Table 2 shows the main findings of the studies included in the review

Khamis et al. 2023 [123]

To investigate if the babiEAT program is feasible and acceptable for infants at risk of CP compared to standard care

Randomized Controlled Trial

12 weeks

38 infants (19 per group)

Age: Mean age of 9.5 months (SD = 2.03) at randomization

Gender: not Specificated

FIPQ, GAS, FSIS

The research emphasized that the babiEAT program was found to be feasible and acceptable in comparison to usual care

This pilot study did not calculate power for effect size because there was no available data, and a power calculation was not conducted

Abd-Elmonem et al. 2021 [120]

To assess whether a particular intervention can enhance oral motor skills in children with spastic CP

Randomized Controlled Trial

November 2018 to April 2020

Out of 70 children who signed up, 64 successfully finished the research, with 32 in each group

Age: 12 to 48 months

Gender: both genders included

OMAS, SATco, GMFM-88

The participants experienced noticeable enhancements in oral motor skills and trunk control as a result of the intervention

The study reports an effect size of 0.75, determined using Cohen's d

Gisel et al. 1995 [88]

To evaluate how well oral sensorimotor therapy improves feeding abilities in children with CP

Randomized Controlled trial

Group 1 received 20 weeks of oral sensorimotor therapy, while Groups 2 and 3 underwent 10 weeks without formal therapy before receiving 10 weeks of the same treatment

27 children

Age: Mean age of children was 4.8 years (Group 1), 5.0 years (Group 2), and 5.4 years (Group 3)

Gender: 14 boys and 13 girls

The amount of time spent chewing (in seconds) from when the food entered the mouth until the first swallow, along with an evaluation of functional feeding abilities using an adapted version of the Functional Feeding Assessment

After the treatment period, there were notable enhancements in the chewing duration of individuals in the aspirating group when consuming puree texture, suggesting that oral sensorimotor therapy could improve feeding efficiency. Groups that did not aspirate showed no substantial alterations in eating duration

Not Specificated

Lagos-Guimarães et al. 2016 [83]

To assess how the severity of dysphagia in children with CP is linked to factors like aspiration pneumonia

Cross-sectional study

September 2009 to December 2012

103 children

Age: 0 to 14 years (average age 4.26 years, standard deviation 4.18)

Gender: 46 girls (44.66%) and 57 boys (55.34%)

Videofluoroscopic swallowing study and the Videofluoroscopic Dysphagia Severity Classification

Mild dysphagia was the most frequent level of severity, with many children experiencing severe dysphagia relying solely on oral nutrition support. There was a strong correlation noted between age and tracheal aspiration, with severe dysphagia cases showing a higher incidence of silent aspiration

Statistical analysis employed the mean to conduct descriptive statistics and utilized chi-square tests to evaluate relationships between variables, with a significance level of p < 0.05

Yilmaz et al. 2004 [122]

To assess eating ability and related challenges in individuals with spastic CP who are undergoing feeding intervention

Prospective Observational Study

Not Specificated

23 children and young adults

Age: between 4 and 25 years (mean age 10.5 ± 5.9)

Gender: 14 males and 9 females

Functional Feeding Assessment Subscale of the Multidisciplinary Feeding Profile,

Most participants demonstrated varying levels of difficulty in feeding abilities, with 69% of those classified as having moderate to severe impairments experiencing problems with swallowing. Saliva leakage was seen in 74% of the patients, impacting their ability to eat, especially when using a straw or swallowing. Younger children had more trouble spoon feeding and using a straw compared to older children

The statistical analysis concentrated on evaluating variations in feeding performance scores among children with and without drooling. In particular, the Mann–Whitney U-test showed statistically significant differences (P < 0.05), suggesting that patients who drool had notably lower scores in these aspects compared to patients who do not drool

Remijn et al. 2017 [84]

To assess the oral-motor abilities of children with CP in relation to TD children while eating a crispy cookie, using different assessment methods

Comparative Observational Study

Not Specificated

There is a total of 22 children, 8 of whom have CP and the other 14 are TD children

Age: CP group: Mean age 9 years 8 months (range 7 years 3 months to 11 years 5 months). TD group: Mean age 9 years 1 month (range 5 years 5 months to 11 years 10 months)

Gender: CP group: 3 boys. TD group: 6 boys

MOE

Compared to the TD group, the CP group showed decreased lateral and vertical tongue movement along with a lower frequency of tongue movements. The CP group exhibited longer chewing cycle durations and greater variability in their chewing cycle durations. In addition, CP children's MOE scores showed decreased oral-motor abilities, especially in swallowing and fluency/coordination when compared to TD children

