Cerebral palsy: association between nutritional status and occurrence of oropharyngeal dysphagia
Paralisia cerebral: associação entre estado nutricional e ocorrência de disfagia orofaríngea
Elenice França Dutra; Aline Freitas Gomes; Raquel Coube de Carvalho Yamamoto; Franceliane Jobim Benedetti; Juliana Saibt Martins; Camila Lehnhart Vargas
Abstract
Objective: to verify the association between nutritional status and the occurrence of oropharyngeal dysphagia in individuals with cerebral palsy.
Methods: a cross-sectional, quantitative study with people aged between two and 20 years. Neuromotor impairment, occurrence and degree of dysphagia, anthropometry, food consumption, feeding route, diet fractionation and consistency were evaluated. Swallowing evaluation was performed by a skilled speech-language-hearing therapist, through the Clinical Evaluation Protocol of Pediatric Dysphagia (PAD-PED, Portuguese acronym). The statistical analysis was performed adopting p<0.05%.
Results: 40 subjects with a median of 8.7 (5.45-14.5) years, 65% of whom were males. Concerning neuromotor impairment, 72.5% were classified at levels IV and V. The prevalence of dysphagia was 70%, the feeding route being predominantly oral (77.5%) with a normal diet consistency (55%). In the growth curves, all of them were classified within an adequate height for their age. As for weight, body mass index and skinfolds, 82.5%, 85% and 62.5% were eutrophic, respectively. Statistically significant association was found between dysphagia and body mass index (p=0.018). The mean daily caloric and proteic intake was 1427.29±338.62 kcal and 56.86±17.57 grams, respectively. Statistically significant association was found between the feeding route and the amount of protein ingested daily (p=0.041).
Conclusion: most subjects presented oropharyngeal dysphagia and more severe motor impairment; they were fed orally with a normal diet consistency. It was observed that the greater the difficulty in swallowing, the greater the impairment of nutritional status.
Keywords
Resumo
Objetivo: verificar a associação entre estado nutricional e ocorrência de disfagia orofaríngea em indivíduos com paralisia cerebral.
Métodos: estudo transversal, quantitativo, realizado com indivíduos entre dois e 20 anos. Foi avaliado comprometimento neuromotor, ocorrência e grau de disfagia, antropometria, consumo alimentar, via alimentar, fracionamento e consistência da dieta. A avaliação da deglutição foi realizada por fonoaudióloga capacitada, por meio do Protocolo para Avaliação Clínica da Disfagia Pediátrica. Foi realizada análise estatística pertinente, adotando p<0,05%.
Resultados: participaram 40 indivíduos com mediana de 8,7 (5,45-14,5) anos, sendo 65% do sexo masculino. Quanto ao comprometimento neuromotor, 72,5% foram classificados no nível IV e V. A prevalência de disfagia foi de 70%, via alimentar predominantemente oral (77,5%) e consistência da dieta normal (55%). Nas curvas de crescimento, todos foram classificados com estatura adequada para idade. Para peso, índice de massa corporal e dobras cutâneas houve, respectivamente, 82,5%, 85% e 62,5% em eutrofia. Foi encontrada associação estatisticamente significante entre disfagia e índice de massa corporal (p=0,018). A média diária de ingestão calórica e proteica foi de 1427,29±338,62 kcal e 56,86±17,57 gramas, respectivamente. Foi encontrada associação estatisticamente significante entre via alimentar e quantidade de proteína ingerida diariamente (p=0,041).
Conclusão: a maioria dos indivíduos apresentou disfagia orofaríngea e comprometimento motor mais grave, alimentavam-se por via oral com consistência de dieta normal. Observou-se que quanto maior a dificuldade de deglutição, maior o comprometimento do estado nutricional.
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Referencias
1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M. A report: the definition and classification of cerebral palsy April 2006. Dev Med ChildNeurol. Supplement. 2007;109(109):8-14.
2. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.
3. Piovesana AMSG, Val Filho JAC, Lima CLA, Fonseca MS, Mürer AP. Encefalopatia crônica: paralisia cerebral. In: Fonseca LF, Pianetti G, Xavier CC (orgs). Compêndio de neurologia infantil. 2ª ed. Rio de Janeiro: Medsi, 2002. p. 826-37.
4. Vianna CIO, Suzuki HS. Paralisia cerebral: análise dos padrões de deglutição antes e após intervenção fonoaudiológica. Rev. CEFAC. 2011;13(5):790-800.
