Cerebral palsy (CP) is the most common cause of severe motor impairment in children, affecting 3 per 1000 in the US and internationally. CP has a profound detrimental impact on all aspects of life. Motor impairment is the primary defining feature, but co-occurring developmental disabilities are frequent and lead to a complex array of problems. Approximately 60% of children with CP have some type of communication disorder, however the specific nature of the communication problems in children with CP and how these problems change with development is virtually unknown. Treatment studies are extremely limited, and the evidence base is poor. Creation of research-based tools for classifying speech and language problems in CP and controlled intervention studies are priority areas. In the previous funding cycle, we developed a model for classifying speech and language impairments in children with CP. Our model comprises 4 broad classification groups distinguished on the presence of speech motor involvement with or without the presence of language/cognitive involvement. A key finding is that children with CP show early speech and language development trajectories that are specific to classification groups. This has critical implications for understanding how deficits in language/cognition and speech production interact during development, and for intervention. Age-stratified prospective longitudinal data on children with CP beyond the age of 6 years are not available;thus, rates and limits of change are unknown. This critical barrier impedes our capacity to predict outcomes and develop interventions that optimize speech and language abilities. Our long-term goal is to generate a theoretically driven, data-based longitudinal model of speech and language development in CP that can be used to predict outcomes, test interventions, and guide treatment decisions. The proposed research will extend the longitudinal window of investigation of speech and language development through the age of 10 years in 100 children with CP who we have been following for the past 4 years.
Specific aims of the proposed study are: 1.) To quantify longitudinal change in speech and language development and determine stability of classification group membership;2.) To identify early predictors of later speech intelligibility and classification group membership;and 3.) To test the effects of behavioral speech interventions on intelligibility. Results will have diect clinical implications for communication intervention and will also advance the broader theoretical understanding of CP. The proposed work will validate a longitudinal classification model for communication in children with CP and quantify rates and limits of change of targeted speech and language variables through the age of 10 years. Results will enable us to predict the relative communication abilities of children later in childhood based on data collected earlier in life, and explore the potential benefit of behavioral speech interventions. This will lay a critica foundation for future studies that address behavioral speech and language intervention in the context of developmental trajectories to maximize functional outcomes.

Public Health Relevance

Cerebral palsy (CP) is the most common cause of severe motor disability in children. CP has a profound detrimental impact on all aspects of life. Most children with CP have communication problems, but very little is known about the specific nature of these problems, how they change as children grow, or how to treat them. This research will examine communication development between the ages of 6 and 10 years in 100 children with CP. We will validate a longitudinal speech and language classification model for children with CP, and will measure how quickly and in what ways speech and language change in children with CP as they grow and develop. We will also examine how well early variables predict later outcomes and will test the potential of two different speech therapies for increasing intelligibility in children with CP. Results will lead to a better understanding of communication prognoses and ultimately may lead to interventions that enhance communication outcomes in children with CP.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Motor Function, Speech and Rehabilitation Study Section (MFSR)
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Shekim, Lana O
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University of Wisconsin Madison
Other Domestic Higher Education
United States
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Hustad, Katherine C; Allison, Kristen M; Sakash, Ashley et al. (2017) Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes. Dev Neurorehabil 20:323-330
Hustad, Katherine C (2016) Reflections on the Functional Communication Classification System for children with cerebral palsy. Dev Med Child Neurol 58:996
Smith, Ashlyn L; Hustad, Katherine C (2015) AAC and Early Intervention for Children with Cerebral Palsy: Parent Perceptions and Child Risk Factors. Augment Altern Commun 31:336-50
Hustad, Katherine C; Oakes, Ashley; Allison, Kristen (2015) Variability and Diagnostic Accuracy of Speech Intelligibility Scores in Children. J Speech Lang Hear Res 58:1695-707
Hustad, Katherine C; Allison, Kristen; McFadd, Emily et al. (2014) Speech and language development in 2-year-old children with cerebral palsy. Dev Neurorehabil 17:167-75
Allison, Kristen M; Hustad, Katherine C (2014) Impact of sentence length and phonetic complexity on intelligibility of 5-year-old children with cerebral palsy. Int J Speech Lang Pathol 16:396-407
Lee, Jimin; Hustad, Katherine C; Weismer, Gary (2014) Predicting speech intelligibility with a multiple speech subsystems approach in children with cerebral palsy. J Speech Lang Hear Res 57:1666-78
Lee, Jimin; Hustad, Katherine C (2013) A preliminary investigation of longitudinal changes in speech production over 18 months in young children with cerebral palsy. Folia Phoniatr Logop 65:32-9
McFadd, Emily; Hustad, Katherine C (2013) Assessment of social function in four-year-old children with cerebral palsy. Dev Neurorehabil 16:102-12
Patel, Rupal; Hustad, Katherine C; Connaghan, Kathryn P et al. (2012) Relationship Between Prosody and Intelligibility in Children with Dysarthria. J Med Speech Lang Pathol 20:

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