Thanks to a range of recent studies, we now know that receptive and
expressive language can be affected in children with CP. We also know that
language problems are more likely in children with severe mobility issues. What
we do not really know at this stage is how well non-verbal children with severe
CP can understand spoken language, and whether there are factors that can to
some extent predict how well they will do.
Geytenbeek and colleagues tried to answer this question. In a recently
published study, they tested the receptive language abilities of 87 Dutch
children with severe CP who spoke fewer than 5 words. The children were between
1 and 6 years old. The authors used the C-BiLLT (which stands
for computer-based instrument for low
motor language testing), a test they have developed that considerably
reduces the need for any motor action to respond to the test stimuli. Children
can use a range of devices to respond including a touch screen, input switches,
switch activators, their own electric wheelchair head support and/or eye
gazing. The test contains 77 sentences, which become more difficult over the
course of the test in terms of vocabulary and grammar. In the test situation,
the test leader says the items out loud. At the same time, the items are
presented visually on the computer. There are a number of practice items, which
are included to make sure that the child can signal a choice between 2 objects.
Only if they do well in this pre-test, they move on to the main test.
Results showed
that 78% of children were able to complete the language test. The results also
showed that type of CP mattered when it came to completing the test. Children
with dyskinetic CP were much more likely to move on to the main test than
children with spastic CP. In terms of response mode, 38% of children used the
touch screen, 24% used their own wheelchair head support and about 20% used
eyegazing. The latter 2 options were used more frequently by children with very
severe mobility problems (GMFCS V).
What about the
language performance? The authors found that receptive language abilities varied
considerably in the group, even though children had similar levels of
functional limitations. Children with dyskinetic CP performed better than
children with spastic CP. For the former group half of the children showed
similar language scores as children with typical development; for the latter
group no such pattern was found showing that language delay is much more likely
with spastic type CP.
Based on these
findings the authors conclude that receptive language abilities in dyskinetic
CP can be good, and therefore expressive as well as receptive language ability
should be tested. This will also help to make sure that the right communication
aids are chosen for each child and their individual abilities.
Geytenbeek, J., Vermeulen, J., Becher, J. & Oostrom,
K. (2015). Comprehension
of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities. Developmental Medicine & Child Neurology,
57, 294–300.
