Follow-up Study of Speech Functions in Children with Cerebral Palsy:Clinical Measures and Acoustic Analysis

• Main Authors: Yi Chen Lin, 林怡辰
• Other Authors: C. L. Chen
• Format: Others
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/85089015691124665815

碩士 === 長庚大學 === 早期療育研究所 === 99 === Background and Purpose: Communication problems in children with cerebral palsy (CP) depended on the severity of brain damage. Mental impairment, language and speech disorders are the common associated problems in children with CP. Previous studies focus on language and motor speech dysfunctions in children with CP at school-age child, adolescents and adults. Few literatures identify the determinants for predicted the motor speech performance in these children. It is important issue to follow-up the language and motor speech functions in children with CP. These data will provide clinicians for outcome prediction and goal setting. The aims of this study: (1) to investigate the difference in motor speech functions among children with CP of different motor severities, and(2) to investigate the longitudinal in motor speech functions at 6 months follow-up phase among children with CP of different motor severities, and(3) the correlation between motor severity, personal factors, family factors, language ability and motor speech in children with CP, and(4) to identify the variables that can predict motor speech functions in children with CP. Method: We collected speech samples from 27 children with CP having language ability greater than 3 years and 21 typically developing (TD) children. The participants’ ages ranged from 4 to 8 years. Children with CP were classified into two groups, Levels I-II and Levels III-IV, based on the Gross Motor Function Classification System (GMFCS). Children with CP underwent the assessments of Peabody Picture Vocabulary Test-Revised (PPVT-R), Percentage of Correct Consonant (PCC) and Preschool Language Scale-Revised (PLS-R) or School-age Language Scale-Revised (LS-R) due to its age. All speech samples were submitted to motor speech control for Verbal Motor Production Assessment for Children (VMPAC) and acoustic analyses for measures of the frequencies of the first two formants (F1 and F2) of corner vowels, vowel spaces, voice onset time (VOT) of voiced and voiceless consonants, and percentage of affricate and fricative burst spectrums and nasality. Children with CP will receive secondary assessment they had in pretest. Statistical analysis: analysis of variance was used to identify difference in language ability and motor speech among children with CP of different motor severities, repeated measurement of ANOVA was use to compare the change of language ability and motor speech among children with CP at follow-up and analysis of correlation was used to identify the variables related to motor speech performance. Result: Study 1: There were no significant differences among three groups in terms of demographic data and language assessment including PPVT-R scores and PLS-R or LS-R scores. The baseline measurements show significant differences among three groups in F1, F2, and F2-F1of /a/, vowel spaces, VOT of voiced and voiceless consonants, percentage of fricative burst spectrums and nasality (p<.05). VMPAC and PCC scores both show significant decrement in children with worse motor severity (p<.001). After 6 month of follow, There were no significant differences between two CP groups in all speech variables besides general motor control and focal oromotor control of VMPAC. Study 2: Linear regression indicated general motor control related to CP subtype and PPVT-R scores (adjusted r2=.856, p<.001), focal oromotor control related to F1/a/ and age (adjusted r2=.643, p<.001), sequence related to age, PPVT-R scores and, VOT of voiced consonants (adjusted r2=.777, p<.001) and the average modified VMPAC scores related to F1/i/, VOT of voiced consonants, PPVT-R scores and age (adjusted r2=.733, p<.001).The PCC scores related to F2/a/ and percentage of fricative burst spectrums (adjusted r2=.824, p<.001). Conclusion: These findings suggest the motor speech functions in children with CP are related to the severity of gross motor impairment. Most speech functions did not increase proportionally with increasing age in children with CP. It is important to plan appropriate verbal motor therapeutic interventions. Future study may examine strategies by the predicted factors for treating motor speech dysfunctions in children with CP.