When we give advice on assessment and maintenance of hydration, we are usually mindful of the barriers to maintenance of good hydration status. However, it is easy to forget that some individuals face specific challenges. Some individuals with neurological or muscle damage, including those with cerebral palsy (CP), have a range of disorders that are may be accompanied by impaired coordination of movements, and this may affect oral motor performance of mastication and swallowing as well as of speech. Previous studies have shown that children with CP may have impaired hydration status.
The authors of the present paper reasoned that this could be due either to a low amount of liquid offered to these individuals, or to compromised oral motor performance that may hamper the liquid diet intake. They further reasoned that if hypohydration status was due to insufficient fluid being offered by their caregivers, then poor nutritional status would also be likely. They recruited 43 CP individuals aged 11–19 y: 21 were classifies as subfunctional using the Oral Motor Assessment Scale, and the other 22 were classified as functional. Hydration status was assessed by salivary markers (flow rate and osmolality) and blood samples were collected to evaluate complete blood count, total protein, albumin⁄globulin ratio and transferrin levels as markers of nutritional status.
The subfunctional CP group had a lower salivary flow rate (P < 0.01) and higher salivary osmolality (P < 0.001) than the functional group. Blood markers of nutritional status were all within the normal range. The authors concluded that cerebral palsy individuals appear to present impaired adequate hydration due to compromised oral motor performance. We should be mindful when assessing any group who may have difficulty in eating and drinking that one possible outcome may be an impaired hydration status. Assessment of markers of nutritional status may not give any indication of hydration status in some of these groups, and hydration status should be assessed separately.
Abstract [button text=”View at PubMed” url=”http://www.ncbi.nlm.nih.gov/pubmed/21906174″ target=”_blank” color=”blue”][/button]
Previous studies reported alterations in salivary parameters in cerebral palsy (CP) individuals; however, none of these considered oral motor performance as possibly responsible for these conditions. The aim of this study was to investigate the influence of oral motor performance on the nutritional status and salivary parameters in individuals with CP.
Forty-three individuals aged 11-19 years-old, with spastic CP were included in this study. Oral motor performance was evaluated using the Oral Motor Assessment Scale, which classified the individuals into two groups: subfunctional or functional. Unstimulated saliva was collected and the flow rate was calculated (ml/min). Salivary osmolality was measured using a freezing point depression osmometer. Blood samples were collected to evaluate complete blood count, total protein, albumin/globulin ratio and transferrin levels.
The subfunctional (n = 21) and the functional group (n = 22) did not differ regarding sex (P = 0.193), however the functional group was older (P = 0.023) and had a higher mean BMI (P < 0.001). The subfunctional CP group presented a reduction in salivary flow rate (36.4%) (P < 0.01) and an increase in salivary osmolality (35.5%) (P < 0.001) compared to the functional group. Slightly lower values for red blood cells (millions/mm(3) ) (P < 0.001), hemoglobin (g/dl) (P < 0.009), hematocrit (%) (P = 0.001), number of platelets (N/mm(3) ), total protein (g/dl) and albumin/globulin ratio (P = 0.003 and P = 0.036, respectively) were determined for the subfunctional group, but within the normal range of normality.
Cerebral palsy individuals appear to present impaired adequate hydration due to compromised oral motor performance.