van den Engel-Hoek Lenie, Erasmus Corrie E, van Hulst Karen C M, Arvedson Joan C, de Groot Imelda J M, de Swart Bert J M
1Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, The Netherlands.
J Child Neurol. 2014 May;29(5):646-53. doi: 10.1177/0883073813501871. Epub 2013 Sep 9.
To determine whether findings on videofluoroscopic swallow studies reveal different patterns of dysphagia between children with central and peripheral neurologic disorders, a retrospective study of 118 videofluoroscopic swallow studies was completed. There were 3 groups: cerebral palsy with only spastic features (n = 53), cerebral palsy with dyskinetic features (n = 34), and neuromuscular disorders (myotonic dystrophy I, n = 5; spinal muscular atrophy I-II, n = 8; Duchenne muscular dystrophy, n = 8; other neuromuscular disorder, n = 10). Interpretation of the videofluoroscopic swallow studies was not blinded. The video fluoroscopic swallow study findings were compared dichotomously between the groups. Children with cerebral palsy demonstrated dysphagia in 1 or all phases of swallowing. In neuromuscular disorder, muscle weakness results in pharyngeal residue after swallow. The underlying swallowing problem in neuromuscular disorder is muscle weakness whereas that in cerebral palsy is more complex, having to do with abnormal control of swallowing. This study serves as a first exploration on specific characteristics of swallowing in different neurologic conditions and will help clinicians anticipate what they might expect.
为了确定电视荧光吞咽造影检查结果是否揭示中枢神经系统和周围神经系统疾病患儿吞咽困难的不同模式,我们完成了一项对118例电视荧光吞咽造影检查的回顾性研究。研究分为3组:仅具有痉挛特征的脑瘫患儿(n = 53)、具有运动障碍特征的脑瘫患儿(n = 34)以及神经肌肉疾病患儿(I型强直性肌营养不良,n = 5;I-II型脊髓性肌萎缩,n = 8;杜氏肌营养不良,n = 8;其他神经肌肉疾病,n = 10)。电视荧光吞咽造影检查的解读未设盲。对各组间电视荧光吞咽造影检查结果进行二分法比较。脑瘫患儿在吞咽的1个或所有阶段均表现出吞咽困难。在神经肌肉疾病中,肌肉无力导致吞咽后咽部残留。神经肌肉疾病中潜在的吞咽问题是肌肉无力而脑瘫中的问题更为复杂,与吞咽的异常控制有关。本研究首次探讨了不同神经疾病中吞咽的具体特征,并将帮助临床医生预测他们可能会遇到的情况。