SPECIAL POPULATIONS Cerebral Palsy

A group of disabling conditions affecting movement and posture Caused by a defect or lesion to one or more specific areas of the brain Damage may occur during fetal development, during delivery, shortly after birth or in early infancy. Usually before 2 years of age. The effects of CP can range from isolated articulation problems to severe sensorimotor involvement.

CP and Language Disorders Damage may not be focal but diffuse, resulting in not only motor speech problems but cognitive and receptive problems Changes in interaction with parents and communication partners – Child’s behaviour influences how parents interact – Less chance of normal imitation, expansion of utterances by communication partners No opportunities for practise and feedback

Assessment Follow same process as for all children but: – Feeding and swallowing issues likely – Motor skills can make some assessment difficult e.g. comprehension ‘point to….., verbal expression tasks

Adapting Assessment Methods Be creative! Could adapt standardised assessment tasks but obviously no longer standardised Make up own assessments e.g. use CR procedures Some checklists/rating scales exist for this population

Intervention Follow same process as for all children but: – Swallowing and feeding intervention likely – Need to adapt tasks to allow for lack of motor skills – May need to work on motor speech specifically – Consideration of augmentative or alternative communication

Augmentative and Alternative Communication (AAC) Speech is always the best option – Most universal form of communication – Most efficient – Access to greatest no. of comm. partners Children not ‘lazy’ But for some speech just not an option….

When to consider AAC – R. Paul Can be too quick to go to alternative modalities Decision tree for choosing non speech modes Fig 3-4 Developmental level of 18mths before introducing any AAC Impt for child to be showing some communication intent (if not work on this)

What type of system? Will depend on cognitive level, motor skills and communication partners Look at all factors before deciding on a system, don’t think of a system first. Trialling essential Be forward thinking

Hi-tech and Low-tech Systems Low tech- communication charts, communication books, symbols Hi-tech - dedicated communication devices, computers

Low Tech Examples

Hi Tech Examples

System Considerations Access Portability/Size Durability Message Representation Ease of Use Support Ability to add/change messages

Ongoing Role of SLT As for all children with speech and language problems but also… remember previous points about reduced interaction, production, imitation and feedback Ensure vocabulary meeting needs Allow for language development Adapt therapy tasks to accommodate physical skills Develop literacy skills