Functional speech assessment for children with CP

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Although there’s a lot of information out there about children with cerebral palsy (CP) who use AAC, what about those who are verbal? The speech of children with CP presents uniquely, with at least half having dysarthria. Because of the myriad presentations of dysarthria (flashback to motor speech disorders in grad school!) it can be difficult to differentiate between dysarthria and other speech/sound disorders. Detecting motor speech disorders at the youngest age possible is vital to ensuring that we are using the most appropriate, evidence-based treatment.

Hustad et al. used measures of functional speech in an attempt to differentiate five-year-old children with CP who have motor speech involvement (i.e. dysarthria) and those who do not. Those functional measures of speech included intelligibility, speech rate, and intelligible words per minute (a measure of speech efficiency). Children’s speech was measured using delayed imitation, so that evaluators knew the target words. However, these measures could be used with just about any speech sample! Below is a little review for how to calculate these handy measurements:

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All three measures readily differentiated children with dysarthria from children without dysarthria (with both typical development and CP). Furthermore, they even differentiated children with CP but without dysarthria from typically developing children, showing that even kids with CP who appear to have typical speech may have borderline to mild speech difficulties. Intelligibility was the strongest differentiator, with 90% of typically developing five-year-olds falling at 87% intelligibility or greater. See Figure 1 in the article for the hard data, including cutoff scores for differential diagnosis of dysarthria in kids with CP.

Note: Although this study focused on children with CP, functional measures of speech can be useful for any speech evaluation. These measurements, along with other assessment tools, can help us both to identify speech disorders at the earliest possible age and to make decisions regarding intervention and the use of AAC.

 

Hustad, K.C., Sakash, A., Broman, A.T., & Rathouz, P.J. (2019). Differentiating typical from atypical speech production in 5-Year-Old children with cerebral palsy: A comparative analysis. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-MSC18-18-0108.