Mary Jo Cooley Hidecker

Developing and validating the Communication Function Classification System for individuals with cerebral palsy.

Aim  The purpose of this study was to create and validate the Communication Function Classification System (CFCS) for children with cerebral palsy (CP), for use by a wide variety of individuals who are interested in CP. This paper reports the content validity, interrater reliability, and test–retest reliability of the CFCS for children with CP.

Cerebral palsy and aging.

Cerebral palsy (CP), the most common major disabling motor disorder of childhood, is frequently thought of as a condition that affects only children. Deaths in children with CP, never common, have in recent years become very rare, unless the child is very severely and multiply disabled. Thus, virtually all children assigned the diagnosis of CP will survive into adulthood. Attention to the adult with CP has been sparse, and the evolution of the motor disorder as the individual moves through adolescence, young adulthood, middle age, and old age is not well understood. Nor do we know what happens to other functional domains, such as communication and eating behavior, in adults with CP. Although the brain injury that initially causes CP by definition does not progressively worsen through the lifetime, the effects of CP manifest differently throughout the lifespan. The aging process must inevitably interact with the motor disorder, but we lack systematic, large‐scale follow‐up studies of children with CP into adulthood and through adulthood with thorough assessments performed over time.

Inter-Relationships of Functional Status in Cerebral Palsy: Analyzing Gross Motor Function, Manual Ability, and Communication Function Classification Systems in Children.

Aim  To investigate the relationships among the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP).

Classification in Childhood Disability: Focusing on Function in the 21st Century

Classification systems in health care are usually based on current understanding of the condition. They are often derived empirically and adopted applying sound principles of measurement science to assess whether they are reliable (consistent) and valid (true) for the purposes to which they are applied. In the past 15 years, the authors have developed and validated classification systems for specific aspects of everyday function in people with cerebral palsy—gross motor function, manual abilities, and communicative function. This article describes the approaches used to conceptualize each aspect of function, develop the tools, and assess their reliability and validity. We report on the utility of each system with respect to clinical applicability, use of these tools for research, and the uptake and impact that they have had around the world. We hope that readers will find these accounts interesting, relevant, and applicable to their daily work with children and youth with disabilities.

Communication ability in cerebral palsy: a study from the CP register of western Sweden.

BACKGROUND Communication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support. AIM To study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden. METHODS Sixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded. RESULTS Half the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I-II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p = 0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p < 0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p < 0.01). CONCLUSION Communication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester.

Building the evidence for communication interventions

lesions reduce movement, which in turn prohibits normal neu-ral development and further reduces movement. Thus, a chal-lenge to the neuroscience and pediatric rehabilitationcommunity is to extend the present findings to early handdevelopment so that subsequent therapies can target emergingdeficits and truly take advantage of the remarkable structuraland neural plasticity of the developing infant central nervoussystem.

Reliability of the Dutch-language version of the Communication Function Classification System and its association with language comprehension and method of communication

The aims of this study were to determine the intra‐ and interrater reliability of the Dutch‐language version of the Communication Function Classification System (CFCS‐NL) and to investigate the association between the CFCS level and (1) spoken language comprehension and (2) preferred method of communication in children with cerebral palsy (CP).

Validity of the Communication Function Classification System for use with preschool children with communication disorders

To evaluate construct and predictive validity of the Communication Function Classification System (CFCS) for use with preschool children with a range of speech and language disorders.

