Longitudinal speech and gross motor function development in children and adolescents with cerebral palsy.
Sydney A Jensen, Katherine C Hustad
Speech motor classification in children with CP can still improve into adolescence even when gross motor level stays the same. 19 of 44 children changed speech level between ages 4 and 14, and every change was toward better speech.
Key findings
1Speech motor and gross motor classifications were strongly associated at both age 4 (r = 0.767, 95% CI 0.596 to 0.918) and age 14 (r = 0.856, 95% CI 0.695 to 0.963), with no statistically significant difference between the two age points.
2Between ages 4 and 14, 19 of 44 children changed VSS level, all toward improvement (15 by one level, 4 by two levels), while 15 of 44 changed GMFCS level (10 improved, 5 declined, all by one level). Only 6 of 44 changed in both domains at the same time.
3Among children at VSS level IV at age 4, 7 of 15 improved by age 14, and the only two-level improvements in the sample (two children from level IV to II, two from level III to I) occurred in children who started at the most severe level.
Still to come
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What it does not show
44 children from a single region (upper Midwest USA); the authors note this may not reflect the ethnic and socioeconomic diversity of the broader CP population. Only two timepoints (ages 4 and 14), so the study cannot show whether changes were gradual, stepped, or occurred at a specific age. A child could have improved at age 6 and plateaued, or declined at age 10 and recovered, and the data would look the same. No accounting for CP type, anatomical involvement, co-occurring conditions, or treatment history. The authors state that specific details of speech and gross motor therapies are unknown for these children. Selection bias: only children with complete data at both timepoints were included. Children who dropped out (death, relocation, other reasons) are not represented, and it is not possible to tell whether they differed in function. The VSS is a four-level ordinal scale. The authors acknowledge that a one-level shift may or may not reflect a meaningful change in intelligibility, and the sensitivity of the VSS to detect change relative to fine-grained speech measures is unknown. Power was limited for detecting a difference between the two age-point correlations. The authors estimate approximately 21 additional participants would be needed to detect the observed difference (0.767 vs 0.856) at 80% power. Unequal distribution of children across VSS levels at age 4 made proportional comparisons across levels difficult to interpret.
Declared interests
The authors declare no financial relationships relevant to the article and no conflicts of interest.
The easy way to misread this
Do not read the strong correlation between speech and gross motor classifications as meaning a child's GMFCS level tells you their speech level, or that stable gross motor means stable speech. The paper itself notes that the majority of children who changed did so in one domain or the other, not both. The correlation describes a shared starting point, not a shared future.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →