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Abstract:

Background: Pharyngeal dysphagia is common in children with neurodisability. Recently, a novel technique, automated impedance manometry (AIM) was developed to quantify deglutitive motor function and bolus flow using integrated analysis of pressure and impedance measurements. The AIM-derived Swallow Risk Index (SRI), has been shown to have excellent sensitivity (0.88) and specificity (0.96) for non-radiological detection of aspiration in adults (Omari et al 2011). Aim: We aim to evaluate the applicability of AIM in dysphagic children with neurodisability. Methods: Videomanometry-impedance was performed in 12 children (1y8m-15y) with complex neurological impairment (9 with cerebral palsy), referred for swallow assessment. First, patient data were compared with a pediatric control group (9 patients without neurodisability referred for esophageal manometry for reasons other than aspiration). Secondly, data were stratified according to the presence of aspiration. Data were compared using Mann-Whitney U Test. Results: First, patients with neurodisability showed higher resistance to bolus flow in both pharynx (p=0.001) and upper esophageal sphincter (p<0.01) compared to controls. Their pharyngeal bolus dwell time was longer (p=0.007) and they had a higher aspiration risk (increased swallow risk index (SRI) (p= 0.002)). Secondly, aspirating patients had a significantly higher SRI versus controls (p=0.002), but not versus non aspirating dysphagic patients (p=0.166). This is possibly due to a low number of non-aspirating patients (N=3). However, a promising trend is visible towards a higher mean SRI in aspirating compared to non-aspirating patients. Conclusion: From this feasibility study, we conclude that AIM may be a valuable method for assessing dysphagia in children with neurodisability. We hypothesize that a large study population will allow us to differentiate specific swallow patterns in these patients and to predict their aspiration risk.