Promoting consistent use of the communication function classification system (CFCS)

Abstract Purpose: We developed a Knowledge Translation (KT) intervention to standardize the way speech-language pathologists working in Ontario Canada’s Preschool Speech and Language Program (PSLP) used the Communication Function Classification System (CFCS). This tool was being used as part of a provincial program evaluation and standardizing its use was critical for establishing reliability and validity within the provincial dataset. Method: Two theoretical foundations – Diffusion of Innovations and the Communication Persuasion Matrix – were used to develop and disseminate the intervention to standardize use of the CFCS among a cohort speech-language pathologists. A descriptive pre-test/post-test study was used to evaluate the intervention. Fifty-two participants completed an electronic pre-test survey, reviewed intervention materials online, and then immediately completed an electronic post-test survey. Results: The intervention improved clinicians’ understanding of how the CFCS should be used, their intentions to use the tool in the standardized way, and their abilities to make correct classifications using the tool. Conclusions: Findings from this work will be shared with representatives of the Ontario PSLP. The intervention may be disseminated to all speech-language pathologists working in the program. This study can be used as a model for developing and disseminating KT interventions for clinicians in paediatric rehabilitation. Implications for Rehabilitation The Communication Function Classification System (CFCS) is a new tool that allows speech-language pathologists to classify children’s skills into five meaningful levels of function. There is uncertainty and inconsistent practice in the field about the methods for using this tool. This study used combined two theoretical frameworks to develop an intervention to standardize use of the CFCS among a cohort of speech-language pathologists. The intervention effectively increased clinicians’ understanding of the methods for using the CFCS, ability to make correct classifications, and intention to use the tool in the standardized way in the future.

Communication activity and participation research

Participation and communication are components of the International Classification of Functioning, Disability, and Health (ICF) framework. ‘Participation’ is involvement in daily life. Communication, listed as an ICF ‘activity’, includes sending and receiving messages (e.g. speaking, listening, reading, writing, and using augmentative and alternative communication). Adequate communication is essential to participate in many activities at home and in the community. However, the role of communication will vary by participation type, body structure ⁄ function requirements, potentially co-occurring activities, and contextual factors including settings and any communication partners. For example, minimal communication performance may be needed to participate in solitary leisure activities such as playing with a pet or completing a jigsaw puzzle. A person with communication challenges may be able to participate in life situations with familiar communication partners such as family and friends but not with unfamiliar communication partners. In contrast, skilled communication performance is needed in many school classes, vocations, and social leisure activities. For example, to participate in a science class, a student may need to move concurrently between laboratory stations, manipulate laboratory supplies, learn new concepts, and communicate verbally and ⁄or in writing. Voorman et al. note the unclear relationship between communication and social functioning, and participation of pre-adolescents and adolescents with cerebral palsy (CP). They explored associations between communication and social functioning and ICF body characteristics, mobility activity level, and contextual factors. Voorman et al. should be commended for grappling with these complex interactions. However, their results are limited by the choice of the Communication and the Socialization domains of the Vineland Adaptive Behavior Scales (VABS) as the measures of communication and social functioning. The VABS domain scores include questions regarding ICF body function areas of speech and expressive and receptive language skills. Some VABS questions, such as using a dictionary, a book’s index, or table of contents, and writing in cursive, may not be critical to the ICF communication concept. Few tools are available either to classify or assess communication at the ICF levels of activity or participation. At least six possible body function and structure impairment areas – voice, articulation, language, cognitive, fluency (e.g. stuttering), and hearing – may restrict communication activities and participation. Speech and language pathologists and audiologists often use a battery of assessments and outcomes to document body structure and function and communication levels. My colleagues and I are finalizing the Communication Function Classification System (CFCS) for individuals with CP, complementary to the Gross Motor Function Classification (GMFCS) and the Manual Ability Classification System (MACS). The CFCS classifies communication effectiveness by one’s performance of sending and receiving messages with familiar and unfamiliar communication partners. ‘Communicative participation’ has been defined as taking part in life situations where knowledge, information, ideas, or feelings are exchanged. It may take the form of speaking, listening, reading, writing or nonverbal means of communication . A communicative participation outcome measure is under construction for individuals with multiple sclerosis. A similar measure may be possible to use with adolescents and adults who have CP. Raghavendra et al. looking at a similar age range as Voorman et al., compared the participation and communicative participation of three groups: (1) people with communication