Statistics were used to describe the outcome measures, including medians, means, and confidence intervals, while independent t-tests were used to compare the groups. Reliability within and between raters was assessed through intraclass correlation coefficient, with a value exceeding 0.80 suggesting robust agreement in manually tracing tongue contours and reliable replication in mandible movements

Benfer et al. 2015 [85]

To evaluate clinical indications indicating possible swallowing difficulties during the pharyngeal phase in young children with CP and to verify these indications through direct evaluations and feedback from parents

Cross sectional study

Between April 2009 and March 2013

A total of 130 children with CP

Age: 18–36 months

Gender: 21 males (52.5%) in the TD group

GMFCS and Clinical signs of pharyngeal phase impairment

37.5% of children with TD showed clinical signs, with notable variations in signs between children with CP at GMFCS IV and V compared to those in the TD group

OR = 1.4 for the entire model and 3.9 is the equivalent of three point nine. An OR of 3.9 suggests that children with lower gross motor function are more likely to show clinical signs when comparing level V to level I

Otapowicz et al. 2010 [86]

To evaluate early swallowing issues in children with ICP and how they relate to cognitive abilities and the specific type of ICP

Cross Sectional Study

Not Specificated

67 children

Age: 3 to 17 years, with a mean age of 8.5 years (SD = 4.3)

Gender: 39 boys (58.2%) and 28 girls (41.8%)

Maternal interviews, dysarthria Scale, speech apparatus and swallowing functioning assessed by a logopaedist

The research discovered that 69% of kids experienced issues with sucking and swallowing, while 61% were currently struggling mainly during the oral phase. The seriousness of swallowing problems was linked strongly to the specific type of ICP and the extent of cognitive difficulties, as dysarthria was found in every child with oral phase difficulties

The research used percentage calculations and the chi-square test for statistical analysis, establishing significance at P < 0.05. The study found a significant link between the seriousness of swallowing problems and the specific type of CP, highlighting that children with tetraplegia showed the most severe oropharyngeal phase issues (p < 0.044)

Yi et al. 2019 [87]

To compare the effects of dysphagia symptoms on quality of life in adults with CP versus healthy individuals

Cross Sectional study

Between January 2018 and June 2018

117 adults with CP and a group of healthy adults

Age: 20 years and older

Gender: both male and female

MMSE, SWAL-QOL, FOIS

Adults with CP showed notably poorer quality of life related to swallowing issues compared to healthy adults, with choking on food being the most common symptom mentioned. Furthermore, predictors of the SWAL-QOL composite score included factors such as FOIS level and age

The effect size in SWAL-QOL scores between healthy adults and adults with CP was found to be highly significant, as healthy individuals had an average score of 97.39 while those with CP scored 60.60 (P < 0.001)

McAlister et al. 2022 [108]

The study sought to evaluate the eating and drinking skills of adults with CP and determine the features linked to dysphagia

Cross Sectional study

Data was gathered from grown-ups with CP enrolled in the CP monitoring program and database starting in 2016 up to June 2021

2,035 adults

Age: 18 to 78 years

Gender: 1,122 males (55.1%) and 913 females (44.9%)

EDACS

Over half of the individuals (52.5%) were able to consume food and beverages in a safe and effective manner (EDACS level I). Nevertheless, 32.4% were grouped in EDACS categories III to V, signaling restricted safety during meals and beverages consumption. Moreover, elderly individuals and individuals with more advanced types of CP experienced increased difficulties with regards to consuming food and beverages

Simple and multivariable linear regression models were used in this study's statistical analysis to examine the connections between independent variables and weight in kilograms. Findings were displayed as unadjusted and adjusted unstandardized coefficients, along with 95% confidence intervals. The models' goodness-of-fit was assessed with R², showing the proportion of weight variance explained by all independent variables

Asgarshirazi et al. 2017 [89]

To examine feeding disorders and their connection with GERD and oropharyngeal dysfunction, a study will be conducted on children with CP who are facing feeding issues like choking, repeated pneumonia, and inadequate weight gain

Cross Sectional study

6 months

50 children

Age: The average age of the participants was 6.28 years, ranging from 2 to 12 years

Gender: 56% of the patients were boys

Fluoroscopy was used for a barium swallow, Upper endoscopy was performed with esophageal biopsies, Evaluation of choking episodes, respiratory infections needing hospitalization, and weight gain after six months of therapy were assessed

The research discovered that 82% of individuals had swallowing issues and 66% had GERD, with notable enhancements in incidents of choking (reduced by 76%) and pneumonia (reduced by 66%) after half a year of therapy, but only 46% of kids saw an increase in weight. Moreover, there was a strong correlation between severe gross motor function and cognitive delays and increased prevalence of oral-motor incoordination and GERD

