Eating And Drinking Ability Classification System Research Articles

More dietary advice may be needed to support healthy body composition for children with cerebral palsy in Aotearoa New Zealand

The available literature on the nutritional status of children with cerebral palsy (CP) worldwide has identified high rates of malnutrition, specifically undernutrition(1). However, there is a current lack of clear CP-specific dietary guidelines for children with CP across all functional levels. Standard reference tools such as estimated energy requirement (EER) and recommended dietary intake (RDI) may overestimate requirements in children with CP, especially those with reduced mobility and activity levels. Furthermore, for children with severe CP, body composition data indicates higher risks of obesity and obesity-related conditions(2). There can be a wide range of functional abilities, classifiable with tools such as the Gross Motor Function Classification System (GMFCS) and the Eating and Drinking Ability Classification System (EDACS). The majority of nutrition-related CP literature focuses on children requiring assistance for feeding (EDACS IV-V) with little information available for children with higher levels of functional independence. The aim of this study was to determine whether children with CP had received any prior dietary guidance for healthy body composition and to summarise the type of advice received. Children aged 5-12 years and their whānau were invited to participate in a study where a purpose-developed questionnaire captured their history of receiving tailored dietary recommendations for CP. Body composition was assessed via whole-body dual-energy X-ray absorptiometry scan. Nine participants (6 males, median age: 10y, n = 2 Māori), across GMFCS levels I-IV and EDACS levels I-III took part in the study. Out of 9 children, 5 (55%) indicated that their child had never received dietary advice, 3 of whom were classified as obese or overweight based on growth chart percentiles using their measures of body fat percentage, 1 was classified as underweight and 1 was within the healthy ranges. Of the 4 who had previously received advice, its nature was reported as in support of weight gain (n = 3), and weight loss (n = 1). All 4 received dietary advice from a dietitian and 1 reported some additional advice from a pediatrician and/or orthopedic doctor. Two of the children who had received dietary advice fell within a healthy body fat percentage based on the growth chart percentiles at the time of the study, while the other two were classified as overweight or obese. The results indicate the importance of developing clear dietary guidance for children with CP which may differ from that for typically developing children, particularly depending upon CP subtype diagnosis and functional level, in order to support healthy body composition.

Adenotonsillectomy for obstructive sleep apnea in children with cerebral palsy: Risks and benefits.

To determine outcomes following adenotonsillectomy for obstructive sleep apnea (OSA) and the impact of motor and swallowing impairment on respiratory complications in children with Cerebral Palsy (CP). A retrospective review of children with CP and sleep disordered breathing (SDB) who underwent adenotonsillectomy (2003-2021) was performed. Children with CP were age-matched to children without CP. Motor and swallowing function was assessed using the Gross Motor Functional Classification System (GMFCS) and the Eating and Drinking Ability Classification System (EDACS). The primary outcome was postoperative obstructive apnea-hypopnea index (OAHI). Secondary outcomes were cure rate, complications, and need for additional interventions. Ninety-seven children with CP were assessed for SDB, and 74 underwent polysomnography. Moderate or severe OSA was found in 49% (36/74). Adenotonsillectomy was performed in 30% (29/97). All children who underwent adenotonsillectomy experienced an initial reduction in OAHI (31.7/h to 2.9/h, p<0.0001). Children with CP were less likely to achieve an OAHI<1 compared with children without CP (62.5% vs 81.8%, p=0.23). Children with CP had more postoperative complications (43.5% vs. 8.7%) and greater odds of respiratory complications compared with children without CP (OR 8.9 95% CI 2.1-37.9). Children with CP and a GMFCS score of 5 and EDACS score between 3 and 5 had more respiratory complications post-adenotonsillectomy compared to those with GMFCS<5 (p=0.002) and EDACS<3 (p=0.031). Children with CP had an improved OAHI initially following adenotonsillectomy but had higher rates of post-adenotonsillectomy complications. Respiratory complications after adenotonsillectomy were more common in children with motor and swallowing impairment. Findings may provide better preoperative planning for caregivers.

