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Ultrasonographic Evaluation of Swallowing Disorder in Children with Cerebral Palsy: Preliminary study

Year 2021, Volume: 11 Issue: 4, 456 - 461, 31.07.2021

Abstract

Abstract:
Aim: Swallowing is a process influenced by many phases and complex neuromuscular mechanisms. Swallowing disorders are common in patients with cerebral palsy (CP) The aim of this study is the dynamic evaluation of oral and pharyngeal phase changes of swallowing by ultrasound (US) in healthy children and children with CP who developed swallowing disorder.
Materials-Methods: Sixteen children with CP (9 boys, mean age 45±21 months) in the patient group and 20 healthy children (11 boys, mean age 60 ±26 months) in the control group enrolled study. CP group was selected from orally fed children. In both groups, the measurements were performed with the transducer was placed under the chin and anterior part of the neck. During swallowing and rest distances between mandible symphysis and hyoid bone and between hyoid bone and thyroid cartilage (HT); frame rate of displays to determine swallowing times at same levels, tongue thickness and shear wave elastography for measuring tongue stiffness determined.
Results: The significant differences were found between tongue thickness, elastogram and screen frame rates at HT level of the two groups (respectively p<0,002, p<0,002, p<0,003). No significant difference was found between the patient and control groups in terms of other measurements. The muscle tone varies during rest in CP patients with dysphagia. This tonus is high in spastic CP cases. Active tone is slightly decreased. The high tongue elastographic values during rest is consistent with this information in the literature. In children with CP, display frame rate elongation, which shows prolongation of swallowing time, is a significant change in the HT level.
Conclusion: Prolonged swallowing time, thickness of the tongue and tonus of the tongue muscles can be used to evaluate dysphagia in patients with CP. Pre- and post-treatment comparisons can be used to evaluate treatment efficacy.

ÖZ
Amaç: Yutma birçok fazdan ve karmaşık nöromüsküler mekanizmalardan etkilenen bir süreçtir. Serebral palsi (CP) olan hastalarda yutma bozuklukları yaygındır. Bu çalışmanın amacı, sağlıklı çocuklarda ve yutma bozukluğu gelişen CP'li çocuklarda ultrason (US) ile yutmanın oral ve faringeal faz değişikliklerinin dinamik olarak değerlendirilmesidir.
Gereç-Yöntem: Hasta grubunda 16 CP (9 erkek, ortalama yaş 45 ± 21 ay) ve 20 sağlıklı çocuk (11 erkek, ortalama yaş 60 ± 26 ay) kontrol grubuna alındı. CP grubu oral yoldan beslenen çocuklardan seçildi. Her iki grupta da ölçümler dönüştürücü ile çene altına ve boynun ön kısmına yerleştirildi. Mandibula simfizi ile hyoid kemik arasındaki ve hyoid kemik ile tiroid kıkırdağı (HT) arasındaki yutma ve dinlenme mesafelerinde; aynı seviyelerde yutma sürelerini belirlemek için ekranların kare hızı, dil kalınlığı ve dil sertliğini ölçmek için kayma dalgası elastografisi belirlenmiştir.
Bulgular: İki grubun HT düzeyinde dil kalınlığı, elastogram ve ekran kare hızları arasında anlamlı fark bulundu (sırasıyla p <0,002, p <0,002, p <0,003). Hasta ve kontrol grubu arasında diğer ölçümler açısından anlamlı fark bulunmadı. Kas tonusu, disfajili CP hastalarında istirahat sırasında değişir. Spastik CP vakalarında bu tonus yüksektir. Aktif ton biraz azalır. Dinlenme sırasında yüksek dilli elastografik değerler, literatürdeki bu bilgilerle tutarlıdır. CP'li çocuklarda, yutma süresinin uzamasını gösteren ekran kare hızı uzaması HT düzeyinde önemli bir değişikliktir.

