Relationship Between Communication Skills and Gross Motor Function in Preschool-Aged Children With Cerebral Palsy

doi:10.1016/j.apmr.2013.03.025

Archives of Physical Medicine and Rehabilitation

Volume 94, Issue 11, November 2013, Pages 2210-2217

Presented in part as an oral presentation to the American Academy of Cerebral Palsy and Developmental Medicine, September 15, 2012, Toronto, Canada; and to the Australasian Academy of Cerebral Palsy and Developmental Medicine, May 30–June 2, 2012, Brisbane, Australia.

https://doi.org/10.1016/j.apmr.2013.03.025 Get rights and content

Abstract

Objectives

To explore the communication skills of children with cerebral palsy (CP) at 24 months' corrected age with reference to typically developing children, and to determine the relationship between communication ability, gross motor function, and other comorbidities associated with CP.

Design

Prospective, cross-sectional, population-based cohort study.

Setting

General community.

Participants

Children with CP (N=124; mean age, 24mo; functional severity on Gross Motor Function Classification System [GMFCS]: I=47, II=14, III=22, IV=19, V=22).

Interventions

Not applicable.

Main Outcome Measures

Parents reported communication skills on the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Two independent physiotherapists classified motor type, distribution, and GMFCS. Data on comorbidities were obtained from parent interviews and medical records.

Results

Children with mild CP (GMFCS I/II) had mean CSBS-DP scores that were 0.5 to 0.6 SD below the mean for typically developing peers, while those with moderate-severe impairment (GMFCS III–V) were 1.4 to 2.6 SD below the mean. GMFCS was significantly associated with performance on the CSBS-DP (F=18.55, P<.001), with gross motor ability accounting for 38% of the variation in communication. Poorer communication was strongly associated with gross motor function and full-term birth.

Conclusions

Preschool-aged children with CP, with more severe gross motor impairment, showed delayed communication, while children with mild motor impairment were less vulnerable. Term-born children had significantly poorer communication than those born prematurely. Because a portion of each gross motor functional severity level is at risk, this study reinforces the need for early monitoring of communication development for all children with CP.

Section snippets

Design

This study used cross-sectional data collected from Australian children with CP at 24 months' corrected age. Data were collected between January 2007 and August 2011 as part of a larger longitudinal prospective cohort study, The CP Child Study of Motor and Brain Development (National Health Medical Research Council of Australia: 569605).²³

Participants

Children were referred to the study from across the states of Queensland and Victoria in Australia by their pediatrician, child neurologist, rehabilitation

Results

A total of 124 children received assessments at 24 months' corrected age, of whom 67% were boys (table 1). The distribution of GMFCS classification was as follows: I=47 (38%); II=14 (11%); III=22 (18%); IV=19 (15%); and V=22 (18%). This distribution is similar to those reported in international samples4, 7 and for the Australian population of children with CP.²

The mean score ± SD on the CSBS-DP total for children with CP was 84.9±18.4, although the mean CSBS-DP scores for GMFCS I and II were

Discussion

This prospective study of 24-month-old children with CP found that parent-reported communication skills were, on average, 0.6 SD (for GMFCS I who walk independently) to 2.6 SD (for GMFCS V who are unable to sit) below the reported mean for typically developing peers. We have confirmed that communication ability decreases as gross motor attainment decreases in very young preschool-aged children with CP, which highlights the need for early communication monitoring of all children.

Using the

Conclusions

The results of this study show that children with CP who have more severe motor impairment demonstrate deviations from normal communication development from as young as 24 months of age, although a small percentage of children with more mild impairments are also at risk. More than half of the sample population required further developmental assessment. The strongest variables associated with poorer communication were severity of gross motor impairment and being born at term. This finding

Suppliers

a.
SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.
b.
StataCorp LP, 4905 Lakeway Dr, College Station, TX 77845.

Acknowledgments

We thank Laura Pareezer, BN; GCertPolicyAnalysis, Clinical Trials Coordinator QCPRRC, for her time on recruitment and administrative support; and physiotherapists Chris Finn, BPhty, and Rachel Jordan, BExSc; MPhty, for data collection for the GMFCS classification.

References (38)

L. Pennington
Cerebral palsy and communication
Paediatr Child Health
(2008)
I. Nip et al.
The co-emergence of cognition, language, and speech motor control in early development: a longitudinal correlation study
J Commun Disord
(2011)
B. Russman et al.
Evaluation of the child with cerebral palsy
Semin Pediatr Neurol
(2004)
G. Legault et al.
Predicting comorbidities with neuroimaging in children with cerebral palsy
Pediatr Neurol
(2011)
K. Towsley et al.
Population-based study of neuroimaging findings in children with cerebral palsy
Eur J Paediatr Neurol
(2011)
S. Pirila et al.
Language and motor speech skills in children with cerebral palsy
J Commun Disord
(2007)
H.M. Feldman et al.
Language abilities following prematurity, preventricular brain injury, and cerebral palsy
J Commun Disord
(1994)
P. Rosenbaum et al.
A report: the definition and classification of cerebral palsy April 2006
Dev Med Child Neurol Suppl
(2007)
ACPR Group. Report of the Australian Cerebral Palsy Register, birth years 1993-2003. 2009 Dec. Available at:...
G. Anderson et al.
Cerebral palsy in Norway: prevalence, subtypes and severity
Eur J Paediatr Neurol
(2008)

J. Fauconnier et al.

Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study

BMJ

(2009)

J. Parkes et al.

Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study

Dev Med Child Neurol

(2010)

J.M. Voorman et al.

