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Background: Speech is the most common method of communication. Video-based clinical communication evaluation is a requirement for children with speech-language impairments living in rural areas, and those who have limited mobility. Aims: To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS-T) via live and video-based observation for children with cerebral palsy (CP) aged 4-18 years. Methods & Procedures: A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating-drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory-Social Function (PEDI-SF), and the Functional Independence Measure for Children-Communication (WeeFIM-C) were assessed to examine the concurrent validity of the VSS-T. The interrater reliability of the VSS-T was analysed between parents, physical therapists, and speech and language therapists from live and video-based observation. Intra-rater reliability was calculated from ratings made from live and video-based observations taken 3 weeks apart. Outcomes & Results: The VSS-T was strongly related to the ICS (r = -0.830), PEDI-SF (r = -0.819), WeeFIM-C (r = -0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (?w [greater than or equal to] 0.838) and intra-rater reliability (intraclass correlation coefficient (ICC) = 0.848-0.995) were found between parents and therapists. Conclusions & Implications: Speech and language therapists, physical therapists, and parents can use the VSS-T as a valid and reliable classification system to describe speech intelligibility of 4-18-year-old children with CP. Both live and video-based observations can be used to administer the VSS-T.

Background The motor speech disorder, dysarthria, is common in cerebral palsy. The Speech Systems Approach therapy programme, which focuses on controlling breath supply and speech rate, has increased children’s intelligibility. Objective To ascertain if increased intelligibility is due to better differentiation of the articulation of individual consonants in words spoken in isolation and in connected speech. Design Secondary analysis. Setting University. Participants Forty-two children with cerebral palsy and dysarthria aged 5–18 years, Gross Motor Function Classification System I–V. Intervention The Speech Systems Approach is a motor learning therapy delivered to individuals by a speech and language therapist in 40-minute sessions, three times per week for 6 weeks. Intervention focuses on production of a strong, clear voice and speaking at a steady rate. Practice changes from single words to increasingly longer utterances in tasks with increasing cognitive load. Main outcome measures Unfamiliar listeners’ identification of singleton consonants (e.g. nap) and clusters of consonants (e.g. stair, end) at the start and end of words when hearing single words in forced choice tasks and connected speech in free transcription tasks. Acoustic measures of sound intensity and duration. Data sources Data collected at 1-week pre- and 1-week post-therapy from three studies: two interrupted time series design, one feasibility randomised controlled trial. Results Word initial and word final singleton consonants and consonant clusters were better identified post-therapy. The extent of improvement differed across word initial and word final singleton consonant subtypes. Improvement was greater for single words than connected speech. Change in sound identification varied across children, particularly in connected speech. Sound intensity and duration increases also were inconsistent. Limitations The small sample size did not allow for analysis of cerebral palsy type. Acoustic data were not available for all children, limiting the strength of conclusions that can be drawn. The different but phonetically balanced word lists, used in the original research, created variability in single words spoken across recordings analysed. Low frequencies of plosives, fricatives and affricates necessitated their combination for analysis preventing investigation of the effect of specific consonants. Connected speech was spontaneous, again creating variability within the data analysed. The estimated effects of therapy may therefore be partially explained by differences in the spoken language elicited. Conclusions The Speech Systems Approach helped children generate greater breath supply and a steady rate, leading to increased intensity and duration of consonant sounds in single words, thereby aiding their identification by listeners. Transfer of the motor behaviour to connected speech was inconsistent. Future work Refining the Speech Systems Approach to focus on connected speech early in the intervention. Personalisation of cues according to perceptual and acoustic speech measures. Creation of a battery of measures that can be repeated across children and multiple recordings. Study registration This trial is registered as Research Registry 6117. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation programme (NIHR130967) and will be published in full in Efficacy and Mechanism Evaluation; Vol. 10, No. 4. See the NIHR Journals Library website for further project information. Plain language summary Some children with cerebral palsy have speech that sounds weak, slurred and difficult to understand, which seriously impacts their social life and education. We developed a therapy programme to help children control their breathing and how fast they speak. Having more breath should make children’s voices stronger. Speaking at a steady rate should give enough time for children to move their jaw, tongue and lips to produce each sound more precisely. Children’s speech was easier to understand after the therapy. This study aimed to find out if the therapy worked by helping children to say consonant sounds more clearly. We used recordings made in previous research to work out which consonants listeners heard correctly. We also looked at waveforms, which showed children’s speech as moving pictures, to find out how speech changed. After therapy, when children spoke in single words, listeners heard almost all types of consonant sounds at the start and end of words more clearly. No particular type of consonant sounds, such as ‘s’ in ‘so’ or ‘t’ in ‘tar’, led to better speech clarity. Waveforms showed that some children produced stronger speech sounds, some slowed their speech, and some did both. Listeners heard some children more clearly after therapy when they spoke in phrases, but found others more difficult to understand. Few consonants were easier to understand after therapy. We saw no clear patterns of change in speech waveforms. Overall, children produced stronger, more precise speech in single words, but not all transferred this skill to speaking in phrases. Children differed in how they achieved clearer speech. We used the findings to refine the therapy to focus on phrases early in the programme and to personalise instructions to children’s individual speech patterns. We will use waveforms to find where children have most difficulty and to measure improvement. Scientific summary Background and introduction The motor disorders of cerebral palsy (CP) often affect breath control and speech production, causing the speech disorder dysarthria. Dysarthria in CP typically affects all speech systems: respiration, phonation, resonance, prosody and articulation. Respiration is often shallow and lacks co-ordination with phonation, generating weak or inconsistent subglottal pressure. Vocal folds may vibrate slowly and irregularly; air may leak through the folds when they should be adducted, reducing the intraoral pressure and weakening the sound source. The velum may rise slowly or fail to close off the nasal passage during speech. The movements of the articulators (jaw, tongue and lips) may be slow and imprecise. They may also be weak, reducing children’s ability to constrict the vocal tract for consonant sounds. The combined effect of these limitations is that children often speak in short phrases, with inappropriate phrasing or rushes of speech if children run out of air. Their voice may sound weak, breathy and sometimes harsh. Speech is often slow with reduced melodic intonation and children may have a restricted range of consonants that they can produce clearly. Intervention focussing on breath support and speech rate is expected to aid with the co-ordination of three phases of speech production, mainly initiation, phonation and articulation. Greater breath supply and increased air pressure during exhalation should increase subglottal air pressure bringing firmer contact of the vocal folds during phonation to generate a stronger vocal note/sound source. The improved audibility and potential for greater intraoral air pressure arising from this will also help compensate for any weak closures of articulators and reduce ‘leakage’ of air during speech. A steady speech rate should allow children to move with precision from one articulatory place and manner to another. Thus, as a result of changes in breath supply and rate, phonemes should be acoustically differentiated and listeners better able to perceive the sounds that children are articulating (increased phonetic intelligibility). The Speech Systems Approach has been developed to focus on breath control and speech rate and has led to improvements in the intelligibility of children’s speech which have been maintained for up to 12 weeks without further intervention. What is not yet known is whether there is a differential effect on types of speech sounds, or whether this effect is moderated by CP type or severity of impairment. Establishing this can then help with further individualisation of therapy and further gains in intelligibility. Aims The aim of the study was to ascertain if therapy focusing on breath supply and speech rate is associated with increased differentiation of the articulation of individual phonemes, enabling listeners to better identify individual phonemes in words spoken in isolation and in connected speech (CS). Methods Design The study was a secondary analysis of previously collected data from two phase II studies using an interrupted time series design and one feasibility randomised controlled trial of the Speech Systems Approach. Participants Forty-two children and young people aged 5–18 years, who had a diagnosis of CP by a medical practitioner and moderate to severe dysarthria as assessed by their local speech language therapist, received the Speech Systems Approach in the original studies. Participants were excluded from the studies if they had hearing impairments >50 decibel HL, visual impairments that were not correctable with glasses, or were unable to follow simple verbal instructions. All 42 participants were included in this secondary analysis. Intervention Children received individual therapy following the Speech Systems Approach from a registered speech and language therapist three times a week for 6 weeks. Sessions lasted approximately 40 minutes. In two of the original studies the sessions were provided face-to-face, the third study session took place remotely using video conferencing software. In the first session the therapist tried several cues