The number of children with complex medical needs has risen in recent years, due to the increase in medical technology and subsequent increased survival rate of premature infants. This has led to an increasing number of children with complex neurological conditions, such as Cerebral Palsy, being seen by speech-language therapists to address their complex feeding and communication needs in schools (Arvedson 2008). Surface electromyography (sEMG) has been successfully used as a tool to facilitate therapy in adult dysphagia rehabilitation (Huckabee & Cannito 1999), and has been used in studies of dysarthric speech in children with Cerebral Palsy (Marchant, Mc Auliffe & Huckabee 2007). This case series report examines the effect of oral motor control therapy with sEMG biofeedback to increase motor control and inhibit increased muscle tone. Three participants aged 6, 16, and 18 were selected from the population of Kimi Ora Special School. Each of the three participants were offered sixty, twice daily treatment sessions of 30 minutes each focusing on active relaxation, and reducing duration of return to reset after recruitment of the masseter and submental muscles using sEMG biofeedback. After each session each participant was fed a prescribed amount of thin fluid and a range of food textures to encourage generalization of increased control of the submental and masseter muscles during eating and drinking. One participant was withdrawn after 42 sessions, and two participants completed all 60 sessions. Results showed variable improvement in feeding skills, with a notable improvement in anterior food loss. All participants were able to participate fully in the treatment and made significant gains in their ability to control their muscles during treatment sessions which was reflected in the reduction of sEMG amplitudes. This study demonstrated that oral motor control therapy with sEMG is a viable treatment tool, which warrants further larger scale research into its effectiveness.

An adjustable chair was developed for children with cerebral palsy in Uganda. The chairs these children use today are custom made which means that they cannot be used when a child outgrows a chair. Sometimes the chair is used by other children and does not give the support that the child needs. The project was executed in the capitol, Kampala, by the two design engineer students Faith Auma and Emma Lingehed in collaboration with Makerere University, Kampala school for the physically handicapped and Katalemwa Cheshire home. The goal of the project was to help pupils with cerebral palsy from a young age develop adequate sitting behaviour and become more physically independent. The chair should be able to be manufactured and assembled in Uganda and the material should be able to be found in the country. The project started by clarifying the problem, information was collected through literature studies, study visits and interviews. The gathered information was used to create a product specification focusing on safety, environment, manufacturing and ergonomics. All background information was used throughout the idea generation. A number of ideas were generated and evaluated until a final concept was found. The final concept, called Billy, was chosen through a concept scoring where it was evaluated against three other concepts. Billy was considered the easiest concept to manufacture in Uganda and had the simplest construction. Billy was developed further and became the final concept Entebbe. Entebbe is a chair that is adjustable and gives the support a child with cerebral palsy needs. A prototype was made at Katalemwa Cheshire home.  Entebbe can be manufactured in Uganda and since it is module-based it can easily be repaired and resized by simply changing the concerned parts. This also means that parts can be reused to build other chairs. Entebbe can be adjusted in five different ways and requires no tools to assemble. / En justerbar stol utvecklades för barn med cerebral pares i Uganda. Stolarna dessa barn använder idag är specialdesignade vilket innebär att de inte kan användas när barnet växer ur stolen. Ibland används då stolen av andra barn och ger därmed inte det stöd som barnet behöver. Projektet genomfördes i huvudstaden, Kampala, av de två designingenjörsstudenter Faith Auma och Emma Lingehed i samarbete med Makerere University, Kampala school for the physically handicapped och Katalemwa Cheshire home. Målet med projektet var att hjälpa elever med cerebral pares redan från unga år att utveckla ett korrekt sittbeteende och bli mer fysiskt oberoende. Stolen ska kunna tillverkas och monteras i Uganda och materialet ska finnas i landet. Projektet började med att studera och klargöra problemet, information samlades in genom litteraturstudier, studiebesök och intervjuer. Den insamlade informationen användes för att skapa en kravspecifikation med fokus på säkerhet, miljö, tillverkning och ergonomi. Bakgrundsinformationen användes under idégenereringen. Ett antal idéer genererades och utvärderades tills ett slutgiltigt koncept hittades. Det slutgiltiga konceptet, Billy, valdes genom en concept scoring där det utvärderades mot tre andra koncept. Billy ansågs vara det koncept som var enklast att tillverka i Uganda och hade den enklaste konstruktionen. Billy vidareutvecklades och blev det slutliga konceptet Entebbe. Entebbe är en stol som är justerbar och ger det stöd ett barn med cerebral pares behöver. En prototyp tillverkades vid Katalemwa Cheshire home. Entebbe kan tillverkas i Uganda och eftersom den är modulbaserad är den lätt att reparera och ändra storlek på genom att enkelt byta ut de berörda delarna. Detta innebär att delarna även kan återanvändas för att bygga andra stolar. Entebbe kan justeras på fem olika sätt och inga verktyg krävs för att montera ihop stolen.

