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S1_AJSLP-22-00137Malandraki.pdf (446.07 kB)

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

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posted on 2023-03-31, 21:24 authored by Georgia A. Malandraki, Çagla Kantarcigil, Bruce A. Craig, Yumin Zhang, Andrew M. Gordon

Purpose: 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.

Method: Thirteen children with SCP (ages 5;10 [years;months]–17;6) participated. Children were divided into unilateral (UCP, n = 6) and bilateral (BCP, n = 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.

Results: 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: p = .0036, Part 2: p = .0002, and TMD: p = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (p = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: p = .0160; Part 2: p = .0141) and shorter TMD (p = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (p < .0001).

Conclusion: 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.

Supplemental Material S1. List of foods/liquids the children consumed each day.

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. American Journal of Speech-Language Pathology, 32(1), 190–200.


This study was partially supported by internal funds provided to Georgia A. Malandraki by Teachers College, Columbia University and Purdue University.