to find the best that elicited a strong, clear voice in an open vowel (ah). Cues included ‘strong, big, loud’ and a combination of these. For children who had difficulty initiating movement cues were ‘nice and easy’ or ‘smooth’. Once the most appropriate cue had been found for the child, that cue was used to elicit open vowels on command. Practice of the target voice then followed a hierarchy of increasing length of utterance and cognitive load. Children first practiced in single words (SWs), then short phrases and finally longer CS. At each stage they started with repetition, moved to picture naming and description, and then questions and answers and games. Children had to use their target voice 8/10 attempts to move to the next level in the hierarchy. Children were provided with knowledge of results on how their voice sounded and were encouraged to use bio feedback (‘How did that feel?’). Feedback was given frequently in the acquisition phase at each level of the hierarchy and then faded to aid retention. Sessions followed a set sequence for practice of the target voice: (1) 10 open vowels; (2) three repetitions of 10 self-selected phrases that children use in daily life; (3) 70–80 words and phrases from the speech task hierarchy; and (4) 10–20 utterances randomly selected from the three preceding tasks. Procedure Data were collected at 6- and 1-week pre-therapy and 1, 6- and 12-weeks post-therapy. The original studies suggested that gains in intelligibility were observed immediately after therapy (1 week) and were maintained at 6 and 12 weeks. For this study we analysed data from 1-week pre- and 1-week post-therapy. At each time point, participants’ speech was recorded on two separate days and elicited through two tasks. SWs were elicited using the Children’s Speech Intelligibility Measure (CSIM) which contains 200 lists of 50 words. The CSIM is a forced choice word recognition task. Listeners heard each word and selected the target word from a list of 12 phonetically similar words. CS was elicited by asking the participants to describe complex pictures and answer questions. The recordings were transcribed live by an expert speech and language therapist and then checked with the child, to create a gold standard transcription of target words. Up to 60 seconds of CS was presented to listeners in phrases separated by pauses of at least three seconds. The CS recognition task was open choice; listeners heard the recordings of CS and wrote down the words they perceived the child to say. Listeners were native speakers of English, aged 18–55 years, and had no hearing difficulties or regular experience of interacting with people with disabilities or speech disorders. In each of the original studies, listeners were randomly allocated three speech recordings, with the limitation that they did not hear the same child more than once. Each recording was heard by three listeners. Outcomes Perceptual data Each word produced by children in the SW and CS tasks was categorised by the single consonants and the clusters of consonants at the start and end of words. Consonants were categorised according to their voicing (voiced = vocal fold vibration; voiceless = vocal folds open), place of articulation (bilabial, labiodental, dental, alveolar, post-alveolar, velar, and glottal), and manner of articulation (plosives, fricatives, affricates, nasals and approximants). The words perceived by listeners were categorised in the same way. A review of the data showed that some manners and places of articulation rarely appeared in the SW lists. We therefore combined manners of articulation into obstruents, which demand constriction/closure of the vocal tract (plosives, fricative and affricates), and sonorants, which allow air to flow out of the mouth or nose (approximants and nasals) and places of articulation to labial (bilabial, labiodental), coronal (dental, alveolar, post-alveolar) and dorsal (velar). Consonants were then further categorised according to a combination of their voicing, place, and manner characteristics (e.g. voiced labial obstruent). This was done owing to dependencies between voice and manner such that consonants with a sonorant manner are never voiceless. Because of this, we were not able to separate the main effects of voice and manner from each other if they were added as individual explanatory variables in modelling. The perceptual data were multilevel such that children were level 2 units and each target word-and-listener combination was a level 1 unit. The primary outcome for the perceptual analysis was the identification of words and segments within them (binary outcomes). Words and sounds were identified if there was a match between the target and perceived word/consonant/cluster/voice/place/manner. Secondary outcomes include the percentage identification measures. We visually inspected radar plots profiling performance on six percentage identification measures comprising the voice, place and manner of word initial and word final singleton consonants at pre- and post-therapy. Acoustic data Recordings of 24 out of the 42 children were available pre- and post-therapy and were automatically transcribed and segmented, and manually corrected. Measures of intensity (dB), duration (ms) and speech rate (seconds per syllable) were made at word and segment level. Changes in intensity and/or speech rate were monitored post-therapy and examined as a function of consonant manner, intelligibility, and groups of children based on the perceptual analyses. Data analysis Perceptual data We used generalised linear mixed modelling (GLMM) with a logit link function and random effect of child to examine the effect of the Speech Systems Approach intervention (post-therapy vs. pre-therapy) on identification of word initial and word final singleton consonants and consonant clusters and whether there was evidence that certain types of consonants benefitted more from the therapy than others. We visually inspected radar plots of change in listeners’ identification of consonants to group children with similar profiles. Acoustic data Acoustic measurements made on SWs and CS, with mean differences and 95% confidence intervals (CIs) calculated between the post- and pre-therapy. Changes in the acoustic variables were then compared to changes in perceptual variables such as single and connected word intelligibility. These comparisons were made for each individual child and groupings derived from the radar plots from the perceptual data analysis. Results Perceptual analysis Using GLMM, we found evidence that the odds of word initial and word final singleton consonants being identified by listeners increased after therapy in both the SW [odds ratio (95% CI) = 1.54 (1.44 to 1.65) and 1.61 (1.51 to 1.73) respectively; all p < 0.01] and CS analyses [1.26 (1.15 to 1.39) and 1.27 (1.15 to 1.41) respectively; all p < 0.01], even after adjusting for potential confounders. There was also evidence for the effect of therapy on the identification of word initial consonant clusters and word final consonant clusters in the SW analyses [1.84 (1.60 to 2.12) and 1.42 (1.15 to 1.75) respectively; all p < 0.01]. Identification of consonant clusters was not examined in the CS data due to the infrequent use of clusters. Additionally, we found evidence of heterogeneity in the effect of therapy on word initial and word final singleton consonant identification between the subtypes of consonants, categorised according to their voicing, place, and manner, in both SW and CS analyses. Nearly all subtypes of consonants, as either word initial or word final singleton consonants, showed an improvement in the probability of being identified by a listener after therapy in the SW analyses, but only about a handful showed an improvement in the CS analyses. We identified six groups of children in the SW data and seven groups of children in the CS data. Each group categorised children according to their relative standing at pre-therapy, the direction and magnitude of change in percentage identification measures, and additionally which combination of the six measures displayed a change. Acoustic analysis Most of the children whose data were analysed acoustically produced slower speech post-therapy, regardless of gains in intelligibility. There was individual variability in the degree of change in speech rate, with a tendency for greater decreases in the speech rate of children whose initial performance was low. Most children also produced words with higher mean intensity post-therapy regardless of gains in intelligibility. However, the majority of the children with an increase in maximum intensity in initial and final word position had improved intelligibility post-therapy. This was particularly the case for the obstruent category. There was variation in changes to intensity across clusters, word position and manner categories, with more modest increases in the intensity of sonorant sounds pre- and post-therapy compared to obstruents. There were also more variable changes in speech rate, intensity and their relationship with intelligibility in CS compared with SWs. Conclusions and recommendations The Speech Systems Approach, which focusses on breath control and speech rate, improved the intelligibility of SWs. Our previous research suggests that gains were maintained for up to 12 weeks following the intensive burst of therapy. This type of intervention is now recommended by National Institute for Health and Care Excellence (NICE) to help address the interaction challenges faced by children with CP. Acoustic analysis of a subset of the data shows change for individuals in intensity and/or duration of individual speech segments. Findings suggest that increased intelligibility was achieved through a stronger vocal signal and allowing children to articulate individual sounds with greater precision. Changes in CS were more modest, suggesting that adaptations to the approach are warranted. The marked individual differences suggest a varying response to therapy between children but also within children across speech segments. Personalisation of the intervention, with cues adapted to the child’s performance, should be investigated. Acoustic analysis of speech during the intervention could aid personalisation, showing how speech changes in response to individual cues. Practice should move to CS quickly. Intelligibility, through listener identification of words and constituent sounds, should continue to be assessed in SWs and CS to investigate the impact of utterance length. Two matched lists of high frequency SWs could be used to facilitate comparison across children and time. Using one list at 6-weeks pre-therapy and immediately post-therapy, and a second list immediately pre-therapy and at follow-up would minimise learning effects. Acoustic change should be measured to help understand how change is achieved by individuals. Study registration This trial is registered as Research Registry 6117. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation programme (NIHR130967) and will be published in full in Efficacy and Mechanism Evaluation; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.

ImportanceCerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.ObjectivesTo systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.Evidence reviewThis study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.FindingsSix systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.Conclusions and relevanceEarly diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

Background: Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants. Aims: To assess the potential feasibility and acceptability of delivering one-to-one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention. Methods & Procedures: We aimed to recruit eight children aged 12-48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post-intervention (3 weeks) and follow-up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis. Outcomes & Results: Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (r[subscript s] = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication. Conclusions & Implications: The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement.

Background: The speech intelligibility of children with dysarthria and cerebral palsy has been observed to increase following therapy focusing on respiration and phonation. Aims: To determine if speech intelligibility change following intervention is associated with change in acoustic measures of voice. Methods & Procedures: We recorded 16 young people with cerebral palsy and dysarthria (nine girls; mean age 14 years, SD = 2; nine spastic type, two dyskinetic, four mixed; one Worster-Drought) producing speech in two conditions (single words, connected speech) twice before and twice after therapy focusing on respiration, phonation and rate. In both single-word and connected speech we measured vocal intensity (root mean square--RMS), period-to-period variability (Shimmer APQ, Jitter RAP and PPQ) and harmonics-to-noise ratio (HNR). In connected speech we also measured mean fundamental frequency, utterance duration in seconds and speech and articulation rate (syllables/s with and without pauses respectively). All acoustic measures were made using Praat. Intelligibility was calculated in previous research. Outcomes & Results: In single words statistically significant but very small reductions were observed in period-to-period variability following therapy: Shimmer APQ -0.15 (95% CI = -0.21 to -0.09); Jitter RAP -0.08 (95% CI = -0.14 to -0.01); Jitter PPQ -0.08 (95% CI = -0.15 to -0.01). No changes in period-to-period perturbation across phrases in connected speech were detected. However, changes in connected speech were observed in phrase length, rate and intensity. Following therapy, mean utterance duration increased by 1.11 s (95% CI = 0.37-1.86) when measured with pauses and by 1.13 s (95% CI = 0.40-1.85) when measured without pauses. Articulation rate increased by 0.07 syllables/s (95% CI = 0.02-0.13); speech rate increased by 0.06 syllables/s (95% CI = < 0.01-0.12); and intensity increased by 0.03 Pascals (95% CI = 0.02-0.04). There was a gradual reduction in mean fundamental frequency across all time points (-11.85 Hz, 95% CI = -19.84 to -3.86). Only increases in the intensity of single words (0.37 Pascals, 95% CI = 0.10-0.65) and reductions in fundamental frequency (-0.11 Hz, 95% CI = -0.21 to -0.02) in connected speech were associated with gains in intelligibility. Conclusions & Implications: Mean reductions in impairment in vocal function following therapy observed were small and most are unlikely to be clinically significant. Changes in vocal control did not explain improved intelligibility.

Background: Research on cognitive and school functioning domains of health‐related quality of life (HRQOL) for children and adolescents with congenital heart disease (CHD) presents inconsistencies. Objectives: To summarize and synthesize data on school and cognitive function domains of HRQOL for children and young people (CYP) with CHD. Methods: Five electronic databases MEDLINE, Scopus, PsycINFO, EMBASE, ERI, and citations were systematically searched. We included original‐research articles reporting the cognitive and school function domains of HRQOL for children and young people with CHD (child and parent reports included). Both fixed and random‐effects meta‐analyses were performed to estimate pooled mean test scores for cognitive and school function. A total of 34 studies met our inclusion criteria and were synthesized narratively, 17 studies were included in formal meta‐analyses. Results: Self‐reported cognitive function was lower for children and young people with CHD than healthy controls (SMD −0.28 (−0.42, −0.15)). Parental reports demonstrated similar results to self‐reports (SMD −0.54 (−0.91, −0.18)). School function was lower in children and young people with CHD compared with healthy controls in self‐reported (SMD −0.30 (−0.48, −0.13)) and parent reported HRQOL (SMD −0.49 (0.64, −0.36)). Self‐reported school function domain scores were lower for young (<8 years) (SMD −0.65 (−1.32, 0.03)) and older children (8–18 years) (SMD −0.25 (−0.47, −0.03)) with CHD than their peers. Similarly, parents reported lower school function domain scores for young (<8 years) (SMD −0.68 (−1.29, −0.07)) and older (8–18 years) (SMD −0.46 (−068, −0.25)) children with CHD than typically developing peers. Conclusion: Children born with CHD may experience lower cognitive and school function HRQOL scores than healthy controls (self and proxy‐report). This is consistent with a subgroup meta‐analysis of young (<8 years) and older (8 years old or more) children with CHD reporting lower school function scores compared to controls. [ABSTRACT FROM AUTHOR]

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.

Aim: To identify the research on childhood disability service adaptations and their impact on children and young people with long‐term disability during the COVID‐19 pandemic. Method: A mapping review was undertaken. We searched the World Health Organization Global COVID‐19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0–19 years) with long‐term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced. Results: Reduction of face‐to‐face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child‐reported satisfaction or acceptability of service changes. Interpretation: The long‐term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well‐being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable. [ABSTRACT FROM AUTHOR]