The study used Chi-square tests for statistical analysis to compare the occurrence of feeding disorders and GERD in children with CP

Benfer et al. 2016 [90]

To examine how common OPD is in preschool-aged children with CP and how it relates to their health results

Longitudinal Cohort Study

April 2009 to April 2013

53 children

Age: Aged 22.9 months (SD = 2.9)

Gender: not Specificated

DDS, Schedule for Oral Motor Assessment, and Pre Speech Assessment Scale

The frequency of OPD dropped from 62 to 59% as time passed. 30% of children showed enhancements in their feeding skills, with gross motor function being the sole consistent risk factor for delayed development in OPD across evaluations

Effect size was evaluated through different statistical approaches, such as McNemar’s Test for binary results, the Wilcoxon Matched Pairs Test for ordinal information, and paired T-tests for continuous factors. The reliability of the DSS was confirmed with a strong agreement rate of 90% and a kappa value of 0.8 (p < 0.001), showing significant consistency

Benfer et al. 2017 [91]

To assess OPD in young children with CP during their preschool years

Longitudinal Study

From April 2009 to March 2015

179 children took part, and initial findings from 53 children were disclosed

Age: Children aged 18 to 60 months at assessment

Gender: not Specificated

DDS, EDACS, GMFCS, MACS

The research discovered a decrease in oral feeding problems in children with CP from 79.7% at 18–24 months to 43.5% at 60 months, with notable links between OPD results and GMFCS stages

OR were used to determine the impact of GMFCS and age on OPD outcomes. The results showed a decrease in OPD prevalence with increasing age (OR = 0.92) and a strong correlation with GMFCS levels (OR = 6.2)

Seo et al. 2019 [92]

To assess the swallowing ability and its correlation with cervical dystonia and gross motor function in adults with DCP using clinical evaluations and VFSS

Observational Study

August 2014 to March 2017

17 participants

Age: Age ranged from 34.9 to 59.0 years (mean age 47.7 ± 6.3 years)

Gender: 8 men and 9 women

CDS, VDS, PAS, GMFCS, TWSTRS

The research discovered common irregularities in swallowing abilities among subjects, mainly including insufficient chewing and limited tongue mobility. A strong relationship was found between VDS total scores and TWSTRS scores, suggesting a connection between difficulty swallowing and the severity of cervical dystonia

The impact sizes were evaluated by testing the reliability within and between raters, resulting in highly impressive intraclass correlation coefficients for both the VDS and PAS, with values of 0.977 and 0.990, respectively

Mouilly et al. 2022 [93]

The research sought to examine the physical measurements and swallowing issues in kids with CP, while also evaluating their dental health

Cross Sectional Study

Not Specificated

65 patients

Age: 2 to 17 years, with a median of 9.25 years

Gender: Predominantly female (52.3%)

Measurements of weight and height, evaluation of GMFCS, examination of swallowing problems, and assessment of oral health

It was revealed that 64.6% of individuals suffering from CP showed signs of swallowing problems, and 52.3% experienced constipation, with 95% needing modified diets. Furthermore, 26.2% of patients had oral-facial malformations, resulting in notable variations in nutritional indices due to the existence of these malformations and swallowing difficulties

Effect sizes were computed to evaluate how oral-facial malformations and swallowing disorders affect the nutritional indices of children with CP, showing notable discrepancies in weight-for-age z-scores (p = 0.001) and height-for-age z-scores (p = 0.0001)

Mishra et al. 2019 [94]

To assess the feeding and swallowing abilities, swallowing physiology, and voluntary cough in children with speech sound disorders in comparison to typically developing children

Comparative study

Not Specificated

21 children (11 with SCP and 10 TDC)

Age: 4–11 years

Gender: not Specificated

DDS, sEMS, respiratory Inductance Plethysmography for respiratory-swallow coordination, voluntary cough assessment

Children with SCP had notably more severe feeding and swallowing issues than TDC, needing to use a higher percentage of maximum amplitude for swallowing puree and solid foods. TDC did not show any signs of aspiration, whereas three children with SCP coughed during the assessment

Effect sizes were computed for relevant measures to assess the extent of variations among groups. Statistical analysis was performed through nonparametric methods because of the data's non-normal distribution and limited power, evaluating intra- and interrater reliability using intraclass correlation coefficients and Cohen's kappa. The significance level's alpha value was established at p < 0.05

Wang et al. 2016 [95]

To assess the development and dietary health of children with CP residing in Chengdu

Cross Sectional Study

February to April 2013

377 children with CP aged between 2 to 18 years

Age: Mean age of 7.9 years (± 3.5 years)

