158
SPEECH PROBLEMS IN CEREBRAL PALSY
CHILDREN*
Postgraduate
Institute
JAYALAKSHMI KAMALASHILE ofMedical Education and Research, Chandigarh
A total of 110 cerebal
palsy children were assessed during a project lasting a Analysis of the cases showed that: (i) Quadriplegics are affected more in speech than spastic children: (ii) Delayed speech forms the predominant speech defect: (iii) A one-to-one relationship is observed between the articulatory and vegetative functions: (iv) All the children with normal speech and hearing have average intelligence: (v) The data reveals that males are affected more than females: (vi) Speech problems are unaltered by stereotaxic surgery: (vii) Paraplegic and dystonic patients have a better prognosis than others. year and
a
half.
INTRODUCTION A research project with special reference to stereotaxic surgery and its effect on rehabilitation in cerebral palsy children was carried out at the Iswari Prasad Dattatreya Orthopaedic Centre, Andhra Mahila Sabha, Madras, from 1969 to 1972. The team consisted of medical and paramedical personnel; the main medical staff included an orthopaedic surgeon, a neurologist and a neurosurgeon. The Speech Therapy Section was established about the middle of the project. An attempt was made to analyse the speech deficits noted in various kinds of cerebral palsy and also the problems encountered in their rehabilitation.
DEFINITION
palsy was defined in this project as a non-progressive condition involving predominantly the motor systems due to brain damage, sustained before or at birth Cerebral
This paper *
Conference,
was
prepared for the
Vth Annual All India
Speech
and
Hearing
1973.
The author is very grateful to Prof. M. Natarajan, B.A., M.B., M.Ch.(Ortho.), F.R.C.S.(Eng.), Project Director, for his permission to publish this paper, to the staff ofthe Andhra Mahila Sabha, for their co-operation, to Dr. K. Srinivas, MB.BS. (Madras) DM. (Madras), MRCP (Glasgow), MRCP (Lond.), Consultant Neurologist, I.P.D.O. Centre, for his encouragement, guidance and help in the preparation of the paper, and to Mr. H. S. Ananthmurthy, B.Sc.(Sp. & Hg.), Speech Therapist, Institute of Child Health, Egmore, Madras.
159 in the early years of childhood. Cerebral palsy cases with visual, auditory, speech and global involvement were included. Cerebral palsy is a persistent but not unchangeable disorder of posture and movement due to dysfunction of the brain (excluding dysfunction due to progressive diseases before the growth or development of the brain is completed). Many other clinical features may also be present. or
MATERIAL
AND
METHODS
Since, for different people, the word tone has different meanings, for the purpose of this study we define the clinical features of tone as follows and adopt the following classification of cerebral palsy for the purposes of clinical description: 1.
Classification
related to clinical
features of
tone
(a) Spasticity. Muscles react to passive stretching by the examiner with strong initially, but there is a sudden yielding towards the end of the movement (commonly classified as the ’ clasp knife’ phenomenon). (b) Rigidity. Rigidity in cerebral palsy is characterized by unchanging resistance a muscle offers to passive stretch, throughout the whole range in the direction of flexion and extension. Rigidity can be continuous as in the ’ persistent’ type or lead pipe rigidity ’, or it may be intermittent. (c) Dystonic movements. Movements have the same writhing quality as those of athetosis but muscles of the neck, trunk and proximal segments of the limbs are chiefly affected, the hands and knee being either spared or slightly involved. Sensory induced dystonia is quite often seen. Also movements in dystonics are quicker than resistance
’
in
of athetosis. (d) Rigidospastic. Both spasticity and rigidity are present. Here, the clinical features and also the results of surface electromyography are considered. cases
2. Anatomical
classification of
cerebral
palsy
( i ) Hemiplegia. Involvement of the limbs of one side of the body. (ii) Paraplegia. Involvement of the lower limbs only: rarely the upper limbs also. (iii) Diplegia. All the four limbs are involved, with upper limbs to a lesser extent. (iv) Quadriplegia. All the four limbs are involved more or less equally. For speech and hearing evaluation, a total of 110 cases have been assessed in detail, of which 47 were females. Speech and language evaluation was carried out in accordance with the Speech and Language Development Chart devised at the Children’s Orthopaedic Hospital, 8ornbay. In addition there was an examination of the articulators for speech functions
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