Consensus on level descriptors for a functional children's eating and drinking activity scale

Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks

Cerebral palsy (CP) is a permanent disorder affecting movement and posture due to nonprogressive brain issues, often leading to various sensory, cognitive, and musculoskeletal challenges. Among these complications, oropharyngeal dysphagia (OPD) is prevalent, impacting up to 85% of children with CP and resulting in significant nutritional deficits. This systematic review aims to explore the prevalence and types of OPD in CP patients, its effects on nutritional status, and its associated health complications, emphasizing the need for thorough assessment and intervention to mitigate risks. The review adheres to PRISMA guidelines, searching five major databases (PubMed, Web of Science, Embase, Cochrane Library, and Scopus) without time range restrictions to capture studies addressing swallowing disorders and their impact on nutritional status in CP. This review has been registered on Open OSF (n) 3KUQX. Individuals with CP often experience swallowing impairments, including delayed pharyngeal transit and aspiration. Research indicates that 81.5% of kids with CP suffer from dysphagia, commonly associated with reduced motor skills and general health. Moreover, as a result of these swallowing difficulties, nutritional complications may occur, with elevated levels of gastroesophageal symptoms causing malnutrition and growth delays, which require thorough evaluations and personalized interventions for successful treatment. Tools like the Videofluoroscopic Swallowing Study were identified as primary methods for evaluation, but assessment remains limited by methodological inconsistencies. This systematic review underscores the significant health impacts of OPD in children with CP, which affects nutrition and overall well-being. Future research should address the need for standardized evaluation methods and effective interventions to balance nutritional needs with practical mealtime strategies.

Characterization of swallowing biomechanics and function in untreated infants with spinal muscular atrophy: A natural history dataset

BACKGROUND

Spinal Muscular Atrophy (SMA) is a progressive neuromuscular disorder that in its most severe form, causes profound swallowing deficits. There remains a paucity of research systematically elucidating the biomechanical and functional correlates. This void limits the ability to evaluate the effects of disease-modifying treatments on swallowing.

OBJECTIVE

Elucidate characteristics of swallowing biomechanics and function among untreated patients with SMA.

METHODS

Infants with SMA who had not received disease modifying therapy when they underwent a videofluoroscopic swallow study (VFSS) were retrospectively identified from 13 international children's hospitals. Infants were eligible if they exhibited symptoms by six months old, or in cases where they detected prior to symptom onset, if they had two copies of SMN2. Eligible infants underwent medical record review to gather oral intake status and need for suctioning for secretion management. Digital files of VFSS' were extracted and analyzed using BabyVFSSImP™. Non-parametric t-tests were used to compare swallowing biomechanics based on viscosity and the presence of dysphagia symptoms.

RESULTS

62 infants were included in this investigation with average age at initial VFSS 4.4 ± 3.11 months. A high proportion of infants exhibited profound deficits in swallowing biomechanics that impeded extraction of the bolus from the nipple, clearance of the bolus from the pharynx, and prevention of the bolus from entering the airway. Deficits were significantly more prevalent in infants referred for VFSS due to dysphagia symptoms than asymptomatic infants referred as part of high-risk referral (t ≤ 2.5, p ≤ 0.03). A high proportion of infants relied on suctioning for secretion management (34%; N = 21) and alternative nutrition (39%; N = 24), with those relying on these supports exhibiting significantly worse swallowing biomechanics than those who did not (t ≤ 2.8, p ≤ 0.01).

CONCLUSIONS

Profound deficits in swallowing biomechanics and function are common in infants with SMA. Though clinical symptoms may aid in identifying infants with the most profound swallowing deficits, their absence in cases of more mild deficits inhibits the ability to use these clinical markers as a valid metric of swallowing integrity.