(A) Evidence of dysarthria treatment in children with cerebral palsy showed improved motor and control of the mouth, tongue, lips, and jaw, resolution of salivation, along with improved swallowing and mastication, and significant improvement in vocal tone and rate rhythm abnormalities and muscle tension [245] (1 Level IV evidence). more than 90% of children had improved speech intelligibility and articulation, incorrect diction was corrected or reduced, the maximum articulatory duration was prolonged, the length of speech flow increased, and fluency improved [246-247] (1 Level II evidence, 1 Level IV evidence). Speech intelligibility in adolescents with cerebral palsy with concomitant dysarthria can be improved by controlling the speed of whistling, articulation, and speech [248] (1 Level III evidence). The younger the age, the faster the effect of correction of articulatory organ motor dysfunction, with a gradual decrease in efficacy with age [249] (1 Level II evidence). It is important to inhibit abnormal reflex postures that are closely related to articulation. The therapist can start training with gross movements such as head, neck, and shoulders gradually transitioning to fine movements such as the jaw, mouth, lips, and tongue with the aim of reducing the tension of the speech muscles [250-252] (3 Level IV evidence). Early initiation of effective oral muscle massage results in improved muscle tension in the mouth, lips, tongue, and jaw, coordination of sucking, swallowing, and chewing, and a reduction in salivation, poor lip and mouth control, and slurred diction. Treatment of orofacial muscle function in children with cerebral palsy resulted in significant improvements in tongue, lip, and mandibular function as well as speech intelligibility [253-254] (2 Level III evidence).
Dysarthria treatment is recommended to improve mouth, tongue, lip, and jaw movements and control, address salivation, swallowing, and chewing difficulties, and improve speech intelligibility and articulation in children with cerebral palsy (level B of recommended strength).
Abnormal postural reflex control training can help children improve the quality of whistling and reduce the tension of speech muscles (recommended intensity level D).
Oral sensory-motor therapy can reduce facial muscle tone, improve tongue, lip and jaw function and motor accuracy, and improve speech intelligibility (recommended intensity C).
(ii) Evidence for treatment of language delay Language delay treatment should mainly improve the communication attitude and communication skills of children with cerebral palsy, increase the awareness of active communication, promote articulation, develop intelligence, and maximize their language abilities in order to improve their quality of life and prepare them for future return to society [255-256] (1 Level II evidence, 1 Level IV evidence). Children with cerebral palsy understand better than they express, and language training can promote both intellectual and gross motor functions and increase the child’s desire for expression.
The recommended treatment for language delay is to improve communication attitudes and communication skills, increase awareness of active communication, promote articulation, and develop intelligence (recommended intensity level B).
(iii) Evidence of neuromuscular electrical stimulation treatment neuromuscular electrical stimulation treatment significantly increased articulation and mouth muscle strength, improved speech function, reduced salivation, and promoted swallowing in children with cerebral palsy [257] (1 Level II evidence). The greatest advantage of transcutaneous electrical nerve stimulation for the treatment of speech disorders is that the painful stimulation is less, and the rhythmic tingling stimulation is more quickly adapted and accepted by the child, allowing the entire treatment cycle to be completed successfully [258] (1 Level II evidence).
Neuromuscular electrical stimulation treatment is recommended to improve salivation, swallowing, articulation, and mouth muscle strength (B level of recommended intensity).
(iv) Evidence of group language training Group language training provides children with opportunities for mutual understanding, learning, and cooperation, and can enable children to imitate, modify, and reinforce their own behaviors with each other, gradually enhancing social adaptation and building language and social interaction skills [259-262] (2 Level II evidence, 2 Level III evidence).
Group language training is recommended to improve verbal communication and social adaptation of the child (level B strength of recommendation).
(v) Evidence of acupuncture therapy Scalp acupuncture is significantly more effective than language function training alone in treating children with cerebral palsy who are lagging in language function, and can improve language function in children with cerebral palsy [263] (1 Level II evidence). Cephalic acupuncture with needle language training was superior to speech training alone in terms of language reception, expression, comprehension, and clinical efficacy [264] (1 Level II evidence). Acupuncture plus oral function training was superior to the oral training group alone and the acupuncture group [265] (1 Level II evidence), and acupuncture was effective in children with cerebral palsy with delayed language development and dysarthria, but the efficacy was independent of the type of language disorder [266] (1 Level III evidence). Combined acupuncture treatment improved language receptivity, expressive ability, and dysarthria in children with cerebral palsy [267] (1 Level II evidence). Acupuncture and Chinese herbal medicine with speech training provide a proven method for treating salivation in children with cerebral palsy. Acupuncture and Chinese medicine treatment can reduce salivation, enhance the function of the sphincter of the oropharynx, and increase the frequency of swallowing, and with speech training, the efficacy is better than using single speech therapy [268] (1 Level II evidence).
Acupuncture therapy combined with speech training is recommended to improve speech, language, salivation, and swallowing in children with cerebral palsy (level B strength of recommendation).
(vi) Oral massage in children with cerebral palsy with evidence of perioral acupressure was found to reduce or disappear the symptoms of mouth opening, tongue extension, and salivation, and the degree of speech impairment was improved [269] (1 Level III evidence). Oral massage, while resulting in improved muscle tension in the mouth, lips, tongue, and jaw, reduced unconscious sucking, swallowing, and chewing, led to improved vocalization and improved language development, and was particularly effective in improving salivation in children with involuntary motor cerebral palsy [270] (1 Level II evidence).