Gender: 53.6% male, 46.4% female

GMFCS, MACS, anthropometric measures (height, weight)

The research discovered that 42.4% of kids with CP were experiencing stunted growth, while 12.7% were considered underweight, with a notably higher occurrence of these issues among those identified as GMFCS IV-V in comparison to GMFCS I-II. Moreover, 59.9% of the children were classified as having a normal weight based on BMI evaluations, showing that motor function severity significantly influences nutritional status

Different statistical measures, like average and standard deviation, were used to assess effect sizes for continuous variables such as age, weight Z scores, and height Z scores. The Mann–Whitney Test and Kruskal–Wallis test were employed to identify variations in growth and nutritional status among gender and age groups, while chi-square tests were used for categorical variables, with a significance level of P < 0.05 for all analyses

Bell et al. 2010 [96]

To explore how linear growth, body composition, oral motor and feeding issues, dietary intake, sedentary behavior, and their effects on health outcomes, healthcare needs, participation, and quality of life in young children with CP connect

Prospective Longitudinal cohort study

Evaluations will be carried out at three different time points: between 17 and 25 months, at 36 ± 1 months, and at 60 ± 1 months corrected age

The objective of the research is to enroll 240 kids in total

Participants in the study will consist of children with CP who were born from September 1, 2006 to December 31, 2009, with a variety of ages and genders expected

GMFM-66 and GMFCS

This research will offer the initial longitudinal analysis on how functional achievement relates to changeable lifestyle elements (eating habits and sedentary habits) and how they affect growth, body structure, and nutritional status in young children with CP regardless of their functional capacity

Descriptive statistics will outline participant traits, while inferential statistics, including mixed-effects models, will assess variations over time and distinctions among groups categorized by the GMFCS

Sousa et al. 2020 [121]

To examine the relationship between the nutritional status of children and adolescents with spastic quadriplegic CP and factors related to their diet and feeding method

Cross Sectional Study

Between July 2016 and January 2017

28 patients

Age: Patients aged ≤ 13 years old

Gender: not Specificated

Nutritional status evaluation (Body mass index, weight, height), Dietary complications (feeding route, type of diet), 24-h dietary recall

The research revealed that 75% of patients opted for alternative methods of feeding, with 57% being deemed as having a normal nutritional status. There was a direct correlation discovered between the diet ingested and nutritional status, with no correlation found between complications and nutritional status

Effect sizes was measured through correlations linking caloric intake and nutritional status, with noted results (r = 0.48, p = 0.01), suggesting a favorable connection between dietary quality and nutritional results

Oftedal et al. 2017 [97]

To explore how WZ, FFM, and %BF interact with lifestyle factors in children with CP of all GMFCS levels over time

Longitudinal Cohort Study

From April 2009 to March 2015, evaluations were conducted every 12–18 months

161 children diagnosed with CP, undergoing a total of 364 evaluations

Age: Age range of participants was 18–60 months (mean age: 2.8 years); GMFCS distribution: I (48%), II (11%), III (15%), IV (11%), V (15%)

Gender: 61% were boys

WZ, FFM, GMFCS, %BF, HPA

Changes in body composition were observed in young children with CP at different GMFCS levels, showing varying body composition traits; higher energy intake and HPA levels were linked to increased FFM in GMFCS group I kids, emphasizing the role of physical abilities and lifestyle in body composition

The statistical analysis involved using mixed-effects linear models to explore age-related changes in weight-for-age z scores, BMI-for-age z scores, fat-free mass, and percentage body fat

Taylor et al. 2017 [98]

To evaluate the efficacy of behavior analytic interventions when it comes to managing feeding challenges and reliance on feeding tubes in children diagnosed with autism and CP

Comparative Study

From 2003 to 2013

58 children

Age: 1 to 12 years, with a mean age of 69.53 months (SD = 30.69)

Gender: 60% (35 children) were male

Grams of food consumed during meal blocks, frequency of food refusal and negative vocalizations, CEBI, and caregiver satisfaction regarding program effectiveness and goals met

The research discovered that both interventions of applied behavior analysis led to a significant enhancement in feeding abilities of children with autism and CP, with functional analysis showing positive results for 78% of the children. Furthermore, both interventions showed success in increasing parental involvement, emphasizing the significance of family participation in the treatment procedure

The examination showed important overall impacts for time on different measures, such as grams consumed, refusal actions, and negative vocalizations. Significantly, the mixed model repeated measures showed significant enhancements in the amount of food consumed orally, displaying an average increase of 121.91 g (p < 0.001) from the initial caregiver baseline to the last treatment session, resulting in a substantial effect size (partial η² = 0.484)

Guarè et al. 2012 [99]

