The motor speech disorder of dysarthria is present in a substantial number of children with cerebral palsy (CP), leading to speech intelligibility deficits, which may negatively affect the children’s communication and quality of life. Few studies to date have examined strategies for increasing intelligibility in children with dysarthria, and most have focused on English speakers. Thus, questions regarding the effects of speech cueing strategies in speakers of other languages are under-explored. The purpose of this study was to determine if (Korean translations of) two cues, “speak with your big mouth,” targeting greater articulatory excursion, and “speak with your strong voice,” targeting greater vocal intensity, would elicit changes in speech acoustics and intelligibility in Korean-speaking children with dysarthria secondary to CP. Fifteen Korean-speaking children with dysarthria repeated word- and sentence-level stimuli in habitual, big mouth, and strong voice conditions. Intelligibility was assessed through the ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC) by 90 blinded listeners. Results indicated significantly greater vocal intensity and greater utterance duration in the cued conditions, demonstrating the children’s ability to vary their speech styles in response to the two cues. Furthermore, word-level EoU gains following both cues and sentence-level EoU gains following the strong voice cue suggest potential intelligibility benefits of the cues in this population. Gains in PWC were not statistically significant, and considerable variability in the children’s responses to the cues was noted overall. These findings contribute to the limited knowledge base for speech-language pathologists working with Korean speaking children. The variability in responses points to the importance of assessing each child’s stimulability to cues aimed to enhance intelligibility. Further clinical and theoretical considerations, including cross-linguistic implications, are discussed.

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"May 2015" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito Participation in social roles and daily activities is considered a primary outcome for children with cerebral palsy (CP) and thus is an important focus of pediatric therapy. The purpose of this study was to describe the participation patterns of children ages 2 to 6 years with CP, investigate how gross motor impairment affects participation, and identify those family and environmental factors that may influence participation in daily activities and social roles. A convenience sample of 51 children with CP between the ages of 2 and 6 years and their parents completed this study. Parents completed four standardized instruments: the Assessment of Life Habits (LIFE-H), the Impact on Family Scale, The Child and Adolescent Scale of Environment, and the Child Health Conditions Questionnaire, which measured participation, family burden, the environment, and associated conditions respectively. Hierarchical multiple regression analysis was used to determine the extent to which family and environmental factors explained participation in daily activities and social roles while controlling for gross motor impairment (GMFCS), associated conditions and age. The findings of this study suggest that very young children with CP experience substantial restrictions across 10 of 11 domains of participation. Parents report greater environmental barriers, associated health conditions and impact on family as GMFCS levels increase. Gross motor impairment, associated health conditions, and age accounted for 65% of the variance in participation. The environment and family factors did not contribute significantly to the model. For the children in this study, intrinsic factors accounted for most of the variance in participation.

Health is a multidimensional, holistic, concept integrating physical and mental health. In childhood, the most common cause of physical disability is Cerebral Palsy (CP). For individuals with CP, health and well-being is impacted by the complex interactions among their physical impairments, activity, participation and environmental barriers. Although CP is considered non-progressive, secondary conditions (pain and fatigue) and their functional consequences have been found to worsen as the individual with CP ages. While preliminary evidence shows that many of the physical impairments (pain, fatigue, depression) reported in adults with CP begin during late adolescence, there is little information about the role personal and environmental factors, impairments, activity limitations, and participation restrictions have on health and well-being of young adults with CP. To understand the health and well-being of young adults with CP, the International Classification of Functioning, Disability and Health (ICF), a World Health Organization framework, guided the selection of survey instruments for this study. Surveys were sent to 610 young adults (18-30 years) with CP. 95 surveys were returned, 55 were self-reported and 40 were completed by proxies. Increasing severity of impairment was associated with decreased participation in daily activities and social roles, while loss of ambulatory ability, pain, fatigue, depression, and activity level did not differ by severity of impairment. Environmental barriers restricted the level of participation only for the self-report participants. Health status was decreased in those who self-reported increased pain, fatigue, and depression; offset by emotional support. Life satisfaction was decreased by depression and poor health; offset by emotional support. Addressing the physical impairments, activity limitations, participation restrictions, personal factors and environmental barriers impacting young adults with CP requires coordinated efforts among the medical, educational and vocational systems. These efforts need to begin early with appropriate assessment and treatment of impairments, provision of assistive technologies and augmentative communication, and adaptation of the environment to facilitate participation in activities and social roles. The health and well-being in young adults with CP can also be improved with enhanced emotional support beyond the family unit through peer support groups, mentors, and other adult role models.

