Speech and Oromotor Outcome in Adolescents Born Preterm: Relationship to Motor Tract Integrity

Gemma B Northam,Frédérique Liégeois,Wui K Chong,Kate Baker,Jacques-Donald Tournier,John S Wyatt,Torsten Baldeweg,Angela Morgan

doi:10.1016/j.jpeds.2011.08.055

Abstract

ObjectiveTo assess speech abilities in adolescents born preterm and investigate whether there is an association between specific speech deficits and brain abnormalities.Study designFifty adolescents born prematurely (<33 weeks’ gestation) with a spectrum of brain injuries were recruited (mean age, 16 years). Speech examination included tests of speech-sound processing and production and speech and oromotor control. Conventional magnetic resonance imaging and diffusion-weighted imaging was acquired in all adolescents born preterm and 30 term-born control subjects. Radiological ratings of brain injury were recorded and the integrity of the primary motor projections was measured (corticospinal tract and speech-motor corticobulbar tract [CST/CBT]).ResultsThere were no clinical diagnoses of developmental dysarthria, dyspraxia, or a speech-sound disorder, but difficulties in speech and oromotor control were common. A regression analysis revealed that presence of a neurologic impairment, and diffusion-weighted imaging abnormalities in the left CST/CBT were significant independent predictors of poor speech and oromotor outcome. These left-lateralized abnormalities were most evident at the level of the posterior limb of the internal capsule.ConclusionDifficulties in speech and oromotor control are common in adolescents born preterm, and adolescents with injury to the CST/CBT pathways in the left-hemisphere may be most at risk.

Highlights

Poor articulation, and phonological impairments have been detected at school age,[3,4,5] and preterm children are more likely to require speech and language therapy
Accurate diagnosis of a speech disorder requires assessment in two key areas: speech-sound perception and production and neuromuscular control of the articulators. The latter is of particular relevance to children born preterm because motor symptoms are common in this population,[7] and speech problems may arise because of a more general motor impairment
The current study used a comprehensive battery of expert-rated speechmotor and speech-sound processing tests in a group of adolescents born very prematurely, with a spectrum of brain injury