Purpose: The Viking Speech Scale is used to classify speech performance in children with cerebral palsy (CP). A Dutch‐language version (VSS‐NL) has recently become available. This study aimed to determine the reliability and validity of the VSS‐NL and the association with motor type of CP, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Communication Function Classification System (CFCS). Methods: A total of 90 children with CP, recruited throughout the Netherlands, took part in the study. VSS‐NL classifications by speech and language therapists unfamiliar (SLT1) and familiar (SLT2) with the child, parents and physicians were compared. Convergent and discriminant validity were determined with the Intelligibility in Context Scale‐Dutch (ICS‐NL) and the Computer Based Instrument for Low Motor Language Testing (C‐BiLLT). Inter‐ and intrarater reliability were determined by weighted Kappa (ƙw). Validity and associations between VSS‐NL and GMFCS, MACS and CFCS were determined with Spearman's coefficient. Association between VSS‐NL and motor type of CP was determined with Fisher's exact test. Results: Interrater reliability was excellent between SLT1‐SLT2 (ƙw = 0.93, 95% confidence interval [CI] 0.87–0.99), good between SLT1‐parent (ƙw = 0.71, 95% CI 0.60–0.83), SLT1‐physician (ƙw = 0.70, 95% CI 0.58–0.81), SLT2‐parent (ƙw = 0.71, 95% CI 0.57–0.84), SLT2‐physician (ƙw = 0.73, 95% CI 0.62–0.85) and parent‐physician (ƙ = 0.72, 95% CI 0.60–0.85). Intrarater reliability was excellent for SLTs familiar and unfamiliar to the child (ƙw = 1.00, 95% CI 1.00–1.00), and very good for physicians (ƙw = 0.89, 95% CI 0.75–1.00) and parents (ƙw = 0.72, 95% CI 0.62–1.00). Convergent validity was very strong (r = −0.81, p < 0.001) and discriminant validity moderate (r = −0.56, p < 0.001). Association with motor type of CP was significant (χ2 = 27.558, p < 0.001) and strong with GMFCS (r = 0.62, p < 0.001), MACS (r = 0.63, p < 0.01) and CFCS (r = 0.69, p < 0.001). Conclusion: The VSS‐NL is a reliable and valid system to classify speech performance in children with cerebral palsy. Classifications can be performed by SLTs, parents and physicians. [ABSTRACT FROM AUTHOR]

Background: Speech is the most common method of communication. Video‐based clinical communication evaluation is a requirement for children with speech–language impairments living in rural areas, and those who have limited mobility. Aims: To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS‐T) via live and video‐based observation for children with cerebral palsy (CP) aged 4–18 years. Methods & Procedures: A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating–drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory—Social Function (PEDI‐SF), and the Functional Independence Measure for Children—Communication (WeeFIM‐C) were assessed to examine the concurrent validity of the VSS‐T. The interrater reliability of the VSS‐T was analysed between parents, physical therapists, and speech and language therapists from live and video‐based observation. Intra‐rater reliability was calculated from ratings made from live and video‐based observations taken 3 weeks apart. Outcomes & Results: The VSS‐T was strongly related to the ICS (r = –0.830), PEDI‐SF (r = –0.819), WeeFIM‐C (r = –0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (κw ≥ 0.838) and intra‐rater reliability (intraclass correlation coefficient (ICC) = 0.848–0.995) were found between parents and therapists. Conclusions & Implications: Speech and language therapists, physical therapists, and parents can use the VSS‐T as a valid and reliable classification system to describe speech intelligibility of 4–18‐year‐old children with CP. Both live and video‐based observations can be used to administer the VSS‐T. What This Paper Adds: What is already known on the subject: The English version of the VSS has been shown to be a valid and reliable tool used to classify the speech of children with CP aged 4–13 years. The scale can be administered by means of live observation of the child or based on clinicians' notes on the case by parents, SLTs, physiotherapists and paediatricians. What this paper adds to existing knowledge: The VSS‐T is valid and reliable for children with CP aged 4–18 years. Video‐based observation is a suitable method for evaluating the VSS‐T levels. The VSS‐T has a moderate association with the CFCS. What are the potential or actual clinical implications of this work?: The VSS‐T is a valid and reliable method of categorizing the severity of motor speech impairment for Turkish children with CP in clinical research studies, registry systems or epidemiological studies. Both experienced and inexperienced therapists can use either live or video‐based observation methods to administer the VSS‐T. This study extended the validity and reliability of the scale in children with CP aged up to 18 years. The VSS‐T is also associated with the Visual Functional Classification System (VFCS), which has been recently developed for describing the visual abilities of children with CP in daily life. In addition, the VSS‐T is associated with the presence of dental, swallowing, cognitive problems and epilepsy. [ABSTRACT FROM AUTHOR]

