How well do children with severe cerebral palsy understand spoken language?

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.