2004 Volume 8 Issue 2 Pages 143-155
Aspiration related respiratory diseases are always the leading cause of death in patients with cerebral palsy (CP)．However，evaluation of dysphagia with videofluoroscopy (VF) or videoendoscopy (VE) in such patients has been difficult due to incorporation，physical deformity，and motor disabiilty．Also，the many small rehabilitation centers in Japan where most of these patients are cared for have limited access to these diagnostic apparatuses．Since 1999 we have attempted to estimate the risk of aspiration with a simple questionnaire survey，in cooperation with a comprehensive project to study disability，social health，and welfare，supported by the Ministry of Health，Labor and Welfare of Japan．In this project we constructed a 2001 version (Ver.2.0) of a dysphagiae valuation system for patients with CP．The purose of this study was to develop a new tool for easily evaluating dysphagia via statistical analysis of the multi center trial data of the Ver.2.0 system．Eighty-one physically disabled patients in eight rehabilitation units (including one university hospital) aged 1-47 years old (61 with cerebral palsy，20 with other diseases) were enrolled in this study．The only patient selection criterion was the risk of aspiration estimated by the attending physician．All the patients were evaluated by the Ver.2.0 system．A family member or a nursing staff taking care of the patient answered “the family questionnaire”. Professionals (pediatrician，dentist，occupational therapist，speech and language pathologist) checked the chart．Two or more experienced pediatric neurologists or rehabilitation specialists evaluated VF results independently．Data of 75 patients were used for the analysis．Based on the results of VF，the patients were divided into three groups：Ⅰ，no aspiration; Ⅱ，pure liquid aspiration (no aspiration of soild food);Ⅲ，solid food (and/or thick liquid) aspiration．The number of patients in each group was 18，20，and 37，respectively．From the results of multivariate logistic regression analysis，eight variables were identified for distinguishing group Ⅰ (no aspiration) from group Ⅱ and Ⅲ，and 14 variables for group Ⅲ (presence of solid food aspiration) from group Ⅰ and Ⅱ with 100％ probability．Content validity was also studied．Identified variables included a wide variety of categories from medical history or physical status to feeding time or cognitive function．These results show the importance of evaluating dysphagia in CP with a broad view．Based on those results we developed a 33-item screening test (2002 edition)，which includes a “Family questionnaire”and “Chart for estimating the possibility of aspiration”． Each item in the estimation chart was weighted and scored by statistical calculation．In a clinical setting，this system may be a powerful tool to identify CP patients who need further diagnostic study such as VF．
