Classification systems of communication for use in epidemiological surveillance of children with cerebral palsy

Abstract

AIM Children with cerebral palsy (CP) often experience communication difficulties. We aimed to identify a classification system for communication of children with CP suitable for epidemiological surveillance.METHOD Systems to classify the communication of children with CP were identified. The Communication Function Classification System (CFCS), Functional Communication Classification System (FCCS), and Viking Speech Scale (VSS) were chosen for further investigation and translated. They were administered to 155 children aged 4 to 13 years with CP (across all motor severity levels) from eight European countries. Children's parents/carers, speech therapists, and other health professionals applied the systems through direct observation. Other professionals applied them from case notes only. The systems were assessed for agreement, stability, ease, and feasibility of application.RESULTS Test-retest stability was moderate-to-high for VSS (k=0.66-0.88), CFCS (k=uncomputed-0.91), and FCCS (k=0.52-0.91). Overall interrater agreement was fair to very good for every classification system. VSS achieved the best agreement between parents/ carers and speech therapists. VSS was considered the easiest instrument to apply.INTERPRETATION Because of its ease of use by a range of healthcare professionals, the VSS should be considered for CP registers which intend to survey speech intelligibility. For a wider assessment of communication, the CFCS or FCC should be considered.Cerebral palsy (CP) is a permanent but not unchanging disorder of movement, posture, and motor function, 1 'often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder'.2 Surveillance programmes monitor trends in CP prevalence and its determinants, and record the functional severity of associated impairments.

Development and reliability of the Functional Communication Classification System for children with cerebral palsy

“…Agreement between SLPs and AHPs was superior to pairings between clinicians and parents. Virella et al 12 reported a moderate interrater agreement for the FCCS and fair to moderate for the CFCS after it had been modified by the SCPE investigators. 10 Whereas the Kappa for parent-professional agreement for the CFCS was 0.49 (0.40-0.59), the FCCS achieved Kappas of 0.594 (parent-SLP) and 0.596 (parent-AHP).…”

“…Results of the FCCS development, validity, and reliability trials were first presented at the International Cerebral Palsy Conference in 2009. 12 All three classification systems were found to be valid and reliable by an expert panel using pre-established sets of construct, validation, and effectiveness parameters. 11 These three systems were recently reviewed for population-based implementation by the Surveillance of Cerebral Palsy in Europe (SCPE).…”

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

“…1 With this population, the CFCS has adequate content validity and interrater and test-retest reliability. [7][8][9] To our knowledge, the CFCS is the only classification tool for overall functional communication skills: both sending and receiving messages for children with a broad range of ages (2-18y). Unlike assessment measures, classification tools do not measure change over time, but simply describe how a child functions at a single point in time.…”

“…6 Traditionally, classification tools have organized children's skills according to their primary impairment, such as the type and severity of speech sound disorder. [7][8][9] To our knowledge, the CFCS is the only classification tool for overall functional communication skills: both sending and receiving messages for children with a broad range of ages (2-18y). 1 One other classification tool, the Functional Communication Classification System, classifies expressive, but not receptive, communication for 4-to 6-year-olds with CP.…”

Adaptação transcultural do Communication Function Classification System para indivíduos com paralisia cerebral

“…Thus, it is within this context that theCFCS was developed in order to reduce this problem, providing a system for the classification of functional communication in children with CP using a language shared by professionals and lay persons 7,16 . Indeed, in a recent study the CFCS was identified as an appropriate system of epidemiological surveillance foi the classification of communication in children withCP 18 . It is important to conclude this report by emphasizing that the Brazilian Portuguese version of theCFCS,in addition to providing a standardized terminology for the characterization of the communication of patients with CP at the various health care facilities and contributing to comparative studies with other countries since the instrument is currently available in 14 langages, can be used as an instrument in programs of evidence-based health practice.…”