Objectives: To investigate the prevalence and characteristics of dysphagia symptoms, evaluate the dysphagia-related quality of life (QOL), and determine the factors affecting dysphagia-related QOL in adults with cerebral palsy (CP).
Methods
This cross-sectional, interview-based survey study enrolled adults with CP (N = 117) and healthy individuals (N = 117). The Swallowing-QOL (SWAL-QOL) questionnaire, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Functional Oral Intake Scale (FOIS) were evaluated by a rehabilitation physician. The Swallowing-QOL (SWAL-QOL) scores were the main outcome measure, with lower scores indicating symptoms with stronger effect on QOL. The SWAL-QOL questionnaire included 14 items regarding dysphagia symptoms and 30 regarding swallowing-related QOL.
Results
Among pharyngeal symptoms, choking on food occurred most frequently (sometimes or more 76.9%), followed by coughing and choking on liquid. Among oral symptoms, chewing problems occurred most frequently (sometimes or more 59.8%), followed by food dribbling from the mouth (sometimes or more 53.8%). Compared to healthy adults, those with CP showed worse QOL across all SWAL-QOL items, with the lowest scores obtained for meal duration, followed by communication, burden, fatigue, sleep, and eating desire. On multiple linear regression analysis, higher MACS level, lower FOIS level, and older age were predictors of worse SWAL-QOL score.
Conclusions
In adults with CP, dysphagia symptoms are very frequent and have a profound effect on SWAL-QOL. Thus, when managing CP patients, it is necessary to evaluate swallowing function and establish an active intervention plan even if total oral diet is established. Interventions for environmental factors, as well as medical interventions, might be also necessary in this population because factors associated with SWAL-QOL are less modifiable (hand function) or not modifiable (age). |
