title: Language comprehension in nonspeaking children with severe cerebral palsy: Neuroanatomical substrate?
abstract: OBJECTIVE
  To identify relations between brain abnormalities and spoken language comprehension, MRI characteristics of 80 nonspeaking children with severe CP were examined.
  
  
  METHODS
  MRI scans were analysed for patterns of brain abnormalities and scored for specific MRI measures: white matter (WM) areas; size of lateral ventricles, WM abnormality/reduction, cysts, subarachnoid space, corpus callosum thinning and grey matter (GM) areas; cortical GM abnormalities, thalamus, putamen, globus pallidus and nucleus caudatus and cerebellar abnormalities. Language comprehension was assessed with a new validated instrument (C-BiLLT).
  
  
  RESULTS
  MRI scans of 35 children were classified as a basal ganglia necrosis (BGN) pattern, with damage to central GM areas; in 60% of these children damage to WM areas was also found. MRI scans of 13 children were classified as periventricular leukomalacia (PVL) with little concomitant damage to central GM areas, 13 as malformations and 19 as miscellaneous. Language comprehension was best in children with BGN, followed by malformations and miscellaneous, and was poorest in PVL. Linear regression modelling per pattern group (malformations excluded), with MRI measures as independent variables, revealed that corpus callosum thinning in BGN and parieto-occipital WM reduction in PVL were the most important explanatory factors for poor language comprehension. No MRI measures explained outcomes in language comprehension in the miscellaneous group.
  
  
  CONCLUSIONS
  Comprehension of spoken language differs between MRI patterns of severe CP. In children with BGN and PVL differences in language comprehension performance is attributed to damage in the WM areas. Language comprehension was most affected in children with WM lesions in the subcortical and then periventricular areas, most characteristic for children with PVL.
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. Electronic address: J.geytenbeek@vumc.nl.
authors.forename: Joke J
authors.initials: JJ
authors.lastname: Geytenbeek
authors.affiliation: Neuroscience Campus Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Oostrom
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Laurike
authors.initials: L
authors.lastname: Harlaar
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.
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
authors.affiliation: The EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neuroradiology, Centro Hospitalar do Porto, Portugal.
authors.forename: Pedro S
authors.initials: PS
authors.lastname: Pinto
authors.affiliation: Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
mesh_terms: D001921:Brain / Q000473:pathology*; D002547:Cerebral Palsy / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D032882:Comprehension; D005260:Female; D006801:Humans; D007802:Language; D007969:Leukomalacia, Periventricular / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Brain abnormalities; Cerebral palsy; Grey matter; Language comprehension; White matter