Respiratory System Impairments in Children with Cerebral Palsy: Outpatient Surveillance, Diagnosis, and Treatment

Abstract

Introduction: Cerebral palsy is the most common physical disability of childhood. Respiratory problems are the main causes of morbidity and mortality in cerebral palsy. Methods: The study is characterized by a scoping review. The search for articles was carried out in August 2021 in the PubMed, Medline, SciELO, LILACs and Google Schoolar databases, with the keywords "cerebral palsy” and "respiratory". Results: Overall, 1037 articles were found, 10 duplicates were removed and 167 were pre-selected after the analysis of titles and abstracts. Then, 90 were excluded due to lack of appropriateness after reading the full-texts, thus yielding a total of 77 studies. Discussion: Risk of respiratory disease should be screened at least every 12 months based on the following criteria: a hospital admission for respiratory illness in the past 12 months; a Gross Motor Function Classification System level V; a Eating and Drinking Ability Classification System level III–V. The screening aims to lead to early diagnosis and treatment, and consists in actively evaluate the risk factors for emergency department visits and hospital admissions. A Gross Motor Function Classification System level V is the strongest predictor, but dysphagia and seizures are the strongest potentially modifiable factors. Aspiration pneumonia is the main cause of death. The main risk for aspiration are dysphagia; uncontrolled seizures; gastroesophageal reflux disease; and drooling. Other comorbidities should also be actively screened: undernutrition; tone disorders; skeletal malalignment; upper respiratory obstruction; airway clearence impairment; and restrictive lung disease. Conclusion: Respiratory impairments in CP results from a complex multifactorial process influenced by several interrelated pathophysiological factors, directly and indirectly influenced by other common comorbidities in CP. Active and early surveillance, diagnosis and treatment, involving multiple medical specialties and rehabilitation professionals is essential for success in improving the quality of life and reducing morbidity and mortality of these patients.

Multisystem compensations and consequences in spastic quadriplegic cerebral palsy children

“…Oropharyngeal dysphagia and gastroesophageal reflux may promote aspiration ( 38 ). Scoliosis is also a risk factor, as a deformed thoracic cage causes reduced lung volume and lung compliance, a reduced force of the respiratory muscles, and increased stiffness of the chest wall ( 40 , 43 ). Furthermore, individuals with more severe gross motor function impairment are known to be almost always in a recumbent position, and only sit up to take meals and immediately get back to the lying position ( 44 ).…”