Drooling, saliva production, and swallowing in cerebral palsy

Abstract

Fourteen participants (six females, eight males) ranging in age from 7 years 11 months to 18 years 2 months (mean 11y 7mo) with a confirmed diagnosis of spastic cerebral palsy (CP) were included in the study. Participants included those who drooled (CP+, n=14); age‐ and sex‐matched children with spastic CP who were dry to mild and never to infrequent droolers (CP−, n=14) as well as typically developing peers (CTRL, n=14) served as controls. Frequency of swallowing was measured by using simultaneous cervical ausculation and videotaping of the head and neck. Saliva production was measured with the Saxon test, a simple gauze‐chewing procedure. In addition, Pediatric Evaluation of Disability Inventory (PEDI), Test of Nonverbal Intelligence‐3 (TONI‐3), dysarthria severity scale, and Gross Motor Function Classification System (GMFCS) scores were obtained for each participant. Both groups of participants with CP tended to swallow less frequently than typically developing participants and tended to produce less saliva than typically developing controls; however, these differences were not statistically significant. No correlation was found between amount of saliva produced and amount drooled (r=0.245). An analysis of variance (ANOVA) conducted on the PEDI functional skills mean scores indicated significant differences between the three groups (F((2,39))=23.522, p<0.0001). Likewise, an ANOVA conducted on the TONI‐3 scores revealed statistically significant differences between the three groups (F(2,39)=31.761, p<0.0001). A Spearman's rho correlation indicated that GMFCS scores were not significantly correlated with drooling severity (Spearman's rho correlation=0.3951, p=0.037). Drooling severity was found to be positively correlated with dysarthria severity (Spearman's rho correlation=0.82, p<0.0001). These findings suggest that drooling in patients with CP is related to swallowing difficulties rather than hypersalivation.

Understanding mealtime changes for adults with cerebral palsy and the implications for support services

“…Health problems experienced by people with cerebral palsy may be complicated by dysphagia and impact adversely on quality of life (Talley & Wiklund, 2005). These problems include being at greater risk for constipation (Balandin & Morgan, 1997;von Kö nigsmark, 2000), gastrooesophageal reflux disease, respiratory disease, and poor oral hygiene (Kaatzke-McDonald, 2003;Zaffuto-Sforza, 2005), along with difficulties with saliva control (Senner, Logemann, Zecker, & Gaebler-Spira, 2004) and taking oral medication (Sheppard, 2006).…”

Clozapine-induced sialorrhea: pathophysiology and management strategies

“…Measuring the increase in weight of absorbent material (cotton rolls or gauze) that is chewed (known as "Saxon test") (Senner et al 2004) or placed intraorally near the orifices of the ducts of salivary glands (Navazesh and Christensen 1982;Ahlner and Lind 1983;Rotteveel et al 2004). The results of therapies that aim to reduce the salivary flow can be evaluated by the swab method ).…”

Clinical-therapeutic management of drooling: Review and update

“…There are also orthopedic techniques involving the use of intraoral acrylic plates to stimulate lingual retrusion or the lips, for example, according to the method developed by Castillo-Morales (18). While logopedic intervention can suffice to ensure adequate saliva control, patient mental retardation or verbal or nonverbal comprehension difficulties unfortunately often complicate the application of such techniques (1). Another management option is the so-called feedback technique (9), based on the monitorization of the muscle group targeted for stimulation using electromyography (EMG).…”

“…In small children drooling is normal until 18-24 months of age, though in some cases the condition can persist up to four years of age, and certain upper airway infections moreover may exacerbate the problem. However, as the child grows older, these problems tend to disappear (1). Drooling can also be observed in patients with certain neurodegenerative diseases, though it is usually seen in patients with developmental disorders -particularly those characterized by alterations in orofacial neuromuscular control (2).…”