Communication Development in Children with Cerebral Palsy

描述（由申请人提供）：脑瘫（CP）被认为是儿童严重运动残疾的最常见原因（1）;在美国每年诊断出约10，000例新病例（2）。虽然运动障碍是CP的主要特征，但其他残疾，如精神发育迟滞、癫痫发作和学习障碍往往同时发生（3-5）。研究表明，60%的脑瘫儿童有沟通问题（6）;然而，这些问题的确切性质从未得到全面研究。现有的研究强调了基于粗大运动障碍的性质（即手足徐动症与痉挛症）的语音特征的区分（7-12）。在这些研究中，语言和认知变量被控制，只包括那些具有“正常”能力的人。因为学习障碍和智力迟钝经常伴随着CP，所以对沟通的真实描述必须包括言语、语言和认知能力的同时量化。在脑瘫儿童的大运动发育（13-17）、精细运动发育（18-21）和脑成像结果（5，6，22-25）研究方面取得了重大进展。然而，由于缺乏有关沟通及其发展的数据，无法彻底了解伴随CP的缺陷之间的相互关系和星座。使用多维理论视角，该项目将在4年的时间内以6个月的间隔量化言语，语言和认知的纵向发展。将对80名CP儿童和17名发育正常的儿童（研究开始时年龄为2-4岁）进行随访。假设是：1.）在患有CP的儿童人群中存在可识别的和纵向稳定的基于通信的亚组;以及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松散相关。针对这些假设的具体目标是：a.）根据横断面沟通（言语、语言和认知）概况建立CP儿童亚组（目标1）; B.）量化言语、语言和认知能力的发展变化，并确定患有CP的幼儿的交流亚组成员随时间的稳定性（目标2）; c.）识别粗运动分类和精细运动分类与交流亚组成员资格相关联的程度（目标3）;以及d.）表征结构神经解剖学参与，并确定神经病理学模式如何与沟通亚组成员关系（目标4）。结果将告知与CP儿童，强调言语，语言和认知之间的相互关系的沟通发展的初步理论。纵向的方法将使个别儿童和假定的通信亚组的生长曲线的发展。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，其中语音和语言问题的分类已被确定为高度优先事项（3，26）。公共卫生相关性：脑瘫（CP）是儿童严重运动残疾的最常见原因;大约80万美国人患有CP。大多数脑瘫儿童都有沟通问题，但对这些问题的具体性质知之甚少。本研究将探讨沟通发展随着时间的推移，在儿童与CP，并将确定通信为基础的儿童谁有类似的问题。结果将导致更好地了解沟通障碍，并最终可能导致干预措施，提高沟通的结果与CP儿童。

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.