Personalised Speech and Language Therapy for Children with Cerebral Palsy and Dysarthria

Abstract

Background: Cerebral Palsy (CP) is the most common childhood motor disorder, with a prevalence of around 1.5-2 per 1000 live births. Approximately half of individuals with CP have speech difficulties, most of whom have dysarthria. Dysarthria disrupts the subsystems underpinning speech and reduces intelligibility. Aim: To examine the effect of personalised dysarthria therapy on the intelligibility of children with CP and dysarthria using perceptual and acoustic speech outcomes. Method: Fifteen children with CP and dysarthria received individualised online therapy. Intelligibility was measured at 6- and 1-week pre-therapy and 1- and 12-weeks post-therapy. Generalised linear mixed models determined whether children made statistically significant gains in the intelligibility of single words (SWs) and connected speech (CS). Acoustic profiling was used to explore acoustic speech changes. Results: Group results showed that SW and CS intelligibility significantly improved from 1-week pre- to 12-weeks post-therapy. Clinically significant gains of greater than 10% words understood were mainly observed in those with a higher intelligibility at baseline. More children made clinically significant gains in SWs than in CS. No single factor explained the change in intelligibility, but better perception of polysyllabic words and word-initial and word-final consonants was observed post-therapy. Acoustic profiling showed no obvious relationship between changes in articulatory precision and vocal cues. Acoustic changes specific to individual children occurred post-therapy, but were not necessarily perceived by ear, e.g., evidence of word-final consonants being produced. Interpretation: Personalised intervention seems to be effective at improving the intelligibility of children with CP and moderate-to-severe dysarthria. Those with profound dysarthria made little change, suggesting that support for their communication should focus on augmentative and alternative communication. Future research should further evaluate personalisation of the intervention to establish the best cues for individual speech characteristics.