The Eating and Drinking Ability Classification System for cerebral palsy: A study of reliability and stability over time

Abstract

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, minimum 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 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).

Reliability and validity of the Eating and Drinking Ability Classification System (EDACS) for children with cerebral palsy in Taiwan

“…The relationship between the EDACS levels for the children in the study, and the GMFCS and MACS was similar to that observed in other studies [9,16,24]. There was a moderate positive correlation; close examination of differences reveals that in 20% of cases, there was a difference of more than two levels in either direction.…”

“…Secondly, there were 38 participants (72%) under 6 years of age in our study. There is currently only limited evidence to support stability of EDACS levels for children with cerebral palsy over 3 years old [9]. It is possible that food and fluid textures suitable for much younger children continue to be given to older children with CP regardless of biting, chewing and swallowing abilities; routine assessment of eating, drinking and swallowing by registered health professionals such as speech and language therapists is not commonplace in the education institutions included in this study.…”

“…Prevalence of eating/drinking/swallowing difficulties has been estimated to be as high as 85% [8] with anecdotal and emerging evidence that limitations increase with age [9,10]. Fatal consequences of choking and aspiration were evident in a UK study where 22% of identified deaths for people with CP resulted from solids or liquids in the lungs or windpipe [11].…”

Sistemas de clasificación para niños, niñas y adolescentes con parálisis cerebral: su uso en la práctica clínica

“…EDACS se ha evaluado en estudios recientes en cuanto a su validez en distintas poblaciones pediátricas con PC demostrando muy buenos resultados de confiabilidad tanto entre profesionales como entre profesionales y familia [28][29][30] . Existe una alta asociación entre los niveles de EDACS con disfagia y dificultades al tragar, sin embargo la asociación entre el EDACS y el GMFCS es moderada [31][32][33] . Aún no son muchas las investigaciones que incorporan esta clasificación, pero se alienta su implementación para la valoración de la PC.…”

Factors Associated with the Caregivers' Perception of the Oral Health of Individuals with Cerebral Palsy

“…In addition, individuals with CP present motor disorders that can be accompanied by changes in sensation, cognition, communication, behavior, and perception [1,4]. These changes limit self-care functions, such as feeding and oral hygiene [4,5].…”