Comprehension of spoken language in non‐speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities

AIM To determine development curves of communication and social interaction from childhood into adulthood for individuals with cerebral palsy (CP). METHOD This Pediatric Rehabilitation Research in the Netherlands (PERRIN)-DECADE studylongitudinally assessed 421 individuals with CP, aged from 1 to 20 years at baseline, after 13 years (n=121 at follow-up). Communication and social interactions were assessed using the Vineland Adaptive Behavior Scales. We estimated the average maximum performance limit (level) and age at which 90% of the limit was reached (age 90 ) using nonlinear mixed-effects modeling.RESULTS One-hundred individuals without intellectual disability were aged 21 to 34 years at follow-up (39 females, 61 males) (mean age [SD] 28y 5mo [3y 11mo]). Limits of individuals without intellectual disability, regardless of Gross Motor Function Classification System (GMFCS) level, approached the maximum score and were significantly higher than those of individuals with intellectual disability. Ages 90 ranged between 3 and 4 years for receptive communication, 6 and 7 years for expressive communication and interrelationships, 12 and 16 years for written communication, 13 and 16 years for play and leisure, and 14 and 16 years for coping. Twenty-one individuals with intellectual disability were between 21 and 27 years at follow-up (8 females, 13 males) (mean age [SD] 24y 7mo [1y 8mo]). Individuals with intellectual disability in GMFCS level V showed the least favourable development, but variation between individuals with intellectual disability was large.INTERPRETATION Individuals with CP and without intellectual disability show developmental curves of communication and social interactions similar to typically developing individuals, regardless of their level of motor function. Those with intellectual disability reach lower performance levels and vary largely in individual development.

Section: Discussionmentioning

confidence: 99%

Development curves of communication and social interaction in individuals with cerebral palsy

Tan

Gorp

Voorman

et al. 2019

“…Studies generally suggest that non‐speaking children with severe motor impairment, regardless of type of motor disorder, have delayed language comprehension. Within motor involvement type, children with spastic CP tended to have language comprehension deficits that were more severe and generally below age expectations relative to language comprehension in children with dyskinetic CP . In addition, receptive communication growth trajectories seem to be more favorable for children with CP without intellectual disabilities .…”

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confidence: 91%

Longitudinal growth of receptive language in children with cerebral palsy between 18 months and 54 months of age

Hustad

Sakash

Broman

et al. 2018

There are two growth trajectories for language comprehension among children with cerebral palsy. Children with speech motor impairment had a constant 6-month receptive language delay. Children without speech motor impairment had age-appropriate receptive language. Non-speaking children had significant receptive language delay. Early language comprehension change was highly predictive of later trajectory group.

“…As mentioned above, cognition and not GMFCS level was independently associated with language impairment; other studies have found that both GMFCS and cognition were independently associated with communication . Another study highlights the importance of taking not only GMFCS level into account but also type of CP . Receptive language (i.e.…”

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confidence: 88%

Differentiating between language domains, cognition, and communication in children with cerebral palsy

Geytenbeek¹

2015

functions when characterizing the skills of children with CP. Children with dysarthria and language impairment were less intelligible than those with motor disorder alone. This finding is interesting from both a theoretical perspective -raising questions about the nature of intelligibility and its underpinnings -and also from a clinical perspective. Further research is required to examine the contributions of both speech and language to intelligibility, which is currently not well understood (as Hustad et al. rightly point out). Detailed descriptions of speech and language in intelligibility research could ultimately influence the provision of augmentative and alternative communication (AAC) systems by specifying the types of information currently unintelligible in an individual's spoken language.The lower agreement Hustad et al. observed between the SLPG and Communication Function Classification System (CFCS) is not entirely unexpected. The CFCS classifies children's understanding and production of messages in face-to-face communication, but is not confined to the production of messages using spoken language. Children with CP may be adept at using multi-modal communication and consequently score higher on the CFCS than on speech and language scales. Research is also needed to examine the components of effective communication in the presence of speech and language impairment, given the heterogeneous nature of CP. Such research could have the power to influence clinical practice in the provision of tailored AAC systems (which vary in their methods of access, and linguistic and cognitive requirements) and help children achieve the goal of independent communication.