Day-to-day variability of clinical dysphagia in cerebral palsy (Malandraki et al., 2023)

<p><strong>Purpose:</strong> We aimed to examine the day-to-day variability of feeding and swallowing performance and mealtime duration in school-age self-feeding children with spastic cerebral palsy (SCP) across 15 days.</p> <p><strong>Method:</strong> Thirteen children with SCP (ages 5;10 [years;months]–17;6) participated. Children were divided into unilateral (UCP, <em>n</em> = 6) and bilateral (BCP, <em>n</em> = 7) SCP groups. Feeding/swallowing assessments using the Dysphagia Disorder Survey (DDS) were conducted and total mealtime durations (TMDs) were calculated for all days. DDS Part 1 (factors related to feeding) and DDS Part 2 (signs of oropharyngeal difficulties) components were rated. Mixed-effects models were used to compare group means and estimate between- and within-subject variances in each group. Likelihood ratio tests were used to determine best covariance structure and compare variance types across groups.</p> <p><strong>Results:</strong> Within-subject variance for all three variables, DDS Part 1, 2, and TMD, across days was larger in the BCP group than the UCP group (Part 1: <em>p</em> = .0036, Part 2: <em>p</em> = .0002, and TMD: <em>p</em> = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (<em>p</em> = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: <em>p</em> = .0160; Part 2: <em>p</em> = .0141) and shorter TMD (<em>p</em> = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (<em>p</em> < .0001).</p> <p><strong>Conclusion:</strong> These preliminary results emphasize the need to account for day-to-day variability when evaluating swallowing especially in children with BCP and provide preliminary ranges of performance that could be useful for clinical prognosis and future treatment research.</p> <p><strong>Supplemental Material S1.</strong> List of foods/liquids the children consumed each day.</p> <p>Malandraki, G. A., Kantarcigil, Ç., Craig, B. A., Zhang, Y., & Gordon, A. M. (2023). Day-to-day variability of clinical feeding and swallowing performance in school-age self-feeding children with cerebral palsy. <em>American Journal of Speech-Language Pathology, 32</em>(1), 190–200. <a href="https://doi.org/10.1044/2022_AJSLP-22-00137" target="_blank">https://doi.org/10.1044/2022_AJSLP-22-00137</a></p>