Cerebral palsy can affect the muscles which controls opening and closing of mouth,moves lips and tongue and jaw movement. The muscle coordination and movements in face and neck allows a person to breath,swallow and talk. Some children may face difficulties in chewing and swallowing food and liquid items, the condition is known as Dysphagia. Dysphagia occurs because the esophagus cannot move food and liquids from back of child’s mouth to the stomach.
Due to feeding and swallowing problems the child may be prone to poor nutritional status,growth failure, chronic aspiration, oesophagitis,and respiratory infections.
Dysphagia can be classified into 2 types:
1. Oropharyngeal Dysphagia : occurs due to nerve and muscle malfunction leading to weaken the throat muscles, thereby making it difficult to move the food from mouth to the throat
2. Esophageal Dysphagia: occurs due to malformation or malfunction of the lower esophageal sphincter, as if the food gets stuck in the esophagus
Signs and Symptoms of feeding and speech related Dysphagia
– apnea during feeding
– delayed swallowing reflex
– esophageal spasm
– difficulty in feeding
– oral apraxia
– pain during feeding
– lack of vocal articulation
– inability to speak
– spastic dysarthria
– verbal apraxia
Indications of Dysphagia
-back pain,chest pain
– choking,constant cough,sore throat
– dry mouth
– nasal regurgitation
– taking a long time to eat
– unexplained weight loss
The ill effects of malnutrition can affect physiology, motor functions, neurological and psychological functions affecting the child’s early growth and development. Diminished muscle strength leads to impairment in motor function as well as weakness of respiratory muscles, with resultant cough and predisposition to pneumonia. Malnutrition results in increased circulation times and diminished cardiac capacity.It also causes diminished cerebral growth,delayed cognitive growth and abnormal behavior. Undernourished children shows lower level of exploratory activity and affected socio-emotional development.
A number of feeding and oral motor intervention strategies has been developed to address the difficulties with sucking,chewing,swallowing. These include oral sensorimotor stimulation,positioning,food appliances,and neuromuscular stimulation.