Turkish Journal of Physical Medicine and Rehabilitation 2005 , Vol 51 , Num 4
Gastrointestinal System and Feeding Problems in Patients with Cerebral Palsy
Gülten Erkin 1 ,Sabite Kacar 2
1 Ankara Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi, Ankara
2 Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği, Ankara

Gastrointestinal system and feeding dysfunction is common among patients with moderate to severe cerebral palsy (CP) and is associated with poor health and nutritional status. Swallowing disorders, gastroesophageal reflux, constipation are chronic problems in patients with cerebral palsy. For those patients, feeding dysfunction is often the result of interacting variables, including dysfunctional oral-motor control (hypotonia, weak suck, delayed or absent tongue lateralization, persistent tongue thrust, poor lip closure), abnormal neurologic maturation (uncoordinated swallowing mechanism, tonic bite, hyperactive gag reflexes) and poor seating posture during feeding due to an unstable trunk. Communication difficulties may interfere with request for food, expressions of hunger, or indications of food preference. Increased intra-abdominal pressure related to spasticity of the abdominal musculature or constipation may be sufficient to overcome the barrier posed by the lower esophageal sphincter, resulting in gastroesophageal reflux disease (GERD). Gastroesophageal reflux also may be a result of the enteric nervous system being impaired in some way in individuals who have cerebral palsy. Delayed gastric emptying increases the likelihood of GERD. A multidisciplinary approach, with input from neurologists, physiatrist, gastroenterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these patients and caregivers. 

Keywords : Cerebral palsy, gastrointestinal system problems, feeding dysfunctio