Nutritional status as predictors for quality of life among caregivers of children with severe cerebral palsy.

Individuals with severe cerebral palsy (CP) often experience various health issues, including feeding difficulties, which can adversely affect their nutritional status and caregivers' quality of life, e.g., more time spent for feeding rather than own selfcare. This study aimed to determine the prevalence of poor nutritional status among individuals with severe CP and explore its role as predictors for caregivers' quality of life. This cross-sectional study was conducted in a government hospital (Cheras Rehabilitation Hospital), Community-Based Rehabilitation (CBR) Program, and Spastic Centre [non-profit organization (NGO)] in Klang Valley, Malaysia. Seventy-one participants with Gross Motor Function Classification System (GMFCS) level IV and V were recruited. Sociodemographic data, health-associated data, and anthropometric data were collected. Caregivers' quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) CP module version 3.0 which included domains such as Movement and Balance, Eating Activities, and School Activities. Most participants were males (60.6%), with 61 classified as level IV in the GMFCS classification. According to the Eating and Drinking Ability Classification System (EDACS), 59 children were at level IV. In total, 40.8% were underweight according to CP growth chart and 49.3% had mid-upper arm circumference (MUAC) readings below the 5th percentile. The lowest scores in the PedsQL CP module version 3.0 were observed in the Daily Activities (5.34±10.87), and School Activities domains (8.15±18.65). Sociodemographic and anthropometric data, including body mass index (BMI)-for-age, MUAC, body fat, triceps, and subscapular skinfold measurement, were predictors for the School Activities domain [F (11, 44)=3.981, P<0.005, R2=0.499]. Poor nutritional status in individuals with severe CP has been shown to negatively impact caregivers' quality of life. Therefore, a multidisciplinary approach involving nutritional intervention is essential to improve dietary provision and the nutritional status of children with CP.

Eating and Drinking Ability Classification System to detect aspiration risk in children with cerebral palsy: a validation study.

This prospective study has two aims. The first aim is to assess the concurrent validity of the Eating and Drinking Ability Classification System (EDACS) as a means of identifying aspiration risk in children with cerebral palsy by using the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) as the reference test. The second aim is to investigate the relationship between the aspiration and non-aspiration groups using both the EDACS and the PEDI-EAT-10. Data were collected and analyzed from the EDACS and PEDI-EAT-10 using a convenience sample of 131 children with cerebral palsy and feeding problems (77 males, 54 females; median age 4.4years [IQR 2.5years]). Risk of aspiration was identified in 118 individuals using the PEDI-EAT-10 scores of ≥ 5 points. The EDACS proved to be a valid tool in identifying aspiration risk in children who are classified in EDACS levels III-V. There was a significant correlation between the EDACS and PEDI-EAT-10 (rs = 0.597, p < 0.001). The EDACS had 78% (95% CI = 71-86%) sensitivity and 92% (95% CI = 88-97%) specificity in identifying aspiration risk a positive predictive value of 0.99, a negative predictive value of 0.32, a positive likelihood ratio of 9.75, and a negative likelihood ratio of 0.24. Conclusion: The EDACS is a useful clinical tool to identify aspiration risk in children with cerebral palsy. Children in EDACS levels III to V are at risk of aspiration. As time permits, we recommend the use of both tools, the EDACS and the PEDI-EAT-10, when making decisions regarding referral for an instrumented swallowing study. What is Known: • Approximately 50% of children with cerebral palsy have dysphagia. • The Eating and Drinking Ability Classification System (EDACS) can be used to classify eating and drinking efficiency and safety in children with cerebral palsy. What is New: • Based on ROC analysis, EDACS demonstrates sensitivity of 78% and specificity of 92% in clinical identification of aspiration risk. • The combined use of the EDACS and the Pediatric version of the Eating Assessment Tool is recommended to make decisions about referral for an instrumented swallow study.

