Recent proposed amendments to the definition of cerebral palsy acknowledge the possibility that some children with cerebral palsy (CP) may present with a wide range of additional difficulties arising from the initial insult to the brain and subsequent neurological/developmental maturation. These difficulties may include sensory deficits (vision and hearing disturbance), epilepsy, uneven learning profiles and communication difficulties over and above those arising from the motor difficulties. It is this latter possibility that has attracted the attention of communication clinicians.
Therapy and teaching targeted at improved speech, and linguistic interventions via the use of augmentative/alternative methods may be offered, but 'foundation' social skills (how to establish joint attention, how to include listeners' needs to support use of eye-pointing, how to make best use of facial expression, sign and gesture) may not emerge naturally for this group of children. This paper will investigate how far understanding of such developments have progressed, and the implicaitons for clinical practice and for the introduction of AAC startegies and equipment.
The paper will review the available literature with regard to early social skills development in children with four-limb cerebral palsy. We will describe any implications for current clinical practice from this literature, and outline the methodology for a research project in progress looking at the early communicaiton skills of children in this group.
Increased understanding of the range and severity of social communication difficulties in children with four-limb CP will have important implications for communicative potential and communication skills intervention. The development of communication competencies, including the effective use of AAC methods, and use of computer-based support, shows considerable variation between children without any obvious reasons to account for such differences. One possibility is that some children have primary deficits in social communication, which impact on their understanding of communicative intention, and hence on their use of core communication skills (eye-gaze, sharing attention).
A better understanding of the source and nature of core social communication deficits has important implications for intervention, with wider implications for families, and for service delivery in the UK and elsewhere. In the long term, it is envisaged that this increased understanding will empower people with cerebral palsy, their families and their representatives in both the statutory and voluntary sectors. It will also contribute to the theoretical perspectives on the development of communication skills for this population of children.