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Saranti A, Dragoumi P, Papavasiliou A, Zafeiriou D. Current approach to cerebral palsy. Eur J Paediatr Neurol 2024; 51:49-57. [PMID: 38824721 DOI: 10.1016/j.ejpn.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90 % of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.
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Affiliation(s)
- Anna Saranti
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | - Pinelopi Dragoumi
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece
| | | | - Dimitrios Zafeiriou
- 1th Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece.
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Sogbossi ES, Baba-Tadja A, Nouatin E, Agbetou M, Adoukonou T, Kossi O. Estimating the Prevalence of Cerebral Palsy in a Semi-Urban City in Benin: A Door-to-Door Community-Based Study. Neuroepidemiology 2024:1-8. [PMID: 38631310 DOI: 10.1159/000538799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in sub-Saharan Africa. METHODS This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. RESULTS In total, 2,630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8 (1.4, 6.15) per 1,000 children. Of the 10 confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the Surveillance of Cerebral Palsy in Europe classification system. Seven children had a Gross Motor Function Classification System level III-V, and six were classified level III to V of the manual ability classification system. CONCLUSION CP is highly prevalent in semi-urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Department of Physical Medicine and Rehabilitation, National Teaching Hospital, Cotonou, Benin
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Adjoua Baba-Tadja
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - Emilienne Nouatin
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - Mendinatou Agbetou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Thierry Adoukonou
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Oyéné Kossi
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
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Declerck MHP, Jahan I, Lissone NPA, Walhain F, Chin A Fat R, Fleurkens M, Muradin SHJ, Cruden R, Ortibus E, Badawi N, Khandaker G. Hospital-based surveillance of children with cerebral palsy in Suriname: The Suriname cerebral palsy register. Dev Med Child Neurol 2024. [PMID: 38525657 DOI: 10.1111/dmcn.15897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
AIM To describe the aetiological risk factors, clinical characteristics, access to rehabilitation, and educational status of children with cerebral palsy (CP) in Suriname. METHOD Hospital-based surveillance of children with CP aged younger than 18 years was conducted at the Academic Hospital Paramaribo, Suriname (known as the Suriname CP Register [SUR-CPR]). Data were collected on sociodemographic characteristics, aetiological risk factors, clinical characteristics, rehabilitation, and educational status. Registry data on aetiological risk factors were compared with available national prevalence rates in Suriname. Descriptive statistics were reported. RESULTS Between August 2018 and March 2020, 82 children with CP (mean [SD] age 5 years 10 months [3 years 10 months]) attending the Academic Hospital Paramaribo were registered in the SUR-CPR. The mean (SD) age at diagnosis was 5 years 5 months (4 years 1 month). Spastic CP was predominant in 90.8% of children and 58.8% were classified in Gross Motor Function Classification System levels III to V. Overall, 43.9% had preterm birth compared with 13.9% reported nationally (p < 0.001) and 61.6% had birth-related complications compared with 15% reported nationally (p < 0.001). Additionally, 39.1% had birth asphyxia and 23.2% had early feeding difficulties. Sixty-two percent were admitted to the neonatal intensive care unit, 54.0% of whom required ventilation. Most children (82.5%) had CP acquired pre- or perinatally and 17.5% had CP acquired postneonatally. Seventeen percent had never received any rehabilitation services, and 31.9% of the school-aged children were not enrolled in any education system. INTERPRETATION The high burden of known aetiological risk factors, delayed diagnosis, and severe functional impairment among children with CP registered at the Academic Hospital Paramaribo is concerning. Public health interventions targeting early diagnosis and early intervention could improve the functional outcome of children with CP in Suriname.
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Affiliation(s)
- Marlies H P Declerck
- Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
| | | | - Fenna Walhain
- Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname
| | - Ruby Chin A Fat
- Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname
| | | | - Sarfaraz H J Muradin
- Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname
| | - Rhea Cruden
- Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Australia
| | - Gulam Khandaker
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Oftedal S, McCormack S, Stevenson R, Benfer K, Boyd RN, Bell K. The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy. J Hum Nutr Diet 2024. [PMID: 38196166 DOI: 10.1111/jhn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.
