Cerebral Palsy Hearing, Speech & Vision Problems

Cerebral palsy is a condition caused by damage to the developing brain (usually during childbirth or pregnancy) which impairs the brain's ability to control the movement of the body. In addition to physical disabilities from impaired muscle control, children with cerebral palsy will often have impaired hearing, speech, and vision.

A significant percentage of children with cerebral palsy will also have some level of hearing impairment. The most recent studies suggest that somewhere between 15-25% of children diagnosed with cerebral palsy will also have some kind of hearing loss. Hearing loss can be particularly problematic because if not diagnosed and addressed very early on (in the first 3 years) hearing impairment can lead to other problems including speech & language issues. This is because the crucial phase of speech & language development occurs during the first 3 years of life. A 2011 study published in the Journal of Developmental Medicine & Child Neurology concluded that it is during these first 3 years of life that the brain builds the nerve pathways necessary for understanding auditory information (i.e., language). If a child is not exposed to language during this early period due to impaired hearing, it will lead to difficulties with speech and understanding language. For this reason, identifying hearing loss as early as possible is very important because early intervention is critical.

Children with cerebral palsy can have 2 different types of hearing loss: conductive or sensorineural. It is also possible to have a combination of the 2 types. Diagnosing the specific type of hearing loss is important to effective treatment and management.

• Conductive: conductive hearing loss occurs when sounds are not able to pass from the outer ear to the inner ear. Conductive hearing loss can be caused by a blockage within the ear (e.g., fluid or wax buildup). Some cases of conductive hearing loss are the result of a developmental abnormality of the bones inside the ear.
• Sensorineural: sensorineural hearing loss is the result of damage or abnormalities affecting the sensitive nerve pathways that connect the inner ear to the brain. High pitched or faint sounds are particularly difficult to hear with this type of impairment.

Many children with cerebral palsy have impaired speech. Speech-language pathologists (SLP) evaluate communication skills and treat speech and language disorders. This includes both receptive language-what your child is hearing and how they are understanding it-and expressive language-what your child is saying and how they are communicating with others.

The Communication Function Classification System (CFCS) is a measure of current communication skills for someone who has cerebral palsy and other disabilities. It is a five-level system that describes communication in the context of activity and participation levels. Speech therapists can also evaluate and treat your child for difficulties with motor skills related to eating, drinking and swallowing. The Eating and Drinking Ability Classification System (EDACS) is similar to the evaluations for gross, fine motor, and communications skills in people with CP. It is also a five-level system which provides descriptions of the child's ability to eat and drink.

An annual speech and language screening during birth to 3 years will help determine whether factors such as motor skills, breath support, posture, oral tone, and eye gaze are developing fully to support your child's verbal and nonverbal communication. Early intervention may decrease the problems associated with speech and language delays.

Children with CP are at risk for various kinds of problems with their vision. There may be problems related to the structures of the eye and how it is working (i.e., focusing) called ocular impairments. Visual impairment may be due to a paucity of occipital neurons associated with vision. But it can also be because of a very short visual attention span.

There may also be problems with the visual pathways and the areas of the brain that receive and make sense of incoming visual information from the eyes. This is commonly referred to as cortical visual impairment (CVI). CVI is the leading cause of pediatric visual impairment in the U.S. Since people with CP have had some type of neurological disturbance, it is possible that the areas of the brain associated with visual processing may have also been affected. CVI may be present in children who do not have ocular impairments and who have had a normal eye exam.

This condition is diagnosed using different techniques that may lead to inconsistent results. For this reason, it is critical for parents to follow their instincts if they believe their child is not visually attending to objects, people, or environments. Specialized assessments and interventions can facilitate improvements in visual processing and their functional vision-the child's ability to use their vision in everyday life.

Because of vision impairment from cerebral palsy, children are often at risk when they are ambulating. The inability to distinguish differences in elevation when ambulating -- such as changes in elevation in the sidewalk, the existence of potholes or broken sidewalk, and the height of stairs, can potentially cause significant injury.

Vision is a complex area of development that has a tremendous impact on a child's ability to learn. Some can be treated effectively over time, or vision support services can be implemented to ensure the child may effectively access their environment. There are many different types of vision professionals listed below who can provide evaluations and support for vision impairments. Ask your child's primary care doctor, rehabilitation physician, or developmental pediatrician for guidance about which professionals to contact for services. In some areas, you may not have all of these specialists and will need to work with your medical team to determine who can best address your concerns or provide the appropriate vision services.