Communication disorders in young children with cerebral palsy

Abstract

Aim To test the prediction of communication disorder severity at 5 years of age from characteristics at 2 years for children with cerebral palsy (CP) whose communication is giving cause for concern. Method In this cohort study, 77 children (52 males; 25 females) with communication difficulties and CP were visited at home at 2 (mean 2y 4mo; SD 3mo) and 5 (mean 5y 5mo; SD 4mo) years of age. Information on the type and distribution of motor disorder, seizures, gross and fine motor function, hearing, and vision were collected from medical notes. Non‐verbal cognition, language comprehension, language expression, spoken vocabulary, and methods of communication were assessed directly at age 2 years. At 5 years, communication and speech function were rated using the Communication Function Classification System (CFCS), Functional Communication Classification System (FCCS), and Viking Speech Scale (VSS). Results In multivariable regression models, CP type, Gross Motor Function Classification System level, vision, the amount of speech understood by strangers, non‐verbal cognition, and number of consonants produced at age 2 years predicted the CFCS level at age 5 years (R2=0.54). CP type, Manual Ability Classification System level, amount of speech understood, vision, and number of consonants predicted the FCCS level (R2=0.49). CP type, amount of speech understood by strangers, and number of consonants predicted the VSS level (R2=0.50). Interpretation Characteristics at 2 years of age predict communication and speech performance at 5 years, and should inform referral to speech and language therapy.

Reproducibility and validity of the Functional Communication Classification System for young children with cerebral palsy

“…12 In a cohort of children with CP aged 2 to 8 years, primarily with a spastic presentation, Hustad and colleagues found that no speech development at 2 years was a risk factor for significant communication difficulties at 4 years of age. 8,13 Similar patterns in communication development have been reported by Pennington et al, 14 where children with a bilateral spastic or dyskinetic CP presentation and limited speech at 2 years were at the highest risk of speech and communication impairment at 5 years. To address this, communication assessment and multimodal communication intervention has been advocated, 12,14 with increasing emphasis on augmentative and alternative communication (AAC) to optimize academic participation for older children.…”

“…Children in this study with poor manual ability (Mini‐MACS levels III–V, n =7) were classified with less effective communication skills (FCCS levels IV and V) than children with more independent manual ability. In another study, Pennington et al 14 found that MACS ratings at 2 years predict FCCS classification at 5 years, especially for MACS levels III and IV.…”

“…31 There was a stronger relationship between FCCS ratings and visual impairment for younger children with CP in this study (r s =0.70, p<0.001) compared to the fair correlation for older children with CP. 18 Pennington et al 32 found that visual function at 2 years predicts FCCS levels for children at 5 years of age. The five children in this study with a known visual impairment presented with less effective communication skills (FCCS levels III-V).…”

“…To address this, communication assessment and multimodal communication intervention has been advocated, 12,14 with increasing emphasis on augmentative and alternative communication (AAC) to optimize academic participation for older children. 12 Together, these findings 11,12,14 emphasize the need for communication competency to consider both language and speech skills.…”

“…17,18 The CFCS rates expressive and receptive function by making a global judgement regarding an individual's ability to alternate between sender and receiver roles at a comfortable pace. 19 Pennington et al, 14 recommend all three classifications (VSS, FCCS, CFCS) are used for a holistic profile of communication function, since each classification rate different communication constructs, and should all contribute to the common data set for CP.…”