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Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Siobhan McCormack
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
- Department of Paediatrics, School of Medicine, University of Galway, Galway, Ireland
| | - Richard Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine Benfer
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
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Nishibu H, Ikeda Y, Inoue T, Himuro N. Reliability and validity of the Japanese version of the Visual Function Classification System for children with cerebral palsy. Child Care Health Dev 2024; 50:e13175. [PMID: 37723844 DOI: 10.1111/cch.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/29/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) often experience visual dysfunction that affects motor function and activities of daily living, but no 'gold standard' classification of visual function has been established. In recent years, however, a valid and reliable Visual Function Classification System (VFCS) for children with CP has been developed. AIMS To examine the reliability and validity of the Japanese version of the VFCS in individuals with CP. METHODS The translation of the VFCS was performed according to international standards for the translation of measurements. We conducted questionnaires of professionals (three physicians, eight physical therapists, five occupational therapists, six speech-language-hearing therapists and a certified orthoptist) regarding the content validity of the Japanese version of the VFCS. For reliability and concurrent validity, 148 individuals with CP were classified twice by professionals using the Japanese version of the VFCS, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Ability Classification System (EDACS), with several weeks between each evaluation. RESULTS The content validity of the Japanese version of the VFCS almost met the criteria set. The percentage of positive and neutral opinions given by the professionals with regard to the four items ranged from 74% to 92%. The intra-rater reliability was 0.86 (95% CI 0.75-0.96) by Cohen's kappa and 0.93 (95% CI 0.88-0.96) by intraclass correlation coefficient. The inter-rater reliability was 0.67 (95% CI 0.56-0.78) by Cohen's kappa and 0.79 (95% CI 0.69-0.86) by intraclass correlation coefficient. The Spearman correlation coefficients between the VFCS and the GMFCS, MACS, CFCS and EDACS were 0.783, 0.764, 0.738, 0.738 and 0.830, respectively. The concurrent validity was confirmed by the correlations observed with other classification systems. CONCLUSIONS The results indicated good reliability and validity for the Japanese version of the VFCS.
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Affiliation(s)
- Hisato Nishibu
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Yousuke Ikeda
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Takahito Inoue
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Nobuaki Himuro
- Department of Public Health, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Bykova KM, Frank U, Girolami GL. Eating and Drinking Ability Classification System to detect aspiration risk in children with cerebral palsy: a validation study. Eur J Pediatr 2023:10.1007/s00431-023-04998-y. [PMID: 37184644 PMCID: PMC10183305 DOI: 10.1007/s00431-023-04998-y] [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] [Received: 12/01/2022] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023]
Abstract
This prospective study has two aims. The first aim is to assess the concurrent validity of the Eating and Drinking Ability Classification System (EDACS) as a means of identifying aspiration risk in children with cerebral palsy by using the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) as the reference test. The second aim is to investigate the relationship between the aspiration and non-aspiration groups using both the EDACS and the PEDI-EAT-10. Data were collected and analyzed from the EDACS and PEDI-EAT-10 using a convenience sample of 131 children with cerebral palsy and feeding problems (77 males, 54 females; median age 4.4 years [IQR 2.5 years]). Risk of aspiration was identified in 118 individuals using the PEDI-EAT-10 scores of ≥ 5 points. The EDACS proved to be a valid tool in identifying aspiration risk in children who are classified in EDACS levels III-V. There was a significant correlation between the EDACS and PEDI-EAT-10 (rs = 0.597, p < 0.001). The EDACS had 78% (95% CI = 71-86%) sensitivity and 92% (95% CI = 88-97%) specificity in identifying aspiration risk a positive predictive value of 0.99, a negative predictive value of 0.32, a positive likelihood ratio of 9.75, and a negative likelihood ratio of 0.24. Conclusion: The EDACS is a useful clinical tool to identify aspiration risk in children with cerebral palsy. Children in EDACS levels III to V are at risk of aspiration. As time permits, we recommend the use of both tools, the EDACS and the PEDI-EAT-10, when making decisions regarding referral for an instrumented swallowing study. What is Known: • Approximately 50% of children with cerebral palsy have dysphagia. • The Eating and Drinking Ability Classification System (EDACS) can be used to classify eating and drinking efficiency and safety in children with cerebral palsy. What is New: • Based on ROC analysis, EDACS demonstrates sensitivity of 78% and specificity of 92% in clinical identification of aspiration risk. • The combined use of the EDACS and the Pediatric version of the Eating Assessment Tool is recommended to make decisions about referral for an instrumented swallow study.
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Affiliation(s)
- Ksenia M Bykova
- College of Applied Health Sciences, University of Illinois at Chicago, 808 S. Wood St., Chicago, 60612, USA
| | - Ulrike Frank
- Linguistics Department, Swallowing Research Laboratory, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14.202, Potsdam, 14476, Germany
| | - Gay L Girolami
- College of Applied Health Sciences, University of Illinois at Chicago, 808 S. Wood St., Chicago, 60612, USA.
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, 60612, USA.
