Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy

Nutrients. 2021 Jul 14;13(7):2413. doi: 10.3390/nu13072413.


Background: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS.

Methods: A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified).

Results: A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH.

Conclusion: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Keywords: cerebral palsy; dehydration; dietary intakes; dysphagia; feeding difficulties; malnutrition; neurological disability; oral health; swallowing disorders.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adolescent Development
  • Adolescent Nutritional Physiological Phenomena
  • Age Factors
  • Cerebral Palsy / diagnosis*
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / physiopathology
  • Cerebral Palsy / therapy
  • Child
  • Child Development
  • Cross-Sectional Studies
  • Deglutition Disorders / diagnosis*
  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / physiopathology
  • Deglutition Disorders / therapy
  • Deglutition*
  • Disabled Children*
  • Feeding Behavior
  • Female
  • Humans
  • Male
  • Malnutrition / diagnosis*
  • Malnutrition / epidemiology
  • Malnutrition / physiopathology
  • Malnutrition / therapy
  • Motor Skills
  • Nutritional Status*
  • Oral Hygiene*
  • Organism Hydration Status*
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Spain / epidemiology