia; and.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Queensland, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Child Health Research Centre, Faculty of Medicine and
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre and
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Benfer KA, Weir KA, Ware RS, Davies PSW, Arvedson J, Boyd RN, Bell KL. Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy. Dev Med Child Neurol 2017; 59:1181-1187. [PMID: 28877337 DOI: 10.1111/dmcn.13498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/27/2022]
Abstract
AIM To determine the most accurate parent-reported indicators for detecting (1) feeding/swallowing difficulties and (2) undernutrition in preschool-aged children with cerebral palsy (CP). METHOD This was a longitudinal, population-based study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD 11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points). Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was indicated by height-weight and skinfold composite z-scores less than -2. Primary parent-reported indicators included mealtime duration, mealtime stress, concern about growth, and respiratory problems. Other indicators were derived from a parent feeding questionnaire, including 'significant difficulty eating and drinking'. Data were analysed using multilevel mixed-effects regression and diagnostic statistics. RESULTS Primary parent-reported indicators associated with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2 [95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with undernutrition was 'moderate-severe concern regarding growth' (height-weight OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01). 'Significant difficulty eating and drinking' was most sensitive/specific for feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%). INTERPRETATION Parent-reported indicators are feasible for detecting feeding and swallowing difficulties and undernutrition in children with CP, but need formal validation. WHAT THIS PAPER ADDS Parent-reported indicators can detect feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Most accurate screening questions were 0-10 scales for 'difficulty eating' and 'difficulty drinking'. Supplementation of these scales with additional indicators would improve detection.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Kelly A Weir
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia.,Gold Coast University Hospital, Gold Coast Health, Southport, Qld, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Qld, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Joan Arvedson
- Children's Hospital of Wisconsin-Milwaukee, Medical College of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.,Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.,Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Qld, Australia
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Speyer R, Cordier R, Parsons L, Denman D, Kim JH. Psychometric Characteristics of Non-instrumental Swallowing and Feeding Assessments in Pediatrics: A Systematic Review Using COSMIN. Dysphagia 2017; 33:1-14. [PMID: 28819914 DOI: 10.1007/s00455-017-9835-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
As early diagnosis of swallowing and feeding difficulties in infants and children is of utmost importance, there is a need to evaluate the quality of the psychometric properties of pediatric assessments of swallowing and feeding. A systematic review was performed summarizing the psychometric properties of non-instrumental assessments for swallowing and feeding difficulties in pediatrics; no data were identified for the remaining twelve assessments. The COSMIN taxonomy and checklist were used to evaluate the methodological quality of 23 publications on psychometric properties. For each assessment, an overall quality score for each measurement property was determined. As psychometric data proved incomplete, conflicting or indeterminate for all assessments, only preliminary conclusions could be drawn; the most robust assessment based on current data is the dysphagia disorder survey (DDS). However, further research is needed to provide additional information on all psychometric properties for all assessments.
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Affiliation(s)
- Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands. .,School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia.
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia
| | - Lauren Parsons
- School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia
| | - Deborah Denman
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Jae-Hyun Kim
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia
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10
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European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr 2017; 65:242-264. [PMID: 28737572 DOI: 10.1097/mpg.0000000000001646] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment. METHODS Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy. Dev Med Child Neurol 2017; 59:647-654. [PMID: 28276586 DOI: 10.1111/dmcn.13403] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/24/2022]
Abstract
AIM To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (EDACS); (2) EDACS classification distribution in a population-based cohort with cerebral palsy (CP); and (3) the relationships between the EDACS and clinical mealtime assessment, other classifications, and health outcomes. METHOD This was a cross-sectional population-based cohort study of 170 children with CP at 3 years to 5 years (mean 57.6mo, standard deviation [SD] 8.3mo; 105 males, n=65 females). Functional abilities were representative of a population sample (Gross Motor Function Classification System level I=74, II=34, III=21, IV=18, V=23). The EDACS was the primary classification of mealtime function. The Dysphagia Disorders Survey was the clinical mealtime assessment. Gross motor function was classified using the Gross Motor Function Classification System. RESULTS EDACS classification had 88.3% intrarater agreement (κ=0.84, intraclass correlation coefficient=0.95; p<0.001) and 51.7% interrater agreement (κ=0.36, intraclass correlation coefficient=0.79; p<0.001). In total, 56.5% of children were classified as EDACS level I. There was a strong stepwise relationship between the Dysphagia Disorders Survey and EDACS (r=0.96, p<0.001). Parental stress (odds ratio=1.3, p=0.05) and feeding tubes (odds ratio=6.4, p<0.001) were significantly related to more limited function on the EDACS. INTERPRETATION The EDACS presents a viable adjunct to clinical assessment of feeding skills in children with CP for use in surveillance trials and clinical practice. A rating addendum would be a useful contribution to the tool to enhance reproducibility.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Kelly A Weir
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Qld, Australia.,Gold Coast University Hospital, Gold Coast Health, Gold Coast, Qld, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.,Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Qld, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Qld, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