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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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Nishibu H, Seino TH, Himuro N. Psychometric evaluation and distribution of classification systems in children with cerebral palsy in Japan. J Pediatr Rehabil Med 2022; 16:223-233. [PMID: 36373301 DOI: 10.3233/prm-210098] [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: 11/09/2022] Open
Abstract
PURPOSE The study sought to examine the content validity, the intra- and inter-rater reliability, and concurrent validity of the Japanese versions of the Manual Ability Classification System, the Communication Function Classification System, and the Eating and Drinking Ability Classification System, and representation of the distribution of the levels of each classification systems in comparison to the Gross Motor Function Classification System levels for children with cerebral palsy. METHODS The Japanese versions were developed using the back-translation method. For content validity, professionals were asked to complete a questionnaire including items on the appropriateness of the translation, its validity, and distinctions among levels. For reliability, professionals used the three classification systems twice in children with cerebral palsy. For concurrent validity, relationships among the four classification systems were examined by correlation analyses. RESULTS Participants included twenty-one professionals and 290 children with cerebral palsy (mean age: 12 years two months, female: 132, male: 158). The content validity was generally good. For reliability, the lower limit of the 95% confidence interval for the intraclass correlation coefficients was greater than 0.89, and the correlation coefficients were high. CONCLUSION The results of this study showed good reliability and validity of the functional classification systems in Japan.
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Affiliation(s)
- Hisato Nishibu
- Division of Rehabilitation Medicine, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan
| | - Tsugumi Hosokawa Seino
- Division of Rehabilitation Medicine, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan
| | - Nobuaki Himuro
- Department of Public Health, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
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A cross-sectional study determining the relationship between eating and drinking skills and functional independence levels of patients with cerebral palsy. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/Aim: In cerebral palsy (CP), drinking/eating disorders are considered common. To evaluate these disorders, a very detailed and lengthy evaluation is required. Few tools are available to identify children who need to be evaluated. This study determined whether the functional independence level of children with CP is sufficient to predict their drinking/eating skills and to determine the relationship between this functional level and these skills.
Methods: A total of 105 children with CP aged 4–8 years participated in a cross-sectional study in our outpatient clinic. Functional classification was assigned using the Gross Motor Function Classification System and Manuel Ability Classification System (GMFCS and MACS, respectively). For a functional assessment of daily life, the Pediatric Evaluation of Disability Inventory (PEDI) was performed by asking a relative of the child. The Eating and Drinking Abilities Classification System (EDACS) level was added to the study after asking the caregivers of the patients for eating/drinking evaluations.
Results: According to the current results, we found a negative correlation between EDACS and PEDI scores. As the EDACS grade increased, the PEDI subscale and total scores decreased in a statistically significant manner (P < 0.001), while the GMFCS and MACS scale increased statistically (P < 0.001). As the PEDI subscale and total scores increased, the levels of GMFCS and MACS decreased statistically significantly (P < 0.001).
Conclusions: The performances of children with CP in terms of activities of daily living are closely related to their performance in eating/drinking activities. If children are independent in their mobility, social functions, and daily self-care, they are also more independent in terms of eating/drinking.
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Yi YG. Intervention for swallowing problems in adults with cerebral palsy. Dev Med Child Neurol 2022; 64:938-939. [PMID: 35352340 DOI: 10.1111/dmcn.15230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- You Gyoung Yi
- Seoul National University Hospital, Rehabilitation Medicine, Seoul, Republic of Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
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Sellers D, Pennington L, Bryant E, Benfer K, Weir K, Aboagye S, Morris C. Mini-EDACS: Development of the Eating and Drinking Ability Classification System for young children with cerebral palsy. Dev Med Child Neurol 2022; 64:897-906. [PMID: 35092689 DOI: 10.1111/dmcn.15172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023]
Abstract
AIM To develop and test Mini-EDACS to describe developing eating and drinking abilities of children with cerebral palsy (CP) aged between 18 and 36 months. METHOD The existing Eating and Drinking Ability Classification System (EDACS) was modified to define Mini-EDACS content. Mini-EDACS was developed in three stages: (1) EDACS was modified after application to videos of standardized feeding evaluations of children with CP aged 18 to 36 months (n = 130); (2) refined content and validity of Mini-EDACS was established through an international Delphi survey; (3) interobserver reliability was assessed by comparing Mini-EDACS levels assigned by speech and language therapists (SaLTs) from video data and parent report. RESULTS Mini-EDACS provides age-appropriate descriptions for children aged 18 to 36 months with CP. Eighty-nine stakeholders participated in the Delphi survey; required levels of agreement were met after one round (i.e. >80% agreement). Thirteen SaLTs completed paired ratings from 43 video recordings: absolute agreement was 58% (kappa 0.43; intraclass correlation coefficient 0.78; 95% confidence interval 0.63-0.87). INTERPRETATION Mini-EDACS provides a valid system for classifying eating and drinking performance of children with CP under 3 years old. Results suggest moderate agreement and good reliability when rating Mini-EDACS levels from video recordings of young children with CP.