Relationship Between Nutritional Status and Severity of Cerebral Palsy: A Multicentre Cross-Sectional Study

Nutritional problems are common in children with cerebral palsy (CP), yet the relationship between nutritional status and the severity of CP is unclear. To describe the nutritional status and characteristics of children with CP, and to explore the relationship between severity of CP and nutritional status in children. This multicentre cross-sectional study included children with CP in China. Weight and height were measured and converted to z-scores. Gross Motor Function Classification System (GMFCS), Eating and Drinking Ability Classification System (EDACS), Subjective Global Nutritional Assessment (SGNA), social life ability, and blood indicators were tested. All 1,151 participants were given oral-feeding and 50.8% of them demonstrated undernutrition. Compared with those in GMFCS or EDACS levels I-III, the odds of moderate and severe undernutrition were 2.6 and 8.9 times higher in GMFCS levels IV and V, and 4.3 and 12.6 times higher in EDACS levels IV and V, respectively. Except for serum 25-hydroxyvitamin D, no significant differences were found in blood indicators among normal, undernourished and overnourished groups. Degrees of undernutrition in children with CP are correlated with the severity of eating and drinking dysfunction and with gross motor impairment. Blood indicators may not reflect nutritional status in children with CP.

Relationship Between Functional Classification Systems in Children With Cerebral Palsy

Objective: Cerebral palsy refers to a group of postural and movement disorders that limit movements and can be related to a non-progressive disorder in the developing brain. The international classification of disability emphasizes the child's functional abilities and routine performance. Some classification tools have been developed to describe and evaluate child's functions in daily activities such as walking, manipulating objects, and everyday communication. The present study aimed to investigate the relationship between classification systems (gross motor function, manual ability, communication function, and eating and drinking ability) in children with cerebral palsy. Materials &amp; Methods: This study was performed by cross-sectional correlation method and of descriptive analytical type. Children with cerebral palsy aged 12-144 months were recruited by convenience sampling from patients referred to clinics and public and private rehabilitation centers in Tehran and Arak cities, Iran, in 2019-2020. After completing the demographic information questionnaire by the child's primary caregiver, the gross motor function classification system (GMFCS), manual ability classification system (MACS), Communication function classification system (CFCS), and eating and drinking ability classification system (EDACS) were completed by a child therapist. Results: In the present study, 154 children with a Mean±SD age of 49.45±32.22 months participated. also, 87 children (56.5%) were boys, and 67(43.5%) were girls. According to GMFCS, the highest percentage distributions at levels II and IV were 31.2% and 26%, respectively. In other words, more than 57% of children were distributed in these two levels. According to MACS, the distributions of the highest percentages at levels II, III, and IV were 28.6%, 22.1%, and 20.8%, respectively. In other words, more than 70% of the children were distributed in these three levels. According to EDACS, the distribution of almost all levels was equal except the V level, with 4.3% having the lowest percentage. According to CFCS, the distribution of the highest percentage at levels V and IV was 23.5%. In examining the relationship between functional systems, significant relationships were observed in all cases: MACS and GMFCS, r=0.672; CFCS and GMFCS, r=0.581; EADCS and GMFCS, r=0.593; CFCS and MACS, r=0.555; EADCS and MACS, r=664; EADCS and CFCS, r=0. 547 (P&lt;0.01). Conclusion: It seems that children with more motor function limitations show more limitations in other performance classification systems, too. Of course, the number of studies in this field is limited and needs further investigation.

