SEREBRAL PALSİLİ ÇOCUKLARDA ORAL MOTOR VE YUTMA BOZUKLUKLARI İLE İLİŞKİLİ ÖZELLİKLERİN İNCELENMESİ: TANIMLAYICI BİR ÇALIŞMA

Amaç: Serebral Palsili (SP) çocuklarda oral motor problemler ve yutma bozukluğu yaygın olarak görülmektedir. Bu çalışma, SP’li çocukların oral motor ve yutma bozukluğu ile ilgili tanımlayıcı özelliklerini incelemek amacı ile planlandı. Yöntem: Bu çalışma, yaş ortalaması 70.35±28.30 ay olan 90 SP’li çocuk (39 kız, 51 erkek) ile gerçekleştirildi. Motor fonksiyonel seviye için Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) kullanıldı. Dil itme şiddetinin değerlendirilmesi için Dil İtme Derecelendirme Ölçeği (TTRS), salya problemi için Salya Şiddet ve Frekans Ölçeği, çiğneme performans seviyesi için Karaduman Çiğneme Performans Ölçeği (KCPS) ve yutma bozukluğu için Pediatrik Yeme Değerlendirme Aracı (PEDI-EAT-10) kullanıldı. Sonuçlar: KMFSS’ye göre çocukların % 55,6'sı seviye V düzeyindeydi. Çocukların %87,8'inde patolojik dil itme refleksi vardı. Ortalama PEDI-EAT-10 skoru 15,42±11,41 idi. SP’li çocukların %87,8'inde çiğneme bozukluğu ve % 87,8'inde salya problemi saptandı. GMFCS düzeyi, klinik SP tipi, open mouth varlığı, besin kıvamı ve pnömoni sayısı tüm oral motor ve yutma değerlendirmeleri ile korelasyon gösterdi (p<0.05). Tartışma: Bu çalışmada SP'li çocuklarda çeşitli oral motor ve yutma bozuklukları tespit edildi ve bu çocuklar için Türk toplumuna özgü genel bir profil elde edildi.

Anahtar Kelimeler:

Serebral Palsi, Çiğneme, Deglügasyon, Yeme

AN INVESTIGATION OF CHARACTERISTICS RELATED TO ORAL MOTOR AND SWALLOWING DISORDERS IN CHILDREN WITH CEREBRAL PALSY: A DESCRIPTIVE STUDY

Purpose: Oral motor problems and swallowing disorders are common in children with cerebral palsy (CP). This study was planned to examine the oral motor and swallowing related descriptive characteristics of children with CP. Methods: This study was carried out with 90 children with CP (39 girls and 51 boys) with a mean age of 70.35±28.39 months. Gross Motor Function Classification System (GMFCS) was used for functional motor level. The Tongue Thrust Rating Scale (TTRS) for tongue thrust severity, Karaduman Chewing Performance Scale (KCPS) for chewing performance level, Pediatric Eating Assessment Tool (PEDI-EAT-10) for dysphagia symptom severity and Drooling Severity and Frequency Scale for drooling were used. Results: According to GMFCS, 55.6% of children were in level V. The 87.8% of the children had pathological tongue thrust. The mean PEDI-EAT-10 score was 15.42±11.41. Chewing disorders were detected in 85.6%, and drooling was detected in 87.8% of CP children. The GMFCS level, clinical type of CP, presence of open mouth, food consistency and the number of pneumonia correlated with all oral motor and swallowing assessments (p<0.05). Conclusion: In this study, various oral motor and swallowing disorders were identified in children with CP, and a Turkish community-specific general profile of these children was obtained.

Keywords:

Cerebral Palsy, Deglutition, Eating, Mastication,

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1. Kakooza‐Mwesige A, Tumwine JK, Eliasson AC, Namusoke HK, Forssberg H. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications. Acta Paediatr. 2015;104(12):1259-68.
2. Bingham PM. Deprivation and dysphagia in premature infants. J. Child Neurol. 2009;24(6):743-9.
3. Slattery J, Morgan A, Douglas J. Early sucking and swallowing problems as predictors of neurodevelopmental outcome in children with neonatal brain injury: a systematic review. Dev Med Chıld Neurol. 2012;54(9):796-806.
4. Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr. 2012;101(1):92-8.,
5. Calis EA, Veugelers R, Sheppard JJ, Tibboel D, Evenhuis HM, Penning C. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev Med Chıld Neurol. 2008;50(8):625-30.
6. Parkes J, Hill N, Platt MJ, Donnelly C. Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study. Dev Med Chıld Neurol. 2010;52(12):1113-9.
7. Polack S, Adams M, O'banion D, Baltussen M, Asante S, Kerac M, et al. Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life. Dev Med Chıld Neurol. 2018;60(9):914-21.
8. Mishra A, Malandraki GA, Sheppard JJ, Gordon AM, Levy ES, Troche MS. Voluntary cough and clinical swallow function in children with spastic cerebral palsy and healthy controls. Dysphagia. 2019;34(2):145-54.
9. Kerem Günel M, Mutlu A, Livanelioğlu A. Kaba Motor Fonksiyon Sınıflandırma Sistemi Genişletilmiş ve Yeniden Düzenlenmiş Şekli. https://canchild.ca/system/tenon/assets/attachments/000/000/083/original/GMFCS-ER_Translation-Turksih.pdf. Access Date: June 10, 2020.
10. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Gross motor function classification system for cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.
11. Palisano R, Rosenbaum P, Bartlett D, Livingston M, Walter S, Russell D, et al. GMFCS-E&R. CanChild Centre for Childhood Disability Research, McMaster University. 2007.
12. El O, Baydar M, Berk H, Peker O, Kosay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3.
13. Serel Arslan S, Demir N, Karaduman A. Reliability and validity of a tool to measure the severity of tongue thrust in children: the Tongue Thrust Rating Scale. J. Oral Rehabil. 2017;44(2):119-24.
14. Thomas-Stonell N, Greenberg J. Three treatment approaches and clinical factors in the reduction of drooling. Dysphagia. 1988;3(2):73-8.
15. Serel Arslan S, Demir N, Barak Dolgun A, Karaduman A. Development of a new instrument for determining the level of chewing function in children J. Oral Rehabil. 2016;43(7):488-95.
16. Serel Arslan S, Demir N, Karaduman AA, Belafsky PC. The pediatric version of the eating assessment tool: A caregiver administered dyphagia-specific outcome instrument for children. Disabil and Rehabil. 2018;40(17):2088-92.
17. Köseoğlu E, Karaoğlan B, Zinnuroğlu M. Serebral Palsili 132 Olgunun Demografik Verileri ve Klinik Özellikleri. Journal of Physical Medicine & Rehabilitation Sciences/Fiziksel Tup ve Rehabilitasyon Bilimleri Dergisi. 2014;17(3).
18. Hermont AP, Martins CC, Zina LG, Auad SM, Paiva SM, Pordeus IA. Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: a systematic review of cohort studies. Int J Env Res Pub He. 2015;12(3):3133-51.
19. Abreu LG, Paiva SM, Pordeus IA, Martins CC. Breastfeeding, bottle feeding and risk of malocclusion in mixed and permanent dentitions: a systematic review. Braz Oral Res. 2016;30(1).
20. Clawson EP, Kuchinski KS, Bach R. Use of behavioral interventions and parent education to address feeding difficulties in young children with spastic diplegic cerebral palsy. NeuroRehabilitation. 2007;22(5):397-406.
21. Vargün R, Ulu HÖ, Duman R, Yağmurlu A. Serebral palsili çocuklarda beslenme problemleri ve tedavisi. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2004;57(04).
22. Arvedson J, Brodsky L. The airway and swallowing. Pediatric swallowing and feeding: Assessment and management.(pp. 153-185). Albany, NY: Singu. lar Publishing Group, a division of Thompson Learning, Inc; 2002.
23. Reilly S, Skuse D, Poblete X. Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J. Pediatr. 1996;129(6):877-82.
24. Çubukçu ÇE. Prenatal dönemde ve bebeklikte ağız ve diş sağlığı. 2007.
25. Ovsenik M. Incorrect orofacial functions until 5 years of age and their association with posterior crossbite. Am. J. Orthod. Dentofac. Orthop. 2009;136(3):375-81.
26. Vázquez-Nava F, Quezada-Castillo J, Oviedo-Trevino S, Saldivar-González A, Sánchez-Nuncio H, Beltrán-Guzmán F, et al. Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. Arch Dis Child. 2006;91(10):836-40.
27. Hurley M, Vyas H. Respiratory problems in children with neurodisability. J Paediatr Child Health. 2015;25(10):463-6.
28. Prasse JE, Kikano GE. An overview of pediatric dysphagia. Clin. Pediatr. 2009;48(3):247-51.