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Affiliation(s)
- Diane Sellers
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Lewes, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kelly Weir
- Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Sonia Aboagye
- Department of Speech, Language and Hearing Sciences, University of Health and Allied Health Sciences, Ho, Ghana
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Schepers FV, van Hulst K, Spek B, Erasmus CE, van den Engel‐Hoek L. Dysphagia limit in children with cerebral palsy aged 4 to 12 years. Dev Med Child Neurol 2022; 64:253-258. [PMID: 34418067 PMCID: PMC9291064 DOI: 10.1111/dmcn.15031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/02/2022]
Abstract
AIM To assess the dysphagia limit in children with cerebral palsy (CP) according to Eating and Drinking Ability Classification System (EDACS) level, sex, and age compared to typically developing children. METHOD Seventy-seven children with CP (54 males, 23 females; mean age 7y 6mo, SD 2y 2mo, age range 4-12y) were assessed with the Maximum Volume Water Swallow Test. Median dysphagia limit in the CP group was compared with data of typically developing children. RESULTS The dysphagia limit of children with CP differed significantly (p<0.001) from typically developing children. The latter showed a threefold higher median dysphagia limit (22mL) compared to children with CP in EDACS level I (7mL). The higher the EDACS level, the lower the dysphagia limit in children with CP. EDACS level explained 55% of the variance in the dysphagia limit of the CP group. INTERPRETATION Where children with CP in EDACS levels IV and V showed that their capacity met the level of their performance, children in EDACS level I had the ability to perform a maximum capacity task, but still had a threefold lower median dysphagia limit than typically developing children. Establishment of the dysphagia limit should be part of general swallowing assessment in children with CP.
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Affiliation(s)
- Florentine V Schepers
- Department of Rehabilitation MedicineUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Bea Spek
- Department of Epidemiology and DatascienceAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamthe Netherlands
| | - Corrie E Erasmus
- Department of Paediatric NeurologyDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Lenie van den Engel‐Hoek
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
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Rush J, Paľa A, Kapapa T, Wirtz CR, Mayer B, Micah-Bonongwe A, Gladstone M, Kamalo P. Assessing neurodevelopmental outcome in children with hydrocephalus in Malawi. A pilot study. Clin Neurol Neurosurg 2021; 212:107091. [PMID: 34922292 DOI: 10.1016/j.clineuro.2021.107091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Congenital and infantile hydrocephalus are assumed to be major contributors to pediatric morbidity, mortality and functional disability in low-income countries. Despite this, epidemiologic data and the overview of neurodevelopmental outcomes in these regions is very limited. We aimed to pilot the use of a wide range of more locally suitable tools to assess neurodevelopment to understand whether they were feasible for use and could provide estimates of developmental delay and poor functioning in a population of children with hydrocephalus in Malawi. METHODS We conducted a prospective observational cohort study, at the tertiary neurosurgery clinic in Blantyre, Malawi in 2018, recruiting consecutive children with congenital and infantile hydrocephalus who were previously treated with ventriculoperitoneal shunts and endoscopic third ventriculostomy (ETV) in the neurosurgery unit of the hospital. We assessed demographic details, and gained information on children's functioning using the Liverpool Outcome Score (LOS), and the Eating and Drinking Ability Classification System as well as full anthropometric assessment and child development with the Malawi Developmental Assessment Tool (MDAT). RESULTS All tools were feasible for use, easy to train on, could be used for assessing children with hydrocephalus and were suitable to adapt for our environment. We evaluated 41 children, aged 2-60 months with a mean age of 22.6 months (interquartile range [IQR] = 8.3 months -36.5 months). Functional assessment using the Liverpool Outcome Score showed the majority of children 92.7% (CI 80.1-98.5, n = 38) had severe sequelae from the hydrocephalus and were dependent on their parents or caregivers. Only 27 children (65.9%, CI 49.4, 80.0) had full or expected control of their bowel and bladder and 6 children (14.6%, CI 5.6, 29.2), had a recent history of seizures. About two thirds (63.4% CI 45.0-77.9, n = 26/41) of children were able to eat and to drink safely and efficiently. Over two thirds of the children (70.7%, CI 56.8, 84.6, n = 29) were stunted and almost half of the cohort underweight (43.9%,(CI 28.5, 60.3, n = 18). Almost half 48.8% (CI 32.9, 64.9, n = 20/41) had developmental delay on MDAT with 41.5% (CI 26.4, 56.6, n = 17/41) graded as severely delayed (-<2sd on developmental age z score). We found significant associations between dependence identified by the LOS and developmental delay according to the MDAT (p = 0.014, Pearson's chi-squared test). CONCLUSION This pilot study demonstrates that the assessment tools we used identified a high proportion of children with hydrocephalus as having functional difficulties, stunted growth and developmental delay, in Malawi. Use of these tools can now be scaled up and will be helpful to support research in understanding what factors contribute to poor functioning, growth and development in these cohorts and help us to investigate what strategies may prevent and support children with hydrocephalus in African settings.
