Videofluoroscopic Swallow Study Findings and Correlations in Infancy of Children with Cerebral Palsy

Abstract

Objectives: Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics. Methods: This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children’s hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed. Results: There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score. Conclusion: While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.

Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding

“…Despite several factors might contribute to baseline, chronic, lung abnormalities (e.g., chest hypomobility), the post-meal increase in LUS findings support at least one, but detectable, contribution to meal-related aspiration. In order to verify the possible impact of mobility on pulmonary abnormality, at post hoc we explored the relationship between GMFCS ( 38 ) and LUS pre-, post-meal, or delta findings in the CP subgroup, but no relationship emerged, consistently with recent findings in infancy ( 39 ), conversely with respect to older ages ( 40 ).…”

“…For all these reasons, despite being conclusive for more severe cases, mostly when overt aspiration occurs, the VFSS assessment may not give an idea of the chronic, instead silent, aspiration risk of a child with neurological impairment ( 13 , 17 ). Moreover, silent aspiration is thought to be the majority in infants and children with feeding and swallowing disorders ( 39 – 41 ). Our results support the introduction of LUS as a non-invasive, infant-friendly, handy, repeatable bed-side and “arm-side” tool to assess aspiration risk in pediatric dysphagia.…”

A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families

“…This applies to the children population with a possibility of dysphagia to also be examined using a procedure such as videofluoroscopy (VFSS) in which barium is being used to gather information about the pharyngeal phase of the swallow and potential silent aspiration. Dysphagia detection using multidisciplinary approaches has been good practice as it looks at multiple aspects that lead to a wholesome treatment [8][9][10]. These include an in-depth physical and clinical examination by a neurologist on the medical and social history, type of medication, and current respiratory problems, in addition to further investigation by the speech therapist focusing on oral motor processes and the dietitian's assessment of the nutrition and hydration status.…”