To systematically map available evidence for school-based interventions led by allied health (i.e., occupational therapy, physiotherapy, and/or speech and language therapy). We searched for studies in pre-school, primary, secondary, or post-secondary settings, published 2004–2020. We coded study, population, and intervention characteristics. Outcomes were coded inductively, categorised, and linked to the International Classification of Functioning, Disability, and Health. We included 337 studies (33 countries) in an interactive evidence map. Participants were mainly pre-school and primary-aged, including individuals with neurodisability and whole-school populations. Interventions targeted wide-ranging outcomes, including educational participation (e.g., writing, reading) and characteristics of school environments (e.g., educators' knowledge and skills, peer support). Universal, targeted, and intensive interventions were reported in 21.7%, 38.9%, and 60.2% of studies, respectively. Teachers and teaching assistants delivered interventions in 45.4% and 22.6% of studies, respectively. 43.9% of studies conducted early feasibility testing/piloting and 54.9% had ≤30 participants. Sixty-two randomised controlled trials focused on intervention evaluation or implementation. In the United Kingdom, future research should take forward school-based allied health interventions that relate directly to agreed research priorities. Internationally, future priorities include implementation of tiered (universal, targeted, intensive) intervention models and appropriate preparation and deployment of the education workforce. Allied health professionals (occupational therapists, physiotherapists, and speech and language therapists) work in schools supporting children and young people affected by neurodisability but the content, impact, and cost-effectiveness of their interventions are not well-understood. We systematically mapped the available evidence and identified that allied health school-based interventions target highly diverse health-related outcomes and wider determinants of children and young people's health, including educational participation (e.g., literacy) and characteristics of the school environment (e.g., educators' knowledge and skills). Our interactive evidence map can be used to help stakeholders prioritise the interventions most in need of further evaluation and implementation research, including tiered models of universal, targeted, and intensive allied health support. Teachers and teaching assistants play a central role in delivering allied health interventions in schools – appropriate preparation and deployment of the education workforce should therefore be a specific priority for future international allied health research. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether speech therapy using a speech systems approach to controlling breath support, phonation, and speech rate can increase the speech intelligibility of children with dysarthria and cerebral palsy (CP). Method: Sixteen children with dysarthria and CP participated in a modified time series design. Group characteristics were as follows: seven males, nine females; age range 12 to 18 years (mean 14y, SD 2); CP type: nine spastic, two dyskinetic, four mixed, one Worster-Drought; Gross Motor Function Classification System levels range I to V (median IV). Children received three 30- to 45-minute sessions of individual therapy per week for 6 weeks. Intelligibility in single words and connected speech was compared across four points: 1 week and 6 weeks before therapy, and 1 week and 6 weeks after its completion. Three familiar listeners and three unfamiliar listeners scored each recording. Mean percentage intelligibility was compared using general linear modelling techniques. Results: After treatment, familiar listeners understood 14.7% more single words and 12.1% more words in connected speech. Unfamiliar listeners understood 15% more single words and 15.9% more words in connected speech after therapy. Interpretation: Therapy was associated with increases in speech intelligibility. Effects of the therapy should be investigated further, in an exploratory trial with younger children and in a randomized controlled trial.

Purpose: To investigate whether It Takes Two to Talk--The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents. Method: Eleven children aged 19-36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion. Results: Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers' linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers' views of parenting did not change. Conclusions: It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.

The study of communication and its disorders often involves coding several behaviors and examining the proportions with which individual behaviors are produced within data sets. Problems are encountered when studying multiple behaviors between data sets, because of the interdependence of the proportions: as one coded behavior increases, at least one other must decrease. The interdependence of data means that traditional statistical techniques can be used to analyse differences in the proportion of only one behavior over time or between clinical groups. We describe a statistical technique, previously used in geological and biomedical research, which can be used to analyse all behaviors in compositional data sets, and give examples of its use with interaction data. The technique allows, for the first time, full comparison of entire patterns of multiple communication behaviors, both over time and between clinical groups. The technique will aid both basic and applied communication research. Learning outcomes: Readers will understand the advantages and limitations of frequency counts and proportions for the analysis of multiple behaviors. Readers will be able to analyze change in proportions of multiple behaviors within a data set between groups and across time. (Contains 7 tables.)

Little is known about the effects of listener characteristics or listening conditions on intelligibility scores. This study compared intelligibility scores of dysarthric speech achieved under a standard listening condition with those obtained in non-standard conditions and investigated the effect of listener age, gender and familiarity with speaker accent on intelligibility scores. No differences were observed in the mean intelligibility scores across standard and non-standard listening conditions. However, mean range of scores in the standard condition was lower than in the non-standard condition (t = 3.07, df 90, p less than 0.003; 95% CI 2.04-9.76). No main effects of listener age, gender or familiarity of accent were observed. When composite effects were examined increased age in male listeners was associated with reduced intelligibility scores. Results from the current study suggest that when conducting intelligibility research listening conditions should be standardised and that adult listeners of either gender and any age may be used to test intelligibility outcomes providing hearing acuity is taken into consideration. (Contains 2 tables.)