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Affiliation(s)
- James Rush
- Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Pl, Liverpool L3 5QA, UK
| | - Andrej Paľa
- University Hospital Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - Thomas Kapapa
- University Hospital Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Christian Rainer Wirtz
- University Hospital Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Benjamin Mayer
- Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Pl, Liverpool L3 5QA, UK; University Hospital Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany; Blantyre Institute of Neurological Surgery, Queen Elizabeth Central Hospital, Department of Neurosurgery, Chipatala Road, Blantyre, Malawi; Institute of Translational Medicine, University of Liverpool, Department of Women's and Children's Health University Department, First Floor, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
| | - Annie Micah-Bonongwe
- Blantyre Institute of Neurological Surgery, Queen Elizabeth Central Hospital, Department of Neurosurgery, Chipatala Road, Blantyre, Malawi
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Department of Women's and Children's Health University Department, First Floor, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
| | - Patrick Kamalo
- Blantyre Institute of Neurological Surgery, Queen Elizabeth Central Hospital, Department of Neurosurgery, Chipatala Road, Blantyre, Malawi
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Chiu HC, Buckeridge K, Lee TA, Sellers D. Reliability and validity of the Eating and Drinking Ability Classification System (EDACS) for children with cerebral palsy in Taiwan. Disabil Rehabil 2021; 44:6438-6444. [PMID: 34396878 DOI: 10.1080/09638288.2021.1962989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The study was to assess the inter- and intra-rater reliability, construct validity and utility of the Eating and Drinking Ability Classification System (EDACS). METHODS EDACS was translated into in Taiwan using an interactive process. Agreement between health professionals and teachers when using EDACS was assessed using Kappa and the Intraclass Correlation Co-efficient. RESULTS Paired ratings of 4 (13%) health professionals (either speech or occupational therapists) and 26 (87%) teachers were obtained for 53 children with CP aged 6.7 years (SD 4.1 years), who worked in six education institutions. The raters used EDACS independently to classify children's eating and drinking ability and re-classified children's eating and drinking abilities after one month. Pairs of raters showed substantial agreement for the EDACS level at the first assessment (k = 0.75; absolute agreement = 81%; ICC = 0.94) and the second assessment (k = 0.70; absolute agreement = 77%; ICC = 0.95). The intra-rater reliability of EDACS level showed almost perfect agreement at rater 1 (k = 0.87; absolute agreement = 91%) and rater 2 (k = 0.87; absolute agreement = 91%). CONCLUSIONS We conclude that the Chinese version of EDACS is valid and reliable to be easily used by health professionals and teachers to classify functional eating and drinking abilities in children with cerebral palsy.IMPLICATIONS FOR REHABILITATIONThe Chinese version of EDACS is valid and reliable to be easily used.EDACS can be used by health professionals and teachers to classify functional eating and drinking abilities in children with cerebral palsy.The EDACS is analogous to other functional classification systems (i.e., GMFCS, MACS and CFCS) and specifically represents eating and drinking ability.
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Katherine Buckeridge
- Specialist Speech and Language Therapist, Sussex Community NHS Foundation Trust, Chailey Clinical Services, Brighton, United Kingdom
| | - Ta-An Lee
- Department of Long-Term Care, Mennonite Christian Hospital, Hualien, Taiwan
| | - Diane Sellers
- Clinical Academic Speech and Language Therapist, Sussex Community NHS Foundation Trust, Chailey Clinical Services, Brighton, United Kingdom
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Ruiz Brunner MDLM, Cieri ME, Rodriguez Marco MP, Schroeder AS, Cuestas E. Nutritional status of children with cerebral palsy attending rehabilitation centers. Dev Med Child Neurol 2020; 62:1383-1388. [PMID: 32893359 DOI: 10.1111/dmcn.14667] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 01/01/2023]
Abstract
AIM To describe the nutritional status of children with cerebral palsy (CP) from rehabilitation and therapeutic centers in Argentina, and to analyze their risk of undernutrition based on their Gross Motor Function Classification System (GMFCS) level. METHOD This was a cross-sectional study with data collected from 321 children (196 males, 125 females) with CP age 2 to 19 years (mean age 9y 3mo, SD 4y 5mo) from 17 rehabilitation and therapeutic centers in five Argentine provinces. Nutritional status was defined by height, weight, and body mass index for age z-scores using World Health Organization growth charts. Odds ratios were used to evaluate the association between GMFCS level and nutritional status. RESULTS Of the children with CP studied, 52.4% were in GMFCS levels IV and V. Regarding the nutritional status, 41.7% were normal, 19.0% had moderate undernutrition, 33.9% severe undernutrition, 2.5% overweight, and 2.8% obese. When compared to those in GMFCS levels I to III, the odds of children in GMFCS levels IV and V having moderate undernutrition are four times greater and the odds of having severe undernutrition are 14 times greater. INTERPRETATION There is a high prevalence of undernutrition associated with CP (GMFCS levels IV and V) among children in rehabilitation and therapeutic centers in Argentina. Risk of severe undernutrition increases with increased motor compromises.
