Communication Development in Children with Cerebral Palsy

描述（由申请人提供）：脑瘫（CP）是儿童严重运动障碍的最常见原因，在美国和国际上影响每1000人中有3人。CP对生活的各个方面都有深远的不利影响。运动障碍是主要的定义特征，但同时发生的发育障碍是常见的，并导致一系列复杂的问题。大约60%的CP儿童有某种类型的沟通障碍，然而，CP儿童沟通问题的具体性质以及这些问题如何随着发展而变化几乎是未知的。治疗研究非常有限，证据基础也很差。优先领域是创建基于研究的工具，用于对CP和控制干预研究中的言语和语言问题进行分类。在上一个资助周期中，我们开发了一个模型，用于对CP儿童的言语和语言障碍进行分类。我们的模型包括4个广泛的分类组区分存在或不存在语言/认知参与的言语运动参与。一个关键的发现是，患有CP的儿童显示出特定于分类组的早期言语和语言发展轨迹。这一点具有重要意义 了解语言/认知和言语产生缺陷在发育过程中如何相互作用，并进行干预。无法获得6岁以上CP儿童的分层前瞻性纵向数据;因此，变化率和限度未知。这一关键障碍阻碍了我们预测结果和开发优化言语和语言能力的干预措施的能力。我们的长期目标是生成一个理论驱动的，基于数据的CP言语和语言发展纵向模型，可用于预测结果，测试干预措施和指导治疗决策。拟议的研究将延长纵向窗口调查的言语和语言的发展，通过10岁的100名儿童与CP谁，我们一直在过去的4年。本研究的主要目的是：（1）。量化语音和语言发展的纵向变化，并确定分类组成员的稳定性; 2）识别后期语音清晰度和分类组成员资格的早期预测因子;以及3.）测试行为言语干预对可懂度的影响。研究结果将对沟通干预有直接的临床意义，也将促进对CP更广泛的理论理解。拟议的工作将验证一个纵向分类模型的沟通与CP儿童和量化率和有针对性的语音和语言变量的变化限制，通过10岁。研究结果将使我们能够根据早期收集的数据预测儿童在童年后期的相对沟通能力，并探索行为言语干预的潜在益处。这将为未来的研究奠定一个关键的基础，解决行为语言和语言干预的发展轨迹的背景下，以最大限度地提高功能的结果。

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is the most common cause of severe motor impairment in children, affecting 3 per 1000 in the US and internationally. CP has a profound detrimental impact on all aspects of life. Motor impairment is the primary defining feature, but co-occurring developmental disabilities are frequent and lead to a complex array of problems. Approximately 60% of children with CP have some type of communication disorder, however the specific nature of the communication problems in children with CP and how these problems change with development is virtually unknown. Treatment studies are extremely limited, and the evidence base is poor. Creation of research-based tools for classifying speech and language problems in CP and controlled intervention studies are priority areas. In the previous funding cycle, we developed a model for classifying speech and language impairments in children with CP. Our model comprises 4 broad classification groups distinguished on the presence of speech motor involvement with or without the presence of language/cognitive involvement. A key finding is that children with CP show early speech and language development trajectories that are specific to classification groups. This has critical implications for understanding how deficits in language/cognition and speech production interact during development, and for intervention. Age-stratified prospective longitudinal data on children with CP beyond the age of 6 years are not available; thus, rates and limits of change are unknown. This critical barrier impedes our capacity to predict outcomes and develop interventions that optimize speech and language abilities. Our long-term goal is to generate a theoretically driven, data-based longitudinal model of speech and language development in CP that can be used to predict outcomes, test interventions, and guide treatment decisions. The proposed research will extend the longitudinal window of investigation of speech and language development through the age of 10 years in 100 children with CP who we have been following for the past 4 years. Specific aims of the proposed study are: 1.) To quantify longitudinal change in speech and language development and determine stability of classification group membership; 2.) To identify early predictors of later speech intelligibility and classification group membership; and 3.) To test the effects of behavioral speech interventions on intelligibility. Results will have diect clinical implications for communication intervention and will also advance the broader theoretical understanding of CP. The proposed work will validate a longitudinal classification model for communication in children with CP and quantify rates and limits of change of targeted speech and language variables through the age of 10 years. Results will enable us to predict the relative communication abilities of children later in childhood based on data collected earlier in life, and explore the potential benefit of behavioral speech interventions. This will lay a critica foundation for future studies that address behavioral speech and language intervention in the context of developmental trajectories to maximize functional outcomes.