References

  • 1. Bass NH, Morrell RM. The neurology of swallowing. In:Groher ME, editor. Dysphagia: diagnosis and management. Boston: Butturworth-Heinemann.1992.p. 1-31
  • 2. Logemann JA. Evaluation and treatment of swallowing disorders.2nd ed. Austin:Pro-Ed.1998
  • 3. American Speech-Language-Heraing Association. Instrumental diagnostic procedures for swallowing. Ad Hoc Committee on Advances in Clinical Practice. ASHA Suppl. 1992;34(Suppl.7):25-33
  • 4. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet. 2004 May 15;363(9421):1619-31.
  • 5. Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. European Journal of Clinical Nutrition (2013) 67, S9–S12.
  • 6. Kim JS, Han ZA, Song DH, Oh HM, Chung ME., Characteristics of dysphagia in children with cerebral palsy, related to gross motor function. Am J Phys Med Rehabil. 2013 Oct;92(10):912-9.
  • 7. Leonard RJ, Kendall KA, McKenzie S, et al. Structural displacements in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15:146–52.
  • 8. Chi-Fishman G. Quantitative lingual, pharyngeal and laryngeal ultrasonography in swallowing research: a technical review. Clin Linguist Phon. 2005;19:589–604
  • 9. Kuhl V, Eicke BM, Dieterich M, et al. Sonographic analysis of laryngeal elevation during swallowing. J Neurol. 2003;250:333–7. 10. Leite KKA, Mangilli LD, et al. Audiol Commun Res 2014; 19: 412-20.
  • 11. Speyer R,Cordier R, Jae-Hyun K et al. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta‐analyses. Volume61, Issue11, November 2019, P. 1249-1258.
  • 12. Arvedson JC, Brodsky L (eds) Pediatric Swallowing and Feeding: Assessment and Management 2nd edn, Singular Publishing Group, a division of Thomson Learning, Inc.,. now Cengage, Albany, NY, USA, 2002.
  • 13. Santos MT, Batista R, Previtali E, Ortega A, Nascimento O, Jardim J . Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated? J Oral Pathol Med 2012; 41: 153–157.
  • 14. Lynch CS, Chammas MC, Mansur L, Cerri GG. Sonographic evaluation of swallowing biomechanics: a preliminary study. Radiologia Brasileira 41(4):241-244.
  • 15. Kenny DJ, Casas MJ, McPherson KA. Correlation of ultrasound imaging of oral swallow with ventilatory alterations in cerebral palsied and normal children: preliminary observations. Dysphagia. 1989;4(2):112-7.
  • 16. Casas MJ, McPherson KA, Kenny DJ. Durational aspects of oral swallow in neurologically normal children and children with cerebral palsy: an ultrasound investigation. Dysphagia. 1995 Summer;10(3):155-9.
  • 17. Yang WT, Loveday EJ, Metreweli C, et al. Ultrasound assessment of swallowing in malnourished disabled children. Br J Radiol 1997;70:992e4.
  • 18. Jadcherla SR, Gupta A, Wang M, Coley BD, Fernandez S, Shaker R. Definition and implications of novel pharyngo-glottal reflex in human infants using concurrent manometry ultrasonography. J Gastroenterol. 2009;104(10):2572-82.
  • 19. Hsiao MY, Chang YC, Chen WS, et al. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol 2012;38:1522e8.
  • 20. Huang YL, Hsieh SF, Chang YC, et al. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol 2009;35:1103e8.
  • 21. Scarborough DR, Waizenhofer S, Siekemeyer L, et al. Sonographically measured hyoid bone displacement during swallowin preschool children: a preliminary study. J ClinUltrasound 2010;38:430e4.
  • 22. Chi-Fishman G, Sonies BC. Kinematic strategies for hyoid movement in rapid sequential swallowing. J Speech Lang Hear Res 2002;45:457e68.
  • 23. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7.
Year 2021, Volume: 11 Issue: 4, 456 - 461, 31.07.2021

