Ultrasonographic Evaluation of Swallowing Disorder in Children with Cerebral Palsy: Preliminary study

Öz

Abstract: Aim: Swallowing is a process influenced by many phases and complex neuromuscular mechanisms. Swallowing disorders are common in patients with cerebral palsy (CP) The aim of this study is the dynamic evaluation of oral and pharyngeal phase changes of swallowing by ultrasound (US) in healthy children and children with CP who developed swallowing disorder. Materials-Methods: Sixteen children with CP (9 boys, mean age 45±21 months) in the patient group and 20 healthy children (11 boys, mean age 60 ±26 months) in the control group enrolled study. CP group was selected from orally fed children. In both groups, the measurements were performed with the transducer was placed under the chin and anterior part of the neck. During swallowing and rest distances between mandible symphysis and hyoid bone and between hyoid bone and thyroid cartilage (HT); frame rate of displays to determine swallowing times at same levels, tongue thickness and shear wave elastography for measuring tongue stiffness determined. Results: The significant differences were found between tongue thickness, elastogram and screen frame rates at HT level of the two groups (respectively p<0,002, p<0,002, p<0,003). No significant difference was found between the patient and control groups in terms of other measurements. The muscle tone varies during rest in CP patients with dysphagia. This tonus is high in spastic CP cases. Active tone is slightly decreased. The high tongue elastographic values during rest is consistent with this information in the literature. In children with CP, display frame rate elongation, which shows prolongation of swallowing time, is a significant change in the HT level. Conclusion: Prolonged swallowing time, thickness of the tongue and tonus of the tongue muscles can be used to evaluate dysphagia in patients with CP. Pre- and post-treatment comparisons can be used to evaluate treatment efficacy. ÖZ Amaç: Yutma birçok fazdan ve karmaşık nöromüsküler mekanizmalardan etkilenen bir süreçtir. Serebral palsi (CP) olan hastalarda yutma bozuklukları yaygındır. Bu çalışmanın amacı, sağlıklı çocuklarda ve yutma bozukluğu gelişen CP'li çocuklarda ultrason (US) ile yutmanın oral ve faringeal faz değişikliklerinin dinamik olarak değerlendirilmesidir. Gereç-Yöntem: Hasta grubunda 16 CP (9 erkek, ortalama yaş 45 ± 21 ay) ve 20 sağlıklı çocuk (11 erkek, ortalama yaş 60 ± 26 ay) kontrol grubuna alındı. CP grubu oral yoldan beslenen çocuklardan seçildi. Her iki grupta da ölçümler dönüştürücü ile çene altına ve boynun ön kısmına yerleştirildi. Mandibula simfizi ile hyoid kemik arasındaki ve hyoid kemik ile tiroid kıkırdağı (HT) arasındaki yutma ve dinlenme mesafelerinde; aynı seviyelerde yutma sürelerini belirlemek için ekranların kare hızı, dil kalınlığı ve dil sertliğini ölçmek için kayma dalgası elastografisi belirlenmiştir. Bulgular: İki grubun HT düzeyinde dil kalınlığı, elastogram ve ekran kare hızları arasında anlamlı fark bulundu (sırasıyla p <0,002, p <0,002, p <0,003). Hasta ve kontrol grubu arasında diğer ölçümler açısından anlamlı fark bulunmadı. Kas tonusu, disfajili CP hastalarında istirahat sırasında değişir. Spastik CP vakalarında bu tonus yüksektir. Aktif ton biraz azalır. Dinlenme sırasında yüksek dilli elastografik değerler, literatürdeki bu bilgilerle tutarlıdır. CP'li çocuklarda, yutma süresinin uzamasını gösteren ekran kare hızı uzaması HT düzeyinde önemli bir değişikliktir.

Anahtar Kelimeler

• cerebral palsy
• dysphagia
• ultrasound
• elastography

Kaynakça

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