Communication ability and communication methods in children with cerebral palsy.

AIM: To investigate if communication ability and method were related to each other and to age, sex, gross motor function, or manual ability in children with cerebral palsy. METHOD: This cross-sectional study used data registered in the Swedish Cerebral Palsy Surveillance Program registry, involving 3000 children aged 0 to 18 years. Pearson's χ2 test and Spearman's correlation were used to test associations between variables. RESULTS: Communication ability and method were related to each other and to age, gross motor function, and manual ability. Aided communication methods were more frequently used among older children. The more functional the communication was, the less use of unaided communication occurred. Different communication methods were used across all Communication Function Classification System (CFCS) levels. Speech was most common in more functional levels, used by 72% of the children. Forty-five per cent were considered effective communicators in all environments. For classification of communication level and method, some recurring registration errors were made by the raters. INTERPRETATION: Some raters may need clarification on interpretations of CFCS instructions. Results indicate that children should be presented to aided augmentative and alternative communication and manual signs earlier and to a greater extent.

Narrative ability in children with cerebral palsy.

In a previous study a group of children with cerebral palsy (CP) were found to have considerable difficulties with narratives, performing several standard deviations below the criteria for the Information score of the Bus Story Test (BST). To examine in depth the performance of children with CP and a control group with typically developing (TD) children on a narrative task, in order to search for possible underlying causes to the problems in the CP group. The results of the BST for 10 children with CP, mean age 7;11 years, were investigated. The analysis of the BST was supplemented with the use of the Narrative Assessment Profile (NAP) and quantitative analyses of number of words, mazes, propositions, types of conjunctions and story elements. A significant relationship between the explicitness dimension on the Narrative Assessment Profile and the BST Information score in the CP group suggested that the problems could be derived to a limited use of cohesion and a scarcity of essential information. Compared to the CP group, the TD group used significantly more causal conjunctions. The results indicate a general problem with cohesion at the textual level in the CP group. A further finding was the occurrence of a positive correlation between the use of mazes and the BST Information score in the CP group. These results have implications for the design of a more specific intervention for children, where the NAP was found to be a valuable tool in combination with the BST or other assessment materials. Further, it is shown that mazes, mostly regarded as a behaviour that not enhances speech production, for some children can be used as a means to find necessary words and pieces of information.

Inferential ability in children with cerebral palsy, spina bifida and pragmatic language impairment.

The aim of the study was to investigate and compare the ability to make inferences in three groups of children ranging from 5.2 to 10.9 years: 10 children with cerebral palsy (CP), 10 children with spina bifida and hydrocephalus (SBH) and 10 children with pragmatic language impairment (PLI). The relationship between inferential and literal comprehension was investigated by analysing atypical responses. For this analysis an analytic framework was developed. The PLI group performed significantly worse on inferential questions than the CP group. It was only in the PLI group that problems with inferential questions exceeded the problems with literal questions, and the CP group even performed significantly better in this condition. Inferential comprehension was found to be related to language comprehension in the CP group, but was more related to the ability to predict future developments in the SBH- and PLI-groups. The PLI group relied more on world knowledge and associations than on text-related factors when delivering an atypical response compared to the CP group. The analysis of atypical responses proved to be a promising tool for the planning of an adequate intervention.

Interaction during intervention: conversations between professionals and children with cerebral palsy.

To develop interactional ability, conversation with both peers and adults is vital. However, for children with physical impairments, like cerebral palsy, interactions with adults often dominate. In this study, interaction between eight Swedish children with cerebral palsy, mean age 8.6 years, and their physiotherapists (PTs) and speech-language therapists (SLTs) was analysed during intervention across 16 dyads. The analysis of data focused on how quantitative, interactional and topical dominance was manifested by the PTs and the SLTs. In addition, mitigating strategies and use of feedback was investigated. Surprisingly, the only significant finding was in topic maintenance, where the PTs' conversations were more directed towards topics unrelated to the intervention context when compared to the conversations of the SLTs. Although not significant, the PTs tended to dominate by having a greater amount of talk, and the SLTs by asking many questions. It is discussed how the two professions may contribute to the development of interactional skills and pragmatic ability among children with cerebral palsy, given their professional training and focus of intervention.

Children with cerebral palsy, spina bifida and pragmatic language impairment: differences and similarities in pragmatic ability.

Pragmatically related abilities were studied in three clinical groups of children from 5 to 11 years of age; children with cerebral palsy (CP; n=10), children with spina bifida and hydrocephalus (SBH; n=10) and children with pragmatic language impairment (PLI; n=10), in order to explore pragmatic abilities within each group. A range of pragmatic, linguistic and cognitive assessments were performed, and comparisons between the groups were made. In addition, connections between variables were studied. The most salient result was the many similarities and the lack of clear boundaries between the groups. The only significant differences found concerned short-term memory and inference ability, where all three groups experienced problems but to varying extent. Different patterns of variance were found in the groups, indicating that different underlying abilities such as reception of grammar, inferential comprehension and lexical comprehension seem to affect pragmatic ability in somewhat different ways. The results suggest that the children with CP and SBH in this study shared a number of pragmatically related traits, being more similar than would be expected according to earlier research. Finally, it is suggested that pragmatic assessment is further subdivided into a socially versus a linguistically related assessment.