THE RELATIONSHIP BETWEEN MOTOR LEVELS OF CHILDREN WITH CEREBRAL PALSY AND THEIR EATING AND DRINKING SKILLS AND DIETARY INTAKES

Aim: Cerebral Palsy (CP) is defined as a musculoskeletal system disorder characterized by a non-progressive but the most important symptom of the disease is loss of motor function. This study was conducted to evaluate the relationship of eating and drinking skills with the intake of energy and some nutrients according to gross motor skills of children with CP. &#x0D; &#x0D; Study Design: The research was conducted on 74 volunteer children (52.7% male; 8.7±3.32 years) and their parents. For the evaluation of the nutritional status of the children, a 3-day food intake record and Eating and Drinking Ability Classification System (EDACS) was used. &#x0D; &#x0D; Results: In all age groups, the daily energy, carbohydrate and fiber intake of children in the GMFCS IV-V group is less than those in the GMFCS I-II-III group. There was a statistically significant positive strong relationship between GMFCS and EDACS, however there was a low negative correlation between GMFCS and average daily carbohydrate intakes. &#x0D; &#x0D; Conclusions: Results are supported by this study and EDACS can be an easy and practical method in classifying children's eating and drinking skills in order to create a common language in the literature.

Comparative Efficacy of Botulinum Toxin in Salivary Glands vs. Oromotor Therapy in the Management of Sialorrhea in Cerebral Palsy Impact on Sleep Quality.

AimsThe aim of this study was to compare the effects of intraglandular abobotuliniumtoxinA application and oromotor therapy in the management of sialorrhea in patients with cerebral palsy and its effect on sleep quality.MethodsA comparative study (n = 134), mean age 7.1 years (± 3.9 years) was performed in pediatric patients, between the efficacy of abobotuliniumtoxinA in salivary glands and oromotor therapy (JT), with a control group receiving exclusive oromotor therapy (EOMT). Demographic variables, as well as Gross Motor Function Classification System (GMFCS), Drooling Severity and Frequency Scale (DSFS), Sleep Disturbance Scale for Children (SDSC) and Eating and Drinking Ability Classification System (EDACS) were analyzed in 134 patients considering two measurements 6 months apart. Statistical analysis was developed between both groups.ResultsThe greatest improvement in safety and efficacy of swallowing were those in the JT group with initial levels of EDACS IV and V. Both therapies result in favorable changes of all subscales means of SDSC, with joint therapy showing the greater benefit (p = 0.003) over EOMT (p = 0.06), especially for Sleep Breathing Disorders and Disorders of initiating and maintaining sleep (p < 0.01 vs. p = 0.07). No major adverse effects were found, only those expected from the application of the toxin, such as pain, mild, and transient local inflammation.InterpretationA correlation between frequency and intensity of sialorrhea, with the frequency of sleep disorders and dysphagia was found. Conventional EOMT proved to be useful, improving the safety and efficacy of swallowing, sialorrhea and sleep disorder, however it can be enhanced with the application of abobotuliniumtoxinA.

Eating and drinking ability and nutritional status in adults with cerebral palsy.

AimTo describe eating and drinking ability in adults with cerebral palsy (CP) relative to sex, age, subtype, and severity of gross motor and hand function and nutritional status.MethodThis was a cross‐sectional study based on data of 2035 adults with CP, median age 26 years (range 18–78 years). The Eating and Drinking Ability Classification System (EDACS), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS) were used in addition to subtype, body weight, height, body mass index (BMI), skin fold thickness, and gastrostomy. Linear regression models were used to estimate associations between body weight and the other variables.ResultsMore than half of the adults (52.5%) eat and drink safely and 32.4% have dysphagia with limitations to eating and drinking safety. Weight, height, and BMI decreased with increasing EDACS levels. In EDACS level V, 86% had a gastrostomy, 23.4% in EDACS levels III to V were underweight, whereas 42.3% in EDACS levels I to II had a BMI over 25, indicating overweight or obesity. Increasing EDACS levels and need of support during meals were associated with lower body weight.InterpretationAdults with CP should be routinely screened and treated for dysphagia to avoid nutritional complications. Being dependent on others during mealtimes is a risk factor for low body weight.

Quality of Life and Its Association with Level of Functioning in Young Children with Cerebral Palsy.

