Cerebral palsy

- Affect movement and muscle tone or posture – abnormal reflexes, floppiness or rigidity of the
limbs and trunk, abnormal posture, involuntary movements, unsteady walking
- Caused by damage to immature brain as it develops, usually before birth

Swallowing disorders associated with cerebral palsy (Logemann, 1983)

- *Oral dysfunctions
o Inappropriate oral reflexive behaviors
o Inability to hold material in cohesive bolus -> particles of food that break away may fall
into pharynx then into open airway as pharyngeal swallow is not triggered
o Disorganized lingual movements that do not contribute to smooth peristaltic action of
the tongue in moving the material posteriorly
o Reduced lip closure, tongue thrust, poor lateralization of tongue, disco-ordinated front-
to-back tongue movement
- Most aspiration in children and adults with CP occurs (not during – adequate laryngeal closure)
o before the swallow
 Reduced tongue control for chewing
 Delayed pharyngeal swallow
o After the swallow
 Poor tongue base action
 Poor laryngeal elevation creating inefficient swallowing with residue left in the
pharynx

Associated feeding/swallowing problems for children with cerebral palsy (Hall, 2001)

- Weak suck
- Oral-motor instability caused by postural problems
- Long term enteral feeding
- Behavioral feeding problem – sensory based; food/texture aversions

Cerebral palsy (Arvedson, 2002)

- Heterogeneous; problems often associated with problems of trunk, shoulder and heal control ->
safety of oral feeding is dependent on proper position of head, neck and trunk
- Major abnormalities of swallowing of children with severe dysphagia:
o Poor lingual function
o Delayed swallow
o Reduced pharyngeal motility
- Pattern of oral sensorimotor dysfx
o Tongue thrust
o Prolonged and exaggerated bite reflex
o Abnormally strong gag reflex
o Tactile hypersensitivity in oral area
o Drooling
Neuromuscular disorders

PNS system damage (Hall, 2001)

- Congenital myopathies and muscular dystrophies – slow progression

- Hypotonia and weakness -> affect respiration, feeding development and swallowing
- Symptoms
o Generalized weakness and atrophy of trunk and limb muscles, difficulty with postural
control
o Facial muscle weakness
o Difficulties coordinating SSB sequence
- Associated feeding/swallowing problems
o Weak suck
o Reduced lip seal
o Reduced jaw/tongue movement or exaggerated jaw movements
o Difficulty with bolus preparation
o Poor coordination of SSB
o Early fatigue

(Arvedson, 2015)

Spinal muscular atrophy:

Respiratory disorders

Respiratory disorders (Hall, 2001)

- Reduced respiratory function -> increase work of breath -> HR and RR increase -> expend more
calories. During feeding, WOB increases even more -> fatigue early; can lose calories during a
feeding instead of gaining weight
- Careful monitoring of infant’s physiologic fx before, during, and after feeding is necessary
- Associated feeding/swallowing problems
o Weak suck, no. of sucks per swallow increases as feeding increases
o Uncoordinated SSB sequence
o Reduced endurance

Central nervous system damage

Intracranial hemorrhage (Hall, 2001)

- Change in muscle tone (abnormal unilateral muscle tone -> motor based feeding problems),
consciousness and seizure activity

TBI (Arvedson, 2002)

- Most common problems
o Reduced tongue control and bolus manipulation in oral cavity
o Delayed pharyngeal swallow
o Inefficient transport of food through the mouth and pharynx