Engagement is the active involvement in experiences which allows for development. For children with severe mobility impairments however, challenges arise in accessing experience which can lead to learned helplessness. Due to these challenges powered mobility has been suggested as a mechanism for the provision of self-initiated access to experiences. However, powered mobility is out of reach of the majority of children with disabilities in South Africa hence a non-powered alternative has been sought. This study sought to determine the effect of non-powered, self-initiated mobility on the engagement of young children, with severe mobility impairment, in play. A multiple probe design across participants was used. Four participants, aged 2 years 10 months to 6 years 9 months with severe mobility impairment (Gross Motor Function Classification Scale (GMFCS) level V) underwent a minimum of 5 baseline sessions, followed by 8 intervention sessions. Engagement was measured during each session using the Individual Child Engagement Record –Revised (ICER-R). The data was analysed using visual graphic and statistical analysis. All participants demonstrated an improvement in engagement in play with the introduction of non-powered, self-initiated mobility. A reciprocal deterioration in non-engagement was also recorded. A decrease in engagement in play at the start of intervention was attributed to the focus of engagement being on mobility skills as the device was introduced but this reverted as the participants spent more time on the mobility device. Functional abilities were identified as having a greater role in engagement than age. The introduction of non-powered, self-initiated mobility correlated with the improvement of engagement of young children with severe motor impairment. Non-powered, self-initiated mobility is a viable, cost effective mechanism for mobility at a young age. / Thesis (PhD)--University of Pretoria, 2015. / Centre for Augmentative and Alternative Communication (CAAC) / PhD / Unrestricted

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Ambulation is critical to a child’s participation, development of selfconcept, and quality of life. Children with cerebral palsy (CP) frequently exhibit limitation in walking proficiency which has been identified as the primary physical disability. Traditional rehabilitative treatment techniques to improve ambulation for children with CP reveal inconsistent results. Driven gait orthosis (DGO) training is a novel approach focusing on motor learning principles that foster cortical neural plasticity. Objective: The objectives are to determine if: (i) the lower extremity muscle activation patterns of children with CP are similar to age-matched TD children in overground (OG) walking, (ii) DGO training replicates muscle activation patterns in OG ambulation in TD children, (iii) the lower extremity muscle activation patterns in OG walking of children with CP are similar to their muscle activation patterns with DGO assistance, and (iv) DGO training promotes unimpaired muscle activation patterns in children with CP. Methods: Muscle activity patterns of the rectus femoris, semitendinosus, gluteus maximus and gluteus medius were recorded in the OG and DGO walking conditions of children with CP and age-matched TD. The gait cycles were identified and the data was averaged to produce final average gait cycle time normalized values. Results: In comparing the variability of the muscle activation patterns within the subject groups, CP DGO walking was considerably lower than CP OG. In comparing the muscle activation patterns in each condition, consistent differences (p < .05) were noted in terminal stance, pre-swing and initial swing phases of gait with the DGO condition consistently revealing greater muscle unit recruitment. Conclusion: The results indicate that training in the DGO provided the ability to practice with measurably repetitive movement as evidenced by decreased variability. Consistent differences were noted in muscle activation patterns in the terminal stance, pre-swing and initial swing phases of gait when most of these muscles are primarily inactive. The alteration in ground reaction force within the DGO environment may play a role in this variance. With the goal of normalizing gait, it is important that the effect of these parameters on ground reaction forces be considered in the use of DGO rehabilitation.

Fragestellung Auswirkungen eines Haltungsmanagements auf die Hüften bei Kindern/Jugendlichen mit Cerebralparese In den bisherigen orientierenden Recherchen konnte ich bereits vier kontrollierte Studien identifizieren (6,7,8,9), die für die Bearbeitung der Fragestellung im Rahmen meiner BSc-These geeignet sein dürften. Methodik: Zur Einarbeitung der Suchstrategie werden zunächst die Suchmaschine Google und Google Scholar verwendet, um einen ersten Überblick zum Thema Cerebralparese und dessen Behandlungsmöglichkeiten zu erhalten. Dabei stößt man immer wieder auf Begrifflichkeiten, Fachbegriffe und Synonyme, die für die weitere Suche als „Schlagwörter“ nützlich sein können. Daraus lässt sich eine umfassende Suchstrategie entwickeln, die im Folgenden grob dargestellt und so zur Anwendung gebracht werden soll. Anschließend werden geeignete Studien in der Fachdatenbank Medline (über die Suchmaschine Pubmed) mit MeSH- Begriffen wie „cerebral palsy therapy“ durchgeführt. Zuerst sollen Übersichtsarbeiten (Meta- Analysen) gesucht werden, um über den Stand der Erkenntnis ein Bild zu erhalten und weitere relevante Schlagworte für die endgültige Suchstrategie ausfindig zu machen.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13220号 / 論医博第2167号 / 新制||医||1033(附属図書館) / (主査)教授 高橋 淳, 教授 宮本 享, 教授 伊佐 正 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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