PROMPT

Improving intelligibility is the common goal of most intervention studies in dysarthria. Therapy approaches differ, though, regarding how to achieve this improvement. While it is well-known that modification to breathing can lead to gains in intelligibility, the benefit of improving timing and coordination of oro-facial movements during speech is underresearched, according to a team of researchers in Australia. Roslyn Ward and colleagues therefore intended to examine the effectiveness of a motor-speech intervention programme to improve intelligibility in CP. They did this by evaluating changes of lips and jaw movements in six children with moderate to severe dysarthria due to CP before, during and after participation in PROMPT.

PROMPT stands for Prompts for Restructuring Oral-Muscular Phonetic Targets. It is a specifically designed treatment approach that employs tactile-kinaesthetic-proprioceptive (...that is our sense of position) information to jaw, lips and tongue to guide the child’s speech movements.

Children participated in two blocks of intervention, each lasting 10 weeks (one 45-minute session per week). For each child a specific protocol was designed which identified intervention priorities for each child in terms of jaw, lip or lingual control. Speech intelligibility and kinematic movements were assessed prior to intervention, after each intervention block and 8 weeks after the end of the intervention. Findings were compared to the speech of 12 typically developing peers.

Results were promising as they showed significant changes in jaw and lip movements for all children with CP. For instance, they showed improvements in jaw stability as well as a decrease in lip rounding, rendering their movements after intervention more similar to those of their peers. These changes in kinematic control were accompanied by considerable gains in intelligibility for all children. Most importantly, the changes in intelligibility were maintained 8 weeks post-treatment.

Despite the successful intervention, it is important to highlight that other approaches that do not provide sensory information such as the LSVT® (Lee Silverman Voice Treatment) to name but one have also improved jaw movements in children with CP. This implies that the exact contribution of the tactile input remains somewhat unclear and further research is needed to find out which patients might benefit most from the motor based approach. It should also be considered that the children’s age ranged from 3 to 11, i.e. they were at different stages in their speech acquisition process.

 

Ward, R., Strauss, G. & Leitão, S. (2013). Kinematic changes in jaw and lip control of children with cerebral palsy following participation in a motor-speech (PROMPT) intervention. International Journal of Speech-Language Pathology, 15(2), 136-155.

Cerebral palsy and communication – Setting the scene

I thought it would be best to briefly outline the communication disorders that are common in children with CP before diving straight into the latest research work. Lindsay Pennington provides a great overview in her 2008 paper (Paediatrics and Child Health). In my explanations, I mainly refer to her paper.

Communication difficulties are frequently associated with CP: It is estimated that about 50% of children with CP have some form of communication disorder. In most children speech is affected, but language and more general aspects of communication can be compromised as well. Due to the oro-motor problems, feeding difficulties, swallowing problems and drooling are common, too.

The most frequent speech impairment observed in CP is developmental dysarthria. Arising from the motor impairment, it can reduce the functioning and control of the different components required to produce speech i.e. respiration, phonation, nasality and articulation. Depending on the component(s) affected, children’s breathing may be shallow and irregular, and their voice may sound harsh. In addition, the speech sounds they produce may be poorly articulated. Speech problems are associated with all types of CP, but difficulties are more likely to be seen in children with dyskinetic (involuntary movements) than spastic (hypertonic, i.e. stiff muscles) types of CP.

Speech disorders can impact on children’s ability to produce spoken language. Depending on the severity, children may only use vocalisations, produce one word utterances, or very short phrases. This may restrict the range of grammatical structures they can use. Furthermore, delayed language development can derive from the cognitive issues associated with CP, but also be the result of limited interaction with the children’s environment.

In addition to the production of speech, nonverbal communication including facial expression, gestures and body movements may be affected as well. Children with CP often exhibit a delayed development of pragmatic skills and functional aspects of communication. Research suggests that this may be partly due to the fact that conversation with familiar partners follows restricted patterns, showing high levels of partner control. As a result, children with CP are often passive communicators; i.e. they initiate less interaction, they are less responsive and less independent communicators.

Early intervention therefore often targets situations in which the children are required to initiate communication.

…More about intervention approaches will follow here soon…watch this space…

Reference: Pennington, L. (2008). Cerebral palsy and communication. Paediatrics and Child Health 18(9), 405-409.