Cerebral Palsy (CP) is a childhood-onset neurological disorder caused by a non-progressive lesion in the developing brain. It causes permanent motor and movement disorders, and can sometimes cause secondary cognitive, sensory, and communication conditions. The majority of children with CP will survive into adulthood; however, a relatively small amount of research has been done about adulthood and aging with CP. Using data collected in Ontario with the Resident Assessment Instrument for Home Care (RAI-HC), a retrospective, cross-sectional analysis was performed to create a clinical profile of adults with CP receiving long term home care services in Ontario. Of the 519, 443 people in the sample, 2000 had CP. Persons with CP tended to be younger than comparison groups, had higher scores on functional assessment scales, and were more likely to use assistive devices. They tended to have lower scores on scales meant to predict decline in health or function than the comparison groups, suggesting increased health and functionality stability compared to other Home Care recipients. A second analysis assessed the association between functional assessment scales, demographic variables and clinical indicators and use of physical therapy (PT), occupational therapy (PT) and either PT or OT for persons with CP in this population. Using three logistic regression models, indicators that were found to have positive, significant associations with use of rehabilitative services were: receipt of initial assessment, likelihood of decline in functionality, use of a wheelchair, being married, and CCAC of assessment origin. Living in a private residence compared to living in an assisted living situation had a significant, negative effect on rehabilitative service use. These findings suggest that PT and OT are referred to persons with CP in reaction to risk of health declines, and not in an attempt to improve baseline functionality. Future research on the factors that would indicate likelihood of improvement with PT or OT could identify whether these associations are appropriate for optimum care for persons with CP who receive home care services.

The vast majority of children with cerebral palsy (CP) are surviving into adulthood due to improved surgical and health care practice. Thus, the expiration of paediatric services means that a new population of adults with CP has emerged that must transition into an ill-equipped adultoriented system. Informed by the perspective of complexity theory, this case study used both quantitative and qualitative data to examine the primary healthcare transition of youth with CP living in Sault Ste. Marie, Ontario. Analysis of Ontario Health Insurance Program claims showed service use changes due to both the expiration of paediatric services and the changing health needs of individuals with CP as they age. Physicians commented on challenges due to the complexity of the CP disease process and the benefits of shared care and teamwork in discussing transition. Future research and clinical practice designed to address transition barriers need to be informed by complexity theory.

This study explored the physiological adjustments made by the speech mechanism when sustained maximum phonations and sentences differing in vocal loudness were produced by typically developing children and children with cerebral palsy (CP). Respiratory adjustments (lung volume initiation, termination and excursions), chest wall muscular amplitude adjustments (intercostal, obliques), vocal fold adjustments (speed quotient), fundamental frequency of selected vowel nuclei and area of mouth opening were calculated. A total of eight children (4 typically developing children, 4 children with CP) were studied. Results indicated that overall typically developing children adjusted lung volume initiation, lung volume excursion, intercostal and oblique muscle activity, speed quotient, fundamental frequency, and area of mouth opening to meet vocal loudness targets. In contrast, children with CP primarily adjusted intercostal and oblique muscle activity, speed quotient, and fundamental frequency to meet vocal loudness targets. / Speech-Language Pathology

