Speech and Language Pathology Assessment of a Child with Cerebral Palsy
In order to assess Ho Lam’s development of communication and language the Speech and language pathologist (SLP) must understand that there are two major areas of concern:
Ø Effect of Cerebral Palsy (CP)- assess the severity of this disability and its effects on functioning (e.g., Diplegia, Spastic Dysarthria, Cognition)
Ø Effect of Learning English as a Second Language (L2)- assessment must be able to objectively tease out normal error patterns that are common to L2 learning (e.g., Silent Period, Mixing), from true learning disabilities
An assessment of the child with CP should include the following: Case History and Interview with the Parent/Teacher, Communication Samples, Medical and Psychological reports, level of language competence, adequacy of Voice and Breathing for speech, speech Intelligibility and Articulation, and the need for use of a non-speech communication system.
** Prior to this point, the SLP has familiarized him/herself with the culture (e.g., books/internet) and has obtained a reliable interpreter (cultural informant) who will work with the SLP to assess child in both the first and second language.
1.Thorough case history or interview with the parent/teacher- getting background information and exploring areas on:
Ø Environmental factors that may influence progressà SES, relationships of child with family members
Ø Multicultural issuesà form and nature of L1 use, linguistic developmental milestones, conditions under which L2 is being learned, attitude towards L2
Ø Medical à pre-, peri- and post-natal conditions, medications
Ø Developmental à communication, ambulation, self-help in feeding, washing, and toileting, degree of social adaptation
Ø Psychological à emotional adjustments and intellectual status e.g., IQ tests
Ø Educational à achievements, school readiness
These are influences that may have had or may be having an effect on the child’s communication development.
2. Communication Samples: Social and Language Interaction between child and the: caregiver (L1); SLP (L2); school environment (L2).
Ø motivation to communicate and level of non-verbal skills give valuable information
Ø strategies that the child uses to initiate, respond to, and maintain social interaction e.g., eye contact, vocalization, body movements, and language during play
Ø ability to turn-take e.g., timing allowed to enable him to participate
Ø intentionality e.g., how does he make others in his environment aware of his interest
Ø informal evaluation of form (syntax, phonology, and morphology), content (semantic, vocabulary), and use (pragmatics)
3. Medical and Psychological reports:
Ø interdisciplinary team approach: Audiologist, Psychologist, Neurologist, etc.
Ø provide information regarding problems that the child is having in areas closely related to communication e.g., type and extent of CP disorder - neuromuscular, hearing, dental pathologies/abnormalities etc.
Ø if not available should refer for additional testing
4. Estimation of the general level of language competence using direct and indirect testing:
Ø Testing for efficiency- the degree to which the child can demonstrate his/her skills to the maximum degree of capability
Ø Adaptive testing à used for children who can’t respond efficiently to the test items
à accommodate for perceptual/motor difficulties by altering materials, response mode or testing procedures
à provides a more valid picture of performance levels
(e.g. Peabody Picture Vocabulary Test- Revised (Dunn and Dunn, 1981) – for a child who has a difficulty with pointing, SLP can cut up the pictures and put them at the four corners of the desk and ask the child to look at rather then point to the correct picture)
Ø Receptive and Expressive Language should be tested in L1 (perhaps L2)
o Formal tests à work with the cultural informant to remove test plates that could lead to cultural bias
à results are descriptive, cannot use norms
à PPVT-R and expressive version- vocabulary knowledge
à Preschool Language Scale-3 (2weeks-6:11), picture/object stimuli tested through tasks, provide instructions for use on special populations
o Informant interview à if verbal language of the child with CP is difficult to assess
à McArthur Communication Development Inventories (Fenson et. a l., 1991) normed on children ages 1-3 years
5. Adequacy of Voice and Breathing for speech:
Ø Vocal intensity/loudness and pitch – variations irregular or smooth?
Ø Voice qualities such as hoarseness or nasality
Ø Determine whether breathing abnormalities are affecting the child’s speech
Example tests:
a) ask the child to say ‘ah’ and prompt whether you want to hear it loudly or softly (control of variations in loudness)
b) determine how long the child can vocalize in one breath (control of breathing)
6. Speech intelligibility and articulation:
Ø intelligibility: a standard way of measuring is to have the child say a list of words which is tape recorded, and then assign listeners to judge by writing down the word
Ø Oral-Facial mechanism exam extremely important to evaluate the structure and function of the articulating mechanisms e.g., tongue movements, diadochokinetic rates, etc.
Ø Supplemental Measure of the PLS-3 – articulation screener where the SLP asks the child to repeat a word e.g., my, bee, do, won
7. The need for use of a non-speech communication system
Ø SLP must be aware of the various alternative communication systems
Ø Criteria for choosing an augmentative mode of communication
o Childs-cognitive strengths and weakness, sensory capacities and motor capabilities
References
Cogher, L., Savage, E., Smith, M.F. (1992) Communication in Cerebral Palsy: The child and young person (eds. M. Edwards, J.Cooper, and R. Ringel), Champman and Hall Medical, London, UK.
Mecham, J.M. (1996) Assessment in Cerebral Palsy (eds. D. Berman), PRO-ED, Texas, U.S.A.
Schiff-Myers, N. (1992) Considering arrested language development of second language learners. LSHSS, 23, 28-33.
Selective Course Materials from Child Language 1: Assessment of Limited English Proficiency Children