Clinical assessment of dysphagia in children with cerebral palsy using DDS and DMSS

Abstract

AIM: This study explored whether the Dysphagia Disorder Screening and Dysphagia Management Staging Scale (DDS and DMSS) are useful in children with cerebral palsy and which factors are related to the severity of their dysphagia.

METHODS: Swallowing competency was measured by two raters in 60 patients (47 male, 13 female; mean age 9y8mo, SD 2y9mo) with the DDS and DMSS. Patients were represented in all levels of Gross Motor Function Classification System and in all types of CP. Mean IQ was 67.98 (SD 21.52).

RESULTS: Good internal consistency in subparts and total DDS was found (α ≥ .88). Good interrater reliability was found for all items of DDS, except for oral pharyngeal swallowing which was moderate. Strength of relationship between individual test items of DDS and severity level on DDS was high, evidenced in discriminant function analysis. Averages of scores of participants known with dysphagia were significantly higher than subjects not known with dysphagia. Part 1 and part 2 of the DDS were positively related (Spearman’s R = .65). The severity of dysphagia was related to GMFCS level and IQ, but there was no effect of age. Significant differences were detected in the scores in patients with dyskinesia versus patients with spasticity and patients with unclassified CP. However, no difference was detected between the latter two.

INTERPRETATION Our results support a positive internal consistency, construct validity, and interrater reliability, as well as the relation between DDS and DMSS for the use in children with CP. Moderate interrater reliability was found for oral pharyngeal swallow and underlines the use of additional necessity of objective assessment with videomanometry in the diagnosis dysphagia in this population. DDS and DMSS are the only validated clinical assessment tools and are useful in this population as they describe the essential aspects to be considered during a mealtime observation screening. Dysphagia is complex and its severity as well as its nature is clearly linked to the type of cerebral palsy the child presents with.