Foundations of phonological awareness in pre-school children with cerebral palsy: the impact of intellectual disability

Background Children with cerebral palsy (CP) and accompanying disabilities are prone to reading difficulties. The aim of the present study was to examine the foundations of phonological awareness in pre‐school children with CP in comparison with a normally developing control group. Rhyme perception was regarded as an early indicator of phonological awareness, whereas non‐verbal reasoning, speech ability, auditory perception, auditory short‐term memory and vocabulary were regarded as foundation measures. Methods A number of tasks were administrated to examine group differences in rhyme perception and its foundation measures. Correlations between the tasks were analysed for both groups followed by multiple regression analyses wherein rhyme perception was predicted by its foundation measures. Results Children with CP scored below their normally developing peers on emergent phonological awareness and its foundation measures. Regarding the prediction of phonological awareness, non‐verbal reasoning followed by pseudoword articulation, were found to predict phonological awareness, i.e. rhyme perception, in the group of children with CP. In the control group, auditory perception was a significant predictor of emergent phonological awareness. The CP group was further split up into two groups according to the children's non‐verbal reasoning skills, i.e. general IQ. The below‐average IQ group scored below the average IQ group on phonological awareness and on most foundation measures. In addition, the average IQ group of the children with CP scored lower than the control group. Conclusion The results of this study indicate that general intelligence and speech ability (i.e. pseudoword articulation) can be seen as important facilitators of emergent phonological awareness in children with CP. These findings support the role of intelligence in the emergence of phonological awareness in children with CP. Children with CP with intellectual disabilities seem to have a disadvantage in acquiring phonological awareness, especially when their speech abilities are also impaired. However, general intelligence is not enough to predict phonological awareness as other foundation measures are also important for phonological awareness independent of general intelligence.     

Effects of targeted reading instruction on phonological awareness and phonic decoding in children with down syndrome

This research evaluated the effectiveness of reading instruction targeting oral reading and phonological awareness for children with Down syndrome (affecting chromosome 21). The participants were 7 children ranging in age from 2 years, 11 months to 10 years, 8 months. Each child acted as his/her own control, with assessments of language, cognition, phonological awareness, word and short-passage comprehension, and oral reading ability conducted on four occasions (initially, preintervention, postintervention and delayed postintervention) over approximately a 12-month period. The intervention was conducted over 10 weekly sessions and involved individual instruction. The postintervention assessment results provided evidence that phonic reading instruction was generally effective in improving reading skills and phonological awareness of children with Down syndrome.     

Intensive speech and language therapy for older children with cerebral palsy: a systems approach

Aim To investigate whether speech therapy using a speech systems approach to controlling breath support, phonation, and speech rate can increase the speech intelligibility of children with dysarthria and cerebral palsy (CP). Method Sixteen children with dysarthria and CP participated in a modified time series design. Group characteristics were as follows: seven males, nine females; age range 12 to 18 years (mean 14y, SD 2); CP type: nine spastic, two dyskinetic, four mixed, one Worster–Drought; Gross Motor Function Classification System levels range I to V (median IV). Children received three 30‐ to 45‐minute sessions of individual therapy per week for 6 weeks. Intelligibility in single words and connected speech was compared across four points: 1 week and 6 weeks before therapy, and 1 week and 6 weeks after its completion. Three familiar listeners and three unfamiliar listeners scored each recording. Mean percentage intelligibility was compared using general linear modelling techniques. Results After treatment, familiar listeners understood 14.7% more single words and 12.1% more words in connected speech. Unfamiliar listeners understood 15% more single words and 15.9% more words in connected speech after therapy. Interpretation Therapy was associated with increases in speech intelligibility. Effects of the therapy should be investigated further, in an exploratory trial with younger children and in a randomized controlled trial.     

