Differential Diagnosis of Functional Speech Deficits in Children with Cerebral Palsy

演讲是大多数人表达自己的主要方式。然而，演讲必须是 足够通俗易懂，以实现成功的沟通。据估计，每1000名儿童中有2.5人 脑性瘫痪(CP)有极大的沟通障碍风险。不同的言语、语言和 慢性阻塞性肺病儿童的沟通障碍特征已有文献记载。然而，一个共同的主题 在整个配置文件中，相对于典型的年龄预期，语音可理解性降低。对于大约一半的儿童来说 对于CP，清晰度缺陷可以明显地与言语运动障碍的临床表现相关联 构音障碍。我们实验室最近的研究也表明，更多患有CP的儿童可能患有 亚临床言语运动障碍导致细微的可理解性降低。可理解性降低 对功能性沟通、社会参与和生活质量产生严重的负面影响。 提高可理解性是干预的主要目标。患有CP的儿童面临的一个关键挑战是早期 语言障碍的诊断。一个关键的问题是区分那些有临界性或轻度言语运动的人 来自那些处于适当年龄变异性范围内的人的赤字。一个重要的障碍是系统性 基于年龄的绩效标准确定典型与非典型的基准和切入点 反映功能性言语运动表现并作为有价值的结果测量的变量的发展 构音障碍是不存在的。因此，典型和非典型言语运动能力的经验区分是 非常困难，特别是对于有更轻微缺陷的儿童(即轻度构音障碍和 可能有亚临床言语运动问题的CP)。因此，许多患有CP的儿童可能会错过一个重要的 干预的机会之窗。这项研究将解决语音的早期诊断问题 脑性瘫痪儿童的运动障碍增加了1。)基于确定年龄的经验数据创建增长曲线- 具体期望并量化3-7岁以下儿童的典型变异性范围 已知的功能性语音容量(清晰度、语速、每分钟可听字数)的测量 构音障碍是有问题的，但从来没有从发育的 典型儿童的视角。2.)建立标准(通过直接测量和统计验证的基于年龄的切入点)，以识别典型和非典型功能言语表现。结果将 能够根据儿童的CP及早经验地识别处于危险中的儿童的言语运动缺陷 诊断。早期确认言语运动障碍并区分最轻病例的能力 从典型的发育差异将确保儿童被识别为治疗，利用 神经可塑性和生长的好处。此外，儿童与年龄水平基准的距离将是 可量化的，这可能具有治疗意义。研究结果也将广泛应用于其他 这将为语言障碍儿童群体的发展奠定基础，并将为其他针对特定人群的工具奠定基础。

Speech is the primary means through which most people express themselves. However, speech must be sufficiently intelligible to enable successful communication. The estimated 2.5 per 1000 children who have cerebral palsy (CP) are at significant risk for communication disorders. Different speech, language, and communication disorder profiles have been documented in children with CP. However, a common theme across profiles is reduced speech intelligibility relative to typical age expectations. For about half of children with CP, intelligibility deficits can be clearly associated with clinical manifestation of the speech motor disorder dysarthria. Recent work from our laboratory also indicates that many additional children with CP may have sub-clinical speech motor deficits resulting in subtle intelligibility reductions. Reduced intelligibility has significant negative consequences for functional communication, social participation, and quality of life. Enhancing intelligibility is a primary goal of intervention. One critical challenge in children with CP is early diagnosis of speech disorders. A key problem is differentiating those with borderline or mild speech motor deficits from those who are within an age appropriate range of variability. A significant barrier is that systematic age-based performance standards establishing benchmarks and cut-points for typical versus atypical development on variables that reflect functional speech motor performance and are valued outcome measures in dysarthria do not exist. Thus, empirical differentiation of typical from atypical speech motor ability is extremely difficult, especially for children with more subtle deficits (i.e. those with mild dysarthria and those with CP who may have sub-clinical speech motor issues). As a result many children with CP may miss an important window of opportunity for intervention. This research will address the problem of early diagnosis of speech motor disorders in children with CP by 1.) creating growth curves based on empirical data that establish age- specific expectations and quantify the range of typical variability for children between the ages of 3-7 years on measures of functional speech capacity (intelligibility, speech rate, intelligible words per minute) that are known to be problematic in dysarthria but that have never been comprehensively quantified from a developmental perspective in typical children. 2.) establishing standards (via directly measured and statistically validated age-based cut-points) for the identification of typical and atypical functional speech performance. Results will enable early empirical identification of speech motor deficits in children who are at-risk based on their CP diagnosis. The ability to confirm speech motor deficits in the early years and to differentiate the mildest cases from typical developmental variability will ensure that children are identified for treatment, capitalizing on the benefits of neuroplasticity and growth. Furthermore, a child's distance from age-level benchmarks will be quantifiable, which may have treatment implications. Results also will have broad application to other populations of children with speech disorders and will lay the foundation other population-specific tools.