Respiratory function during speech production in children with cerebral palsy

University Of Arizona, Tucson AZ

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Abstract

Up to 75% of children with cerebral palsy (CP) may have dysarthria, a motor speech impairment that negatively impacts speech intelligibility and naturalness. Despite the overwhelming need, the evidence base guiding intervention for dysarthria associated with CP is extremely limited. As a result, speech-language pathologists must resort to using intervention techniques that are based on the adult dysarthria literature, are not specific to the underlying impairment, and do not take into account the unique developmental issues faced by children with CP. A critical barrier to the development of effective, evidence-based intervention is the lack of objective information regarding respiratory function during speech production in children with CP. The respiratory system is the most commonly targeted speech subsystem in the treatment of dysarthria for children with CP. Observational studies from the 1950?s indicate that a majority of children with CP have respiratory deficits, such as shallow inspirations, that contribute to their dysarthria. Despite advances in respiratory science, there are little to no objective data about the functional capacity of the respiratory system to support speech production in children with CP. Additionally, current clinical practice relies on auditory-perceptual analyses of speech production to base intervention decisions and determine progress. However, auditory- perceptual data do not provide information about the underlying impairment in respiratory function during speech production in children with CP or the mechanisms of change following a particular intervention. Without a quantitative and direct understanding of respiratory function during speech production in children with CP and the impact of common intervention techniques on both respiratory function during speech production and global speech production outcomes (e.g., speech intelligibility and naturalness) we have a limited ability to identify children who would benefit from respiratory intervention, to choose intervention targets, and to facilitate lasting change. The first specific aim of this proposal is to quantify respiratory function during speech production in children with CP. The second specific aim of this proposal is assess the effects of increasing loudness, a common intervention technique, on respiratory function during speech production and global speech production outcomes in children with CP. This technique, though often used, has very little supporting evidence. The key innovation of this proposal is the systematic examination of respiratory kinematic, pressure, acoustic, and auditory-perceptual data collected during connected speech production in children with CP. The expected outcomes of this proposal will provide: 1) quantifiable characterization of respiratory function during speech production in children with CP and 2) phase I evidence regarding the effectiveness of an intervention technique commonly utilized with children with CP, increasing loudness. This proposal has the potential to spur a paradigm shift in how we develop and implement interventions for children with CP by providing the foundation on which to base intervention decisions.