Factors determining the efficiency of logopaedic care of children in Poland.

The purpose of this article is to establish factors which determine the efficiency of the system of care provided to children with speech disorders attending regular schools and kindergartens. The analysis was made using Poland as an example, which, similar to other countries, has made some achievements in this matter. Although Poland has had an institutionalised care system for children with speech development anomalies for 30 years, the problem of speech disorders is still very difficult to solve. Due to the large scale of the phenomenon among Polish children, this problem can be defined as a social problem in this country. The above-described situation makes it necessary to search for methods of fighting this adverse phenomenon. One of the means of solving this problem is following examples and learning from the experience of countries in which efficient systems of disabled children's care have already been worked out. By giving examples from other countries the author attempts to establish factors determining the efficiency of logopaedic care.

The impact of art therapy on the intelligibility of speech in children with cerebral palsy.

Background. Children with cerebral palsy (CP) frequently have dysarthria, which reduces the intelligibility of their speech and can seriously impede their psycho-social adjustment. Traditional "bottom-up" rehabilitation oriented directly on the articulatory apparatus is not always successful in helping these children to speak intelligibly. The authors have developed a program of art therapy with elements of logopedic therapy to model and stimulate perception and expression, including linguistic performance, which has proven in clinical to be a helpful "top-down" approach to helping these children to speak more early.
Material and methods. Out of the population of CP children treated in the Cracow Rehabilitation Center's Art Therapy Workshop in the period 1994-2001, we identified 14 children, 9 boys and 5 girls, average age 15,3, who showed severe dysarthria at admission without other language or cognitive disturbances. Our retrospective study was based on recorder results from the Auditory Dysarthria Scale and standard neuropsychological tests for fluency of speech, administered routinely once each month during the 4-month art therapy program.
Results. All the children in the study group showed some degree of improvement after art therapy in all tested parameters. On the Auditory Dysarthria Scale, the largest improvements were noted in overall intelligibility (p < 0,0001); less improvement, though still statistically significant (p < 0,001) took place in respect to volume, tempo, and control of pauses. The least improvement was noted in the pronunciation of vowels and consonants (the most purely motor of the measured parameters). All the children also exhibited significant improvement in fluency of speech.
Conclusions. Art therapy with elements of logopedic therapy improves the ability of children with cerebral palsy to engage in purposeful behavior, including speech and language functions, especially intelligibility.