Delays in the reading and spelling of children with cerebral palsy: Associations with phonological and visual processes

BackgroundThis investigation addresses the question of whether there exists a significant discrepancy in the cognitive abilities of children with cerebral palsy (CP) who, despite the presence of age appropriate communication and language, have reading and spelling delays.AimsWe wanted to discover whether there was a relationship between the phonological and visual perceptual abilities of children with CP and their progress in reading and spelling.Methods and proceduresFifteen children with CP (aged between 6:9 years and 11:6 years) were assessed on reading and spelling; communication and language; non-verbal reasoning; phonological processing; and visual perception.Outcomes and resultsTen of the children had very weak reading and spelling skills. Five children had (mostly) age appropriate scores of reading and spelling. No differences were found between these two groups in non-verbal reasoning or communication and language. However, phonological abilities, visual sequential memory and perception of visuospatial relationships were found to be related to reading and spelling.Conclusions and implicationsThe findings suggest that children with CP are at risk for reading and spelling delays when they have poor phonological processing, visual sequential memory and perception of visuospatial relationships. The implications of the findings for classroom practice are discussed.     

Development of The Viking Speech Scale to classify the speech of children with cerebral palsy

Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k > .58 for all comparisons). Test–retest reliability was substantial to almost perfect for all groups (k > .68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review.     

The role of phonological awareness,speech perception,and auditory temporal processing for dyslexia

There is strong evidence that auditory processing plays a major role in the etiology of dyslexia. Auditory temporal processing of non-speech stimuli, speech perception, and phonological awareness have been shown to be influential in reading and spelling development. However, the relationship between these variables remains unclear. In order to analyze the influence of these three auditory processing levels on spelling, 19 dyslexic and 15 control children were examined. Significant group differences were found for all speech variables, but not for any non-speech variable. Structural equation modeling resulted in a fairly simple model with direct paths to the respective next lower level. One additional path from preattentive speech processing to spelling had to be included in order to improve the model fit. These results strengthen the role of speech and phonological processing for the etiology in dyslexia.     

Reading ability and phonological awareness in Japanese children with dyslexia

In alphabetic languages, the deficit of the phonological awareness is considered as the core deficit in developmental dyslexia. However, the role of phonological awareness in the acquisition of reading Japanese kana, the transparent, mora-based phonogram, has not been understood completely. We examine the abilities of Japanese dyslexic children on different types of Japanese phonological tasks, and discussed which tasks significantly account for each aspect of reading ability. METHODS: Fifteen dyslexic children (9.53+/-1.52 years old), and 15 children with normal reading ability (9.17+/-0.90 years old) participated in this study. They performed three types of phonological awareness tasks. The mora counting task and the mora reversal task of words require phonological awareness at the mora level. The letter rhyming task, which resembles the task in English language, requires phonological awareness at the phoneme level. We evaluated the reading ability by the reading speed, the reading errors, and the number of pauses while reading sentences aloud. RESULTS: The task performances of the dyslexic group on all three phonological awareness tasks were significantly lower than those of the control group. Stepwise multiple regression analysis revealed that the mora counting task and the rhyming letter task most significantly explained the reading speed and number of reading pauses. The mora reversal task of words, together with the antegraded digit span, significantly explained the reading errors. CONCLUSIONS: Japanese dyslexics showed deficits of phonological awareness both at the mora and the phoneme levels. Phonological awareness must be crucial for acquiring the ability of decoding phonograms, including Japanese kana.     

Rehabilitation approaches for children with cerebral palsy: overview

This article reviews the use of the World Health Organization classification framework for assessing children and adolescents with cerebral palsy and the use of outcome measures as they relate to the International Classification of Functioning, Disability and Health. Various intervention philosophies and approaches are discussed, including the evidence to support their use with children with cerebral palsy. Therapists will be able to use this information to formulate an assessment plan, incorporate the use of outcome measures, and employ evidence-based intervention methods.     

Aquatic exercise for children with cerebral palsy

Exercise for children with cerebral palsy (CP) is gaining popularity among pediatric physical therapists as an intervention choice. Exercise in water appeals to children with CP because of the unique quality of buoyancy of water that reduces joint loading and impact, and decreases the negative influences of poor balance and poor postural control. In this paper, research of land-based exercise and aquatic exercise for children with CP is reviewed. Clinically relevant considerations for aquatic exercise programming for children with CP are discussed.     

