Motor speech impairment, activity, and participation in children with cerebral palsy

Figures & data

Table I. Characteristics of participants (n = 79) and non-participants (n = 147).

	Participants, n (%)	Non-participants, n (%)	p-value
Gender
Female	34 (43)	62 (42)	.90
Male	45 (57)	85 (58)
CP motor type
Spastic	61 (77)	123 (84)	.69
Dyskinesia	1 (1)	1 (1)
Hypotonia	3 (4)	4 (3)
Ataxic	1 (1)	2 (1)
Mixed	13 (16)	15 (10)
Unknown	0 (0)	2 (1)
CP distribution
Monoplegia	1 (1)	2 (1)	.93
Hemiplegia	29 (37)	58 (39)
Diplegia	23 (29)	44 (30)
Triplegia	1 (1)	3 (2)
Quadriplegia	25 (32)	38 (26)
Unknown	0 (0)	2 (1)
GMFCS level
I	31 (39)	54 (37)	.50
II	14 (18)	34 (23)
III	12 (15)	12 (8)
IV	15 (19)	22 (15)
V	7 (9)	14 (10)
Unknown	0 (0)	11 (7)
MACS level^a
I	28 (35)	—
II	27 (34)	—
III	11 (14)	—
IV	7 (9)	—
V	6 (8)	—
Epilepsy
No	61 (77)	104 (71)	.74
Yes	17 (22)	36 (24)
Resolved	1 (1)	1 (1)
Unknown	0 (0)	6 (4)
Cognitive impairment^b
No	49 (62)	59 (40)	.21
Yes	22 (28)	40 (27)
Unknown	8 (10)	48 (33)
Hearing impairment
No	73 (92)	105 (71)	.13
Yes	6 (8)	18 (12)
Unknown	0 (0)	24 (16)
Vision impairment
No	52 (66)	67 (46)	.32
Yes	27 (34)	47 (32)
Unknown	0 (0)	33 (22)
Language impairment^c
No	27 (34)	—
Yes	51 (65)	—
Unknown	1 (1)	—

p-value calculated using the chi-square test. GMFCS, Gross Motor Function Classification System level (Palisano et al., 1997); MACS, Manual Ability Classification System (Eliasson et al., 2006).

^aMACS levels for non-participants are not reported due to the high percentage of missing data on the Victorian Cerebral Palsy Register.

^bCognitive status (recorded as “no impairment”, “probably no impairment”, “probably some impairment”, “unknown”) was based on data obtained by the Victorian Cerebral Palsy Register.

^cLanguage data not available for non-participants. Language was measured using the Preschool Language Scale, 4th edition (Zimmerman, Steiner, & Pond, 2002). Language impairment was defined as a standard score greater than one standard deviation below the mean on the Auditory Comprehension and/or Expressive Communication sub-scales.

Table II. National Technical Institute for the Deaf (NTID) speech intelligibility, Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) ratings.

Measure	n (%)
NTID speech intelligibility scale
5	9 (11)
4	34 (43)
3	11 (14)
2	7 (9)
1	18 (23)
CFCS
I	17 (22)
II	13 (16)
III	35 (44)
IV	10 (13)
V	4 (5)
FCCS
I	10 (13)
II	39 (49)
III	9 (11)
IV	18 (23)
V	3 (4)

Table III. Association between the Viking Speech Scale (VSS), National Technical Institute for the Deaf (NTID) speech intelligibility, Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS).

	VSS level, n (%)
	I (n = 8)	II (n = 43)	III (n = 9)	IV (n = 19)	p-value
NTID speech intelligibility scale
5	7 (88)	2 (5)	0 (0)	0 (0)	< .001^a
4	1 (13)	33 (77)	0 (0)	0 (0)
3	0 (0)	8 (19)	3 (33)	0 (0)
2	0 (0)	0 (0)	6 (67)	1 (5)
1	0 (0)	0 (0)	0 (0)	18 (95)
CFCS
I	7 (88)	10 (23)	0 (0)	0 (0)	< .001^b
II	1 (13)	12 (28)	0 (0)	0 (0)
III	0 (0)	19 (44)	8 (89)	8 (42)
IV	0 (0)	2 (5)	1 (11)	7 (37)
V	0 (0)	0 (0)	0 (0)	4 (21)
FCCS
I	3 (38)	7 (16)	0 (0)	0 (0)	< .001^c
II	5 (63)	34 (79)	0 (0)	0 (0)
III	0 (0)	1 (2)	7 (78)	1 (5)
IV	0 (0)	1 (2)	2 (22)	15 (79)
V	0 (0)	0 (0)	0 (0)	3 (16)

p-value calculated using the chi-square test.

^aχ² = 173.17, df = 12.

^bχ² = 62.60, df = 12.

^cχ² = 114.63, df = 12.

Table IV. Association between ratings on the National Technical Institute for the Deaf (NTID) speech intelligibility, Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS).