Quality of life (QOL) in older children, adolescents, and adults with cerebral palsy (CP) is significantly impaired. Level of functioning is one of the probable determinants of impairment in QOL. However, such studies in young children with CP are scarce in the literature. Parents of all consecutive children aged between 1 and 4 years with a confirmed diagnosis of CP completed the Infant Toddler Quality of Life (ITQOL) questionnaire. Total and individual subdomain scores of ITQOL were examined for association with the level of functioning measured by Gross Motor Function Classification System-Expanded & Revised (GMFCS E&R), Mini-Manual Ability Classification System (Mini-MACS), Communication Function Classification System (CFCS), and Eating and Drinking Ability Classification System (EDACS), with/without adjustment to probable confounding variables. One hundred three children with CP (74 boys, mean age: 2.6 ± 0.9 years, 49% lower and 39% middle socioeconomic status) were enrolled. All four scales (GMFCS, Mini-MACS, CFCS, and EDACS) describing levels of functioning had significant association with ITQOL total score (β= -0.19, -0.15, -0.11, -0.09, respectively), which persisted even after adjusting for confounding variables (p = 0.004, 0.01, 0.03, and 0.046, respectively). Among the confounding variables, uncontrolled seizures, significant vision impairment, lower socioeconomic status, type of CP, and institution of comprehensive rehabilitation measures for ≥6 months had a significant association with ITQOL score (p = 0.03, 0.04, 0.02, 0.02, and 0.01, respectively). Level of functioning as measured by GMFCS, Mini-MACS, EDACS, and CFCS is independent predictors of impairment in QOL in young children with CP.

The effects of the functional levels of children with cerebral palsy on the quality of life of caregivers

Background/Aim: Psychological status and quality of life of caregivers with children with cerebral palsy are lower than the population. The functional status of the child is one of the factors affecting the caregiver's quality of life. However, the relationship between gross motor and hand functions, communication, oromotor skills, oropharyngeal functions and the caregiver's quality of life remains unclear. The aim of the study is to examine the effects of the functional levels of children with cerebral palsy on the quality of life of their caregivers. Methods: Two hundred and seventeen children with cerebral palsy and their caregivers were included in this cross-sectional study. Inclusion criteria were; (i) Children aged 0-18, diagnosed with cerebral palsy (CP), followed in the pediatric rehabilitation outpatient clinic of the university, (ii) individuals who care for children with CP and volunteer to participate in the study, (iii) individuals who have a literacy level of understanding the purpose of the study and the forms to be filled in. Children's demographic information (age, gender), cerebral palsy types were recorded and detailed functional evaluation was made. The identity of the caregiver was recorded and quality of life was evaluated with the Short Form-12 (SF-12). Functional classification of the children were evaluated with Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Ability Classification System (EDACS). The relationship between the child's functional level in each scale and the caregiver's SF-12 score was investigated. Results: Of the 117 children with a mean age of 7.62 (4.08), 52.5% were male (n=114) and 47.5% (n=103) female. According to CP types, 89.3% were spastic (n=191) (78.1% of them bilateral, 21.9% unilateral), 5.6% ataxic (n=12) and 5.1% dyskinetic (n=11). Median SF-12 PCS and MCS were 51.69 (25.76-62.92) and 55.36 (26.64-60.69), respectively. When the SF-12 scores were evaluated according to the functional levels of the children, both SF-12 PCS and SF-12 MCS scores differed significantly according to the GMFCS, MACS, CFCS and EDACS levels (P

Nutritional status and prevalence of dysphagia in cerebral palsy: usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System

Introduction and objectivesDigestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. Material and methodsWe conducted a descriptive, cross-sectional, open-label study of out-patients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). ResultsOur sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. ConclusionsThis is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients’ neurological status.

Development of social participation classification system for children with cerebral palsy.

