The salivagram in severe cerebral palsy and able-bodied adults

Aims: To test the hypothesis that the salivagram is frequently positive in those at high risk of aspiration but negative in individuals at low risk of aspiration lung disease. Methods: We studied 63 individuals with spastic quadriparetic cerebral palsy (CP), aged 14 months to 16 years (31 females and 32 males), and 20 able-bodied young adult volunteers, aged 19-29 years (17 female and three males) using the salivagram. Twenty millilitres of 99mTc-sulphur colloid in saline was instilled into the pharynx of each subject over 1 h. Aspiration was characterised by the appearance of activity in either lung field. Results: Aspiration was demonstrated by salivagram in 56% of children with CP (95% confidence interval 43% to 68%), compared to 0% of young adults (97.5% one-sided confidence interval 0% to 17%). The difference in frequency is highly significant (P < 0.0006). Conclusions: The salivagram is frequently positive in those at high risk of aspiration, but frequently negative in those at low risk of aspiration. It may be a useful investigation for the demonstration of aspiration.