It is recommended that perioral massage can improve mouth and lip muscle tension and salivation in children with cerebral palsy (level B strength of recommendation).
(vii) Music therapy evidence Music promotes language learning by emphasizing rhythm, repetition, word to word and pauses between words, and music therapy is combined with speech therapy to improve phonological and expressive skills through musical activities, starting with melodic elements [271] (1 level IV evidence). Music therapy improves speech intelligibility in patients with mixed spasticity-ataxia dysarthria [272] (1 Level IV evidence), and combining music therapy is superior to speech delay training alone in children with language delay [273] (1 Level II evidence).
The combination of music therapy and speech therapy is recommended to improve language skills in children with cerebral palsy, which is superior to speech therapy alone (level C strength of recommendation).
(viii) Evidence of feeding therapy Children with cerebral palsy suffer from early brain injury that impairs the innervation of oropharyngeal movements as well as the learning of feeding skills, resulting in abnormal eating skills of varying nature and degree [274] (1 Level III evidence). Early initiation of feeding function and mouth function training can significantly reduce the incidence of various eating problems. Effective oral muscle massage results in improved muscle tension in the mouth, lips, tongue, and jaw, coordinated sucking, swallowing, and chewing, and a reduction in salivation, poor lip control, and slurred diction [275] (1 Level III evidence). Oral sensory-motor therapy helped improve feeding skills in children with cerebral palsy, with a significant reduction in salivation [276] (1 Level III evidence). Functional treatment of the orofacial muscles in children with cerebral palsy improved tongue, lip, and jaw function as well as speech intelligibility [277] (1 Level III evidence). Orofacial motor sensory therapy in children with cerebral palsy who have difficulty eating significantly improves the child’s oral motor and feeding skills and significantly reduces salivation [276] (2 Level III evidence).
Feeding training, mouth function training, oral muscle massage and oral sensory-motor therapy are recommended to improve feeding and oral function in children with cerebral palsy (level C strength of recommendation).
Oral sensory-motor therapy including intraoral massage, taste, temperature sensory, and stereo sensory stimulation can improve feeding difficulties and improve speech comprehension along with improved mastication and swallowing ability in children with cerebral palsy (recommended intensity level C).
(ix) Evidence of the use of communication appliances Many children with cerebral palsy do not have the ability to express themselves verbally, and some children with cerebral palsy have the ability to express themselves verbally, but the clarity of their language is extremely poor and cannot be used as a means of communication. Therefore, non-verbal means of communication, such as communication aids, pictures, photos, and word cards, need to be used to assist children with cerebral palsy to communicate and express themselves. The use of augmentativeandalternativecommunication (AAC) significantly enhances the communication, language, and literacy skills of children with cerebral palsy [278] (1 Level I evidence). Our domestic research on augmentative communication systems is still at the theoretical stage, and there is a gap in research on the application of human activity-assisted technology assessment models. Therefore, it is important to conduct research on AAC interventions for communication skills in children with cerebral palsy in our country [279-280] (3 Level IV evidence). Since children with cerebral palsy are multiply handicapped and have great individual variability, the non-verbal communication modality chosen for them varies widely. Therefore, a thorough assessment by a professional is required before the appropriate communication aids can be configured for them.
It is recommended that augmentative communication systems can be used in cerebral palsy speech therapy to enhance the child’s communication, language and literacy skills (recommended intensity level A).
(x) Evidence of oral muscle training techniques Oral muscle training techniques normalize oral tactile sensitivity by increasing oral muscle cognition, improve autonomous control of oral structures during speech, increase dissociative activity of oral muscles, improve feeding techniques and nutritional uptake, and improve articulation to optimal intelligibility [281] (1 Level III evidence). Oral muscle training techniques contribute to the rehabilitation of salivation in children with cerebral palsy with clear results [282] (1 Level III evidence), and the method organically combines the training of the child’s daily swallowing activities with mouth muscle motor training. The application of the child’s acquired mouth muscle motor skills to his daily life is what allows for the essential improvement of the muscle motor patterns, thus contributing to the establishment and consolidation of normal patterns, with significant improvement in physical and mouth muscle sensitivity problems, significant reduction in food refusal and anorexia; significant improvement in postural control, tongue movement, and chewing, swallowing, and aspiration, the ability to eat liquid and semifluid diets independently without choking, and the ability to swallow more viscous or solid foods without choking, and salivation was improved [283] (1 Level III evidence).
Oral muscle training techniques are recommended for speech therapy in children with cerebral palsy to help establish and improve oral function (level C for strength of recommendation).
VII. evidence of guided education Guided education is used to stimulate the interest, own desires and needs of children with cerebral palsy through a variety of guided contents and means such as recreational, rhythmic intentions and games in the form of group teaching by a guide, so that they can actively participate in learning training and achieve rehabilitation results by maximizing the potential of the organism. It is more effective when combined with other methods [284-287] (4 Level I evidence). Conductive education provides conscious directive induction mediated by appropriate purposes, and through a complex interaction of teaching and learning between the guide and the dysfunctional person as a whole, the child with cerebral palsy achieves a comprehensive improvement in motor, intellectual, language, social interaction, personality, emotion, volition, hand function, daily living skills and cultural knowledge [288-296] (6 Level I evidence, 3 Level II evidence).
Guided education is recommended to be effective for pediatric cerebral palsy rehabilitation, with better efficacy in combination with other methods (level A strength of recommendation).