Intensive voice treatment for children with spastic cerebral palsy

Abstract

Purpose. The purpose of this study was to examine the effects of an intensive speech treatment for children with spastic cerebral palsy (CP). Background. Children with spastic CP have speech and voice disorders, which may limit functional communication and negatively impact quality of life. There are limited published outcome data on speech treatment approaches for these children. Recent advances in theories of motor development and behavioral gait and limb treatment provide a solid framework (consistent with theories of motor learning) from which to test different speech treatment concepts (e.g., intensive treatment, high effort exercises, repeated practice trials, and sensory augmentation/sensory awareness training) in children with spastic CP. Method. A multiple baseline single-subject design with replication across participants (five children with spastic CP) was used. Acoustic measures related to voice functioning, auditory-perceptual analysis of speech samples, and perceptual ratings by parents of participants in this study were obtained from baseline, post-treatment, and 6 week follow-up data recording sessions. Results. The four participants who received treatment demonstrated a marked change in performance on one or more of the acoustic measures and there were strong listener preferences for the treated speech samples (post-treatment or follow-up sessions) over baseline samples for most perceptual characteristics rated. In addition, parents of these four participants reported improved perceptions on two or more voice, speech, or communication characteristics following treatment, and all had an overall favorable impression of their child's treatment outcome and of the treatment approach used. No changes were observed in the one participant with CP who did not receive treatment. Conclusions. These findings suggest that in these four participants with CP, intensive speech treatment changed the output of the speech motor system in a manner that listeners preferred over baseline speech samples. In addition, this positive effect was maintained in nearly all cases 6 weeks after the conclusion of treatment. These findings are consistent with those in limb and gait treatment literature, thus highlighting potential key treatment concepts to consider in behavioral treatment for children with spastic CP.