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

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Abstract

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.

Translated abstract

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.

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Most cited references 42

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A report: the definition and classification of cerebral palsy April 2006.

Peter Rosenbaum, Nigel Paneth, Alan Leviton … (2007)

For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.

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Development and reliability of a system to classify gross motor function in children with cerebral palsy.

Marie Wood, P Rosenbaum, R Palisano … (1997)

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.