Social functioning and communication in children with cerebral palsy: association with disease characteristic and personal environmental factors

Dev Med Child Neurol

(2010)

J.M. Voorman et al.

Activities and participation of 9- to 13-year-old children with cerebral palsy

Clin Rehabil

(2006)

L. Pennington

Predicting patterns of interaction between children with cerebral palsy and their mothers

Dev Med Child Neurol

(2001)

R. Power et al.

Hardship, dedication and investment: an exploration of Irish mothers commitment to communicating with their children with cerebral palsy

J Psychiatr Ment Health Nurs

(2009)

M. Robertson et al.

Magnetic resonance imaging findings in a population-based cohort of children with cerebral palsy

Dev Med Child Neurol

(2008)

D. Lamônica et al.

Periventricular leukomalacia and spastic diplegia: implications in the psycholinguistic abilities

Pró-Fono Revista de Atualização Científica

(2007)

K. Hustad et al.

Classification of speech and language profiles in 4-year-old children with cerebral palsy: a prospective preliminary study

J Speech Lang Hear Res

(2010)

Cited by (39)

Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy
2018, Disability and Health Journal
Citation Excerpt :
A review is reported that impairment of speech is more common in dyskinetic CP and tetraplegic more than diplegic.31 The results of Coleman et al. confirmed our findings and indicated that children with more severe gross motor impairment showed poorer and less effective communication, while children with mild motor impairment had better and more effective communication.32 However, current findings show that individuals with CP who have severe influence on performing motor activities have good communication skills.33
Functional classification systems have generally been used by clinicians and recently by parents to classify various functions of children with cerebral palsy (CP).
This study evaluated the agreement between clinicians and parents when classifying the communication function of children with CP using the Communication Function Classification System (CFCS). In addition, the relationships between the Gross Motor Function Classification System – Expanded and Revised (GMFCS-E&R), the Manual Ability Classification System (MACS), and CFCS were investigated.
This study was a cross-sectional study and included 102 children aged 4–18 years with CP and their parents. The parents and clinician classified the communication of children by using the Turkish language version of CFCS. Furthermore GMFCS-E&R and MACS were used for classification only by the clinician.
The weighted Kappa agreement between CFCS results of the parents and clinicians was 0.95 (95% CI 0.95–0.96, p < 0.001). GMFCS-E&R levels were highly correlated with CFCS levels (r = 0.78 (95%CI 0.68–0.84, p < 0.001)). MACS and CFCS results were also highly correlated (r = 0.73 (95%CI 0.63–0.81, p < 0.001).
The child's communication was classified as indicating higher functioning by the parents compared with the clinicians. The excellent agreement between parents and clinicians with the Turkish language version of CFCS for children with CP indicated that parents and clinicians could use the same language while classifying the communication function of children.
Comparisons of severity classification systems for oropharyngeal dysfunction in children with cerebral palsy: Relations with other functional profiles
2018, Research in Developmental Disabilities
Citation Excerpt :
The safety issue also considered in determining the level of EDACS (Sellers, Pennington et al., 2014), but it is uncertain how well EDACS reflects the safety issue relating to swallow in children with CP. There was a trend to have more severe gross motor function to also have more limited function in other functions such as manual ability and communication function (Coleman, Weir, Ware, & Boyd, 2013; Compagnone et al., 2014; Hidecker et al., 2012). As part of the effect showing the relationships between functional classification systems in children with CP, the significant associations between EDACS and Gross Motor Function Classificaion System- Expanded and Revised (GMFCS- E&R) were shown in previous studies (Benfer et al., 2017; Sellers, Mandy et al., 2014).
This study aimed to investigate the relationships between various classification systems assessing the severity of oropharyngeal dysphagia and communication function and other functional profiles in children with cerebral palsy (CP). This is a prospective, cross-sectional, study in a university-affiliated, tertiary-care hospital. We recruited 151 children with CP (mean age 6.11 years, SD 3.42, range 3–18 yr). The Eating and Drinking Ability Classification System (EDACS) and the dysphagia scales of Functional Oral Intake Scale (FOIS), Swallow Function Scales (SFS), and Food Intake Level Scale (FILS) were used. The Communication Function Classification System (CFCS) and Viking Speech Scale (VSS) were employed to classify communication function and speech intelligibility, respectively. The Pediatric Evaluation of Disability Inventory (PEDI) with the Gross Motor Function Classification System (GFMCS) and the Manual Ability Classification System (MACS) level were also assessed. Spearman correlation analysis to investigate the associations between measures and univariate and multivariate logistic regression models to identify significant factors were used. Median GMFCS level of participants was III (interquartile range II–IV). Significant dysphagia based on EDACS level III–V was noted in 23 children (15.2%). There were strong to very strong relationships between the EDACS level with the dysphagia scales. The EDACS presented strong associations with MACS, CFCS, and VSS, a moderate association with GMFCS level, and a moderate to strong association with each domain of the PEDI. In multivariate analysis, poor functioning in EDACS were associated with poor functioning in gross motor and communication functions.
Relationship between brain lesion characteristics and communication in preschool children with cerebral palsy
2016, Research in Developmental Disabilities
Citation Excerpt :
There is an absence of prospective population-based data exploring the relationship between the type and severity of brain lesion (using standardised MRI/CT classification systems) and communication ability (using standardised communication assessments) across the full spectrum of severity of children with CP. A previous study that considered the cohort of children with CP described within this paper (124 children, mean age 24 months across the full range of gross motor function), demonstrated that communication skills were strongly related to gross motor function, distribution of motor impairment and gestational age at birth (Coleman, Weir, Ware, & Boyd, 2013). We have also found that early communication ability and early gross motor function at 18–24 months were significant predictors of communication function at school entry (Coleman, Weir, Ware, & Boyd, 2014).
MRI shows promise as a prognostic tool for clinical findings such as gross motor function in children with cerebral palsy(CP), however the relationship with communication skills requires exploration.
To examine the relationship between the type and severity of brain lesion on MRI and communication skills in children with CP.
131 children with CP (73 males(56%)), mean corrected age(SD) 28(5) months, Gross Motor Functional Classification System distribution: I = 57(44%), II = 14(11%), III = 19(14%), IV = 17(13%), V = 24(18%). Children were assessed on the Communication and Symbolic Behavioral Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Structural MRI was analysed with reference to type and semi-quantitative assessment of the severity of brain lesion. Children were classified for motor type, distribution and GMFCS. The relationships between type/severity of brain lesion and communication ability were analysed using multivariable tobit regression.
Children with periventricular white matter lesions had better speech than children with cortical/deep grey matter lesions (β = −2.6, 95%CI = −5.0, −0.2, p = 0.04). Brain lesion severity on the semi-quantitative scale was related to overall communication skills (β = −0.9, 95%CI = −1.4, −0.5, p < 0.001). Motor impairment better accounted for impairment in overall communication skills than brain lesion severity.
Structural MRI has potential prognostic value for communication impairment in children with CP.
This is the first paper to explore important aspects of communication in relation to the type and severity of brain lesion on MRI in a representative cohort of preschool-aged children with CP. We found a relationship between the type of brain lesion and communication skills, children who had cortical and deep grey matter lesions had overall communication skills > 1 SD below children with periventricular white matter lesions. Children with more severe brain lesions on MRI had poorer overall communication skills. Children with CP born at term had poorer communication than those born prematurely and were more likely to have cortical and deep grey matter lesions. Gross motor function better accounted for overall communication skills than the type of brain lesion or brain lesion severity.
The relationship between family empowerment and fine motor, gross motor and cognitive skills in young children with cerebral palsy
2023, Child: Care, Health and Development
School readiness of children at high risk of cerebral palsy r andomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials
2023, BMJ Open
Determinants of spoken language comprehension in children with cerebral palsy
2023, Disability and Rehabilitation