	Speech intelligibility (NTID rating), n (%)
	5 (n = 9)	4 (n = 34)	3 (n = 11)	2 (n = 7)	1 (n = 18)	p-value
CFCS
I	7 (78)	10 (29)	0 (0)	0 (0)	0 (0)	< .001^a
II	2 (22)	11 (33)	0 (0)	0 (0)	0 (0)
III	0 (0)	13 (38)	9 (82)	6 (86)	7 (39)
IV	0 (0)	0 (0)	2 (18)	1 (14)	7 (39)
V	0 (0)	0 (0)	0 (0)	0 (0)	4 (22)
FCCS
I	4 (44)	6 (18)	0 (0)	0 (0)	0 (0)	<.001^b
II	5 (56)	28 (82)	6 (55)	0 (0)	0 (0)
III	0 (0)	0 (0)	4 (36)	4 (57)	1 (6)
IV	0 (0)	0 (0)	1 (9)	3 (43)	14 (78)
V	0 (0)	0 (0)	0 (0)	0 (0)	3 (17)

p-value calculated using the chi-square test.

^a χ^{2 =} 72.95, df = 16.

^b χ² = 102.69, df = 16.

Table V. Impact of motor speech impairment, speech intelligibility, and parent perception of communication on participation within the home, school, and community.

	Level of difficulty for the child participating because of their communication, in the:
	Home				School				Community
	Range	Mean^a (SD)	Mean difference (95% CI)	p	Range	Mean (SD)	Mean difference (95% CI)	p	Range	Mean (SD)	Mean difference (95% CI)	p
VSS level^b (I) speech is not affected; (II) speech is imprecise but usually understandable to unfamiliar listeners; (III) speech is unclear and not usually understandable to unfamiliar listeners out of context; and (IV) no understandable speech.
I (n = 8)	1–2	1.3 (.5)	Ref	Ref	1–4	2.0 (1.1)	Ref	Ref	1–8	2.8 (2.4)	Ref	Ref
II (n = 43)	1–7	2.4 (1.7)	1.2 (−.4, 2.8)	.15	1–10	3.5 (2.3)	1.5 (−.3, 3.2)	.10	1–10	3.9 (2.4)	1.2 (−.6, 3.0)	.20
III (n = 9)	2–10	4.0 (2.5)	2.8 (.7, 4.8)	.009*	3–10	5.1 (2.3)	3.1 (1.0, 5.3)	.006*	4–10	6.1 (1.8)	3.4 (1.1, 5.6)	.004*
IV (n = 17)^c	1–10	5.5 (3.1)	4.2 (2.4, 6.0)	< .001*	1–10	5.8 (2.7)	3.8 (1.8, 5.7)	< .001*	1–10	8.4 (2.4)	5.7 (3.7, 7.7)	< .001*
NTID speech intelligibility rating^d (1) speech is unintelligible; (2) only isolated words or phrases are intelligible; (3) half of the message is understood; (4) speech is intelligible with some exceptions; and (5) speech is completely intelligible.
5 (n = 9)	1–5	1.7 (1.3)	Ref	Ref	1–7	2.4 (2.0)	Ref	Ref	1–8	3.0 (2.5)	Ref	Ref
4 (n = 34)	1–6	2.1 (1.3)	−1.1 (−3.0, .8)	.30	1–9	3.0 (2.0)	−.4 (−2.4, 1.6)	.70	1–8	3.5 (2.1)	−2.1 (−4.1, .0)	.05*
3 (n = 11)	1–7	3.5 (2.2)	−2.0 (−3.7, −.4)	.02*	3–10	4.9 (2.1)	−.9 (−2.6, .8)	.30	1–10	5.4 (2.3)	−3.3 (−5.0, −1.5)	< .001*
2 (n = 7)	2–10	4.4 (2.7)	−3.4 (−4.7, −2.1)	< .001*	3–10	5.4 (2.5)	−2.8 (−4.2, −1.5)	< .001*	5–10	6.6 (1.8)	−5.2 (−6.5, −3.8)	< .001*
1 (n = 16)^c	1–10	5.5 (3.2)	−3.8 (−5.6, −2.1)	< .001*	1–10	5.8 (2.8)	−3.4 (−5.2, −1.5)	.001*	1–10	8.6 (2.3)	−5.6 (−7.5, −3.8)	< .001*

^aBased on a scale of 1–10 (1 = extremely easy, 10 = extremely difficult), Mean difference = difference in mean scores on the 10-point scale compared to the reference (Ref) group representing children without impairment.

^bANOVA: home: F = 11.00, df = 3; school F = 6.96, df = 3; community: F = 18.20, df = 3.

^cData missing for two participants.

^dANOVA: home: F = 8.82, df = 4; school F = 6.67, df = 4; community: F = 17.29, df = 4.

*Significant at p < .05.

Table

(a) In the home
○ 1	○ 2	○ 3	○ 4	○ 5	○ 6	○ 7	○ 8	○ 9	○ 10
Extremely easy									Extremely difficult
(b) At school/kindergarten
○ 1	○ 2	○ 3	○ 4	○ 5	○ 6	○ 7	○ 8	○ 9	○ 10
Extremely easy									Extremely difficult
(c) In the community
○ 1	○ 2	○ 3	○ 4	○ 5	○ 6	○ 7	○ 8	○ 9	○ 10
Extremely easy									Extremely difficult

Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39, 214–223.

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Eliasson, A. C., Krumlinde-Sundholm, L., Rosblad, B., Beckung, E., Arner, M., Ohrvall, A. M., et al. (2006). The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Developmental Medicine and Child Neurology, 48, 549–554.

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Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2002). Preschool language scale, fourth edition. San Antonio, TX: Harcourt Assessment, Inc.

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