From the Guidelines
Dysphagia is a common issue in individuals with cerebral palsy, affecting approximately 60-90% of people with the condition, particularly those with severe motor impairment. The prevalence of dysphagia in cerebral palsy is high due to the neurological damage that affects muscle control and coordination, including the muscles involved in swallowing 1. This can lead to problems with chewing, moving food to the back of the mouth, and triggering the swallow reflex, resulting in choking, aspiration, malnutrition, dehydration, and respiratory infections.
Causes and Risk Factors
The neurological damage that causes cerebral palsy can impair oral motor function, making it difficult for individuals to eat and swallow safely. The risk of dysphagia increases with the severity of motor impairment, particularly in those with quadriplegic cerebral palsy.
Management and Intervention
Management of dysphagia in cerebral palsy typically involves a multidisciplinary approach with speech-language pathologists, nutritionists, and physicians. Early identification and intervention are crucial to prevent complications and improve quality of life for individuals with cerebral palsy who have dysphagia. Recommendations may include modified food textures, positioning strategies during meals, oral motor exercises, and in severe cases, alternative feeding methods such as gastrostomy tubes 1.
Importance of Early Intervention
Regular assessment of swallowing safety is essential, especially if there are concerns or a clinical history of pneumonia, which is a leading cause of death in individuals with cerebral palsy 1. Early intervention can help mitigate the risk of malnutrition, dehydration, and respiratory infections, ultimately improving the quality of life for individuals with cerebral palsy.
From the Research
Prevalence of Dysphagia in Cerebral Palsy
- Dysphagia, or swallowing disorder, is a common issue in individuals with cerebral palsy, with studies indicating a high prevalence of swallowing problems 2.
- A systematic review and meta-analyses found that the pooled prevalence estimates for swallowing problems in persons with cerebral palsy were as high as 50.4% (95% confidence interval 36.0-64.8) 2.
- Another study found that 82.5% of children with cerebral palsy exhibited symptoms of dysphagia, which was associated with lower daily energy, carbohydrate, and fluid intake 3.
Impact of Dysphagia on Nutrition and Health
- Dysphagia can lead to malnutrition, dehydration, and other health complications in individuals with cerebral palsy 2, 3.
- A study found that children with cerebral palsy who had symptoms of dysphagia had lower daily energy and nutrient intake, which can contribute to malnutrition and impaired growth 3.
- Another study found that requiring a change in food consistency was almost 7 times more likely to present undernutrition in children with cerebral palsy 4.
Importance of Oral Motor Treatment
- Oral motor treatment can improve feeding and swallowing skills in children with cerebral palsy, regardless of the severity of gross motor involvement 5.
- A study found that oral motor treatment was associated with significant improvements in mandibular mobility, tongue activity, and general oral motor skills in children with cerebral palsy 5.
- Oral motor treatment was also found to be associated with a lower presence of respiratory diseases and nutritional compromise in children with cerebral palsy 5.
Need for Multidisciplinary Rehabilitation Programs
- Regular multidisciplinary rehabilitation programs should include evaluation, advice, and intervention regarding eating and drinking ability to increase social participation and self-management in individuals with cerebral palsy 6.
- A study found that adolescents and young adults with cerebral palsy experienced many restrictions in eating and drinking situations, leading to negative feelings and lower participation levels, while little attention was directed towards these difficulties 6.