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Using the Communication Function Classification System (CFCS)

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Title: Using the Communication Function Classification System (CFCS)


1
Using the Communication Function Classification
System (CFCS)
  • Mary Jo Cooley Hidecker, PhD, CCC-A/SLP 

Speech-Language Pathology University of Central
Arkansas Email MJCHidecker_at_uca.edu
2
Cerebral Palsy Definition
  • describes a group of permanent disorders of the
    development of movement and posture, causing
    activity limitations, that are attributed to
    non-progressive disturbances that occurred in the
    developing fetal or infant brain.
  • The motor disturbances of cerebral palsy are
    often accompanied by disturbances of sensation,
    perception, cognition, communication, and
    behaviour, by epilepsy, and by secondary
    musculoskeletal problems Rosenbaum, et al.
    (2007)

3
Cerebral Palsy Definition
  • Annotations of each term follow, including
    sensation Vision, hearing and other sensory
    modalities may be affected, both as a function of
    the primary disturbance(s) to which CP is
    attributed, and as a secondary consequence of
    activity limitations that restrict learning and
    perceptual development experiences.
    communication Expressive and/or receptive
    communication and/or social interaction skills
    may be affected, both as a function of the
    primary disturbance(s) to which CP is
    attributed, and as a secondary consequence of
    activity limitations that restrict learning and
    perceptual development experiences.
    Rosenbaum, et al. (2007)

4
How many individuals with CP have communication
problems?
  • Few recent studies conducted by SLPs and
    audiologists
  • Many citations are based on published U.S.
    research in 1950s and 1960s
  • Need for CP epidemiological studies of
    communication and eating
  • In U.S., no national registry of individuals with
    CP
  • Expensive research to carry out and maintain
  • Need for multidisciplinary teams

5
How many individuals with CP have communication
problems?
  • No consensus on operational definitions
  • 58 with communication problem 7 with
    hearing problem Bax et al (2006)
  • Cerebral palsy registries (n26) Hidecker et al
    (2009)
  • 11 speech definitions used by 22 registries
  • 8 language definitions used by 11 registries
  • 14 hearing definitions used by 25 registries
  • 6 AAC definitions used by 6 registries

6
How many individuals with CP have communication
problems?
  • Norway CP Registry (Andersen, et al. 2010)
  • 51 of 564 children had speech problems
  • Speech problems indistinct or no speech
  • 54 of children with speech problems had AAC
  • 58 of the children with speech problems used
    graphic AAC
  • 33 of the children with speech problems used
    hand signs

7
Few Communication Measures in CP Studies
  • Need Better measures of speech, language, and
    hearing within existing CP epidemiological
    studies.
  • Challenge Quick, multidisciplinary measure of
    communication
  • Hope More SLPs and audiologists will be included
    on CP research teams

8
WHO ICF Model
  • The World Health Organizations (WHO)
    International Classification of Functioning,
    Disability and Health (ICF)

Health Condition (Disorder or Disease)
Body Functions Structures
Participation
Activity
Environmental Factors
Personal Factors
WHO, 2001
9
WHO ICF Model 3 perspectives on assessment and
intervention
  1. body structure and function anatomy
    physiology includes language subsystems
  2. daily activities carrying out tasks such as
    communication
  3. participation in home, school, work and/or
    community

10
Also consider interactions with
  • personal factors
  • (e.g., age, motivation, desires) and
  • environmental factors
  • (e.g., settings of home or community, familiarity
    with communication partner)

11
ICF Body/Structure Function Level
Denes Pinson, p.5
12
The Communication Model ICF Activities/Participa
tion Levels
Message
Sender
Receiver
Communication Environment
13
Functional Limitations in Daily Activities
  • Mobility Palisano et al., 1997
  • Gross Motor Function Classification System
    (GMFCS)
  • www.canchild.ca/Portals/0/outcomes/pdf/GMFCS
    -ER.pdf
  • Handling Objects Eliasson et al., 2006
  • Manual Ability Classification System (MACS) for
    children with cerebral palsy 4-18 years
    www.macs.nu/
  • Communication Hidecker et al., under development
  • Communication Function Classification System
    (CFCS) www.cfcs.us/
  • Eating/Drooling Sellers et al., under development
    Manchester U.K.

14
Comparison of Classification Tools
15
Purpose of CFCS
  • Communication classification tool in CP clinical
    and research settings
  • Grounded in SLP and audiology literature
  • Understandable to all interested in CP
  • Valid and reliable
  • Easily administered with other protocols
  • Will not replace existing communication
    assessments

16
Method 4 Phases
  1. Development
  2. Nominal Groups
  3. Delphi Surveys
  4. Reliability

17
CFCS Development
  • 8 Stakeholder groups
  • Adults with CP
  • Educators
  • Neurologist
  • Occupational Therapists
  • Parents of children with CP
  • Pediatricians
  • Physical Therapists
  • Speech-Language Pathologists

18
Participants
19
Results
20
Reliability
  • Professional inter rater (n69)
  • Parent-professional inter rater
  • Parents/Family members (n68)
  • Professionals (n61)
  • Test-retest (n48 professionals)

21
Professional Inter rater Reliability
Professional 1 Professional 1 Professional 1 Professional 1 Professional 1 Professional 1
CFCS I II III IV V
I 5 2
II 2 3
III 3 5 7 6
IV 1 2 2 17 1
V 4 13
Professional 2
Weighted kappa.66 (95 CI. 55-.77) Increases to
.77 for kids gt 4 years
22
Parent-Professional Inter rater Reliability
Professional Professional Professional Professional Professional Professional
CFCS I II III IV V
I 10 4 3 2
II 7 9 9 12 1
III 6 9 7 6
IV 1 4 24 11
V 2 11
Parent
Weighted kappa.49 (95 CI .39-.58)
23
Professional Test-Retest Reliability
Time 2 Time 2 Time 2 Time 2 Time 2 Time 2
CFCS I II III IV V
I 11 2 1 1
II 7 3 2
III 11 7
IV 21 3
V 20
Time 1
Weighted kappa.82 (95 CI .74-.90)
24

25

26
(No Transcript)
27
Current CFCS Draft
28
CFCS Level Identification Chart
Hidecker et al.
Please do not use
without permission
29
Clinical Implications
  • Accessible, common tool that can be used by both
    parents and professionals.
  • Useful when talking with families and other
    professionals.
  • Support understanding among various members of
    multidisciplinary teams.

30
Clinical Implications examples
  • Knowing a persons CFCS classification may
    suggest a starting point for intervention (we
    still need clinical research evidence)
  • Level I Any activity or participation
    limitations? Decrease any residual speech sound
    errors?
  • Level II Any ways to speed up communication,
    especially with unfamiliar partners? Can repair
    strategies be improved? Can AAC access/composing
    methods be faster?

31
Clinical Implications examples
  • Level III Increase communication partners?
    Improve communication repair strategies? Add AAC?
  • Level IV Increase sender and/or receiver
    skills? Add AAC?
  • Level V Improve partner recognition of gestures
    and unconventional messages?
  • Focus on communication partner training.
  • Create a communication dictionary of these
    unconventional message.
  • Pair AAC message with unconventional message.

32
Current research directions
  • Measure the CFCS stability across the life span.
  • Need research partners who serve individuals with
    CP from age 2 to 21
  • Will classify CFCS and collect additional data
    over the course of 4 years

33
Current research directions
  • CFCS to cerebral palsy registries data?
  • Surveillance of CP in Europe (SCPE)
  • Translate/validate CFCS in languages
  • Currently underway
  • Arabic
  • Dutch
  • Turkish
  • Need Spanish partners
  • Translation Interests
  • ?????

34
Future research directions
  • Create a snapshot of a persons functional levels
    by reporting the CFCS in conjunction with GMFCS
    MACS.
  • Correlate the CFCS level to quality of life
    and/or participation measures.

35
Future research directions
  • Validate the CFCS in other populations including
    those with autism, Down syndrome, and
    post-stroke.
  • Study the possible effect of additional AAC
    components and operational competencies on CFCS
    Levels.

36
Acknowledgements
  • Thank you to the individuals who participated
  • In addition to those who chose to contribute
    anonymously,
  • Development Team Sally Bucrek, Kipp Chillag, DO,
    Ann-Christin Eliasson, PhD, Maria S. French, PhD,
    Lisa Herren, Rebecca Jones, PhD, Lena
    Krumlinde-Sundholm, PhD
  • Nominal Group Deena Agree, George Baker, Lisa
    Bardach, Lehua Beamon, Susan Davenport, Denise
    Fitzpatrick, Elizabeth A. Fox, Barb Galuppi,
    Jonathon Gold, Clare Jorgensen, Marilyn Kertoy,
    John Lawton, Michael Livingston, Rhonda Massa,
    Jeanette Miller, Chris Morris, Nancy Novakoski,
    Krista Richardson, Cindy J. Russell, Dianne
    Russell, Geraldine Schram, Dennis Schroeder,
    Becky Schroeder, Yakov Sigal, Nancy
    Thomas-Stonell, David VanDyke, Lynna M. Walta,
    Kristin J. Whitfield
  • Delphi Survey Janet H. Allaire, Ilona
    Autti-Rämö, Rita L. Bailey, Simona Bar-Haim,
    David Bauer, Kristie Bjornson, PhD, PT, Timothy J
    Brei, MD, Wendy Burdo-Hartman, MD, Megan Carter,
    Michael Collis, Cynthia Cress, Diane L. Damiano,
    Pamela K. De Loach, Leo V. Deal, Shelley Deegan,
    Steven T DeRoos, MD, Cindy DeYoung, Laura Drower
    M.S., SLP, Joseph R. Duffy, Stephanie Farnham
    OTR, James W. Fee, Jr., Iris Fishman, Deb
    Gaebler, Gay L. Girolami, PT, MS, Jan Willem
    Gorter, MD PhD, Kate Himmelmann, Megan M. Hodge,
    Tara Kehoe, Debora K. Kerr, Barbara A. Krampac,
    MS CCC/SLP-L, Nicole Lomerson, Mary Ann Lowe,
    Valerie Maples, Jill Meilahn, D.O., Michael E.
    Msall, MD, Susan Murr, Dana Overhake, Robert J.
    Palisano, Carol Palk, Lindsay Pennington, Judy
    Phelps, OTR, Matthew Phillips, Margaret R. Poore,
    SLP/AAC Specialist, Dinah Reddihough, Tom J Reed,
    Dr. Gina Rempel, James M Renuk, Bernadette
    Robertson, Cheryl Robins, Sharon Rogers, Lynn
    Rothman, Julie Scherz, Diane Dudas Sheehan, Kevin
    Vance, Candace Hill Vegter, Jo Watson, Ellen
    Wood, Marilyn Seif Workinger, PhD, Marshalyn
    Yeargin-Allsopp, MD
  • Reliability Sites BC Centre for Ability
    (Vancouver, British Columbia), Helen DeVos
    Childrens Hospital (Grand Rapids, Michigan),
    Gillette Childrens Hospital (St. Paul,
    Minnesota), Marshfield Clinic (Marshfield,
    Wisconsin), Seattle Childrens Hospital (Seattle,
    Washington), Rehabilitation Institute of Chicago
    (Chicago, Illinois)
  • Research Team Aliah Alsarraf, Megan Bigalke,
    Kenneth Chester, Stephanie Currier, Kristen
    Darga, Julie Fisk, Kelly Gowryluk, Carly Hanna,
    Brenda Johnson, Lauren Klee, Lauren Klier, Jenny
    Koivisto, Lauren Michalsen, Hye Sung Park, Sarah
    Parker, Tiffany Quast, Kristen Raabis, Marliese
    Sharp, Archie Soelaeman, Katie VanLandschoot,
    Lauren Werner, Jacqueline Wilson
  • This research is supported in part by an NIH
    postdoctoral fellowship (NIDCD 5F32DC008265-02)
    as well as grants from the Cerebral Palsy
    International Research Foundation and The Hearst
    Foundation.

37
References
  • 1 World Health Organization. (2001) International
    classification of functioning, disability and
    health ICF. Geneva World Health Organization.
  • 2 World Health Organization. (2007) International
    classification of functioning, disability, and
    health children youth version ICF-CY.
    Geneva World Health Organization.
  • 3 Raghavendra P, Bornman J, Granlund M,
    Björck-Åkesson E. (2007) The World Health
    Organization's international classification of
    functioning, disability and health implications
    for clinical and research practice in the field
    of augmentative and alternative communication.
    Augmentative and Alternative Communication 23
    349 - 61.
  • 4 Hidecker MJC, Paneth N, Rosenbaum P, Kent RD,
    Lillie J, Johnson B, Chester K. (2009)
    Development of the Communication Function
    Classification System (CFCS) for individuals with
    cerebral palsy. Developmental Medicine and Child
    Neurology 51(Suppl2) 48.
  • 5 Palisano R, Rosenbaum P, Walter S, Russell D,
    Wood E, Galuppi B. (1997) Development and
    reliability of a system to classify gross motor
    function in children with cerebral palsy. Dev Med
    Child Neurol 39 214-23.
  • 6 Eliasson AC, Krumlinde-Sundholm L, Rosblad B,
    Beckung E, Arner M, Ohrvall AM, Rosenbaum P.
    (2006) The Manual Ability Classification System
    (MACS) for children with cerebral palsy scale
    development and evidence of validity and
    reliability. Dev Med Child Neurol 48 549-54.
  •  

38
Contact us
  • Mary Jo Cooley HideckerMJCHidecker_at_uca.edu
  • Accepting graduate and postdoctoral students
  • CFCS Websitehttp//cfcs.us
  • Updated presentation slides will be posted
    athttp//faculty.uca.edu/mjchidecker
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