Dysphagia in Patients with Cerebral Palsy: A Pediatric View

Dysphagia often occurs in patients with cerebral palsy so severe as to have no head control or be unable to maintain a sitting posture. Abnormal muscle tonus causes various complications such as respiratory failure and gastrointestinal dysfunction. The primary brain involvement is non-progressive. However, with aging, these patients tend to suffer from the secondary progression of their complications, including dysphagia. When a patient is clinically suspected of having aspiration, video-fluorography and laryngeal fiberscopy are indicated. Assessment of respiratory failure, gastroesophageal reflux (GER), and nutritional state is also needed. The following problems suggest that full oral feeding is inappropriate, and supplementary tube feeding should also be used: frequent lower respiratory infection (twice a year or more), silent aspiration, upper respiratory obstruction, GER, emaciation, and lethargy. Treatment consists of rehabilitation of the swallowing function and implementation of tube feeding. Control of the posture, postural drainage of sputum, and preservation of the cough reflex are important to prevent concomitant respiratory failure. For cases intractable by medical management, surgical procedures such as laryngotracheal diversion and gastrostomy may be indicated.