To assess the occurrence of GERD and its link with dental erosion, dietary intake, gastrointestinal symptoms, bruxism, and salivary flow rate in children with CP

Cross Sectional Study

Not Specificated

46 children

Age: 3 to 13 years

Gender: both genders included

Presence of dental erosion, dietary habits (acid drink consumption), gastrointestinal symptoms (regurgitation and heartburn), presence of bruxism, salivary flow rate (measured in ml/min)

The research discovered that kids with CP and GERD had a much higher occurrence of dental erosion than those without GERD, and dental erosion was linked to GERD on its own. Moreover, quadriplegic individuals with GERD were found to be at higher risk for oral disease

Effect sizes were computed using odds ratios to assess the relationship between GERD and dental erosion in children with CP. Statistical tests for normality included Shapiro–Wilk and Kolmogorov–Smirnov tests, and mean comparisons were conducted using Mann–Whitney tests

Caltepe et al. 2016 [100]

To study GER in children with CP by utilizing a combination of MII-pH monitoring

Prospective Study

24-h combined MII-pH monitoring

30 kids were registered, and enough information was gathered from 29 individuals

Age: Mean age of 4.0 ± 2.3 years

Gender: 16 females (55.2%) and 13 males (44.8%)

MII-pH

In total, there were 3,899 recorded reflux episodes, with 29% identified as acid, 60% as weakly acid, and 11% as alkaline. The research found that GER is prevalent in children with CP, predominantly consisting of non-acidic episodes, and that pH testing alone would not detect 70% of these episodes

The impact size was determined through the average and standard deviation of reflux occurrences among the subjects in the research, indicating a notable disparity in weakly acidic reflux frequency versus acidic reflux (p < 0.010)

Calis et al. 2008 [101]

To evaluate the clinical signs and seriousness of trouble swallowing in a typical group of kids with severe widespread CP and mental disability

Longitudinal Study

Not Specificated

166 children

Age: Mean age was 9 years 4 months, with a range from 2 years 1 month to 19 years 1 month

Gender: 85 males and 81 females

DSS

The research discovered a high occurrence of dysphagia (99%) in kids with severe generalized CP and intellectual disability, with 76% showing moderate to severe dysphagia and 15% categorized as profound dysphagia. The severity of dysphagia was found to have a positive correlation with the severity of motor impairment and, surprisingly, was linked to a higher weight for height, suggesting that parents may be underestimating feeding issues

Various statistical tests, such as analysis of variance, Mann–Whitney U test (z-score), and Spearman's rank correlation, were used to assess relationships between general child characteristics, DDS Part 1, and parental questionnaire items with the dysphagia severity scale

Schepers et al. 2022 [102]

To compare dysphagia limits in children with CP based on EDACS level, gender, and age with those of typically developing children

Comparative Study

Not Specificated

77 children

Age: Mean age of 7 years and 6 months (SD 2 years 2 months; age range 4–12 years)

Gender: 54 males and 23 females

Maximum Volume Water Swallow Test

Children diagnosed with CP had a much lower median dysphagia limit (3.0 mL) than children who typically develop (22.0 mL). The severity of dysphagia decreased as the EDACS level increased, accounting for 55% of the variability in the dysphagia limit

The research employed the Mann–Whitney U test to examine dysphagia thresholds in children with CP and normally developing peers, resulting in a statistically significant outcome (U = 1279.5, p < 0.001, r = 0.65), showing a substantial impact

Caramico-Favero et al. 2018 [103]

To examine the link between eating habits, nutritional health, and digestive issues in kids with CP

Cross Sectional Study

Not Specificated

40 children

Age: 4 to 10 years (mean age 6.7 ± 2.4 years)

Gender: 23 (57.5%) male and 17 (42.5%) female

Anthropometric measurements, evaluation of typical household food consumption, assessment of GI symptoms, and testing blood for hemoglobin and ferritin levels are methods used for dietary assessment

Children with CP showed noticeable stunted growth, with a median height-for-age Z-score of −4.05, and a high occurrence of gastrointestinal issues: 82.5% dealt with difficulty swallowing, 40% had GER, and 60% suffered from constipation, resulting in reduced energy and fluid consumption for those with swallowing difficulties

Both parametric and non-parametric tests were utilized for statistical analysis based on the data distribution. Notable disparities were discovered in height-for-age Z-scores in relation to weight-for-age and weight-for-height, with a p-value below 0.05 demonstrating a considerable deficiency in growth among the subjects

Clancy et al. 2011 [104]

To investigate how feeding patterns vary among children with CP with different levels of oral motor impairment and track changes in feeding habits over time across severity levels

