Clinical And Videofluoroscopic Evaluation Of Swallowing In Patients With Spastic Tetraparetic Cerebral Palsy And Athetosic Cerebral Palsy [evaluación Clínica Y Videofluoroscópica De La Deglución En Pacientes Con Parálisis Cerebral Tetraparésica Espástica Y Atetósica]

Abstract

Aim. To evaluate and to compare the findings of oral and pharyngeal phases of swallowing in children with both spastic tetraparetic cerebral palsy (STCP) and with athetosic cerebral palsy (ACP). Patients and methods. 11 children were evaluated, with their ages ranging from 10 months to 8 years old, through both clinical assessment and videofluoroscopic evaluation. Results. The children with STCP were more involved at the neurologic, clinical and speech-language and hearing aspects. At the oral phases all the children had presented some involvement. At the pharyngeal phases the clinical signs of aspiration were identified in 10 children. It was observed aspirations in 80% of children with STCP and in 67% with ACP. The changes on swallowing were similar in both cerebral palsy groups, but the performance of the children with STCP was inferior. Conclusion. The videofluoroscopy was an important method which makes possible the verification of aspirations, helping the professionals at the therapeutical program for these children. © 2006, Revista de Neurología.428462465Chen, M.Y.M., Peele, V.N., Donati, D., Ott, D.J., Donofrio, P.D., Gelfand, D.W., Clinical and fluoroscopic evaluation of swallowing in 41 patients with neurologic disease (1992) Gastrointest Radiol, 17, pp. 95-98Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Furkim, A.M., (1999) Deglutição de crianças com paralisia cerebral do tipo tetraparética espástica: Avaliação clínica fonoaudiológica e análise videofluoroscó pica, , São Paulo: Universidade Federal de São Paulo;Furkim AM, Silva RG. Conceitos e implicações para a prática clínica e para a classificação da disfagia orofaríngea neurogênica. In Furkim AM, Silva RG. Programas de reabilitação em disfagia neurogênica. São Paulo: Frôntis1999. p. 1-20Logemann, J.A., (1983) Evaluation and treatment of disorders, , San Diego: College Hill;Pino-Quera R, Caffri-Defilippi C. Disfagia orofaríngea. Acta Gastroenterol Latinoam 200112: 26-35Perlman, A.L., Lu, C., Jones, B., Radiographic contrast examination of the mouth, pharynx and esophagus (1997) Deglutition and its disorders: Anatomy, phisiology, clinical diagnosis, and management, pp. 153-199. , Perlman AL, Schulze-Delrieu K, eds, San Diego: Singular;Rogers, B., Arvedson, J., Buck, G., Smart, P., Msall, M., Characteristics of dysphagia in children with cerebral palsy (1994) Dysphagia, 9, pp. 69-73Grunert-Paolinelli, P., Bontes-Lukoviek, A., Videofluoroscopía VFC em el estúdio de los transtornos de la deglución (2000) Revista Chilena de Radiología, 6, pp. 5-7Furkim, A.M., Behlau, M.S., Weckx, L.L.M., Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraparética espástica (2003) Arq Neuropsiquiatr, 61, pp. 611-616Kramer, S.S., Eicher, P.S., Swallowing in children (2003) Normal and abnormal swallowing: Imaging in diagnosis and therapy, pp. 205-226. , Jones B, ed, 2 ed. New York: Springer;Morton, R.E., Bonas, R., Fourie, B., Minford, J., Videofluoroscopy in the assessment of feeding disorders of children with neurological problems (1993) Dev Med Child Neurol, 35, pp. 388-395Helfrich-Miller, K.R., Rector, K.L., Straka, J.A., Dysphagia: Its treatment in the profoundly retarded pacient with cerebral palsy (1986) Arch Phys Med Rehabil, 67, pp. 520-525Plant, R.L., Anatomy and physiology of swallowing in adults and geriatrics (1998) Otolaryngol Clin North Am, 31, pp. 477-488Griggs, C.A., Jones, P.M., Lee, R.E., Videofluoroscopic investigation of feeding disorders of children with multiple handicap (1989) Dev Med Child Neurol, 31, pp. 303-308Buchholz, D.W., Neurogenic dysphagia: What is the cause when the cause is not obvious? (1994) Dysphagia, 9, pp. 245-255Arvedson, J., Rogers, B., Buck, G., Smart, P., Msall, M., Silent aspiration prominent in children with dysphagia (1994) Int J Pediatr Otorhinolaryngol, 28, pp. 173-181Dantas, R.O., Kern, M.K., Massey, B.T., Dodds, W.J., Kahrilas, P.J., Brasseur, J.G., Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing (1990) Am J Physiol, 258, pp. 675-681Lazarus, C.L., Logemann, J.A., Rademaker, A.W., Kahrilas, P.J., Pajak, T., Lazar, R., Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients (1993) Arch Phys Med Rehabil, 74, pp. 1066-1070Costa, M.M.B., Moscovici, M., Pereira, A.A., Koch, A., A avaliação videofluoroscópica da transição faringoesofágica (esfíncter superior do esôfago) (1993) Radiologia Brasileira, 23, pp. 71-80Perlman, A.L., Booth, B.M., Grayhack, J.P., Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia (1994) Dysphagia, 9, pp. 90-95Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Kandel ER. Linguagem. In Kandel ER, Schwartz JH, Jessel TM. Fundamentos da neurociência e do comportamento. Rio de Janeiro: Guanabara Koogan2000. p. 505-1