Abstract

References

  • 1. Bass NH, Morrell RM. The neurology of swallowing. In:Groher ME, editor. Dysphagia: diagnosis and management. Boston: Butturworth-Heinemann.1992.p. 1-31
  • 2. Logemann JA. Evaluation and treatment of swallowing disorders.2nd ed. Austin:Pro-Ed.1998
  • 3. American Speech-Language-Heraing Association. Instrumental diagnostic procedures for swallowing. Ad Hoc Committee on Advances in Clinical Practice. ASHA Suppl. 1992;34(Suppl.7):25-33
  • 4. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet. 2004 May 15;363(9421):1619-31.
  • 5. Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. European Journal of Clinical Nutrition (2013) 67, S9–S12.
  • 6. Kim JS, Han ZA, Song DH, Oh HM, Chung ME., Characteristics of dysphagia in children with cerebral palsy, related to gross motor function. Am J Phys Med Rehabil. 2013 Oct;92(10):912-9.
  • 7. Leonard RJ, Kendall KA, McKenzie S, et al. Structural displacements in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15:146–52.
  • 8. Chi-Fishman G. Quantitative lingual, pharyngeal and laryngeal ultrasonography in swallowing research: a technical review. Clin Linguist Phon. 2005;19:589–604
  • 9. Kuhl V, Eicke BM, Dieterich M, et al. Sonographic analysis of laryngeal elevation during swallowing. J Neurol. 2003;250:333–7. 10. Leite KKA, Mangilli LD, et al. Audiol Commun Res 2014; 19: 412-20.
  • 11. Speyer R,Cordier R, Jae-Hyun K et al. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta‐analyses. Volume61, Issue11, November 2019, P. 1249-1258.
  • 12. Arvedson JC, Brodsky L (eds) Pediatric Swallowing and Feeding: Assessment and Management 2nd edn, Singular Publishing Group, a division of Thomson Learning, Inc.,. now Cengage, Albany, NY, USA, 2002.
  • 13. Santos MT, Batista R, Previtali E, Ortega A, Nascimento O, Jardim J . Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated? J Oral Pathol Med 2012; 41: 153–157.
  • 14. Lynch CS, Chammas MC, Mansur L, Cerri GG. Sonographic evaluation of swallowing biomechanics: a preliminary study. Radiologia Brasileira 41(4):241-244.
  • 15. Kenny DJ, Casas MJ, McPherson KA. Correlation of ultrasound imaging of oral swallow with ventilatory alterations in cerebral palsied and normal children: preliminary observations. Dysphagia. 1989;4(2):112-7.
  • 16. Casas MJ, McPherson KA, Kenny DJ. Durational aspects of oral swallow in neurologically normal children and children with cerebral palsy: an ultrasound investigation. Dysphagia. 1995 Summer;10(3):155-9.
  • 17. Yang WT, Loveday EJ, Metreweli C, et al. Ultrasound assessment of swallowing in malnourished disabled children. Br J Radiol 1997;70:992e4.
  • 18. Jadcherla SR, Gupta A, Wang M, Coley BD, Fernandez S, Shaker R. Definition and implications of novel pharyngo-glottal reflex in human infants using concurrent manometry ultrasonography. J Gastroenterol. 2009;104(10):2572-82.
  • 19. Hsiao MY, Chang YC, Chen WS, et al. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol 2012;38:1522e8.
  • 20. Huang YL, Hsieh SF, Chang YC, et al. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol 2009;35:1103e8.
  • 21. Scarborough DR, Waizenhofer S, Siekemeyer L, et al. Sonographically measured hyoid bone displacement during swallowin preschool children: a preliminary study. J ClinUltrasound 2010;38:430e4.
  • 22. Chi-Fishman G, Sonies BC. Kinematic strategies for hyoid movement in rapid sequential swallowing. J Speech Lang Hear Res 2002;45:457e68.
  • 23. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Avni Merter Keçeli 0000-0002-9412-6733

Zeliha Ünlü 0000-0003-2270-0414

Publication Date July 31, 2021
Acceptance Date April 10, 2021
Published in Issue Year 2021 Volume: 11 Issue: 4

Cite

AMA Keçeli AM, Ünlü Z. Ultrasonographic Evaluation of Swallowing Disorder in Children with Cerebral Palsy: Preliminary study. J Contemp Med. July 2021;11(4):456-461. doi:10.16899/jcm.764439