Cerebral palsy and communication

Also called CP and speech, CP and AAC

Movement differences can make speech slow, unclear or impossible; they say nothing about what the person understands, and AAC access is the whole question.

What it is

Cerebral palsy is a group of lifelong conditions affecting movement and posture, caused by differences in the developing brain, and the Health A-Z carries it as cerebral palsy. This entry is about communication, which is affected for a large minority of people with CP because the same muscle control differences that affect walking and hands also affect the tongue, lips, breath and voice.

The crucial fact: the degree of movement difficulty tells you nothing about the person's understanding. Some people with the most severe physical involvement have entirely typical language and intelligence and have spent years being spoken to as if they didn't. Others have a learning disability alongside. You cannot tell by looking, and you must not guess.

Who it can help

Anyone with CP whose speech is hard to understand or absent, from a toddler whose first sounds are effortful to an adult whose speech has always been clear to family and nobody else. Their families, schools and care staff, who make the access decisions.

The plan differs with the type of CP. Spastic CP tends towards slow, tight, effortful speech. Dyskinetic CP brings involuntary movements that disrupt speech and make pointing at a board unreliable. Ataxic CP affects coordination and timing. A speech and language therapist and an occupational therapist together work out what the person can control reliably.

How it works

Speech difficulties in CP are usually dysarthria: weak breath support, so short quiet phrases; imprecise articulation; sometimes a nasal quality. Drooling and swallowing difficulties often go alongside. Therapy works on breath, pacing and clarity, and many people with CP speak well enough for familiar listeners with a text or symbol backup for everyone else.

Where speech won't carry the message, AAC does, and the whole question is access: which body part can the person move reliably, on purpose, without exhausting effort. A finger, a fist, a knee against a switch, a head movement, or the eyes with eye gaze. Seating and mounting come first because a person fighting to stay upright can't spare the control for a switch.

Partner-assisted scanning is the reliable low-tech fallback: you read the options aloud and the person signals yes. It needs no equipment and works in the bath, in bed and when the device is charging.

Getting started

Presume understanding and speak to the person at their age level, always. Establish a reliable yes and no signal this week, whatever it is: a look up, a fist, a sound. Write it on a card and put it where every visitor sees it.

Ask for a joint speech and language therapy and occupational therapy assessment of access, and ask about a referral to the regional specialised AAC service. Meanwhile try switch scanning on a free app with a cheap switch, which shows what the person can do and builds the case.

For a child, ask school what they're doing to give the child a way to answer in every lesson, not just in therapy sessions.

Where to get help

Scope has a helpline and covers communication and AAC for people with CP. Cerebral Palsy Scotland runs therapy services north of the border. Communication Matters explains AAC and lists the regional NHS hubs, and the ACE Centre assesses and advises. NHS speech and language therapy and occupational therapy are via the GP, paediatrician or school.