Respiratory function during speech production in children with cerebral palsy

高达75%的脑性瘫痪(CP)儿童可能患有构音障碍，这是一种运动性言语障碍， 对语音清晰度和自然度产生负面影响。尽管有巨大的需求，但证据基础 对与CP相关的构音障碍的指导性干预是极其有限的。因此，演讲语言 病理学家必须使用基于成人构音障碍文献的干预技术， 没有针对潜在的损害，也没有考虑到面临的独特的发展问题 由患有脑瘫的儿童提供。发展有效的循证干预的一个关键障碍是缺乏 目的了解慢性阻塞性肺疾病儿童言语产生过程中的呼吸功能。这个 呼吸系统是儿童构音障碍治疗中最常见的靶向语音子系统 有CP。自20世纪50年代S以来的观察研究表明，大多数CP儿童有呼吸道症状 缺陷，如肤浅的灵感，导致他们构音障碍。尽管呼吸道疾病取得了进展 科学上，很少甚至没有关于呼吸系统支持的功能能力的客观数据 脑性瘫痪儿童的言语产生。此外，目前的临床实践依赖于听觉-知觉 对言语产出的分析为干预决策和确定进展奠定了基础。然而，听觉上- 感知数据不提供有关呼吸功能潜在损害的信息 脑性瘫痪儿童的言语产生或特定干预后的变化机制。如果没有 定量直观地了解慢性阻塞性肺疾病儿童言语产生过程中的呼吸功能 以及常用干预技术对言语产生和呼吸功能的影响 全球语音生成结果(例如，语音可理解性和自然度)我们的能力有限 确定将从呼吸干预中受益的儿童，选择干预目标，并促进 持久的改变。这项建议的第一个具体目标是量化说话时的呼吸功能。 慢性阻塞性肺病儿童的生殖功能。这项提案的第二个具体目标是评估增加 响度，一种常见的干预技术，在语音产生和全球范围内对呼吸功能的影响 脑性瘫痪儿童的言语产出结果。这项技术虽然经常使用，但很少得到支持。 证据。这一方案的关键创新是对呼吸运动学、压力、 脑性瘫痪儿童在连通言语产生过程中收集的声学和听觉-知觉数据。这个 这项提议的预期结果将提供：1)呼吸功能的量化特征 慢性阻塞性肺病儿童的言语产生和2)关于干预有效性的阶段I证据 脑性瘫痪儿童常用的技术，增加音量。这项提议有可能刺激 我们为CP儿童制定和实施干预措施的方式发生了范式转变 干预决策所依据的基础。

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.