Communication Development in Children with Cerebral Palsy

描述(由申请人提供)：脑性瘫痪(CP)被认为是儿童严重运动障碍的最常见原因(1)；美国每年约有10,000例新诊断病例(2)。虽然运动障碍是脑性瘫痪的主要定义特征，但其他残疾，如智力低下、癫痫发作障碍和学习障碍通常是同时发生的(3-5)。研究表明，60%的CP儿童有沟通问题(6)；然而，这些问题的确切性质从未被全面检查过。现有的研究强调基于粗大运动障碍(7-12)的性质来区分语音特征(即手足徐动型与痉挛型)。在这些研究中，语言和认知变量得到了控制，只包括那些能力“正常”的人。因为学习障碍和智力低下经常伴随着脑瘫，所以真正的交流必须包括对言语、语言和认知能力的同时量化。在脑性瘫痪儿童的粗大运动发育(13-17)、精细运动发育(18-21)和脑影像表现(5、6、22-25)方面的研究取得了重大进展。然而，由于缺乏关于传播及其发展的数据，无法透彻地了解伴随着国家方案而来的缺陷的星座和相互关系。利用多维理论视角，本项目将在4年内每隔6个月量化一次言语、语言和认知的纵向发展。将跟踪研究开始时年龄在2-4岁的80名脑瘫儿童和17名典型发育儿童的队列。假设如下：1)在患有脑瘫的儿童群体中，有可识别的和纵向稳定的以沟通为基础的亚群；和2.这些亚组与这些儿童的粗大运动、精细运动和脑成像结果有松散的关系。针对这些假设的具体目标是：a.)根据横断面交流(言语、语言和认知)资料建立脑瘫儿童分组(目标1)；b.量化患有脑瘫的幼儿在言语、语言和认知能力方面的发展变化，并确定沟通亚组成员随时间的稳定性(目标2)；c.确定粗大和精细运动分类与通信分组成员资格之间的关联程度(目标3)；和d.确定结构神经解剖受累的特征，并确定神经病理模式如何与通信亚组成员相关联(目标4)。研究结果将为儿童认知障碍儿童的沟通发展提供一个初步的理论，该理论强调言语、语言和认知之间的相互关系。纵向方法论将能够为个别儿童和假定的交流小组制定成长曲线。研究结果将对沟通干预有直接的临床意义，并将促进对CP的更广泛的理论理解，在CP中，言语和语言问题的分类已被确定为高度优先(3，26)。公共卫生相关性：脑性瘫痪(CP)是导致儿童严重运动障碍的最常见原因；大约有80万美国人患有脑瘫。大多数患有CP的儿童都有沟通问题，但人们对这些问题的具体性质知之甚少。这项研究将考察患有CP的儿童随时间的沟通发展，并将确定有类似问题的基于沟通的儿童亚群。结果将导致更好地了解沟通预后，并最终可能导致干预措施，以提高CP儿童的沟通结果。

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is regarded as the most common cause of severe motor disability in children (1); approximately 10,000 new cases are diagnosed each year in the United States (2). Although motor impairment is the primary defining feature of CP, other disabilities such as mental retardation, seizure disorder, and learning disabilities often co-occur (3-5). Research suggests that 60% of children with CP have communication problems (6); however, the exact nature of these problems has never been comprehensively examined. Existing research has emphasized differentiation of speech features based on the nature of the gross motor movement disorder (7-12) (i.e. athetoid vs. spastic). Language and cognitive variables have been controlled in these studies by including only those with "normal" abilities. Because learning disabilities and mental retardation frequently accompany CP, a true account of communication must include simultaneous quantification of speech, language, and cognitive abilities. There have been significant advances in the study of gross motor development (13-17), fine motor development (18-21), and brain imaging findings in children with CP (5, 6, 22-25). However, the lack of data regarding communication and its development has prohibited a thorough understanding of the constellations of and inter-relations among deficits that accompany CP. Using a multidimensional theoretical perspective, this project will quantify longitudinal development of speech, language, and cognition at 6 month intervals over a period of 4 years. A cohort of 80 children with CP and 17 typically developing children, who are 2-4 years of age at the onset of the study, will be followed. Hypotheses are: 1.) there are identifiable and longitudinally stable communication-based subgroups within the population of children who have CP; and 2.) these subgroups are loosely related to gross motor, fine motor, and brain imaging findings for these same children. Specific aims that target these hypotheses are to: a.) establish subgroups of children with CP on the basis of cross sectional communication (speech, language, and cognition) profiles (Aim 1); b.) quantify developmental changes in speech, language, and cognitive abilities and determine the stability of communication subgroup membership over time in young children with CP (Aim 2); c.) identify the extent to which gross and fine motor classifications are associated with communication subgroup membership (Aim 3); and d.) characterize structural neuro-anatomical involvement and determine how patterns of neuropathology are associated with communication subgroup membership (Aim 4). Results will inform an initial theory of communication development in children with CP that emphasizes the inter-relations among speech, language, and cognition. The longitudinal methodology will enable development of growth curves for individual children and for the putative communication subgroups. Results will have direct clinical implications for communication intervention and will also advance the broader theoretical understanding of CP, where classification of speech and language problems has been identified as a high priority (3, 26). PUBLIC HEALTH RELEVANCE: Cerebral palsy (CP) is the most common cause of severe motor disability in children; approximately 800,000 Americans are living with CP. Most children with CP have communication problems, but very little is known about the specific nature of these problems. This research will examine communication development over time in children with CP and will identify communication-based subgroups of children who have similar kinds of problems. Results will lead to a better understanding of communication prognoses and ultimately may lead to interventions that enhance communication outcomes in children with CP.