View all citing articles on Scopus

: Supported by the National Health and Medical Research Council of Australia (project grant no. 569605), and by an NHMRC Career Development Fellowship (no. 1037220).

: No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

View full text

Original articleRelationship Between Communication Skills and Gross Motor Function in Preschool-Aged Children With Cerebral Palsy

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Design

Participants

Results

Discussion

Conclusions

Suppliers

Acknowledgments

Paediatr Child Health

J Commun Disord

Semin Pediatr Neurol

Pediatr Neurol

Eur J Paediatr Neurol

J Commun Disord

J Commun Disord

A report: the definition and classification of cerebral palsy April 2006

Dev Med Child Neurol Suppl

Cerebral palsy in Norway: prevalence, subtypes and severity

Eur J Paediatr Neurol

Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study

BMJ

Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study

Dev Med Child Neurol

Social functioning and communication in children with cerebral palsy: association with disease characteristic and personal environmental factors

Dev Med Child Neurol

Activities and participation of 9- to 13-year-old children with cerebral palsy

Clin Rehabil

Predicting patterns of interaction between children with cerebral palsy and their mothers

Dev Med Child Neurol

Hardship, dedication and investment: an exploration of Irish mothers commitment to communicating with their children with cerebral palsy

J Psychiatr Ment Health Nurs

Magnetic resonance imaging findings in a population-based cohort of children with cerebral palsy

Dev Med Child Neurol

Periventricular leukomalacia and spastic diplegia: implications in the psycholinguistic abilities

Pró-Fono Revista de Atualização Científica

Classification of speech and language profiles in 4-year-old children with cerebral palsy: a prospective preliminary study

J Speech Lang Hear Res

Original article
Relationship Between Communication Skills and Gross Motor Function in Preschool-Aged Children With Cerebral Palsy