Background: Some classification systems have been designed to measure domains of function of children with cerebral palsy (CP), including the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Eating and Drinking Ability Classification System (EDACS), and Communication Function Classification System (CFCS). The purpose of the present study was to develop a Social Participation Classification System for children with cerebral palsy (SPCS) with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) and assess its reliability. Methods: In this cross-sectional analytic study, 274 parents of 6 to 12 year-old children with CP were asked to complete the questionnaires (CPAS-P, MACS, GMFCS, and CFCS) for their child. The expert review consisting of 10 occupational therapists with at least 5 years of experience working with children with CP was asked to rate the level of social participation with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) of these children according to the variables (intelligent quotient [IQ], CP type, walking ability, GMFCS, CFCS, and MACS). Then, these data were analyzed using the polynomial discriminant function. After performing discriminant function, a flowchart model was determined for the level of children's social participation. To calculate the reliability of the model, 53 new samples were collected and their level of social participation was determined based on the flowchart model. The experts were then asked to determine the social participation level of these 53 new samples in the same manner as before, and then to calculate reliability, intraclass correlation coefficient (ICC) and Cronbach alpha. The SPSS Version 22 (SPSS Inc) and discriminant function model analysis was used for statistical analysis. Results: Based on the discriminant function model, the results between the predicted classification and expert review are over 88% consistent. The ICC and Cronbach alpha values were 0.952 and 0.975, respectively, with absolute agreement and multivariate mixed effects. Conclusion: Based on the results of the present study, the SPCS was developed in 5 levels (very low, low, moderate, high, and very high) and to determine it, the GMFCS, MACS, and CFCS scores, CP type, and IQ level should be calculated.

Chronic pain among children with cerebral palsy attending a Ugandan tertiary hospital: a cross-sectional study

BackgroundChildren with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments. Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated.MethodsA cross-sectional study of children with CP, aged 2–12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale.ResultsA total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were co- morbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFCS level IV & V, CFCS level IV & V, EDACS level IV & V, female children, and caretaker aged more than 30 years.ConclusionsTwo-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.

Dysphagia limit in children with cerebral palsy aged 4 to 12 years.

AimTo assess the dysphagia limit in children with cerebral palsy (CP) according to Eating and Drinking Ability Classification System (EDACS) level, sex, and age compared to typically developing children.MethodSeventy‐seven children with CP (54 males, 23 females; mean age 7y 6mo, SD 2y 2mo, age range 4–12y) were assessed with the Maximum Volume Water Swallow Test. Median dysphagia limit in the CP group was compared with data of typically developing children.ResultsThe dysphagia limit of children with CP differed significantly (p<0.001) from typically developing children. The latter showed a threefold higher median dysphagia limit (22mL) compared to children with CP in EDACS level I (7mL). The higher the EDACS level, the lower the dysphagia limit in children with CP. EDACS level explained 55% of the variance in the dysphagia limit of the CP group.InterpretationWhere children with CP in EDACS levels IV and V showed that their capacity met the level of their performance, children in EDACS level I had the ability to perform a maximum capacity task, but still had a threefold lower median dysphagia limit than typically developing children. Establishment of the dysphagia limit should be part of general swallowing assessment in children with CP.

Reliability and validity of the Eating and Drinking Ability Classification System (EDACS) for children with cerebral palsy in Taiwan

Purpose The study was to assess the inter- and intra-rater reliability, construct validity and utility of the Eating and Drinking Ability Classification System (EDACS). Methods EDACS was translated into in Taiwan using an interactive process. Agreement between health professionals and teachers when using EDACS was assessed using Kappa and the Intraclass Correlation Co-efficient. Results Paired ratings of 4 (13%) health professionals (either speech or occupational therapists) and 26 (87%) teachers were obtained for 53 children with CP aged 6.7 years (SD 4.1 years), who worked in six education institutions. The raters used EDACS independently to classify children’s eating and drinking ability and re-classified children’s eating and drinking abilities after one month. Pairs of raters showed substantial agreement for the EDACS level at the first assessment (k = 0.75; absolute agreement = 81%; ICC = 0.94) and the second assessment (k = 0.70; absolute agreement = 77%; ICC = 0.95). The intra-rater reliability of EDACS level showed almost perfect agreement at rater 1 (k = 0.87; absolute agreement = 91%) and rater 2 (k = 0.87; absolute agreement = 91%). Conclusions We conclude that the Chinese version of EDACS is valid and reliable to be easily used by health professionals and teachers to classify functional eating and drinking abilities in children with cerebral palsy. IMPLICATIONS FOR REHABILITATION The Chinese version of EDACS is valid and reliable to be easily used. EDACS can be used by health professionals and teachers to classify functional eating and drinking abilities in children with cerebral palsy. The EDACS is analogous to other functional classification systems (i.e., GMFCS, MACS and CFCS) and specifically represents eating and drinking ability.