5. Zanini G, Cemin NF, Peralles SN. Paralisia cerebral: causas e prevalências. Rev. Fisioter Mov. 2009;22(3):375-81.
6. Johnston MV, Hagberg H. Sex and the pathogenesis of cerebral palsy. Dev Med Child Neurol. 2007;49(1):74-8.
7. Erasmus CE, Hulst KV, Rotteveel JJ, Willemsen MAAP, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012;171(3):409-14.
8. Fung EB, Fang LS, Stallings VA, Conaway M, Liptak G, Henderson RC et al. Feeding dysfunction is associated with poor and health status in children with cerebral palsy. J Am Diet Assoc. 2002;102(3):361-73.
9. Linhares FMP. Avaliação do estado nutricional de crianças com disfagia por paralisia cerebral [dissertação]. Santa Maria (RS): Universidade Federal de Santa Maria; 2004.
10. Stevenson RD. Beyond growth: gastrostomy feeding in children with cerebral palsy. Dev Med Child Neurol. 2005;47(2):76-76.
11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à pessoa com paralisia cerebral. Brasília: Ministério da Saúde; 2014.
12. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: Norma Técnica do Sistema de Vigilância Alimentar e Nutricional – SISVAN. Brasília: Ministério da Saúde; 2011.
13. Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Arch Pediatr Adolesc Med. 1995;149(6):658-62.
14. Chumlea WC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc. 1994;94(12):1385-8.
15. Day SM, Strauss DJ, Vachon PJ, Rosenbloom L, Shavelle RM, Wu YW. Growth patterns in a population of children and adolescents with cerebral palsy. Dev. Med. Child. Neurol. 2007;49(3):167-71.
16. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor: University of Michigan Press; 1990.
17. Institute of Medicine. Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Washington, DC: National Academies Press; 2001.
18. Almeida FCF, Bühler KEB, Limongi SCO. Protocolo de avaliação clínica da disfagia pediátrica (PAD-PED). 1 ed. Barueri: Pró-Fono; 2014.
19. Caraviello EZ, Cassefo V, Chamlian TR. Estudo epidemiológico dos pacientes com paralisia cerebral atendidos no Lar Escola São Francisco. Med. Reabil. 2006;25(3):63-7.
20. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments. Res. Dev. Disabil. 2014;35(12):3469-81.
21. Otapowicz D, Sobaniec W, Okurowska-Zawada B, Artemovicz B, Sendrowski K, Kulak W et al. Dysphagia in children with infantile cerebral palsy. Adv Med Sci. 2010;55(2):222-7.
22. Araújo LA, Silva LR. Anthropometric assessment of patients with cerebral palsy: which curves are more appropriate? J Pediatr. 2013;89(3):307-14.
23. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Longitudinal study of oropharyngeal dysphagia in preschool children with cerebral palsy. Arch Phys Med Rehab. 2016;97(4):522-60.
24. Brooks J, Day S, Shavelle R, Strauss D. Low weight, mobidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics. 2011;128(2):299-307.
25. Caram ALA, Morcillo AM, Pinto EAL. Estado nutricional de crianças com paralisia cerebral. Rev Nutr. 2010;23(2):211-9.
26. Romano C, Wynckel MV, Hulst J, Broekaert I, Bronsky J, Dall'Oglio L et al. ESPGHAN guidelines for the evaluation and treatment of gastrointestinal and nutricional complications in children with neurological impairment. JPNG. 2017;65(2):242-64.
27. Tomoum HY, Badawy NB, Hassan NE, Alian KM. Anthropometry and body composition analysis in children with cerebral palsy. Clin. Nutr. 2010;29(4):477-81.
28. Mota MA. Concordância entre métodos de avaliação nutricional em crianças e adolescentes com paralisia cerebral [dissertação]. Porto Alegre (RS): Universidade Federal do Rio Grande do Sul; 2010.
29. Sullivan PB, Juszczak E, Bachlet AME, Lambert B, Vernon-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.
30. Susin FP, Bortolini V, Sukiennik R, Mancopes R, Barbosa LR. Perfil de pacientes com paralisia cerebral em uso de gastrostomia e efeito nos cuidadores. Rev. CEFAC. 2012;14(5):933-42.
Submitted date:
03/06/2019
Accepted date:
12/08/2019
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