title: Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy.
abstract: OBJECTIVE
  To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and the relationship to health outcomes.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Community and tertiary institutions.
  
  
  METHODS
  Children (N=53, 33 boys) with a confirmed diagnosis of CP assessed first at 18 to 24 months (Assessment 1: mean age ± SD, 22.9±2.9 mo corrected age; Gross Motor Function Classification System [GMFCS]: I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at 36 months (Assessment 2).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/distribution.
  
  
  RESULTS
  Prevalence of OPD decreased from 62% to 59% between the ages of 18 to 24 months and 36 months. Thirty percent of children had an improvement in severity of OPD (greater than smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3, P=.011; Assessment 2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment 2: OR=15.8, P=.003), and OPD severity (Assessment 1: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049).
  
  
  CONCLUSIONS
  Classification and severity of OPD remained relatively stable between 18 to 24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes that consider critical developmental transitions that are anticipated to present challenges for children from each of the GMFCS levels.
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: katherine.benfer@uqconnect.edu.au.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Benfer
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Speech Pathology, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Weir
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Bell
authors.affiliation: Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Davies
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
mesh_terms: D015992:Body Mass Index; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009048:Motor Skills / Q000145:classification; D009752:Nutritional Status; D015995:Prevalence; D012720:Severity of Illness Index
keywords: Cerebral palsy; Deglutition disorders; Longitudinal studies; Rehabilitation