Communication Function Classification System: the Farsi version for children with CP

The Communication Function Classification System, or short CFCS, is one of the scales that can be used by health care professionals to classify everyday communication abilities of their clients. The original version was developed for use with people with CP, but is now also used to describe communication in people with any speech and language impairment or developmental disabilities.

The CFCS has 5 levels to describe a person’s communication performance. The ability to send and receive messages is rated, taking into account whether the conversation partner is familiar or not. Level 1 describes a person who is an effective sender and receiver, whereas Level 5 describes a person who is rarely successful in communicating effectively even with familiar partners. 

The CFCS has been translated into various languages by now, and a recent addition to this growing list is the Iranian version. The research team around Zahra Soleymani led the development of the Farsi version. 

In a first step, the original version was translated by two experienced translators. Their individual translations were merged, and together with a speech and language therapist a working version was created. This version was then discussed with parents and other health professionals. It was decided that the version would benefit from some changes as not all terms used were known to the people consulted. For this reason, the authors added an introduction defining the terms used as well as explaining the advantages and benefits of the tool. A third translator then back-translated the adapted version, and based on this a final version was developed. 

In a second step, inter-rater as well as test-retest reliability was tested. For this, professionals and parents were asked to use the tool to rate the communication performance of 152 children. Other professionals and parents were further asked to use the test again after 2 weeks. It was then checked how similar judgements were between raters or between time points. Results show that reliability was excellent, meaning that the CFCS is a tool that can be used by health professionals in Iran to better understand clients’ communication abilities.

Soleymani, Z., Joveini, G. & Baghestani, A. R. (2015). The Communication Function Classification System: Cultural Adaptation, Validity and Reliability of the Farsi Version for Patients With Cerebral Palsy. Pediatric Neurology, 52, 333-337.

Coordination of lip and jaw movements in children with CP

Does reduced movement of lip and jaw contribute to difficulties understanding some children with CP? According to Ignatius Nip from San Diego State University, yes. Nip explores the development of speech from a kinematic perspective - that is the study of motion - and in this case the movement of jaw and lips. In his latest publication, he investigated how coordination between lips and jaw affect speech production and intelligibility in children with CP. As part of this study, he also intended to find out whether the complexity of an articulatory movement - there is a difference between repeating sentences and repeating the same syllable - plays a role as well.

To answer these questions Nip invited 12 children with spastic CP and 12 typically-developing kids into his lab. Reflective markers were put on the children’s faces to capture the movements of upper lip and jaw, lower lip and jaw and upper, and lower lips when repeating syllables and sentences. Temporal and spatial movement were measured, that is the timing of the movements as well as how well the movements fit together.

The study found that the children with CP had difficulties coordinating the movements between upper and lower lips. This is likely to affect sounds that are produced using both lips such as [b]. The timing for moving upper lip and jaw was also affected. With regard to the complexity of the speech movements the results showed that the coordination of lips and jaw was more precise for the sentences than for the syllables. In addition, there was a clear relation between effective movement coordination and intelligibility. That is, the children who showed signs of dysarthria – reflected in their intelligibility scores – were less successful in coordinating their movements. Children with CP and dysarthria do seem to move their lips and jaw differently than their typically-developing peers. This difference in articulatory movement is measurable and there is a chance that information on articulatory performance can be used to help describe dysarthria problems in children with CP…provided relevant resources are in place...

Nip, I.S.B (2015). Interarticulator coordination in children with and without cerebral palsy. Developmental Neurorehabilitation. Early online, 1-13.

How are speech and language therapists (SLTs) managing the communication needs of young people with CP: Findings from a recent UK survey

Speech and language therapy for children with CP aims to support the development of effective communication skills. Many clinicians will agree that reducing the speech impairment and improving speech intelligibility will support the child to be part of family, school and community life. However, there is likely to be less consensus regarding how this can be achieved. Rose Watson and Lindsay Pennington think that practices may vary due to differences in health and social care resources as well as uncertainty about which intervention is indeed effective. 

To explore this, they conducted a UK wide online survey asking SLTs about their assessment and intervention practices for communication problems in children and young people with CP, i.e. which problems are commonly addressed, which areas are assessed and how, and which areas are treated and how. The survey was advertised via NHS and RCSLT channels as well as associated social media. Over the course of two months about 300 SLTs replied, of which 265 responses were analysed.

Assessment practices

The responses showed that a wide range of published standardised tests is used to assess including oro-motor function, receptive and expressive language and speech. This shows that children’s communication skills are thoroughly assessed. SLTs also made an effort to individualise assessments where needed. For example, they enlarged pictures or cut them up for children with sensory and/or motor problems. On the other hand, the survey found that non-standardised tests were used as well, which means results cannot be compared to norms. Also, communication skills were sometimes assessed by observation only, which can underestimate children’s abilities.

Intervention practices

Swallowing and receptive language skills were listed by SLTs as the main areas of intervention. Assisted communication, also referred to as AAC, was another intervention priority for them to achieve the aim of communication participation. Again, SLTs used a number of intervention techniques, which is not surprising given the wide and varied range of communication difficulties in children with CP. However, the authors also noted that some of the techniques used are not supported by the literature. This means that in previous studies these techniques were not found to improve communication much.

Overall, the findings show that there is indeed a wide variation in the assessment and intervention of communication difficulties in children with CP. This variation makes it difficult to compare practices across different services. The authors conclude that a set of agreed clinical measures would be a good starting point to inform service development and identify research priorities to move evidence-based practice forward.

Watson, R. M. & Pennington, L. (2015). Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice. International Journal of Language and Communication Disorders, 50(2), 241-259.

Young people and CP - experiences of health, well-being and support needs

Last time, I blogged about quality of life in children and adolescents. This blog stays close to the topic writing about young people with CP embarking on their road to independence, the challenges they face and their dreams about their future. Elisabet Björquist and colleagues from Lund University explored how young people with CP experience their own health, well-being and support needs on their way to becoming adults. They were hoping that the views will help them to see how transition programmes work in Sweden and whether there is anything that could be done to make transition easier for young people with CP.

The authors interviewed 12 Swedish 17-18 year olds either individually or in a group setting to learn about their views on important topics such as family, friends and love, hopes for the future and challenges in daily life and the support they would need. During the interviews, the authors used pictures to guide them through the discussions. 

From the interviews it became clear that they were looking forward to being adults, but were not always sure whether they were ready yet. They voiced the same hopes for their future as any other young person about to leave home: stressing how important good friends are and that finding a partner would be nice too, but sometimes being unsure how to get to know people. On the other hand they were aware of needing continued support to gain more independence. Not just for learning new skills such as cooking but also doing things like preparing a sandwich or tying shoe laces. 

The young people look forward to becoming more independent and think that the process should be a gradual one. Knowledge on what kind of support to expect and where to find it will help them through the process and allow them to take part in activities that matter to them.

Björquist, E.,  Nordmark E. & Hallström, I. (2014). Living in transition – experiences of health and well-being and the needs of adolescents with cerebral palsy. Child: care, health and development, 41(2), 258–265