Day-to-Day Variability of Clinical Feeding and Swallowing Performance in School-Age Self-Feeding Children With Cerebral Palsy

Georgia A. Malandraki*, Andrew M. Gordon, Çagla Kantarcigil, Bruce A. Craig, Yumin Zhang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: We aimed to examine the day-to-day variability of feeding and swallowing performance and mealtime duration in school-age self-feeding children with spastic cerebral palsy (SCP) across 15 days. Method: Thirteen children with SCP (ages 5;10 [years;months]–17;6) partici-pated. Children were divided into unilateral (UCP, n = 6) and bilateral (BCP, n = 7) SCP groups. Feeding/swallowing assessments using the Dysphagia Disorder Survey (DDS) were conducted and total mealtime durations (TMDs) were calcu-lated for all days. DDS Part 1 (factors related to feeding) and DDS Part 2 (signs of oropharyngeal difficulties) components were rated. Mixed-effects models were used to compare group means and estimate between-and within-subject variances in each group. Likelihood ratio tests were used to determine best covariance structure and compare variance types across groups. Results: Within-subject variance for all three variables, DDS Part 1, 2, and TMD, across days was larger in the BCP group than the UCP group (Part 1: p = .0036, Part 2: p = .0002, and TMD: p = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (p = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: p = .0160; Part 2: p = .0141) and shorter TMD (p = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (p < .0001). Conclusion: These preliminary results emphasize the need to account for day-to-day variability when evaluating swallowing especially in children with BCP and provide preliminary ranges of performance that could be useful for clinical prognosis and future treatment research. Supplemental Material:

Original languageEnglish (US)
Pages (from-to)190-200
Number of pages11
JournalAmerican journal of speech-language pathology
Issue number1
StatePublished - Jan 2023

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Speech and Hearing
  • Otorhinolaryngology
  • Linguistics and Language


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