Acessibilidade / Reportar erro

Medidas de tempo de trânsito oral em crianças com paralisia cerebral de diferentes níveis motores e sua relação com o grau de severidade para disfagia

Temporal measurements of oral transit time in children with cerebral palsy of different levels motors and the relationship with the severity of dysphagia

Resumos

OBJETIVO: Verificar o tempo de preparo e de trânsito oral da deglutição de crianças com paralisia cerebral e relacioná-lo ao grau de severidade da disfagia e ao nível motor, de acordo com o Gross Motor Function Classification System. MÉTODOS: Participaram desta pesquisa 50 crianças com paralisia cerebral, média de idade de 3,6 anos, sendo dez crianças de cada nível motor. A avaliação fonoaudiológica clínica da deglutição consistiu na oferta de alimentos nas consistências "líquido fino" (água) e "pastoso homogêneo" (iogurte tipo petit suisse). Foi mensurado o tempo de preparo e de trânsito oral e realizado o diagnóstico da função de deglutição, classificando-a em normal, disfagia leve, moderada, ou grave. RESULTADOS: A média do tempo de deglutição foi de 1,33 segundos para a consistência líquida e de 3,33 segundos para a consistência pastosa. Quanto maior o nível motor do grupo de crianças, maior o tempo de deglutição para a consistência líquida. Encontrada diferença significativa entre os grupos para as duas consistências, com aumento progressivo do tempo de deglutição quanto maior o comprometimento da função de deglutição. CONCLUSÃO: O tempo de trânsito oral em crianças com paralisia cerebral mostrou-se aumentado e pôde representar a gravidade da disfagia apresentada, já que esse aumento ocorreu conforme maior o comprometimento da função de deglutição. Quanto maior o comprometimento motor global apresentado, maior o tempo de trânsito oral.

Paralisia cerebral; Transtorno de deglutição; Tempo; Deglutição; Criança


PURPOSE: To verify the oral transit time in children with cerebral palsy, and relating it to the degree of dysphagia severity and motor level. METHODS: The sample was 50 children with cerebal palsy, 23 males and 27 females, mean age of 3 years 7 months. The clinical assessment consisted in to provide food in liquid and pasty consistency. It measured the time of oral transit, and performed the diagnosis of swallowing function classifying it into normal, mild, moderate or severe dysphagia. RESULTS: The mean of oral transit time was found to be 1.33 seconds to liquid and 3.33 seconds for pasty consistency. As higher the level of the motor group of children, higher the time for swallowing liquid consistency, which was statistically significant. Statistically significant difference was found between groups for both consistencies, with a progressive increase of the time in accordance with the increase in impairment of swallowing. CONCLUSION: The oral transit time in children with cerebral palsy was found increased and may represent the severity of dysphagia presented, because this time was longer as worse the impairment in swallowing function. The higher the overall motor impairment presented, the longer oral transit time.

Cerebral palsy; Deglutition disorders; Time; Deglutition; Child


  • 1
    Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;(109):8-14.
  • 2
    Avivi-Arber L, Martin R, Lee J-C, Sessle BJ. Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol. 2011;56(12):1440-65.
  • 3
    Parkes J, Hill N, Platt MJ, Donnelly C. Oromotor dysfunction and communication impairments in children with cerebral palsy: aregister study. Dev Med Child Neurol. 2010;52(12):1113-9.
  • 4
    Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MAAP, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012;171(3):409-14.
  • 5
    Furkim AM, Behlau MS, Weckx LLM. Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraperética espástica. Arq Neuropsiquiatr. 2003;61(3-A):611-6.
  • 6
    Han TR, Bang MS, Chung SG, Shin HI, Jeon JY. The pattern of malnutrition in cerebral palsy and relating factors. J Korean Acad Rehabil Med. 2001;25(1):18-25.
  • 7
    Spadotto AA, Gatto AR, Cola PC, Montagnoli AN, Schelp AO, Silva RG, et al. Software para análise quantitativa da deglutição. Radiol Bras. 2008;41(1):25-8.
  • 8
    Molfenter SM, Steele CM. Temporal variability in the deglutition literature. Dysphagia. 2012;27(2):162-77.
  • 9
    Palisa R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to clarify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.
  • 10
    Weckmueller J, Easterling C, Arvedson J. Preliminary temporal measurement analysis of normal oropharyngeal swallowing in infants and young children. Dysphagia. 2011;26(2):135-43.
  • 11
    Jonckheere AR. A distribution-free k-sample test again ordered alternatives. Biometrika.1954;41:133-45.
  • 12
    Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev. 2008;14(2):128-36.
  • 13
    Fung EB, Samson-Fang L, Stallings VA, Conoway M, Liptak G, Henderson RC, et al. Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc. 2002;102(3):361-73.
  • 14
    Calis EAC, Veugelers R, Sheppard JJ, Tibboel D, Evenhuis HM, Penning C. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev Med Child Neurol. 2008;50(8):625-30.
  • 15
    Sullivan PB, Juszczak E, Bachlet AME, Lambert B, Vemon-Roberts A, Grant HW, et al. Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. Dev Med Child Neurol. 2005;47(2):77-85.
  • 16
    Soylu OB, Unalp A, Uran N, Dizdarer G, Ozgonul FO, Conku A, et al. Effect of nutritional support in children with spastic quadriplegia. Pediatr Neurol. 2008;39(5):330-4.
  • 17
    Otapowicz D, Sobaniec W, Okurowska-Zawada B, Artemowicz B, Sendrowski K, Kulak W, et al. Dysphagia in children with infantile cerebral palsy. Adv Med Sci. 2010;55(2):222-7.
  • 18
    Kim JS, Han ZA, Song DH, Oh H-M, Chung ME. Characteristics of dysphagia in children with cerebral palsy, related to gross motor function. Am J Phys Med Rehabil. 2013;4(ahead of print).
  • 19
    Benfer KA, Weir KA, Bell KL, Ware RS, Davies OS, Boyd RN. Oropharyngeal dysphagia and gross motor skills in children with cerebral palsy. Pediatrics. 2013;131(5):1553-62.
  • 20
    Clancy KJ, Hustad KC. Longitudinal changes in feeding among children with cerebral palsy between the ages of 4 and 7 years. Dev Neurorehabil. 2011;14(4):191-8.
  • 21
    Sullivan PB, Juszczak E, Lambert BR, Rose M, Ford-Adams ME, Johnson A. Impact of feeding problems on nutritional intake and growth: Oxford Feeding Study II. Dev Med Child Neurol. 2002;44(7):461-7.
  • 22
    Waterman ET, Koltai PJ, Downey JC, Cacace AT. Swallowing disorders in a population of children with cerebral palsy. Int J Pediatr Otorhinolaryngol. 1992;24(1):63-71.
  • 23
    Vivone GP, Tavares MMM, Bartolomeu RS, Nemr K, Chiappetta ALML. Análise da consistência alimentar e tempo de deglutição em crianças com paralisia cerebral tetraplégica espástica. Rev CEFAC. 2007;9(4):504-11.

Datas de Publicação

  • Publicação nesta coleção
    14 Out 2013
  • Data do Fascículo
    2013

Histórico

  • Recebido
    03 Jun 2013
  • Aceito
    14 Ago 2013
Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711, Fax: (11) 3253-8473 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br