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Oftedal S, Davies PS, Boyd RN, Stevenson RD, Ware RS, Keawutan P, Benfer KA, Bell KL. Body composition, diet, and physical activity: a longitudinal cohort study in preschoolers with cerebral palsy. Am J Clin Nutr 2017; 105:369-378. [PMID: 28077375 DOI: 10.3945/ajcn.116.137810] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Altered body composition in children with cerebral palsy (CP) could be due to differences in energy intake, habitual physical activity (HPA), and sedentary time. OBJECTIVE We investigated the longitudinal relation between the weight-for-age z score (WZ), fat-free mass (FFM), percentage of body fat (%BF), and modifiable lifestyle factors for all Gross Motor Function Classification System (GMFCS) levels (I-V). DESIGN The study was a longitudinal population-based cohort study of children with CP who were aged 18-60 mo (364 assessments in 161 children; boys: 61%; mean ± SD recruitment age: 2.8 ± 0.9 y; GMFCS: I, 48%; II, 11%; III, 15%; IV, 11%; and V, 15%). A deuterium dilution technique or bioelectrical impedance analysis was used to estimate FFM, and the %BF was calculated. Energy intake, HPA, and sedentary time were measured with the use of a 3-d weighed food diary and accelerometer wear. Data were analyzed with the use of a mixed-model analysis. RESULTS Children in GMFCS group I did not differ from age- and sex-specific reference children with typical development for weight. Children in GMFCS group IV were lighter-for-age, and children in GMFCS group V had a lower FFM-for-height than those in GMFCS group I. Children in GMFCS groups II-V had a higher %BF than that of children in GMFCS group I, with the exception of orally fed children in GMFCS group V. The mean %BF of children with CP classified them as overfat or obese. There was a positive association between energy intake and FFM and also between HPA level and FFM for children in GMFCS group I. CONCLUSIONS Altered body composition was evident in preschool-age children with CP across functional capacities. Gross motor function, feeding method, energy intake, and HPA level in GMFCS I individuals are the strongest predictors of body composition in children with CP between the ages of 18 and 60 mo.
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Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center, .,Children's Nutrition Research Center, and
| | | | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center
| | - Richard D Stevenson
- Division of Developmental Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Piyapa Keawutan
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center.,Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; and
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center.,Dietetics and Food Services, Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Australia
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Benfer KA, Weir KA, Bell KL, Nahar B, Ware RS, Davies PSW, Boyd RN. Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country. Disabil Rehabil 2016; 39:2404-2412. [PMID: 27669884 DOI: 10.1080/09638288.2016.1229363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia. METHOD Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18-36 months, 81 in Bangladesh (mean = 27.6 months, 61.7% males), and 130 in Australia (mean = 27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) - Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution. RESULTS (i) Bangladesh sample: proportion OPD = 68.1%; severity = 10.4 SD = 7.9. Australia sample: proportion OPD = 55.7%; severity = 7.0 SD = 7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR = 2.4, p = 0.051 and β = 1.2, p = 0.08, respectively). CONCLUSIONS Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context. Implications for Rehabilitation The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs). Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework. The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes. Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III-V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).
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Affiliation(s)
- Katherine A Benfer
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,b Paediatric Unit, Centre for the Rehabilitation of the Paralysed , Chapain , Savar , Dhaka , Bangladesh
| | - Kelly A Weir
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,c Menzies Health Institute of Queensland, Griffith University , Gold Coast Campus , Queensland , Australia
| | - Kristie L Bell
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia
| | - Baitun Nahar
- e Nutrition and Clinical Services, International Centre for Diarrhoeal Disease Research , Mohakhali Dhaka , Bangladesh
| | - Robert S Ware
- f Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia.,g School of Population Health, The University of Queensland , Herston , Australia
| | - Peter S W Davies
- d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia
| | - Roslyn N Boyd
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia
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Kantarcigil C, Sheppard JJ, Gordon AM, Friel KM, Malandraki GA. A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:207-217. [PMID: 27132060 DOI: 10.1016/j.ridd.2016.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. AIM To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. METHODS AND PROCEDURES Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. OUTCOMES AND RESULTS Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76). CONCLUSIONS AND IMPLICATIONS Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.
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Affiliation(s)
- Cagla Kantarcigil
- Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Justine Joan Sheppard
- Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Andrew M Gordon
- Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
| | - Kathleen M Friel
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Georgia A Malandraki
- Purdue University, Lyles-Porter Hall, 715 Clinic Drive, West Lafayette, IN 47907, USA; Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN. Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy. Arch Phys Med Rehabil 2015; 97:552-560.e9. [PMID: 26707458 DOI: 10.1016/j.apmr.2015.11.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/02/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
Abstract
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±2.9 mo 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: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=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.
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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, Queensland, Australia.
| | - Kelly A Weir
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Speech Pathology, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter S Davies
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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