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Affiliation(s)
- María de Las Mercedes Ruiz Brunner
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany
| | - Maria E Cieri
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Maria P Rodriguez Marco
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - A Sebastian Schroeder
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany
| | - Eduardo Cuestas
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Cátedra de Clínica Pediátrica, Hospital Nuestra Señora de la Misericordia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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16
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Ruiz Brunner MDLM, Cieri ME, Rodriguez Marco MP, Schroeder AS, Cuestas E. Estado nutricional de niños y niñas con parálisis cerebral que asisten a centros de rehabilitación. Dev Med Child Neurol 2020; 62. [PMID: 33017056 DOI: 10.1111/dmcn.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
ObjetivoDescribir el estado nutricional de niños con parálisis cerebral (PC) en centros de rehabilitación y terapéuticos de Argentina, y analizar el riesgo de desnutrición en relación su nivel según el sistema de la clasificación de la función motora gruesa (GMFCS).MétodoEste fue un estudio transversal con datos recolectados de 321 niños (196 varones, 125 mujeres) con PC de 2 a 19 años (edad media 9 años 3 meses, DE 4 años) de 17 centros de rehabilitación y terapéuticos en cinco provincias argentinas. El estado nutricional se definió con puntajes z según peso, talla e índice de masa corporal para la edad utilizando patrones de crecimiento de la Organización Mundial de la Salud. Se utilizó Odds ratio para evaluar la asociación entre el nivel GMFCS y el estado nutricional.ResultadosDe los niños con PC estudiados, 52.4% tenían nivel IV y V de GMFCS. En cuanto al estado nutricional, 41,7% eran normales, 19,0% tenían desnutrición moderada, 33,9% desnutrición severa, 2,5 % sobrepeso, y 2,8% obesidad. En comparación con los niños con niveles I–III de GMFCS, los niños con niveles IV y V de GMFCS presentaron 4 veces más probabilidades de presentar desnutrición moderada y 14 veces más probabilidades de tener desnutrición severa.InterpretaciónExiste una alta prevalencia de desnutrición asociada a la PC (niveles IV y V de GMFCS) entre niños de centros de rehabilitación y terapéuticos en Argentina. El riesgo de desnutrición severa aumenta cuando aumenta el compromiso motor.
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Affiliation(s)
- María de Las Mercedes Ruiz Brunner
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Departamento de Neurología Pediátrica, Medicina y Pediatría del Desarrollo Social, Hospital de la Universidad de Munich (LMU), Hospital de niños Hauner, Munich, Alemania
| | - Maria E Cieri
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Maria P Rodriguez Marco
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Andreas Sebastian Schroeder
- Departamento de Neurología Pediátrica, Medicina y Pediatría del Desarrollo Social, Hospital de la Universidad de Munich (LMU), Hospital de niños Hauner, Munich, Alemania
| | - Eduardo Cuestas
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Cátedra de Clínica Pediátrica, Facultad de Ciencias Médicas, Hospital Nuestra Señora de la Misericordia, Universidad Nacional de Córdoba, Córdoba, Argentina
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Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy. Front Pediatr 2020; 8:333. [PMID: 32671000 PMCID: PMC7326778 DOI: 10.3389/fped.2020.00333] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 12/15/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.
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Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - A. Marie Blackmore
- Research, Ability Centre, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Noula Gibson
- Research, Ability Centre, Perth, WA, Australia
- Department of Physiotherapy, Perth Children's Hospital, Perth, WA, Australia
| | - Monica S. Cooper
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, VIC, Australia
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia
| | - Andrew C. Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
- Department of Paediatrics, The University of Western Australia, Perth, WA, Australia
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Reliability and Validity of the Eating and Drinking Ability Classification System in Adults with Cerebral Palsy. Dysphagia 2020; 36:351-361. [PMID: 32519149 DOI: 10.1007/s00455-020-10141-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
The Eating and Drinking Ability Classification System (EDACS) was developed to evaluate dysphagia in children with cerebral palsy (CP). This study aimed to investigate the interrater reliability and validity of the EDACS in adults with CP. This cross-sectional study included 117 community-dwelling adults (mean age, 37.9 ± 12.5 years) with a confirmed CP diagnosis. A swallowing occupational therapist (SwOT) conducted detailed interviews with participants and/or caregivers to classify the EDACS. Another SwOT and participants/caregivers evaluated the EDACS. Correlations were evaluated between the EDACS and Functional Oral Intake Scale (FOIS), Swallowing Quality of Life (SWAL-QOL), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). Interrater reliabilities between SwOTs (κ = 0.866, intraclass correlation coefficient (ICC) = 0.867), and between SwOT and participant/caregiver (κ = 0.884, ICC = 0.717) were reported. The EDACS correlated with the FOIS, SWAL-QOL, and MACS, although no significant correlation was found with the GMFCS. The EDACS of spastic-type showed better correlation than that of dyskinetic-type with the FOIS, MACS, and GMFCS. There was a significant correlation between the EDACS and the GMFCS in those aged ≤ 30 years, whereas there was no correlation in those aged ≥ 30 years. The EDACS is a reliable and valid tool for classifying eating and drinking ability in adults with CP. The correlation between the EDACS with gait or hand function was more prominent in individuals with spastic CP and in younger individuals. The EDACS is a valuable adjunct to comprehensive functional classification in adults with CP.
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Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 438] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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20
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Sherman V, Greco E, Moharir M, Beal D, Thorpe K, Martino R. Feeding and swallowing impairment in children with stroke and unilateral cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:761-769. [PMID: 30411334 DOI: 10.1111/dmcn.14094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/12/2023]
Abstract
AIM This systematic review targeted frequency estimates of dysphagia (feeding and swallowing problems), related health outcomes, and caregiver burden in children with stroke or unilateral cerebral palsy (CP). METHOD Six electronic databases were searched from their inception to November 2017 along with a manual search of eight relevant journals. Two blinded raters assessed abstracts and full articles for eligibility. Discrepancies were resolved by consensus. Accepted articles were evaluated for quality. Data were extracted and analysed descriptively. RESULTS Of 1660 abstracts, five met inclusion criteria, of which three focused on stroke and two unilateral CP. Across studies, operational definitions of feeding and swallowing varied. Insufficient details were provided on assessment methods and timing. Reported frequencies of dysphagia ranged from 24.2% to 88.6%. One study reported dysphagia-related health outcomes and none reported caregiver burden. INTERPRETATION These results suggest that dysphagia is common in children with stroke and unilateral CP; however, its frequency is yet unknown as is its impact on health and caregiver burden. Availability of a standardized tool to identify dysphagia in these children accurately is a recommended first step to address this evidence gap. WHAT THIS PAPER ADDS There is limited data on the incidence of dysphagia after childhood stroke and unilateral cerebral palsy. Available evidence shows reported dysphagia frequencies from 24.2% to 88.6%. Only one study reported on dysphagia-related health outcomes. No study reported on caregiver burden.
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Affiliation(s)
- Victoria Sherman
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elissa Greco
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deryk Beal
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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21
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Viñals-Labañino CP, Velazquez-Bustamante AE, Vargas-Santiago SI, Arenas-Sordo ML. Usefulness of Cerebral Palsy Curves in Mexican Patients: A Cross-Sectional Study. J Child Neurol 2019; 34:332-338. [PMID: 30854918 DOI: 10.1177/0883073819830560] [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: 11/16/2022]
Abstract
Cerebral palsy describes a group of movement and posture disorders that cause activity limitation, and are attributable to nonprogressive disorders that occur in the fetal or infant brain. The growth of these children should not be compared with those of the healthy population. We studied 452 children, 186 female and 266 male. We compared the results in 2 growth charts, Centers for Disease Control and Prevention (CDC) and cerebral palsy, and the results were statistically significant ( P = .00001). With the CDC charts, 40.71% of the patients were below the 5th percentile and only 5.5% of them when we used the charts for cerebral palsy patients. The Mexican cerebral palsy patients were similar to US cerebral palsy patients when we compared height ( P = .4075) and body mass index (BMI) ( P = .4075). Only the weight was found to be different ( P = .00001). All the correlation indexes were negative: Eating and Drinking Ability Classification System (EDACS)-BMI (rho = -0.4798) ( P = .00001), Communication Function Classification System (CFCS)-BMI (rho = -0.4353) ( P = .00001), and Gross Motor Function Classification System (GMFCS)-BMI (rho = -0.3584) ( P = .00001). The growth charts of the healthy pediatric population tend to overestimate the underweight. We propose to use cerebral palsy charts as a reference in our patients. It is possible to determine a functional profile (communication, gross motor function and safety, and feed efficiency) for the cerebral palsy population based on their BMI.
