Prevalence of Speech and Hearing Impairment in Children with Cerebral Palsy in Muzaffarabad Azad Jammu and Kashmir and Its Suburbs

Abstract

Background: Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder frequently accompanied by communication-related comorbidities that can substantially limit rehabilitation participation and long-term functioning, particularly in resource-constrained settings. Objective: To determine the prevalence of speech and hearing impairment among children with CP in Muzaffarabad, Azad Jammu and Kashmir (AJK), and to assess associations with CP subtype and gross motor severity, alongside patterns and barriers to accessing relevant services. Methods: A cross-sectional observational study was conducted at the Muzaffarabad Rehabilitation Centre using retrospective record review of children with CP aged ≥2 years who attended between January 2018 and February 2020. Sociodemographic and clinical variables, CP subtype, GMFCS level, documented speech and hearing impairment, and service utilization/barriers were extracted using a structured proforma. Associations were examined using chi-square tests with effect sizes. Results: Among 225 children (mean age 5.03±3.31 years), speech impairment was present in 70.2% (158/225; 95% CI 64.2–76.2), comprising 58.7% (132/225) with speech impairment only and 11.6% (26/225; 95% CI 7.4–15.8) with combined speech and hearing impairment; isolated hearing impairment was not documented. Combined impairment was more frequent in spastic quadriplegic than spastic diplegic CP (22.3% vs 7.3% within the speech-impaired subgroup; p=0.03), and CP subtype was strongly associated with GMFCS severity (p<0.001). Service uptake was minimal: 94.3% (149/158) had never consulted a speech therapist and no child received therapy sessions; no child with hearing impairment underwent ENT evaluation. Conclusion: Speech impairment was highly prevalent and clustered with severe motor phenotypes, while hearing impairment was less frequently documented and occurred with speech impairment; profound gaps in access to speech and hearing services highlight the need for integrated multidisciplinary care pathways in AJK.