Children with cerebral palsy often have speech, language and communication difficulties that affect their access to social and educational activities. Speech and language therapy to improve the intelligibility of the speech of children with cerebral palsy has long been advocated, but there is a dearth of research investigating therapy effectiveness. To begin to explore the possible effectiveness of therapy focussing on speech production, six students aged 10-18 years, were given intensive individual therapy to increase breath support for speech, maintain breath support and volume across utterances and hence maximise their background effort for speech. Intelligibility of single words and connected speech was measured immediately before and after the block of therapy and again seven weeks later. Gains in intelligibility were observed at the single word level, but not for continuous speech. Implications for therapy and future research are discussed.

Background: Research has shown that children with cerebral palsy have difficulties acquiring communication skills and that conversation with familiar partners follows restricted patterns, which are characterized by high levels of partner control and children's responsivity. Speech and language therapy often includes training for conversational partners to help to them recognize children's communicative signals and to create opportunities for children to take a more equal and independent role in conversation. However, the effectiveness of this indirect therapy has not been demonstrated reliably. Aims: To review systematically all experimental research on communication training for conversational partners of children with cerebral palsy and to evaluate the effectiveness of this type of intervention. Methods & Procedures: As part of a wider review, health, psychology and education electronic databases were searched up to December 2002 for reports of experimental studies on the training of conversational partners to facilitate the communication of children with cerebral palsy, which contained an element of control. References from identified studies were followed-up and relevant journals and conference reports were hand-searched. Identified studies were assessed for inclusion by the first author. Two reviewers independently abstracted data on the quality and content of each study. Outcomes & Results: Four studies were identified from five research reports that met the criteria for inclusion in the review, comprising three group studies and one single case experiment. Common targets for training were observed across the studies. These included positioning of the conversational partner and child for interaction, creating communication opportunities and responding to children's communicative signals. Changes were observed in the conversation patterns used by conversational partners, which should facilitate the communication of children with cerebral palsy. However, the studies contain methodological flaws and as a result they cannot demonstrate that the changes were definitely a result of the intervention. Conclusions: Research on the effectiveness of interaction training for conversational partners of children with cerebral palsy is in its early stages. Training has incorporated common targets, which are widely acknowledged by clinicians to affect the communication of children with motor disorders. Trends in behaviour change have been suggested by research to date, but further studies that address the methodological inadequacies of the original research are needed to evaluate the effectiveness of this type of intervention. Suggestions of ways to improve the design and reporting of future studies, that will allow the mapping of interventions to clients, are discussed in this review.

Purpose: To investigate whether It Takes Two to Talk--The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents. Method: Eleven children aged 19-36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion. Results: Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers&apos; linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers&apos; views of parenting did not change. Conclusions: It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted. KEY WORDS: speech disorders, parents, treatment outcomes, cerebral palsy, children, Children with congenital motor disorders, the most common cause of which is cerebral palsy (Koman, Smith, & Shilt, 2004), often have problems acquiring and controlling movements for facial expression, gesture, [...]

To explore the characteristics and associated factors of oromotor dysfunction in minimally verbal children with cerebral palsy (CP) aged five to six years, recruited from a population-based registry. Twenty children with CP who were minimally verbal completed a standardised, observational oromotor assessment. Linear regression analyses examined the relationship between oromotor dysfunction and potential associated factors (e.g., fine and gross motor function, communication, and feeding). Oromotor dysfunction affected every participant and was identified in all structures examined (i.e., face, jaw, lips, and tongue). Oromotor movements showed little dissociation among jaw, lip, and tongue movements. Oromotor dysfunction was univariately associated with the Manual Ability Classification System levels IV–V (p = 0.001), reduced communication skills (p = 0.002), and a prolonged eating duration (>45 min) (p = 0.006), even when non-verbal cognition served as a covariate. Oromotor dysfunction was highly prevalent in our sample of minimally verbal children with CP, having significant functional impacts on feeding and communication. Findings suggest that fine motor function (i.e., Manual Ability Classification System levels IV–V) is a stronger predictor than gross motor function for identifying children with CP who are minimally verbal and at risk of oromotor dysfunction. Oromotor dysfunction was highly prevalent in our sample of minimally verbal children with cerebral palsy. Severe fine motor impairment strongly predicted oromotor dysfunction, indicating that fine motor function may provide an early indicator of impaired oromotor function for this clinical population. Robust, standardised measures of motor speech-related oromotor development suitable for children with cerebral palsy who are minimally verbal are lacking. Until such a measure is developed, formal evaluation may be achieved via oral motor assessments standardised for typically developing children, with the caveat one must interpret the results with caution. [ABSTRACT FROM AUTHOR]