526
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wileyonlinelibrary.com/journal/joor J Oral Rehabil. 2018;45:526–531.
© 2018 John Wiley & Sons Ltd
1 | BACKGROUND
Children with neuromuscular diseases (NMDs) are characterised
with progressive muscle weakness which could affect food manipu-
lation and swallowing function besides the most common problems
including muscular weakness, postural problems, reduced mobility
and respiratory problems.
1
Inadequate lip closure and tongue move-
ments, problems in bolus formation and prolonged oral transport
are known to be the most common problems in children with NMDs
which may affect the quality of life besides other neuromuscular
problems of this patient population. These problems are encoun-
tered primarily in Duchenne muscular dystrophy (DMD), spinal
Accepted: 26 April 2018
DOI: 10.1111/joor.12642
ORIGINAL ARTICLE
Reliability and validity of the Karaduman Chewing
Performance Scale in paediatric neuromuscular diseases:
A system for classification of chewing disorders
S. Serel Arslan | G. Aydın | İ. Alemdaroğlu | Ö. Tunca Yılmaz | A. A. Karaduman
Clinical trial number: NCT03116620
Department of Physiotherapy and
Rehabilitation, Faculty of Health
Sciences, Hacettepe University, Ankara,
Turkey
Correspondence
Selen Serel Arslan, Department of
Physiotherapy and Rehabilitation, Faculty
of Health Sciences, Hacettepe University,
Ankara, Turkey.
Email: selen.serel@hacettepe.edu.tr
Summary
Chewing disorders can be seen in children with neuromuscular diseases (NMDs),
which may cause swallowing difficulties such as choking, retching and food stuck
feeling in the throat. Due to these effects, it is important to determine chewing dis-
orders early with appropriate assessment methods to plan appropriate therapies in
NMDs. The aim of this study was to investigate reliability and validity of the
Karaduman Chewing Performance Scale (KCPS) in children with NMDs. Age, sex and
diagnosis were recorded. Children were asked to chew a standardised biscuit while
video- recording. Two physical therapists scored each video according to the KCPS.
The correlation between the KCPS scores of 2 therapists was analysed for interob-
server reliability. One therapist rescored the recordings after an interval of 2 weeks
for intra- observer reliability. The Pediatric Version of the Eating Assessment Tool
(PEDI- EAT- 10) was used for criterion- based validity. Sixty- eight children with a mean
age of 8.34 ± 3.73 (min = 2.5, max = 14.5) years were included, of which 94.1% were
male. Karaduman Chewing Performance Scale scores were found to be level 0 in 20
cases, level 1 in 35 cases, level 2 in 12 cases and level 3 in 1 case. A positive, very
strong correlation was detected between 2 therapists (r = .93, P < .001) and between
2 examinations of 1 therapist (r = .83, P < .001). A good correlation between the
KCPS and PEDI- EAT- 10 was detected (r = .62, P < .001). Chewing function, especially
food processing phase, deteriorated in children with NMDs. The KCPS could be used
as a reliable and valid instrument in determining chewing performance level for chil-
dren with NMDs.
KEYWORDS
chewing, chewing disorder, mastication, neuromuscular disease, reliability
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