Background: Feeding deficits worsen with age in Duchenne Muscular Dystrophy (DMD). The Eating Assessment Tool-10 (EAT-10) is self-administered and scored by adding the 0–4 ratings for the 10 items, with higher scores indicating greater swallowing difficulty and a score of >3 suggesting dysphagia. Little is known regarding how upper limb function measured by the Performance Upper Limb 2.0 (PUL) and pulmonary function, use of noninvasive ventilation (NIPPV), relates to feeding difficulties, measured by EAT-10. This study further explores the relationship between the three in DMD.
Methods: A retrospective cohort study was conducted over a 5‑year period in a single institution’s Adult Muscle Clinic. Participants were included if they had at least two multidisciplinary clinic visits documenting BMI, PUL 2.0, and EAT‑10 scores. Patients were stratified into higher-(>3) and lower-functioning (1-2) groups based on their PUL 2.0 entry scores.
Results: Forty-eight patients were included with 67% in the lower functioning group. EAT-10 scores increased over time at that same rate in both PUL groups. Increases in EAT-10 scores did not correlate with PUL total score. There was only a significant correlation between EAT-10 Questions 4 (swallowing solids) and PUL total score. Three questions (4, 5 (difficulty with pills), and 8 (food sticks in throat)) on EAT-10 correlated with vital capacity of < one liter. Initial PUL total scores were significantly lower for patients requiring NIPPV compared to those not requiring NIPPV. There was no significant difference in EAT-10 scores based on ventilatory status.
Discussion: Dysphagia symptoms were seen to increase over time based on EAT-10 scores. The use of targeted EAT-10 questions and PUL scores in DMD may inform clinicians of better practices, such as timing of referrals to speech or feeding therapy and/or swallow study, or earlier intervention with alternative means of nutrition. This study also identified the need for more sensitive dysphagia screening in this population.