Communication Development in Children with Cerebral Palsy

脑瘫儿童的沟通发展

• 批准号: 7664702
• 负责人: Katherine C Hustad
• 金额: $ 4.13万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7664702
• 关键词: Accounting; Age; Age-Years; American; Brain imaging; Cerebral Palsy; Characteristics; Child; Classification; Clinical; Cognition; Cognitive; Communication; Cross-Sectional Studies; Data; Development; Diagnosis; Dysarthria; Epilepsy; Growth; Growth and Development function; Individual; Intervention; Language; Lead; Learning Disabilities; Life; Mental Retardation; Methodology; Motivation; Motor; Movement Disorders; Nature; Outcome; Pattern; Population; Prevalence; Production; Prohibit; Public Health; Research; Sampling; Spastic; Speech; Speech Development; Speech Disorders; Subgroup; Time; United States; Validation; Work; base; cohort; communication theory; disability; innovation; motor impairment; neuropathology; outcome forecast; skills; theories; tool

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is regarded as the most common cause of severe motor disability in children (1); approximately 10,000 new cases are diagnosed each year in the United States (2). Although motor impairment is the primary defining feature of CP, other disabilities such as mental retardation, seizure disorder, and learning disabilities often co-occur (3-5). Research suggests that 60% of children with CP have communication problems (6); however, the exact nature of these problems has never been comprehensively examined. Existing research has emphasized differentiation of speech features based on the nature of the gross motor movement disorder (7-12) (i.e. athetoid vs. spastic). Language and cognitive variables have been controlled in these studies by including only those with "normal" abilities. Because learning disabilities and mental retardation frequently accompany CP, a true account of communication must include simultaneous quantification of speech, language, and cognitive abilities. There have been significant advances in the study of gross motor development (13-17), fine motor development (18-21), and brain imaging findings in children with CP (5, 6, 22-25). However, the lack of data regarding communication and its development has prohibited a thorough understanding of the constellations of and inter-relations among deficits that accompany CP. Using a multidimensional theoretical perspective, this project will quantify longitudinal development of speech, language, and cognition at 6 month intervals over a period of 4 years. A cohort of 80 children with CP and 17 typically developing children, who are 2-4 years of age at the onset of the study, will be followed. Hypotheses are: 1.) there are identifiable and longitudinally stable communication-based subgroups within the population of children who have CP; and 2.) these subgroups are loosely related to gross motor, fine motor, and brain imaging findings for these same children. Specific aims that target these hypotheses are to: a.) establish subgroups of children with CP on the basis of cross sectional communication (speech, language, and cognition) profiles (Aim 1); b.) quantify developmental changes in speech, language, and cognitive abilities and determine the stability of communication subgroup membership over time in young children with CP (Aim 2); c.) identify the extent to which gross and fine motor classifications are associated with communication subgroup membership (Aim 3); and d.) characterize structural neuro-anatomical involvement and determine how patterns of neuropathology are associated with communication subgroup membership (Aim 4). Results will inform an initial theory of communication development in children with CP that emphasizes the inter-relations among speech, language, and cognition. The longitudinal methodology will enable development of growth curves for individual children and for the putative communication subgroups. Results will have direct clinical implications for communication intervention and will also advance the broader theoretical understanding of CP, where classification of speech and language problems has been identified as a high priority (3, 26). PUBLIC HEALTH RELEVANCE: Cerebral palsy (CP) is the most common cause of severe motor disability in children; approximately 800,000 Americans are living with CP. Most children with CP have communication problems, but very little is known about the specific nature of these problems. This research will examine communication development over time in children with CP and will identify communication-based subgroups of children who have similar kinds of problems. Results will lead to a better understanding of communication prognoses and ultimately may lead to interventions that enhance communication outcomes in children with CP.

描述（由申请人提供）：脑瘫 (CP) 被认为是儿童严重运动障碍的最常见原因 (1)；美国每年诊断出约 10,000 例新病例 (2)。尽管运动障碍是 CP 的主要定义特征，但其他残疾，如精神发育迟滞、癫痫发作和学习障碍经常同时发生 (3-5)。研究表明 60% 的脑瘫儿童存在沟通问题 (6)；然而，这些问题的确切性质从未得到全面审查。现有研究强调根据粗大运动障碍的性质区分言语特征 (7-12)（即手足徐动与痉挛）。在这些研究中，语言和认知变量受到控制，只包括那些具有“正常”能力的人。由于学习障碍和智力低下经常伴随脑瘫，因此对沟通的真实描述必须包括言语、语言和认知能力的同时量化。脑瘫儿童的粗大运动发育 (13-17)、精细运动发育 (18-21) 和脑成像结果 (5、6、22-25) 的研究取得了重大进展。然而，由于缺乏有关传播及其发展的数据，无法彻底了解伴随 CP 的一系列缺陷及其相互关系。该项目将采用多维理论视角，在 4 年内以 6 个月为间隔对言语、语言和认知的纵向发展进行量化。研究人员将对 80 名 CP 儿童和 17 名正常发育儿童（研究开始时年龄为 2-4 岁）进行跟踪研究。假设是： 1.) 脑瘫儿童群体中存在可识别且纵向稳定的基于沟通的亚组； 2.) 这些亚组与这些儿童的粗大运动、精细运动和脑成像结果松散相关。针对这些假设的具体目标是： a.) 根据横截面交流（言语、语言和认知）概况建立脑瘫儿童亚组（目标 1）； b.) 量化患有 CP 的幼儿言语、语言和认知能力的发展变化，并确定沟通亚组成员随时间的稳定性（目标 2）； c.) 确定粗大和精细运动分类与沟通亚组成员资格的关联程度（目标 3）； d.) 描述结构神经解剖学参与的特征，并确定神经病理学模式如何与沟通亚组成员资格相关（目标 4）。研究结果将为脑瘫儿童沟通发展的初步理论提供依据，该理论强调言语、语言和认知之间的相互关系。纵向方法将能够为个别儿童和假定的沟通亚组制定成长曲线。结果将对沟通干预产生直接的临床影响，并且还将促进对 CP 的更广泛的理论理解，其中言语和语言问题的分类已被确定为高度优先事项 (3, 26)。公众健康相关性：脑瘫 (CP) 是儿童严重运动障碍的最常见原因；大约 800,000 名美国人患有脑瘫。大多数脑瘫儿童都有沟通问题，但人们对这些问题的具体性质知之甚少。这项研究将调查患有脑瘫的儿童随着时间的推移沟通能力的发展，并将确定具有类似问题的以沟通为基础的儿童亚组。结果将有助于更好地了解沟通预后，并最终可能导致采取干预措施，增强脑瘫儿童的沟通结果。