Speech Language Profile Group (SLPG) 분류체계에 따른 뇌성마비 아동의 하위그룹 분포 및 판별요인 분석

Analysis of Subgroup Distribution and Discriminant Function Analysis in Children with Cerebral Palsy Based on Speech Language Profile Group

배경 및 목적: 본 연구는 Speech Language Profile Group (SLPG) 하위그룹별 뇌성마비 아동의 분포를 알아보고, 이러한 분류체계를 가장 잘 판별해 줄 수 있는 요인이 무엇인지 알아보고자 하였다. 방법: 본 연구에는 4-16세 뇌성마비 아동 87명(경직형 67명, 불수의 운동형 4명, 실조형 3명, 혼합형 13명)이 참여하였다. 평가 과제는 말능력(모음연장발성, 아동용 발음평가, 문장 따라말하기), 언어능력(수용어휘력 검사), 인지능력(동작성 지능검사) 검사였고, 이 과제를 통해 최대발성 지속시간, 음성강도, 말명료도, 말속도, 수용어휘력 및 인지능력을 측정하였다. 기능적 분류를 위해 CFCS와 GMFCS 평정을 실시하였다. SLPG 하위그룹은 말장애 유무, 언어문제 유무에 따라 말과 언어문제가 없는 NSMI-LCT, 말문제는 없지만 언어문제가 있는 NSMI-LCI, 말문제가 있지만 언어문제는 없는 SMI-LCT, 말과 언어문제가 있는 SMI-LCI, 무발화이지만 언어문제는 없는 ANAR-LCT, 무발화이면서 언어문제가 있는 ANAR-LCI 등 6개 그룹으로 나누어 분석하였다. 결과: 첫째, SLPG 하위그룹별 분포비율은 NSMI-LCT는 11.5%, NSMI-LCI 8.0%, SMI-LCT 12.6%, SMI-LCI 19.5%, ANAR-LCI 11.5%, ANAR-LCI 36.8%를 나타내었다. SLPG와 CFCS 간에는 .875, SLPG와 GMFCS 간에는 .548의 상관을 나타내었다. 둘째, SLPG 하위그룹을 가장 잘 판별하는 함수는 말명료도, 말속도, 수용어휘력 순으로 나타났다. 논의 및 결론: SLPG 하위그룹별 분석을 통해 말, 언어능력에 따른 그룹 간 분포비율을 제시하였고, 기존의 운동능력 중심의 분류체계를 상호보완할 수 있는 말, 언어 및 의사소통능력에 근거한 분류체계의 적용이 필요함을 시사하였다.

Objectives: This study aimed to identify the subgroups distribution of children with cerebral palsy (CP) by using Speech, Language Profile Group (SLPG), and examine discriminant factors that differentiate subgroups. Methods: Eighty-seven children aged 4-16 years with CP participated in the study (spastic 67, dyskinetic 4, ataxic 3, mixed 13). Data was collected from a speech production task (sustained vowel /a/, Assessment of Articulation and Phonology for Children, sentence repetition), language test (receptive vocabulary), and PIQ test (K-WISC-III, K-WIPPSI). Independent variables were maximum phonation time (MPT), intensity, speech rate, intelligibility, receptive vocabulary score, and cognition ability. For the analysis, children with CP were classified into six speech language profile groups; NSMI-LCT (no clinical speech motor involvement and age appropriate language, cognition abilities), NSMI-LCI (no clinical speech motor involvement and impaired language, cognition abilities), SMI-LCT (speech motor impairment and age appropriate language, cognition abilities), SMI-LCI (speech motor impairment and impaired language, cognition abilities), ANAR-LCT (anarthria and age appropriate language, cognition abilities), and ANAR-LCI (anarthria and impaired language, cognition abilities). Results: Descriptive study showed that of all children with CP, the proportion of NSMI-LCT was 11.5%, NSMI-LCI was 8.0%, SMI-LCT was 12.6%, SMI-LCI was 19.5%, ANAR-LCT was 11.5%, and ANAR-LCI was 36.8%. Very strong relationships were noted between SLPG and CFCS, and moderate relationships were noted between SLPG and GMFCS. Canonical discriminant function analysis revealed that the speech intelligibility variable accounted for 85.1%, the speech rate variable was 9.7%, and the language variable was 5.2%. Conclusion: This study suggested that the SLPG classification system helps us to stratify the subgroups for understanding speech, language features in children with CP.