Longitudinal Observational Study

30 months, gathering data every 6 months

23 children

Age: Mean age of 4.53 years (SD = 0.41 years)

Gender: 9 females and 14 males

FSQ, discussing tube feeding, thickened liquids, unique feeding methods, feeding therapy, studies on swallowing, instances of choking, and coughing

Most feeding variables showed notable disparities between severity groups, except for choking and coughing, where individuals with severe cases experienced the greatest challenges. Over time, the "within normal limits" group was the only one to experience a notable change in coughing, with other factors staying consistent among severity groups

Chi-square tests were used to analyze the effect size, which aimed to explore variations in feeding and swallowing behaviors across three severity groups of children with CP. Significant variances were noted in tube feeding (χ² = 11.32, p = .003), thickened liquids (χ² = 6.16, p = .046), special feeding techniques (χ² = 12.68, p = .002), feeding therapy (χ² = 7.45, p = .024), and swallow studies (χ² = 8.63, p = .013)

Mishra et al. 2018 [105]

To assess the dependability of fresh methods to measure mealtime length and explore their connection with the clinical feeding/swallowing abilities in children with SCP

Observational Study

Information was gathered at two summer camps in the years 2014 and 2015

17 children

Age: Range from 5 years and 1 month to 17 years and 6 months

Gender: 9 boys and 8 girls

DDS

The recently created measures for mealtime duration showed high reliability, with mealtime duration being positively correlated with DDS scores. Kids with one-sided brain involvement showed improved feeding/swallowing ability, shorter meal times, and lower DDS scores in comparison to those with brain involvement on both sides

Eta squared values were used to calculate effect sizes for the Kruskal–Wallis H test, showing significant differences in mealtime durations and DDS total scores, which further supported the study's results

Zhao et al. 2023 [106]

To discuss the nutritional status and features of children with CP and to investigate the connection between CP severity and nutritional status

Cross Sectional Study

July 2020 to June 2021

1151 participants

Age: Children aged 1–18 years

Gender: 49 males and 402 females

GMFCS, EDACS, SGNA, social life ability scale, and serum blood indicators

50.8% of children were found to be experiencing undernutrition. Children with GMFCS and EDACS levels IV and V had a noticeably greater chance of experiencing moderate to severe undernutrition than those in levels I-III. There were no notable variations in blood markers (aside from serum 25-hydroxyvitamin D) among different nutrition status categories

OR and 95% confidence intervals were used to determine effect sizes for examining the connection between nutritional status and motor function as categorized by the GMFCS and EDACS

Oliveira et al. 2023 [107]

To evaluate the nutritional condition of adult individuals with CP and swallowing difficulties who have stayed in a long-term care facility for more than a decade

Prospective Cohort Study

Between December 2015 and December 2016

56 patients

Age: 25 to 71 years (Mean: 44 ± 12 years)

Gender: 27 men (48%) and 29 women (52%)

Body Mass Index, PARD, FOIS

There were no notable differences in weight, nutritional status, diet consistency, dysphagia, or functional eating levels between the two evaluation periods. Nevertheless, greater dysphagia severity and strict dietary restrictions were linked to worse nutritional status

Effect sizes were calculated using the Wilcoxon and McNemar tests for continuous variables, and Fisher’s exact test was used for categorical variables. Findings were shown as averages, deviations, and middle values for continuous factors, and as total occurrences for categorical factors, with significance indicated at P < 0.05

Santoro et al. 2012 [109]

To assess clinical markers and severity of feeding difficulties in kids with neurodevelopmental conditions, especially CP, using a thorough multidisciplinary evaluation

Observational Study

Not Specificated

40 children

Age: Mean age of 38 months (range, 4–136 months)

Gender: 26 boys and 14 girls

GMFCS, clinical evaluation with a mealtime observation, and a modified barium swallow examination

All participants had feeding issues, and 37 out of 40 were found to have dysphagia. Of these, a high number had severe bilateral CP, exhibiting decreased swallowing frequency, sucking-swallowing coordination issues, and diverse oral sensitivity abnormalities. Moreover, 20% of the individuals also showed redness in the back of the throat, indicating stomach acid coming up the esophagus which was verified through a barium swallow in all potential instances

Statistical analysis showed that over 90% of the participants had adequate sucking abilities, with 50% showing decreased swallowing frequency, and more than two-thirds demonstrating sucking-swallowing coordination issues, indicating significant oral motor function challenges within the group. Data was gathered using a thorough assessment protocol, and descriptive statistics were used to summarize the clinical characteristics and feeding problems seen in the participants

Kantarcigil et al. 2016 [110]

Assessing the trustworthiness of a telehealth model for standardized clinical evaluations of swallowing in children with CP, by comparing remote evaluations to in-person assessments