Dysarthria is one of the most common signs of speech impairment in the cerebral palsy (CP) population. Facilitating strategies for speech enhancement in this population often include training on speech breathing. Treatment efficacy studies with cross-system measures in this population are needed for improved understanding and management of the interrelationship between respiratory, phonatory, and articulatory systems. The purpose of this study was to investigate the effect of breath group control on the coordination of articulatory and phonatory muscles and the acoustic measures related to speech and voice quality. A simultaneous acoustic, electroglottographic (EGG), and marker-based facial tracking recording system was employed to monitor the speech production behaviors of four adults with CP and 16 neurologically healthy controls. Subjects were instructed to perform three tasks, each containing speech targets with a voiceless plosive (/p/, /t/, or /k/) preceding a vowel (/i/, /a/, /u/, or /ɔ/). Task 1 consisted of a short reading passage embedded with target vowels without cueing from breath group markers. Task 2 included reading a series of monosyllabic and 3-syllable or 5-syllable non-speech words with the speech targets. Task 3 included reading the same short passage from Task 1 with cueing from breath group markers separating the passage into phrases with no more than five syllables per phrase. Measures from the acoustic, EGG and facial tracking recordings of the first and last syllable of all syllable trains produced in the non-speech task and the target vowels in the passage reading task were examined. Acoustic measures included voice onset time (VOT), vowel duration, fundamental frequency (F0), percent jitter (%jitter), percent shimmer (%shimmer), signal-to-noise ratio (SNR), and frequencies of Formants one and two (F1 and F2). EGG measures included speed quotient (SQ) and open quotient (OQ). Facial tracking measures consisted of maximum jaw displacement. Individual and averaged data were submitted to a series of two-way Analysis of Variances (ANOVAs) or two-way Repeated Measures ANOVAs to determine the effects of the relative position of an utterance in the breath group and the place of articulation of the consonants involved. In addition, mean vowel spaces derived from all three tasks were examined. Results revealed significant changes of VOT, F1, F2, SNR and SQ as a function of position. Significant changes of VOT, vowel duration, F2, F0, %jitter, %shimmer, and maximum jaw displacement as a function of place of articulation were also evident. In particular, breath group control was found to result in expansion of vowel space, especially for individuals with CP. These findings suggest that proper phrasing enhances articulatory and phonatory stability, providing empirical evidences in support of its usage in treating individuals with CP.

Background: Social participation is essential to well-being for adolescents with and without disabilities. Adolescents with a disability, however, often have fewer friendships and experience social isolation compared to their peers without disability. Telecommunications play a vital role in facilitating social participation for adolescents yet those with a disability experience reduced access. Based on the World Health Organisation’s framework of the International Classification of Functioning, Disability and Health (ICF) this study aimed to identify environmental factors (barriers and facilitators) that impact on participation in telecommunication use, as perceived by adolescents with cerebral palsy and their communication partners. Method: A qualitative research design was adopted using observations and in-depth interviews with five dyads of adolescents with cerebral palsy and significant communication partners. Data from interviews was analysed using qualitative content analysis to identify barriers and facilitators. Results and Conclusions: A total of 66 facilitators and 72 barriers to telecommunication use were identified. These were divided into four categories; people-related, equipment-related, support/training-related and ‘other’. A large number of interrelated people and equipment related factors were identified. Participants also identified the need for further training and support. In order to improve social participation for adolescents with disabilities, future research must investigate the development of assessment tools that accurately identify environmental barriers to telecommunication use and contribute to the development of strategies to over come these barriers.

Participation in regular physical activity provides health, psychological and physiological benefits for people both with and without physical impairment. This thesis describes three sequential studies that were undertaken to examine current patterns of physical and sedentary behaviours and evaluate the impact of internet-based intervention (Get Set) on activity patterns of adolescents with cerebral palsy.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (M.Sc.)--University of Western Australia, 2006.