Consonant production and overall speech characteristics in school-aged children with cerebral palsy and speech impairment

Figures & data

Table I. Demographic data for 19 children with CP and speech impairment.

Child	Gender	Age	Hearing deficit**	Type of CP**	Gross motor function level**	Receptive language measured with*** TROG-2 (percentiles)	Non-verbal cognitive level measured with**** RAVEN (percentiles)
S1	F	9:6	No	Unilateral Spastic	I	< 1^st	< 5^th
S2	M	9:9	No	Unilateral Spastic	I	10^th	25^th
S3*	M	12:8	No	Unilateral Spastic	I	34^th	< 5^th
S4	M	11:11	Hearing loss one ear	Unilateral Spastic	I	1^st	10^th–25^th
S5	F	12:9	No	Unilateral Spastic	I	34^th	25^th–50^th
S6	F	12:8	No	Unilateral Spastic	I	1^st	50^th–75^th
S7	F	9:8	No	Bilateral Spastic	IV	77^th	< 5^th
S8	M	10:7	No	Bilateral Spastic	IV	< 1^st	< 5^th
S9	M	11:3	No	Unilateral Spastic	III	2^nd	10^th–25^th
S10*	M	11:8	Monoaural deafness	Unilateral Spastic	I	1^st	< 5^th
S11	M	11:8	No	Bilateral Spastic	1	< 1^st	< 5^th
S12*	F	12:8	No	Bilateral Spastic	IV	< 1^st	< 5^th
S13	F	11:9	No	Bilateral Spastic	III	< 1^st	< 5^th
D1	M	11:10	No	Dyskinetic	III	34^th	25^th
D2	F	9:2	No	Dyskinetic	II	18^th	5^th
A1	F	10:1	No	Ataxic	I	14^th	5^th–10^th
A2	F	9:2	No	Ataxic	IV	< 1^st	< 5^th
A3	M	10:7	No	Ataxic	I	< 1^st	< 5^th
A4	M	12:01	No	Ataxic	I	1^st	< 5^th

F, Female; M, Male; S, spastic CP; D, dyskinetic CP; A, ataxic CP; GMFCS, Gross Motor Function System (GMFCS) has five levels for describing severity of gross motor impairment with level I—walks without limitations, level II—walks with limitations, level III—walks with adaptive equipment assistance, level IV—self-mobility is limited, likely to be transported in a wheelchair, level V—transported in a wheelchair.

*Bilingual children. **Himmelmann et al. (2010). ***Test for Reception of Grammar Version 2 (TROG-2) (Bishop, 2003, Swedish translation, 2009). Norms available for children 4–16.11 years. ****Raven Coloured Progressive Matrices (Raven et al., 1998). Norms available for children 5.6–11.6 years. For children > 11.6 we used the 11.6 norms.

Table II. Correct consonant articulation, frequency of consonant errors, and results of overall listener ratings of speech characteristics for the children with spastic, dyskinetic, and ataxic CP. A four-point scale was used for the listener ratings (0 = no disorder, 1 = mild, 2 = moderate, 3 = severe). Standard scores for the SVANTE-test are: −1 SD = 95.5%, −2 SD = 92.3%, 5^th percentile = 88.2 %, 10^th percentile = 95.3%.

	Consonant articulation SVANTE-test (%) Correct	Type and numbers of consonant errors							Listener ratings dysarthria	Listener ratings hyper-nasality	Verbal and non-verbal profiles***
Type of CP		Substitution	Omission	Addition	Distortion	Voicing	Nasalization	Total
Spastic CP
S1	78.0	8		4		1		13	1	0	V+ N-V
S2	89.3	2				4		6	0	0	0
S3	98.3					1		1	0	0	N-V
S4	93.1				2	2		4	1	0	V
S5	98.3					1		1	0	0	0
S6	89.8					8		8	1	0	V
S7	93.1				2		4	6	1	2	N-V
S8	96.5		1			1		2	1	1	V+ N-V
S9	79.7	1	1	1		9		12	1	0	V
S10	91.4			1		4		5	1	0	V+ N-V
S11	49.6	4	21	2		4		31	3**	1	V+ N-V
S12	66.1	14	2		1	2		19	2	1	V+ N-V
S13	*	17	35			2		54	3	2	V+ N-V
	Mean (range) 90.6 (49.6–98.3)	Total (%) 29 (26.9)	Total (%) 25 (23.1)	Total (%) 8 (7.4)	Total (%) 5 (4.6)	Total (%) 37 (34.3)	Total (%) 4 (3.7)
Dyskinetic CP
D1	100							0	2	0	0
D2	91.5				2	3	5	10	2	2	N-V
Ataxic CP
A1	91.4	4				1		5	1	0	N-V
A2	74.1	6	2			7		15	2	0	V+ N-V
A3	50	23		1		2		26	3**	0	V+ N-V
A4	75.8	4		1	3	7		15	1	0	V+ N-V
	Mean (range) 72.8 (50–91.4)	Total (%) 37 (60.6)	Total (%) 2 (3.3)	Total (%) 2 (3.3)	Total (%) 3 (4.9)	Total (%) 17 (27.9)	Total 0

V, verbal deficits only; V+ N-V, verbal and non-verbal deficits; N-V, non-verbal deficits only.

*S13 had small speech material and was, therefore, not included in the data analysis of correctly articulated consonants.

**S11 and A3 were commented on as having dyspraxia of speech.

***Verbal and non-verbal deficits = cut-off scores below 10^th percentile on TROG-2 (Bishop, 2003) and Raven Coloured Progressive Matrices (Raven et al., 1998).

Figure 1. Number of children (n = 19) by type of CP with degree of overall severity of dysarthria rated on a 4-point scale.

Figure 2. Number of children (n = 19) by type of CP with degree of hypernasality rated on a 4-point scale.

Himmelmann, K., Hagberg, G., & Uvebrant, P. (2010). The changing panorama of cerebral palsy in Sweden X. Prevalence and origin in the birth-year period 1999-2002. Acta Paediatrica, 99, 1337–1343.

 PubMed Web of Science ®Google Scholar

Bishop, D. V. M. (2003). Test for Reception of Grammar Version 2, TROG-2 Manual. Department of Experimental Psychology, University of Oxford. London: The Psychological Corporation. Swedish version, 2009, Pearson Education.

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Raven, J., Raven, J. C., & Court, J. H. (1998). Manual for Raven's Coloured Progressive Matrices and Vocabulary Scales – Section 2 Coloured Progressive Matrices. Oxford: Oxford Psychologists Press.

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