Alignment of classification paradigms for communication abilities in children with cerebral palsy.

AIM: We examined three communication ability classification paradigms for children with cerebral palsy (CP): the Communication Function Classification System (CFCS), the Viking Speech Scale (VSS), and the Speech Language Profile Groups (SLPG). Questions addressed interjudge reliability, whether the VSS and the CFCS captured impairments in speech and language, and whether there were differences in speech intelligibility among levels within each classification paradigm. METHOD: Eighty children (42 males, 38 females) with a range of types and severity levels of CP participated (mean age 60mo, range 50-72mo [SD 5mo]). Two speech-language pathologists classified each child via parent-child interaction samples and previous experience with the children for the CFCS and VSS, and using quantitative speech and language assessment data for the SLPG. Intelligibility scores were obtained using standard clinical intelligibility measurement. RESULTS: Kappa values were 0.67 (95% confidence interval [CI] 0.55-0.79) for the CFCS, 0.82 (95% CI 0.72-0.92) for the VSS, and 0.95 (95% CI 0.72-0.92) for the SLPG. Descriptively, reliability within levels of each paradigm varied, with the lowest agreement occurring within the CFCS at levels II (42%), III (40%), and IV (61%). Neither the CFCS nor the VSS were sensitive to language impairments captured by the SLPG. Significant differences in speech intelligibility were found among levels for all classification paradigms. INTERPRETATION: Multiple tools are necessary to understand speech, language, and communication profiles in children with CP. Characterization of abilities at all levels of the International Classification of Functioning, Disability and Health will advance our understanding of the ways that speech, language, and communication abilities present in children with CP.

Qualitative analysis of decision making by speech-language pathologists in the design of aided visual displays.

For children with complex communication needs, augmentative and alternative communication (AAC) devices offer a functional way to communicate thoughts and feelings. Despite many significant advances in the field, effective and efficient aided communication can remain a challenge for some clients and their partners. One critical element of aided AAC intervention is systematic attention to the design of the communication display itself. A well-designed display will foster communication outcomes; a poorly designed one might have the opposite effect. Surprisingly, to our knowledge there are no studies of the strategies that clinicians actually employ when putting together a display. In this research note, we examine, on a case-by-case basis, the strategies six clinicians used when constructing display pages, as a means of highlighting potential areas that might warrant systematic research on display design.

Communication Modes and Functions in Children With Cerebral Palsy.

Purpose This study seeks to determine how speech-language impairments relate to the frequency and diversity of communication modes and functions produced by children with cerebral palsy (CP) during interactions with their mothers. Method We studied 40 children with CP (M age = 62 months) comprising three groups: those who were unable to speak and had anarthria (n = 15), those with speech motor impairment and language comprehension impairment (SMI-LCI; n = 15), and those with speech motor impairment and typical language comprehension (SMI-LCT; n = 10). Mother-child play interactions were coded for child modes and functions. Generalized linear regression models were used to examine the relationship between profile group and frequencies of communication modes and functions. Results Results indicated groups SMI-LCI and SMI-LCT had significantly higher mean frequencies of vocalizations, vocalizations + gestures, comments, initiations, and requests than the group of those who were unable to speak and had anarthria. All children used vocalizations primarily, though these vocalizations were often not understood. SMI-LCI and SMI-LCT differed on two measures: frequency of gestures and frequency of initiations. The majority of children in this sample did not have access to augmentative and alternative communication devices. Conclusion Results of this study highlight the need for parent-mediated interventions for children with CP that emphasize multimodal communication tailored to impairment profiles. Supplemental Material https://doi.org/10.23641/asha.12354704.

Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes.

OBJECTIVE: To determine whether communication at 2 years predicted communication at 4 years in children with cerebral palsy (CP); and whether the age a child first produces words imitatively predicts change in speech production. METHOD: 30 children (15 males) with CP participated and were seen 5 times at 6-month intervals between 24 and 53 months (mean age at time 1 = 26.9 months (SD 1.9)). Variables were communication classification at 24 and 53 months, age that children were first able to produce words imitatively, single-word intelligibility, and longest utterance produced. RESULTS: Communication at 24 months was highly predictive of abilities at 53 months. Speaking earlier led to faster gains in intelligibility and length of utterance and better outcomes at 53 months than speaking later. CONCLUSION: Inability to speak at 24 months indicates greater speech and language difficulty at 53 months and a strong need for early communication intervention.

Speech and language development in 2-year-old children with cerebral palsy.

OBJECTIVE: We examined early speech and language development in children who had cerebral palsy. Questions addressed whether children could be classified into early profile groups on the basis of speech and language skills and whether there were differences on selected speech and language measures among groups. METHODS: Speech and language assessments were completed on 27 children with CP who were between the ages of 24 and 30 months (mean age 27.1 months; SD 1.8). We examined several measures of expressive and receptive language, along with speech intelligibility. RESULTS: Two-step cluster analysis was used to identify homogeneous groups of children based on their performance on the seven dependent variables characterizing speech and language performance. Three groups of children identified were those not yet talking (44% of the sample); those whose talking abilities appeared to be emerging (41% of the sample); and those who were established talkers (15% of the sample). Group differences were evident on all variables except receptive language skills. CONCLUSION: 85% of 2-year-old children with CP in this study had clinical speech and/or language delays relative to age expectations. Findings suggest that children with CP should receive speech and language assessment and treatment at or before 2 years of age.

Assessment of social function in four-year-old children with cerebral palsy.

OBJECTIVE: To determine whether scores from the social function domain of the Paediatric Evaluation of Disability Inventory (PEDI) would reflect differences among speech-language profile groups for children with cerebral palsy (CP). METHODS: Thirty-four children with CP participated (mean age = 54.4 months). PEDI social function raw scores, developmentally stratified skill levels, and types of skills mastered at a 75% criterion level were examined. RESULTS: Significant differences were observed in social function scores overall and within early and age-appropriate skills among all profile groups with one exception. Skill mastery varied based on profile group and on developmental age category of each skill. CONCLUSIONS: The PEDI appears to capture language delay in children with CP, but it may not be sensitive to the impact of speech intelligibility deficits on social function. Findings call for the development of a new tool that more accurately assesses communicative activities and participation in children with CP.