Prevalence of speech and communication disorders in children with CP

Abstract

Cerebral palsy (CP) is the most common cause of physical impairment in children. The physical disabilities have been the hallmark of CP for a long period of time. Fortunately, over the last few years more attention has been deservedly focused on the associated impairments of CP. This is not only reflected by the revised definition of CP in 2007, or by using the International Classification of Functioning, Disability and Health framework to provide a functional approach for daily activity and participation of the child with CP, but also by more studies reporting on associated impairments of CP. The severity of the motor impairment, as well as the associated impairments, such as disturbances of sensation, perception, cognition, communication, and behavior, are different for each child with CP resulting in a large variability in functioning in all domains. The widely used and adapted classification systems (Gross Motor Function Classification System and Manual Ability Classification System) provide a more detailed and straightforward description of the level of the gross and fine motor skills of children with CP. In contrast, a classification system for communication is currently being developed and implemented. In addition, clinical studies reporting on level of communication skills or speech and language abilities of children with CP are still limited or dated. The study of Sigurdardottir and Vik is to be commended for the effort to report on speech, expressive language, and verbal cognition of preschool children with CP in Iceland. This study is a valuable contribution to the trend of increasing interest in communication abilities in children with CP. As the study highlights too, it is important to distinguish between communication, speech, (expressive) language, and verbal cognition. Because of the multiple aspects that accompany communication and language, it is necessary to use a detailed description of both elements in order to establish more detailed comparison of results between different (future) studies. The study by Sigurdardottir and Vik reports that 84% of the children communicated verbally. However, in this study, children using sentences (or phrases of at least three words) or producing one-word utterances were considered verbal communicators. This is effective in making a clear distinction between a verbal and non-verbal group, but doesn’t yield the impaired language skills that still exist when 5-year-old children only communicate with one-word utterances, phrases, or three-word sentences. Sixteen percent of the children were non-verbal while in a similar study of Andersen et al. (not referred to by the authors), 28% of the children had severely impaired or no speech. A distinction between normal, impaired but understandable, and severely impaired or no speech (as used in Andersen et al.) would enhance clarity and insights of prevalence of speech and communication disorders in children with CP. Another matter of concern is that of the 21 children using augmentative and alternative communication (AAC) methods, none used technology with speech output and no children used AAC methods to express phrases. Similar findings are reported in the study of Andersen et al. where only 28 (34%) of 82 children with severely or no speech communicated with the help of pictures or pictograms. There is a compelling need in the interests of the child with severe CP to investigate why this is the case. Furthermore, it is a challenge to achieve early introduction and continued use of AAC devices for children with difficulties in communication abilities. More reports and detailed studies of the communication, speech, and language skills of children with CP can contribute to the importance of these topics and underline the need of early interventions and adequate assessment tools (intellectual and language assessment of severely affected children with unintelligible or no speech is difficult) to investigate, improve, and optimize the communication, speech and language skills of children with CP. The authors of the present study are encouraged to continue with their research and conduct follow-up studies with more in-depth analyses in this matter.