DYSPHAGIA IN PATIENTS WITH SPASTIC TETRAPLEGIA AND MENTAL RETARDATION

Abstract

Spastic tetraplegia (TPL) is considered to be a particular form of cerebral palsy. It is characterised by its association with severe mental retardation, serious epileptic pathology, visual defects, orthopaedic deformities and pseudobulbar paralysis. The latter condition leads to problems in feeding and breathing in 80% of patients with TPL thus compromising day-to-day primary care. Eighty-nine patients aged from 2 years to 45 years (mean age 22) with TPL and severe mental retardation were investigated with a videofluoroscopic examination. Episodes of pneumonia or bronchitis, or the presence of bronchial secretions characterise the clinical history of the majority of these patients who had feeding difficulties. False tracheal passageways (laryngeal aspiration) by nature silent, were documented in 71% of subjects. In particular, the extent of the bronchographical image, present in 50% of patients is only very accentuated in 12% of patients. It can be seen from this that false tracheal passageways, however frequent in these patients, do not necessarily cause serious problems in connection with the respiratory airways. A further cause of respiratory problems must also be attributed to the presence of gastroesophageal refluxes, found in at least 36% of the patients who were examined.