Manual Ability Closely Related to Communication Function in Cerebral Palsy Children, Study Finds

Manual ability, rather than gross motor function, seems to be more closely related to communication function in cerebral palsy children, according to a study in South Korea.

The study, “Functional Communication Profiles in Children with Cerebral Palsy in Relation to Gross Motor Function and Manual and Intellectual Ability,” was published in the Yonsei Medical Journal.

Patients with cerebral palsy tend to experience communication difficulties. Therefore, a number of different classification systems have been designed to allow physicians to categorize patients according to their degree of communication difficulty.

Three tests exist that separately assess communication function, speech intelligibility, speech motor and language/cognition ability:

• Communication Function Classification System (CFCS), which classifies patients based on their functional communication ability;
• Viking Speech Scale (VSS), a four-level rating scale designed to classify functional speech intelligibility in daily life; and
• Speech Language Profiles Groups (SLPG), designed to separate patients based on the presence or absence of speech motor involvement and language or cognitive involvement.

Previous studies had shown a significant association between CFCS and gross motor function — the movement and coordination of arms, legs, and other large body parts — and the ability of children with cerebral palsy to use their hands to handle objects in daily activities, known as manual ability.

However, neither VSS or SLPG have been investigated in relation to gross motor function and manual ability.

In this study, researchers investigated the relationships between communication function, gross motor function, manual ability, and intellectual function in children with cerebral palsy using a specific battery of classification systems.

All three tests — CFCS, VSS, and SLPG — along with two additional classification systems, the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS), were assessed in 117 children with cerebral palsy between the ages of 4 and 16. Brain magnetic resonance imaging (MRI) also was performed.

Intellectual functioning was assessed using a number of different tests including the Wechsler Intelligence Scale for Children.

Of note, speech, gestures, eye gaze, facial expression, or pointing were the only communication methods for all children in the study.

Researchers found very strong relationships between the three main classification systems, a finding that can be explained by the fact that speech motor impairment is reflected in all three classification systems to a varying degree. As such, the authors recommend “the use of all three communication classification systems … for a comprehensive description of speech, language, and communication ability in children with CP.”

All three communication classification systems were strongly related for manual ability, but only moderately related for gross motor skills.

Statistical analysis indicated that manual ability and intellectual functioning were significantly related in VSS and CFCS, while only intellectual functioning was significantly related in SLPG in these children.

According to researchers, these results support a more significant role of manual ability for communication function, rather than gross motor function in children with cerebral palsy.

“Very strong relationships were noted among three communication classification systems that are closely related with intellectual ability. Compared to gross motor function, manual ability seemed more closely related with communication function in these children,” the authors wrote.

Also, the authors noted that language and cognition seem to be more problematic than speech intelligibility and communication function in cerebral palsy children with a particular type of brain lesion called periventricular white matter lesion.