title: Comprehension of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities.
abstract: OBJECTIVE
  To assess spoken language comprehension in non-speaking children with severe cerebral palsy (CP) and to explore possible associations with motor type and disability.
  
  
  METHODS
  Eighty-seven non-speaking children (44 males, 43 females, mean age 6y 8mo, SD 2y 1mo) with spastic (54%) or dyskinetic (46%) CP (Gross Motor Function Classification System [GMFCS] levels IV [39%] and V [61%]) underwent spoken language comprehension assessment with the computer-based instrument for low motor language testing (C-BiLLT), a new and validated diagnostic instrument. A multiple linear regression model was used to investigate which variables explained the variation in C-BiLLT scores. Associations between spoken language comprehension abilities (expressed in z-score or age-equivalent score) and motor type of CP, GMFCS and Manual Ability Classification System (MACS) levels, gestational age, and epilepsy were analysed with Fisher's exact test. A p-value <0.05 was considered statistically significant.
  
  
  RESULTS
  Chronological age, motor type, and GMFCS classification explained 33% (R=0.577, R(2) =0.33) of the variance in spoken language comprehension. Of the children aged younger than 6 years 6 months, 52.4% of the children with dyskinetic CP attained comprehension scores within the average range (z-score ≥-1.6) as opposed to none of the children with spastic CP. Of the children aged older than 6 years 6 months, 32% of the children with dyskinetic CP reached the highest achievable age-equivalent score compared to 4% of the children with spastic CP. No significant difference in disability was found between CP-related variables (MACS levels, gestational age, epilepsy), with the exception of GMFCS which showed a significant difference in children aged younger than 6 years 6 months (p=0.043).
  
  
  CONCLUSIONS
  Despite communication disabilities in children with severe CP, particularly in dyskinetic CP, spoken language comprehension may show no or only moderate delay. These findings emphasize the importance of introducing alternative and/or augmentative communication devices from early childhood.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands; The EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.
authors.forename: Joke J M
authors.initials: JJ
authors.lastname: Geytenbeek
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Oostrom
mesh_terms: D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003147:Communication Disorders / Q000209:etiology / Q000503:physiopathology*; D032882:Comprehension / Q000502:physiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007807:Language Tests; D008297:Male; D012720:Severity of Illness Index; D013067:Speech Perception / Q000502:physiology*