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)
Project #
Application #
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Shekim, Lana O
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Wisconsin Madison
Other Domestic Higher Education
United States
Zip Code
Hustad, Katherine C; Sakash, Ashley; Broman, Aimee Teo et al. (2018) Longitudinal growth of receptive language in children with cerebral palsy between 18 months and 54 months of age. Dev Med Child Neurol 60:1156-1164
Chen, Li-Mei; Hustad, Katherine C; Kent, Ray D et al. (2018) Dysarthria in Mandarin-Speaking Children With Cerebral Palsy: Speech Subsystem Profiles. J Speech Lang Hear Res 61:525-548
Allison, Kristen M; Hustad, Katherine C (2018) Acoustic Predictors of Pediatric Dysarthria in Cerebral Palsy. J Speech Lang Hear Res 61:462-478
Sakash, Ashley; Broman, Aimee Teo; Rathouz, Paul J et al. (2018) Executive function in school-aged children with cerebral palsy: Relationship with speech and language. Res Dev Disabil 78:136-144
Darling-White, Meghan; Sakash, Ashley; Hustad, Katherine C (2018) Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study. J Speech Lang Hear Res 61:2502-2515
Allison, Kristen M; Annear, Lucas; Policicchio, Marisa et al. (2017) Range and Precision of Formant Movement in Pediatric Dysarthria. J Speech Lang Hear Res 60:1864-1876
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; Oakes, Ashley; McFadd, Emily et al. (2016) Alignment of classification paradigms for communication abilities in children with cerebral palsy. Dev Med Child Neurol 58:597-604
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

Showing the most recent 10 out of 23 publications