Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Successful use of an eye gaze AAC communication board by a young adult with advanced Sanfilippo Syndrome (MPS IIIA): Case report

Sanfilippo syndrome (Mucopolysaccharidosis Type III or MPS III) is a family of rare, lysosomal disorders characterized by progressive cognitive and motor deterioration. Even though individuals with MPS III present with complex communication needs, research regarding augmentative and alternative communication (AAC) in this population is scarce. While life expectancy for individuals with MPS IIIA typically does not exceed 20 years of age, this case report involves a 22-year-old adult with postregression MPS IIIA. Prior to this study, the participant could not communicate using speech and only responded to yes/no questions using eye blink responses. The participant was given a low-tech AAC system utilizing eye gaze so that she could respond to a variety of caregiver questions and take conversational turns. The following communication outcomes were measured during each session in which caregivers used the AAC system: number of eye gaze responses, total number of responses (using any means), the percent of responses to questions asked, and the total count of expressive vocabulary words available to the participant with the AAC system. Increases were observed in the number of eye gaze responses per session and in the expressive vocabulary accessible via the eye gaze board. A higher percentage of responses given caregiver questions was noted for the intervention sessions (71%) compared to the baseline sessions (55%). There were also qualitative changes characterized by the types of questions the participant could respond to during conversational exchanges. Despite the progression of MPS IIIA, the results suggest that use of the eye gaze board resulted in quantitative and qualitative changes in functional communication. This case report provides preliminary evidence that AAC can improve communication in a young adult with postregression MPS IIIA.

Developmental trajectories of spoken language comprehension and functional communication in children with cerebral palsy: A prospective cohort study

AIM

To investigate spoken language comprehension (SLC), single-word comprehension (SWC), functional communication development, and their determinants, in children with cerebral palsy.

METHOD

This was a prospective cohort study in the Netherlands spanning 2 years 6 months. The main outcomes were SLC and SWC, assessed by the Computer-Based instrument for Low motor Language Testing (C-BiLLT) and the Peabody Picture Vocabulary Test-III-NL (PPVT-III-NL) respectively; and functional communication, measured by a subscale of the Focus on the Outcomes of Communication Under Six-34 (FOCUS-34). Linear mixed models were used to determine developmental trajectories, which were compared with norm and reference data. Potential determinants, for example intellectual functions, speech production, functional communication level (classified with the Communication Function Classification System, CFCS), and functional mobility, were added to assess their effects.

RESULTS

Children with cerebral palsy (n = 188; mean age 59 months, range 17-110) were monitored for 2 years 6 months. Developmental trajectories for SLC (C-BiLLT) and SWC (PPVT-III-NL) were nonlinear; those for functional communication (FOCUS-34) were linear. Compared with norm and reference groups, significantly delayed SLC, SWC, and functional communication development were found. Determinants for SLC and SWC were intellectual functions and functional communication level (CFCS); and for functional communication development (FOCUS-34), speech production and arm-hand functioning.

INTERPRETATION

Children with cerebral palsy showed delayed SLC, SWC, and functional communication development compared with norm and reference groups. Remarkably, functional mobility was not associated with the development of SLC, SWC, or functional communication.

WHAT THIS PAPER ADDS

Children with cerebral palsy have delayed spoken language comprehension (SLC), single-word comprehension (SWC), and functional communication development, compared to norm and reference data. Determinants for SLC and SWC development are intellectual functions and functional communication level. Determinants for functional communication development are speech production and arm-hand functioning. Functional mobility is not associated with SLC, SWC, or functional communication.

Implementación del Sistema Pictográfico de Comunicación en un deportista con parálisis cerebral espástica: Reporte de un caso

La parálisis cerebral (PC) es definida como uno de los trastornos neurológicos no progresivos que puede originarse por lesiones o anomalías en el cerebro inmaduro o en desarrollo. La parálisis cerebral de tipo espástica, concomitan con alteraciones a nivel motor y de lenguaje, alterando los procesos de transmisión de mensajes durante la comunicación. En respuesta a dichas alteraciones a nivel comunicativo se crean los Sistemas de Comunicación Aumentativa y Alternativa (SAAC), herramientas que permiten la interacción con el medio, ya sea complementando las emisiones orales o sustituyéndolas por símbolos, palabras escritas, lectoresdigitales, entre otros. El objetivo de la presente investigación es implementar un sistema de comunicación alternativo en un deportista con parálisis cerebral, mediante el uso de la aplicación Let Me Talk®. Se inicia con una evaluación utilizando como instrumento el Testde Barcelona, para la identificación de habilidades de comunicación y lenguaje. El proceso de adaptación del Sistema Pictográfico de Comunicación se desarrolló en 10 sesiones, en las cuales el deportista participó mediante el uso de la aplicación; las sesiones se registraron en un formato de observación participante de autoría propia. En el análisis de los resultados, se concluye que el SAACimplementado le permitió al deportista la participación durante las conversaciones planteadas, estructurando oraciones simples y complejas con el uso de las categorías y flexiones gramaticales, y la ejecución de preguntas movilizadoras complementadas por expresiones no verbales, que favorecieron la participación independiente en las situaciones comunicativas.