Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice

Abstract

Background: Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice.

Aims: To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood.

Methods & procedures: An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012.

Outcomes & results: Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service.

Conclusions & implications: The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice.

Keywords: Cerebral palsy; assessment; children; communication; intervention; survey.

Figure 1

Settings in which SLTs work. Percentages sum to greater than 100 as therapists may work in more than one setting.

Figure 2

Numbers of children with CP on SLTs’ caseloads including active and review cases.

Figure 3

Frequency with which individual domains were assessed at referral/initial assessment expressed as percentages. n for each domain is reported in parentheses.

Figure 4

Provision of interventions to improve speech of children with motor speech disorders. Numbers add up to more than 100% as more than one option could be selected for each intervention.

Figure 5

Types of multimodal functional communication intervention provided by SLTs, SLT assistants and others, and their frequency of use. Numbers add up to more than 100% as more than one option could be selected for each intervention.