Prospective Cohort Study

Observation and evaluation conducted for three days in a row during lunch periods

19 children

Age: Mean age of 11.6 years (range: 6.9–17.5 years)

Gender: 12 males and 7 females

DSS, DMSS

Significant agreement was observed between in-person and asynchronous online assessments by the same evaluator for five out of the seven DDS Part 2 variables

The weighted kappa coefficient (KW) was used to evaluate the effect size, with values ranging from 0 to 1, showing the level of agreement between assessments. Intra-rater agreement among the same raters was high to very high (KW = 0.64–1), whereas inter-rater agreement among different evaluators showed high agreement levels (KW = 0.62–0.86)

Araújo et al. 2013 [111]

To evaluate the nutritional health of children with CP, we will compare CP-specific growth charts with general growth charts and investigate how growth measurements are related to digestive issues like dysphagia, constipation, and respiratory infections

Cross Sectional Study

Data was gathered from individuals who were hospitalized at a rehab facility between March 2001 and March 2007

187 individuals

Age: Mean age of 5.6 years (± 3.5 years)

Gender: 58% were male

Anthropometric data (weight, height), assessment of dysphagia, constipation, and recurrent respiratory infections

The research discovered a notable difference in growth curves between CP and general pediatric patients, showing that standard curves tend to overestimate malnutrition in CP individuals. Furthermore, the majority of people with dysphagia, respiratory infections, and constipation had weights below the 50th percentile, showing a weak association between CP-specific and general growth standards

The effect size and statistical analysis were assessed mainly using descriptive statistics and inferential tests, such as the chi-squared test and the Kruskal–Wallis H test, to compare categorical variables. The weighted kappa coefficient was used to evaluate the consistency of agreement among various reference growth curves, with a significance level of 5% being established. The research discovered a significant occurrence of malnutrition and weight disparities below the 50th percentile in both the CP and CDC growth charts, emphasizing substantial variations in the gathered anthropometric information

Alaçam et al. 2020 [112]

To assess the presence of OFD in Turkish children with CP using the NOT-S and to contrast results with those of a healthy control group

Cross Sectional Study

August 2017 to September 2017

84 children in total (42 with CP and 42 healthy controls)

Age: Children aged 3–16 years

Gender: both groups included 20 boys and 22 girls each

NOT-S

Children diagnosed with CP showed higher scores in NOT-S interviews and clinical examination, which pointed to more frequent OFD in comparison to healthy individuals. The majority of dysfunctions were found in the areas of facial expression (55.9%), chewing/swallowing (52.4%), and sensory function (47.6%)

The effect size was calculated by comparing the NOT-S screening test scores between children with CP and healthy controls using the Mann–Whitney U test for data that is not normally distributed. The findings showed a notable increase in the total NOT-S score among the CP group (p < 0.001), suggesting a prominent presence of orofacial dysfunction

Costa et al. 2021 [113]

To evaluate how common OD, malnutrition, dehydration, and oral health issues are among students at a special needs school with severe neurological disabilities including CP

Cross Sectional Study

February 1, 2019, to May 30, 2019

33 students

Age: Mean age of 13.3 years

Gender: 36.4% female

GMFCS, V-VST, EDACS, OHIS, evaluation of nutrition and hydration through measuring body size, electrical impedance, and food intake documentation

Every student diagnosed with OD demonstrated compromised safety while swallowing, with 90.6% exhibiting this issue. Additionally, 68.7% were categorized as levels II-III of EDACS, and 31.3% needed PEG feeding. Furthermore, 89.3% experienced chronic malnutrition, 21.4% were acutely malnourished, 70% had dehydration at a cellular level, and 83.9% showed signs of inadequate oral health

Effect sizes were computed in this study to gauge the size of observed effects in different clinical and functional evaluations, including GMFCS levels, swallowing function, and masticatory capacity. A statistical analysis was carried out using confidence intervals, p-values, and reliability metrics, such as the kappa value, to evaluate differences and relationships between important variables

Goh et al. 2018 [114]

To explore how different classification systems evaluating the seriousness of OD and communication function relate to other functional profiles in children with CP

Cross Sectional Study

From March 2016 to February 2017

151 children with CP

Age: Mean age of 6.11 years (SD 3.42, range 3–18 years)

Gender: non Specificated

EDACS, FOIS, SFS, FILS, CFCS, VSS, PEDI, GMFCS, MACS

15.2% of children were found to have high levels of dysphagia (EDACS level III-V). There were significant correlations between EDACS and dysphagia scales, as well as with MACS, CFCS, and VSS. Inadequate performance in EDACS correlated with deficiencies in gross motor skills and communication abilities

