How are speech and language therapists (SLTs) managing the communication needs of young people with CP: Findings from a recent UK survey

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.

Activity and participation in children with CP

Research has shown that children with CP and speech problems can find it harder to engage with others in social situations than children with CP who do not have any speech difficulties. Cristina Mei and colleagues from Australia built on these findings trying to find out how speech problems can affect children’s day-to-day interactions in different communication settings such as home, school and community. 

Seventy-nine 5- to 6-year olds from Victoria, Australia, took part in the study. A range of scales were used by the first author to collect information on the presence of speech problems, and the severity of speech problems reflected in level of intelligibility and functional communication, i.e. how well children get their messages across: 

1. Viking Speech Scale (VSS) to judge presence of speech problems 
2. National Technical Institute for the Deaf (NTID) rating scale to rate intelligibility (using connected speech obtained during free-play between parent and child
3.  Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS) to measure functional communication

In addition, parents were asked to rate on a 1 to 10 point scale whether their children find it easy or difficult to participate in activities within home, school and community settings because of their ability to communicate.

Results revealed that 90% of children did show some speech problems. This is a high number compared to other studies, which found that between 30 to 70% of children with CP have some form of communication problem. The authors think that maybe only those parents who were concerned about their children’s speech were interested in participating. The analysis of the intelligibility scores also showed that over half of the children were highly intelligible. The authors also found that about 60% of children were good at getting their messages across. In addition, a clear link between speech skills and activity and participation was found with children with mild speech problems being more successful communicators in social situations than children with severe speech problems.

The study also revealed that participation was easiest in familiar environments such as home, and more difficult in school and community, although this was influenced by the severity of the speech problems. The good news is that children with mild problems were equally successful in participating in social interactions than children without speech problems. This means that mild speech problems did not have any negative effects on communication – at least for the children in this study. It can therefore be reasonably concluded that intervention to increase social participation is likely to be more important for children with moderate to severe speech problems.

Mei, C., Reilly, S., Reddihough, D., Mensah, F. & Morgan, A. (2014). Motor speech impairment, activity and participation in children with cerebral palsy. International Journal of Speech-Language Pathology, 16(4), 427-435.