Electropalatography in the description and treatment of speech disorders in five children with cerebral palsy

Some children with cerebral palsy have articulation disorders that are resistant to conventional speech therapy. The aim of this study was to investigate whether the visual feedback method of electropalatography (EPG) could be an effective tool for treating five children (mean age of 9.4 years) with dysarthria and cerebral palsy and to explore whether training improved the posteriorly placed articulation of the Swedish dental/alveolar target consonants /t/, /d/, /n/ and /s/ produced in different positions. An EPG analysis was conducted and some of the data were combined with a perceptual analysis. A more anterior placement was seen after treatment for the target sounds. Features of diagnostic importance revealed were unusual tongue-palate contacts, such as double articulation and abnormally retracted articulation. A possible change in stop closure duration was indicated. The results suggest that EPG could be of potential benefit for diagnosing, treating and describing articulation errors associated with cerebral palsy.     

Electropalatography in the description and treatment of speech disorders in five children with cerebral palsy

Some children with cerebral palsy have articulation disorders that are resistant to conventional speech therapy. The aim of this study was to investigate whether the visual feedback method of electropalatography (EPG) could be an effective tool for treating five children (mean age of 9.4 years) with dysarthria and cerebral palsy and to explore whether training improved the posteriorly placed articulation of the Swedish dental/alveolar target consonants /t/, /d/, /n/ and /s/ produced in different positions. An EPG analysis was conducted and some of the data were combined with a perceptual analysis. A more anterior placement was seen after treatment for the target sounds. Features of diagnostic importance revealed were unusual tongue–palate contacts, such as double articulation and abnormally retracted articulation. A possible change in stop closure duration was indicated. The results suggest that EPG could be of potential benefit for diagnosing, treating and describing articulation errors associated with cerebral palsy.     

Early phonological awareness and reading skills in children with Down syndrome

Increasingly, children with Down syndrome receive literacy instruction with the expectation of acquiring functional reading skills. Unfortunately, little is known about the processes underlying literacy skills in this special population. Phonological awareness contributes to literacy development in typically developing children, however, there is inconclusive evidence about these skills in younger children with Down syndrome. 9 children with Down syndrome (5.6-8.10 years) participated in this investigation. Due to the paucity of standardised phonological awareness measures for children with special needs, in particular children with Down syndrome, a variety of tasks were adapted from the literature. The assessment battery examined the skills of phonological awareness, literacy, speech production, expressive language, hearing acuity, speech perception, and auditory-visual memory. The results suggest that children with Down syndrome are at risks for reading acquisition difficulties due to reduced phonological awareness skills. These deficits are in addition to delays caused by reduced cognitive skills. Only one of the participants was able to demonstrate rhyme awareness, which may have been due to task effects. Written word recognition ability was correlated with tests of phonemic awareness, and error analysis of the spelling and non-word reading tasks suggested grapheme-phoneme connections deficits. Further research is needed to determine the best methods of assessment and intervention for phonological awareness in children with Down syndrome.     

Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes

ABSTRACT

Objective: To determine whether communication at 2 years predicted communication at 4 years in children with cerebral palsy (CP); and whether the age a child first produces words imitatively predicts change in speech production. Method: 30 children (15 males) with CP participated and were seen 5 times at 6-month intervals between 24 and 53 months (mean age at time 1 = 26.9 months (SD 1.9)). Variables were communication classification at 24 and 53 months, age that children were first able to produce words imitatively, single-word intelligibility, and longest utterance produced. Results: Communication at 24 months was highly predictive of abilities at 53 months. Speaking earlier led to faster gains in intelligibility and length of utterance and better outcomes at 53 months than speaking later. Conclusion: Inability to speak at 24 months indicates greater speech and language difficulty at 53 months and a strong need for early communication intervention.