Effect sizes were calculated using Spearman correlation coefficients, with associations classified as very strong (≥ 0.80), strong (0.80–0.60), moderate (0.60–0.40), weak (0.40–0.20), and very weak (≪ 0.20). For all tests, a significance level of p < 0.05 was utilized, categorizing functional measures into two groups (good and poor functioning) for regression examinations

Sellers et al. 2014 [115]

To create an accurate system for categorizing eating and drinking skills in individuals with CP and assess its consistency

Methodology quality study

Not Specificated

The research included 56 individuals in the nominal groups and 95 individuals in the Delphi survey, comprising a total of 100 children assessed by SaLTs and 48 children assessed by both SaLTs and parents

Age: from 4 to 22 years

Gender: not Specificated

EDACS

The findings showed that the EDACS is a dependable and accurate method for categorizing how individuals with CP eat and drink. The level of complete agreement among SaLTs was 78%, while the agreement between SaLTs and parents was 58%. Disagreements were usually minimal, which demonstrates the classification system's reliability for both clinical and research purposes

Kappa coefficients and intraclass correlation coefficients were utilized in the research to assess inter-rater reliability for the EDACS classifications. The kappa values showed substantial agreement (0.72) between SaLTs and moderate agreement (0.45) between SaLTs and parents. Intraclass correlation coefficients indicated high consistency, with 0.93 between SaLT pairs and 0.86 between SaLTs and parents

Bell et al. 2019 [116]

To create and confirm a screening instrument for identifying feeding/swallowing issues and/or malnutrition in children diagnosed with CP

Cross Sectional Study

Between February 2017 and March 2018

89 children with CP

Age: Median age of 6 years (range 4 to 8 years, 11 months)

Gender: 63 males and 26 females

EDACS, DDS, SGNA, VFSS

The ultimate 4-item screening tool showed great sensitivity and specificity, correctly detecting 81% of children with feeding/swallowing issues and 72% with undernutrition. It effectively identified every instance of extreme malnutrition and children categorized as EDACS level IV or V

The effect size in this study was calculated by determining the best diagnostic properties of each questionnaire item for assessing feeding and nutritional difficulties, and choosing those with the highest sensitivity and specificity. Statistical analysis included summarizing data using mean, standard deviation, frequency, and percentage, as well as conducting chi-square tests for associations

Parrott et al. 1992 [117]

To determine if the EDAT is as effective as a thorough clinical evaluation by a team of different specialists, in assessing feeding issues in children with CP

Comparative Study

The EDAT assessment takes 15–20 min for each child and is conducted in a setting familiar to them

18 children

Age: 3 years, 7 months to 15 years, with a mean of 7 years, 8 months

Gender: not Specificated

EDAT

EDAT demonstrated high agreement (minimum 78%) with clinical evaluations for assessing the designated feeding abilities. EDAT was found to be a successful, non-invasive method for detecting feeding difficulties in different skills that were evaluated

The effect sizes of feeding skills, such as anticipation, intraoral sensory perception, oral-motor efficiency, and pharyngeal triggering, was calculated by comparing each child's results to norms of the same age

Bykova et al. 2023 [118]

To assess how well the EDACS can predict aspiration risk in children with CP, by comparing it to the PEDI-EAT-10. Another objective is to explore how aspiration and non-aspiration groups are related based on EDACS and PEDI-EAT-10 classifications

Prospective Study

Not Specificated

131 children

Age: Median age of 4.4 years

Gender: 77 males and 54 females

EDACS and PEDI-EAT-10

The EDACS demonstrated good accuracy in detecting aspiration risk in children with CP, with 78% sensitivity and 92% specificity based on the PEDI-EAT-10 as a comparison. It is advised to use both EDACS and PEDI-EAT-10 together to help determine if further swallowing studies are needed

Effect size analysis demonstrated the effectiveness of EDACS in detecting risk of aspiration, boasting a high specificity of 92% and sensitivity of 78%, yielding an area under the curve of 0.892 on the receiver operating characteristic curve

Su et al. 2016 [119]

To assess how well the MASA predicts VFSS outcomes in children with CP and suspected aspiration

Observational Study

Not Specificated

16 children

Age: from 6 to 19 years

Gender: 5 girls and 11 boys

MASA and FDS

There was no significant difference in MASA scores between those who aspirate and those who do not, or between silent and overt aspirators. Nevertheless, MASA demonstrated predictive capability for oral dysfunction but not for pharyngeal function in VFSS

The effect size analysis showed a significant relationship between the MASA and FDS scores, with a strong negative correlation found for the oral phase subtotal FDS scores as indicated by the Spearman correlation coefficient (rs = −0.713, p < 0.05)