Respiratory function during speech production in children with cerebral palsy

高达75%的脑瘫儿童可能患有构音障碍，这是一种运动性语言障碍， 负面地影响语音可懂度和自然度。尽管需求巨大， 对与CP相关的构音障碍的指导性干预非常有限。因此，言语 病理学家必须求助于使用基于成人构音障碍文献的干预技术， 没有具体针对潜在的障碍，也没有考虑到面临的独特发展问题 患有CP的孩子制定有效的循证干预措施的一个关键障碍是缺乏 CP儿童言语产生过程中呼吸功能的客观信息。的 呼吸系统是儿童构音障碍治疗中最常针对的言语子系统 在CP。20世纪50年代的观察性研究表明，大多数CP儿童有呼吸道疾病， 缺陷，如浅的灵感，这有助于他们的构音障碍。尽管在呼吸系统方面取得了进展 科学，很少或没有关于呼吸系统功能能力的客观数据，以支持 CP儿童的言语产生此外，目前的临床实践依赖于认知-知觉 分析言语产生，以制定干预决策并确定进展。但是，听觉- 感知数据不提供关于在呼吸期间呼吸功能的潜在损害的信息。 CP儿童的言语产生或特定干预后的变化机制。没有 定量和直接了解CP儿童言语产生过程中的呼吸功能 以及常见干预技术对言语产生期间呼吸功能的影响， 全局语音产生结果（例如，语音清晰度和自然度），我们的能力有限， 识别将从呼吸干预中受益的儿童，选择干预目标， 持久的变化该提案的第一个具体目标是量化说话期间的呼吸功能 CP儿童的生产。该提案的第二个具体目标是评估增加 响度，一种常用的干预技术，对言语产生和整体呼吸功能的影响， CP儿童的言语产生结果。这种技术虽然经常使用，但很少得到支持。 证据该建议的关键创新是系统检查呼吸运动学、压力、 声学和听觉感知数据收集在连接语音生产在儿童与CP。的 该提案的预期结果将提供：1）在治疗期间呼吸功能的可量化表征 CP儿童的言语产生和2）关于干预有效性的I期证据 通常用于CP儿童的技术，增加响度。这一提议有可能刺激 我们如何为CP儿童制定和实施干预措施的模式转变， 干预决策的基础。

Up to 75% of children with cerebral palsy (CP) may have dysarthria, a motor speech impairment that negatively impacts speech intelligibility and naturalness. Despite the overwhelming need, the evidence base guiding intervention for dysarthria associated with CP is extremely limited. As a result, speech-language pathologists must resort to using intervention techniques that are based on the adult dysarthria literature, are not specific to the underlying impairment, and do not take into account the unique developmental issues faced by children with CP. A critical barrier to the development of effective, evidence-based intervention is the lack of objective information regarding respiratory function during speech production in children with CP. The respiratory system is the most commonly targeted speech subsystem in the treatment of dysarthria for children with CP. Observational studies from the 1950’s indicate that a majority of children with CP have respiratory deficits, such as shallow inspirations, that contribute to their dysarthria. Despite advances in respiratory science, there are little to no objective data about the functional capacity of the respiratory system to support speech production in children with CP. Additionally, current clinical practice relies on auditory-perceptual analyses of speech production to base intervention decisions and determine progress. However, auditory- perceptual data do not provide information about the underlying impairment in respiratory function during speech production in children with CP or the mechanisms of change following a particular intervention. Without a quantitative and direct understanding of respiratory function during speech production in children with CP and the impact of common intervention techniques on both respiratory function during speech production and global speech production outcomes (e.g., speech intelligibility and naturalness) we have a limited ability to identify children who would benefit from respiratory intervention, to choose intervention targets, and to facilitate lasting change. The first specific aim of this proposal is to quantify respiratory function during speech production in children with CP. The second specific aim of this proposal is assess the effects of increasing loudness, a common intervention technique, on respiratory function during speech production and global speech production outcomes in children with CP. This technique, though often used, has very little supporting evidence. The key innovation of this proposal is the systematic examination of respiratory kinematic, pressure, acoustic, and auditory-perceptual data collected during connected speech production in children with CP. The expected outcomes of this proposal will provide: 1) quantifiable characterization of respiratory function during speech production in children with CP and 2) phase I evidence regarding the effectiveness of an intervention technique commonly utilized with children with CP, increasing loudness. This proposal has the potential to spur a paradigm shift in how we develop and implement interventions for children with CP by providing the foundation on which to base intervention decisions.