Communication Development in Children with Cerebral Palsy

脑瘫儿童的沟通发展

基本信息

批准号：
10407585
负责人：
Katherine C Hustad
金额：
$ 61.61万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10407585
关键词：
10 year old 15 year old 2 year old Address Advanced Development Affect Age Age of Onset Age-Months Age-Years Area Biometry Cerebral Palsy Child Childhood Classification Cognitive Communication Communication impairment Complex Data Decision Making Development Developmental Disabilities Dysarthria Enrollment Funding Goals Growth Heterogeneity Impaired cognition International Intervention Investigation Language Language Development Lead Length Life Longitudinal Studies Measures Methods Modeling Motor Nature Neurodevelopmental Disorder Outcome Predictive Value Preschool Child Production Quality of life Research Specific qualifier value Speech Speech Development Speech Intelligibility Statistical Models Testing Time Validation Visit Work base cohort course development disability early onset evidence base experience improved improved outcome language impairment language outcome motor impairment outcome prediction predictive modeling prognostic indicator prognostic value prospective rate of change skills therapy development

项目摘要

Project Summary Cerebral palsy (CP) is the most common cause of severe motor impairment in children, affecting 3 per 1000 in the US and internationally. Motor impairment is the primary defining feature, but co-occurring developmental disabilities are frequent and lead to a complex array of problems. Approximately 60% of children with CP have some type of communication disorder, which may include dysarthria and its associated speech intelligibility deficits; language and/or cognitive impairments; or a combination of both speech and language/cognitive problems. Advancing our understanding of communication abilities is a priority area in CP research. However, heterogeneity among children with CP makes the study of speech, language, and communication and its development difficult, necessitating the use of prospective longitudinal methods where each child is his/her own control to allow for direct connection between early speech-language markers and later development. We began such work 10 years ago, following over 90 children with CP who were as young as 2 years at the onset of the study. The long-term goal of our research is to generate theoretically driven, empirically validated longitudinal models of speech and language development in CP that can be used to predict outcomes, test interventions, and guide treatment decisions. Over the past two funding cycles, we have developed a classification model of speech-language profile groups among children with CP, which we are using to predict outcomes. Results suggest that children in more advanced profile groups at 2 years of age remain in more advanced profile groups in later childhood. Also, those who are producing speech by 2 years make faster gains in intelligibility and utterance length and have better speech production later than those who begin speaking at older ages. We are also developing speech and language growth curves and using data to create models of profile group membership based on development across childhood. Data indicate that children with CP are still changing through 10 years of age and have not yet reached developmental endpoints. Progress is currently limited by two key barriers, addressed in this application: 1.) longitudinal speech and language development data prior to 2 years of age have never been gathered for children with CP. These data are necessary to refine our ability to predict speech-language outcomes beginning at the earliest possible age and establish prognostic indicators that can inform intervention decision-making; and 2.) longitudinal data beyond 10 years of age have never been gathered, but are needed to quantify rates and limits of change in speech-language variables through the full course of development so that we can develop predictive models of age-based endpoints that guide interventions and improve outcomes. Toward this end, we will collect new longitudinal data on our existing cohort of children with CP to the age of 15 years, and we will collect new longitudinal data on a new cohort of very young children with CP beginning at 12 months of age to address the following two specific aims: Aim 1 - To establish and validate prognostic indicators beginning at 12 months of age that have predictive value for later speech-language development in children with CP. Aim 2 - To develop comprehensive predictive models of speech-language development up to 15 years of age in children with CP. Results will advance the development and validation of longitudinal models of speech and language growth in children with CP, quantifying of rates and limits of change for select speech and language variables. Results will enable us to predict outcomes for children from 1-15 years of age, which will have implications for intervention decision-making and for creation of interventions to enhance quality of life for children with CP.

项目概要脑瘫 (CP) 是儿童严重运动障碍的最常见原因，影响每人 3 人美国和国际上有 1000 个。运动障碍是主要的定义特征，但同时发生发育障碍很常见，并会导致一系列复杂的问题。大约 60% 患有 CP 的儿童存在某种类型的沟通障碍，其中可能包括构音障碍及其相关的障碍言语清晰度缺陷；语言和/或认知障碍；或语音和语音的组合语言/认知问题。增进我们对沟通能力的理解是 CP 的优先领域研究。然而，脑瘫儿童之间的异质性使得对言语、语言和行为的研究沟通及其发展很困难，需要使用前瞻性纵向方法每个孩子都是他/她自己的控制者，以允许早期言语标记和语言标记之间的直接联系后期发展。我们从 10 年前就开始了这项工作，跟踪了 90 多名患有脑瘫的儿童，他们年龄很小研究开始时为 2 年。我们研究的长期目标是产生理论驱动的、经过实证验证的 CP 言语和语言发展纵向模型，可用于预测结果、测试干预措施并指导治疗决策。在过去的两个融资周期中，我们开发了 CP 儿童言语特征组的分类模型，我们正在用于预测结果。结果表明，处于更高级群体的儿童在 2 岁时在童年后期留在更高级的群体中。另外，那些在 2 岁之前就可以发表演讲的人与那些较晚的人相比，他们在可懂度和话语长度上获得更快的提升，并且有更好的言语表达年纪较大时才开始说话。我们还正在开发语音和语言增长曲线，并使用数据来根据整个童年的发展创建档案组成员资格模型。数据表明脑瘫儿童在 10 岁时仍在发生变化，尚未达到发育终点。目前进展受到本申请中解决的两个关键障碍的限制：1.) 纵向语音和从未收集过 CP 儿童 2 岁之前的语言发展数据。这些数据有必要从尽可能早的年龄开始提高我们预测言语结果的能力并建立可为干预决策提供信息的预后指标； 2.) 纵向数据从未收集过 10 岁以上的数据，但需要量化其变化率和限制语音语言变量贯穿整个发展过程，以便我们可以开发预测模型基于年龄的终点可指导干预措施并改善结果。为此，我们将收集新的我们现有 15 岁以下 CP 儿童队列的纵向数据，我们将收集新的一组从 12 个月大开始患有脑瘫的幼儿的纵向数据，旨在解决以下问题：遵循两个具体目标：目标 1 - 从 12 个月开始建立并验证预后指标年龄对 CP 儿童后期言语发展具有预测价值。目标 2 - 发展脑瘫儿童 15 岁以下言语发展的综合预测模型。研究结果将推动语音和语言增长纵向模型的开发和验证患有 CP 的儿童，对选定的言语和语言变量的比率和变化限制进行量化。结果将使我们能够预测 1-15 岁儿童的结果，这将对干预决策和制定干预措施以提高脑瘫儿童的生活质量。