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障碍的最常见原因(1)；在美国，每年大约有10,000个新病例被诊断出来(2)。虽然运动障碍是CP的主要特征，但其他残疾，如智力迟钝、癫痫发作障碍和学习障碍经常同时发生（3-5）。研究表明，60%患有CP的儿童有沟通问题(6)；然而，这些问题的确切性质从未得到全面研究。现有的研究强调基于大肌肉运动障碍的性质来区分言语特征（7-12）（即动脉状突与痉挛性）。在这些研究中，语言和认知变量通过只包括那些“正常”能力的人来控制。因为学习障碍和智力迟钝经常伴随CP，一个真正的交流记录必须同时包括言语、语言和认知能力的量化。在大运动发展（13-17）、精细运动发展（18-21）和脑瘫儿童的脑成像研究方面取得了重大进展（5,6,22 -25）。然而，缺乏关于沟通及其发展的数据，阻碍了对CP伴随的缺陷的星座和相互关系的全面了解。使用多维理论视角，该项目将量化语音，语言和认知的纵向发展，每隔6个月，为期4年。一组80名患有CP的儿童和17名正常发育的儿童，在研究开始时年龄为2-4岁，将被跟踪。假设是：1.)在患有CP的儿童人群中存在可识别且纵向稳定的基于交流的亚群；2)这些亚组与大肌肉运动、精细运动和这些孩子的脑成像结果有松散的关系。针对这些假设的具体目标是：a.基于横断面沟通（言语、语言和认知）概况建立CP儿童的亚群（目标1）；b)量化言语、语言和认知能力的发展变化，并确定CP幼儿的沟通亚群成员随时间的稳定性（目标2）；c.)确定大动作和精细动作分类与沟通亚群成员关系的程度（目标3）；d)表征结构神经解剖学的参与，并确定神经病理学模式如何与沟通亚群成员关联（目标4）。研究结果将为CP儿童沟通发展的初步理论提供依据，该理论强调言语、语言和认知之间的相互关系。纵向方法将能够为个别儿童和假定的交流分组制定生长曲线。研究结果将对沟通干预具有直接的临床意义，也将促进对CP的更广泛的理论理解，其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：脑瘫（CP）是儿童严重运动障碍的最常见原因；大约有80万美国人患有CP。大多数患有CP的儿童都有沟通问题，但对这些问题的具体性质所知甚少。这项研究将检查患有CP的儿童随着时间的推移的沟通发展，并将确定具有类似问题的以沟通为基础的儿童亚组。结果将有助于更好地理解沟通预后，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.