Speech and language therapy for children with CP aims to support the
development of effective communication skills. Many clinicians will agree that
reducing the speech impairment and improving speech intelligibility will support
the child to be part of family, school and community life. However, there is
likely to be less consensus regarding how this can be achieved. Rose Watson and
Lindsay Pennington think that practices may vary due to differences in health
and social care resources as well as uncertainty about which intervention is indeed
effective.
To explore this, they conducted a UK wide online survey asking SLTs
about their assessment and intervention practices for communication problems in
children and young people with CP, i.e. which problems are commonly addressed,
which areas are assessed and how, and which areas are treated and how. The
survey was advertised via NHS and RCSLT channels as well as associated social
media. Over the course of two months about 300 SLTs replied, of which 265
responses were analysed.
Assessment practices
The responses showed that a wide
range of published standardised tests is used to assess including oro-motor
function, receptive and expressive language and speech. This shows that children’s
communication skills are thoroughly assessed. SLTs also made an effort to
individualise assessments where needed. For example, they enlarged pictures or
cut them up for children with sensory and/or motor problems. On the other hand,
the survey found that non-standardised tests were used as well, which means
results cannot be compared to norms. Also, communication skills were sometimes assessed
by observation only, which can underestimate children’s abilities.
Intervention practices
Swallowing and receptive language skills were listed by SLTs as the main
areas of intervention. Assisted communication, also referred to as AAC, was
another intervention priority for them to achieve the aim of communication
participation. Again, SLTs used a number of intervention techniques, which is
not surprising given the wide and varied range of communication difficulties in
children with CP. However, the authors also noted that some of the techniques
used are not supported by the literature. This means that in previous studies these
techniques were not found to improve communication much.
Overall, the findings show that there is indeed a wide variation in the
assessment and intervention of communication difficulties in children with CP. This
variation makes it difficult to compare practices across different services.
The authors conclude that a set of agreed clinical measures would be a good
starting point to inform service development and identify research priorities to
move evidence-based practice forward.
Watson, R. M. & Pennington, L. (2015). Assessment and management of
the communication difficulties of children with cerebral palsy: a UK survey of
SLT practice. International Journal of
Language and Communication Disorders, 50(2), 241-259.