The Dyskinetic Cerebral Palsy Functional Impact Scale: development and validation of a new tool.

To outline the development and examine the content and construct validity of a new tool, the Dyskinetic Cerebral Palsy Functional Impact Scale (D-FIS), which measures the impact of dyskinesia on everyday activities in children with cerebral palsy (CP). D-FIS content was informed by a systematic review of dyskinesia outcome measures, in collaboration with children with dyskinetic CP, parents, caregivers, and expert clinicians. The D-FIS uses parent proxy to rate impact of dyskinesia on everyday activities. Construct validity was determined by examining internal consistency; known groups validity with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), and Eating and Drinking Ability Classification System (EDACS); and convergent validity with the Barry-Albright Dystonia Scale (BADS). Fifty-seven parents of children (29 males, 28 females, mean [SD] age 11y 8mo [4y 4mo], range 2y 6mo-18y) completed the D-FIS. Correlation between D-FIS and GMFCS was r=0.86 (95% confidence interval [CI]: 0.77-0.91, p<0.001); MACS r=0.84 (95% CI: 0.73-0.90, p<0.001); CFCS r=0.80 (95% CI: 0.67-0.88, p<0.001); and EDACS r=0.78 (95% CI: 0.66-0.87). Correlation between D-FIS and BADS was r=0.77 (95% CI: 0.64-0.86, p<0.001). Cronbach's alpha was 0.96. The D-FIS demonstrates good construct validity and high internal consistency. The D-FIS will be useful for identifying priorities for intervention. It adds to the measurement tool kit for children with dyskinetic CP by addressing functional impact of dyskinetic movements and postures. What this paper adds The Dyskinetic Cerebral Palsy Functional Impact Scale (D-FIS) assesses the perceived impact of dyskinesia on daily activities in children with cerebral palsy (CP). The D-FIS demonstrates good construct validity and high internal consistency. The D-FIS is a clinically feasible, family-centred tool that fills a current gap in the dyskinetic CP assessment toolkit.

YEME VE İÇME BECERİLERİ SINIFLANDIRMA SİSTEMİNİN TÜRKÇE VERSİYONU: SEREBRAL PALSİLİ ÇOCUKLARDA DEĞERLENDİRİCİ-İÇİ GÜVENİRLİĞİ VE DİĞER FONKSİYONEL SINIFLANDIRMA SİSTEMLERİ İLE İLİŞKİSİ

