Communication Development in Children with Cerebral Palsy

项目摘要 脑性瘫痪（CP）是儿童严重运动障碍的最常见原因， 1000在美国和国际。运动障碍是主要的定义特征，但同时发生 发育障碍是常见的，并导致一系列复杂的问题。大约60%的 患有CP的儿童有某种类型的沟通障碍，其中可能包括构音障碍及其相关的 语言清晰度缺陷;语言和/或认知障碍;或语言和/或认知障碍的组合。 语言/认知问题。提高我们对沟通能力的理解是CP的优先领域 research.然而，CP儿童的异质性使得对言语、语言和 沟通和发展困难，需要使用前瞻性的纵向方法， 每个孩子都是他/她自己的控制，以允许早期言语语言标记之间的直接联系， 后来的发展。我们在10年前开始了这项工作，跟踪了90多名患有脑瘫的儿童， 研究开始时为2年。我们研究的长期目标是产生理论驱动的， 经经验验证的CP言语和语言发展的纵向模型，可用于 预测结果，测试干预措施，并指导治疗决策。在过去的两个融资周期中， 开发了一个分类模型的语音语言轮廓组与CP儿童，我们是 用来预测结果。研究结果表明，在2岁时， 在童年后期仍保持在更高级的侧写组中。此外，那些谁是生产语音2年 在可懂度和话语长度方面获得更快的增益，并且比那些 开始说话的年龄较大。我们还在开发语音和语言增长曲线，并利用数据 根据儿童期的发展情况建立档案组成员资格模型。数据表明 CP儿童在10岁时仍在变化，尚未达到发育终点。 目前的进展受到本申请中解决的两个关键障碍的限制：1。纵向语音和 2岁以前的语言发育数据从未被收集用于患有CP的儿童。这些数据 是必要的，以完善我们的能力，预测语言的结果开始在尽可能早的年龄 并建立可为干预决策提供信息的预后指标; 2.）纵向数据 10岁以上的人从来没有被收集过，但需要量化的变化率和限制， 语音语言变量通过整个发展过程，使我们能够开发预测模型， 基于年龄的终点，指导干预措施和改善结果。为此，我们将收集新的 我们现有的15岁以下CP儿童队列的纵向数据，我们将收集新的 一个新的12个月大的CP幼儿队列的纵向数据，以解决 以下两个具体目标：目标1-建立和验证从12个月开始的预后指标， 年龄对CP儿童以后的言语语言发育有预测价值。目标2-发展 15岁以下CP儿童言语-语言发育的综合预测模型。 研究结果将推动发展和验证纵向模型的语音和语言的增长， CP儿童，选择言语和语言变量的变化率和限度的量化。结果 将使我们能够预测1 - 15岁儿童的结果，这将对 干预决策和创建干预措施，以提高CP儿童的生活质量。

Project Summary Cerebral palsy (CP) is the most common cause of severe motor impairment in children, affecting 3 per 1000 in the US and internationally. 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, which may include dysarthria and its associated speech intelligibility deficits; language and/or cognitive impairments; or a combination of both speech and language/cognitive problems. Advancing our understanding of communication abilities is a priority area in CP research. However, heterogeneity among children with CP makes the study of speech, language, and communication and its development difficult, necessitating the use of prospective longitudinal methods where each child is his/her own control to allow for direct connection between early speech-language markers and later development. We began such work 10 years ago, following over 90 children with CP who were as young as 2 years at the onset of the study. The long-term goal of our research is to generate theoretically driven, empirically validated longitudinal models of speech and language development in CP that can be used to predict outcomes, test interventions, and guide treatment decisions. Over the past two funding cycles, we have developed a classification model of speech-language profile groups among children with CP, which we are using to predict outcomes. Results suggest that children in more advanced profile groups at 2 years of age remain in more advanced profile groups in later childhood. Also, those who are producing speech by 2 years make faster gains in intelligibility and utterance length and have better speech production later than those who begin speaking at older ages. We are also developing speech and language growth curves and using data to create models of profile group membership based on development across childhood. Data indicate that children with CP are still changing through 10 years of age and have not yet reached developmental endpoints. Progress is currently limited by two key barriers, addressed in this application: 1.) longitudinal speech and language development data prior to 2 years of age have never been gathered for children with CP. These data are necessary to refine our ability to predict speech-language outcomes beginning at the earliest possible age and establish prognostic indicators that can inform intervention decision-making; and 2.) longitudinal data beyond 10 years of age have never been gathered, but are needed to quantify rates and limits of change in speech-language variables through the full course of development so that we can develop predictive models of age-based endpoints that guide interventions and improve outcomes. Toward this end, we will collect new longitudinal data on our existing cohort of children with CP to the age of 15 years, and we will collect new longitudinal data on a new cohort of very young children with CP beginning at 12 months of age to address the following two specific aims: Aim 1 - To establish and validate prognostic indicators beginning at 12 months of age that have predictive value for later speech-language development in children with CP. Aim 2 - To develop comprehensive predictive models of speech-language development up to 15 years of age in children with CP. Results will advance the development and validation of longitudinal models of speech and language growth in children with CP, quantifying of rates and limits of change for select speech and language variables. Results will enable us to predict outcomes for children from 1-15 years of age, which will have implications for intervention decision-making and for creation of interventions to enhance quality of life for children with CP.