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Affiliation(s)
- Carlos P Viñals-Labañino
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Ana E Velazquez-Bustamante
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Silvia I Vargas-Santiago
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Maria L Arenas-Sordo
- 2 Genetics Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
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22
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Sellers D, Bryant E, Hunter A, Campbell V, Morris C. The Eating and Drinking Ability Classification System for cerebral palsy: A study of reliability and stability over time. J Pediatr Rehabil Med 2019; 12:123-131. [PMID: 31227668 DOI: 10.3233/prm-180581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM This study evaluated the inter-observer reliability and stability over time of the Eating and Drinking Ability Classification System (EDACS) for children and young people with cerebral palsy (CP). METHOD Case records for 97 children with CP were examined to collect retrospective data about eating and drinking abilities at four time-points with a minimum of 2 years between each time-point. Sex, Gross Motor Function Classification System (GMFCS) level, presence of feeding tube and orthopaedic issues were recorded from case records. One speech and language therapist (SaLT1) classified eating and drinking ability using EDACS for all cases at all time-points; SaLT2 assigned EDACS levels for 50 cases at time-point 1; SaLT3 assigned EDACS levels for 24 cases at all time-points. Inter-observer reliability and stability over time were assessed using the Intraclass Correlation Coefficient (ICC). Associations between EDACS levels and functioning recorded with other Functional Classification Systems (FCSs) were calculated using Kendall's tau (τ). RESULTS Out of 97 children, 48 were male, 48 had feeding tubes, and 83 had orthopaedic issues. ICC for EDACS levels recorded by SaLT1 across all time-points was 0.97 (95% CI 0.96-0.98); changes in EDACS levels occurred infrequently and never by more than one level. ICC between SaLT1 and SaLT2 at time-point 1 was 0.8 (95% CI 0.67-0.89); ICC between SaLT1 and SaLT3 across all time-points was 0.95 (95% CI 0.92-0.98). Association between GMFCS and EDACS was moderate (τ= 0.58). INTERPRETATION Retrospective use of EDACS to classify children's eating and drinking abilities appears reliable; EDACS appeared stable over 6 or more years in 86% of the cases.
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Affiliation(s)
- Diane Sellers
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, East Sussex, UK
| | - Elizabeth Bryant
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, East Sussex, UK.,School of Health Sciences, University of Brighton, Brighton, East Sussex, UK
| | - Alison Hunter
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, East Sussex, UK
| | - Vivienne Campbell
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, East Sussex, UK
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23
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Sellers D. Eating and Drinking Ability Classification System. Dysphagia 2018; 34:279-280. [PMID: 30232549 DOI: 10.1007/s00455-018-9943-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Sellers
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Beggars Wood Road, North Chailey, Nr Lewes, East Sussex, BN8 4JN, UK.
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24
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Tschirren L, Bauer S, Hanser C, Marsico P, Sellers D, van Hedel HJA. The Eating and Drinking Ability Classification System: concurrent validity and reliability in children with cerebral palsy. Dev Med Child Neurol 2018; 60:611-617. [PMID: 29656386 DOI: 10.1111/dmcn.13751] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 11/28/2022]
Abstract
AIM As there is little evidence for concurrent validity of the Eating and Drinking Ability Classification System (EDACS), this study aimed to determine its concurrent validity and reliability in children and adolescents with cerebral palsy (CP). METHOD After an extensive translation procedure, we applied the German language version to 52 participants with CP (30 males, 22 females, mean age 9y 7mo [SD 4y 2mo]). We correlated (Kendall's tau or Kτ ) the EDACS levels with the Bogenhausener Dysphagiescore (BODS), and the EDACS level of assistance with the Manual Ability Classification System (MACS) and the item 'eating' of the Functional Independence Measure for Children (WeeFIM). We further quantified the interrater reliability between speech and language therapists (SaLTs) and between SaLTs and parents with Kappa (κ). RESULTS The EDACS levels correlated highly with the BODS (Kτ =0.79), and the EDACS level of assistance correlated highly with the MACS (Kτ =0.73) and WeeFIM eating item (Kτ =-0.80). Interrater reliability proved almost perfect between SaLTs (EDACS: κ=0.94; EDACS level of assistance: κ=0.89) and SaLTs and parents (EDACS: κ=0.82; EDACS level of assistance: κ=0.89). INTERPRETATION The EDACS levels and level of assistance seem valid and showed almost perfect interrater reliability when classifying eating and drinking problems in children and adolescents with CP. WHAT THIS PAPER ADDS The Eating and Drinking Ability Classification System (EDACS) correlates well with a dysphagia score. The EDACS level of assistance proves valid. The German version of EDACS is highly reliable. EDACS correlates moderately to highly with other classification systems.
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Affiliation(s)
- Lea Tschirren
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Fakultät für Gesundheit und Medizin, Donau-Universität Krems, Krems, Austria
| | - Susanne Bauer
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Department of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Chiara Hanser
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
| | - Petra Marsico
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Diane Sellers
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, North Chailey, East Sussex, UK
| | - Hubertus J A van Hedel
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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25
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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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26
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Gisel EG. Distribution of children in class I through V in functional classification systems. Dev Med Child Neurol 2017; 59:572. [PMID: 28374890 DOI: 10.1111/dmcn.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Erika G Gisel
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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