Amaç: Oral motor problemler ile beslenme ve yutma problemleri serebral palsili çocuklarda en sık rastlanan problemlerden bir tanesidir. Yeme İçme Becerisi Sınıflandırma Sistemi (EDACS) serebral palsili çocuklarda yeme ve içme performansını sınıflandırmak için kullanılır. Bu çalışmanın amaçları, EDACS’ı Türkçe’ye çevirmek, değerlendirici-içi güvenirliği ve diğer fonksiyonel sınıflandırma sistemleri ile ilişkisini araştırmaktı. Yöntem: EDACS İngilizce’den Türkçe’ye çevrildi. EDACS’ın Türkçe versiyonu 125 serebral palsili çocuğa uygulandı. Değerlendirici-içi güvenirliği için Türkçe EDACS iki hafta sonra tekrar puanlandı. Çocukların fonksiyonel durumlarını belirlemek için Kaba Motor Fonksiyon Sınıflandırma Sistemi, El Becerileri Sınıflandırma Sistemi ve İletişim Fonksiyonları Sınıflandırma Sistemi seviyeleri de kaydedildi. Sonuçlar: Yaş ortalaması 7,44±3,95 yıl olan 54 kız ve 71 erkek çalışmaya katıldı. Türkçe EDACS’ın değerlendirmeci içi güvenirliği neredeyse mükemmeldi (ICC=0,972 ve Güven Aralığı=0,959-0,980, p&amp;lt;0,001). Türkçe EDACS ile Kaba Motor Fonksiyon Sınıflandırma Sistemi (r=0,769), El Becerileri Sınıflandırma Sistemi (r=0,786) ve İletişim Fonksiyonları Sınıflandırma Sistemi (r=0,824) arasında anlamlı pozitif korelasyon bulundu (p&amp;lt;0,001). Tartışma: Türkçe EDACS son derece güvenilir bir araç olarak bulundu. Serebral palsili çocukların fonksiyonel yeme ve içme becerileri, motor fonksiyon seviyeleri ve iletişim durumları ile ilişkilidir.

Functional outcomes of children with dyskinetic cerebral palsy depend on etiology and gestational age.

To elucidate the differences in etiology of dyskinetic cerebral palsy (DCP) between term-born and preterm-born children and its relationship to functional outcomes. We determined the etiology of DCP based on the clinical course and brain MRI of 163 term-born and 136 preterm-born children. Information about genetic abnormality was also collected if available. Functional outcomes were compared between the two major etiologies in each group, i.e., hypoxic ischemic encephalopathy (HIE) and bilirubin encephalopathy (BE), using four standardized classification systems, i.e., Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), and Eating and Drinking Ability Classification System (EDACS). The most common etiologies were HIE (123/163) in term-born and BE (93/136) in preterm-born children. Genetic mutations were identified in 14 of 30 term-born children with no other known etiology. GMFCS levels of the preterm children with BE were significantly poorer than those of term children with HIE (p<0.01). Both the CFCS and EDACS levels were significantly better in preterm children with BE than in term children with HIE (p<0.01). The most common etiology of DCP is different between term-born and preterm-born children, and the distribution of functional impairment is significantly influenced by etiology and gestational age. The difference should be taken into consideration to allow the provision of adequate interventions.

Reliability and Validity of the Eating and Drinking Ability Classification System in Adults with Cerebral Palsy.

The Eating and Drinking Ability Classification System (EDACS) was developed to evaluate dysphagia in children with cerebral palsy (CP). This study aimed to investigate the interrater reliability and validity of the EDACS in adults with CP. This cross-sectional study included 117 community-dwelling adults (mean age, 37.9 ± 12.5years) with a confirmed CP diagnosis. A swallowing occupational therapist (SwOT) conducted detailed interviews with participants and/or caregivers to classify the EDACS. Another SwOT and participants/caregivers evaluated the EDACS. Correlations were evaluated between the EDACS and Functional Oral Intake Scale (FOIS), Swallowing Quality of Life (SWAL-QOL), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). Interrater reliabilities between SwOTs (κ = 0.866, intraclass correlation coefficient (ICC) = 0.867), and between SwOT and participant/caregiver (κ = 0.884, ICC = 0.717) were reported. The EDACS correlated with the FOIS, SWAL-QOL, and MACS, although no significant correlation was found with the GMFCS. The EDACS of spastic-type showed better correlation than that of dyskinetic-type with the FOIS, MACS, and GMFCS. There was a significant correlation between the EDACS and the GMFCS in those aged ≤ 30years, whereas there was no correlation in those aged ≥ 30years. The EDACS is a reliable and valid tool for classifying eating and drinking ability in adults with CP. The correlation between the EDACS with gait or hand function was more prominent in individuals with spastic CP and in younger individuals. The EDACS is a valuable adjunct to comprehensive functional classification in adults with CP.