Inter‐relationships of functional status in cerebral palsy: analyzing gross motor function, manual ability, and communication function classification systems in children

Hidecker, Mary Jo Cooley; Ho, Nhan Thi; Dodge, Nancy N.; Hurvitz, Edward A.; Slaughter, Jaime; Workinger, Marilyn Seif; Kent, Ray D.; Rosenbaum, Peter; Lenski, Madeleine; M, Messaros, Bridget; Vanderbeek, Suzette Baez; DeRoos, Steven; Paneth, Nigel

doi:10.1111/j.1469-8749.2012.04312.x

Cited by 97 publications

(115 citation statements)

References 22 publications

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“…In line with others, 8 a moderate correlation was found between the CFCS and GMFCS levels, thereby emphasizing the association between severity of CP (expressed in GMFCS levels) and disabilities in expressive and receptive communication. 22 No significant correlation was found between type of CP and CFCS levels, suggesting that communication problems occur within every type of CP.…”

Section: Discussion Cfcs-nlsupporting

confidence: 90%

“…3,5,6 Because the diagnosis of CP is based on clinical features but does not describe all the consequences of the disability, 7 the diagnosis must be used in combination with functional classifications. [8][9][10] Using a five-level approach, the Communication Function Classification System (CFCS) can classify the everyday communication of a person with CP, including communication with AAC systems. 11 Distinctions between the five levels of the CFCS are based on important aspects of functional communication, namely the performance of the sender and receiver roles, the pace of the conversation, and the type of communication partner.…”

Section: Resultsmentioning

confidence: 99%

“…8 Therefore, we suggest that the CFCS-NL is a suitable tool for classifying everyday communication of children with CP in clinical practice by professionals, in close collaboration with parents.…”

Section: Resultsmentioning

confidence: 99%

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

Zwart¹,

Geytenbeek

Kleijn³

et al. 2015

Develop Med Child Neuro

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AIM The aims of this study were to determine the intra-and interrater reliability of the Dutchlanguage 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). , recruited from rehabilitation centres throughout the Netherlands. Because some centres only contributed to part of the study, different numbers of participants are presented for different aspects of the study. Parents and speech and language therapists (SLTs) classified the communication level using the CFCS. Kappa was used to determine the intra-and interrater reliability. Spearman's correlation coefficient was used to determine the association between CFCS level and spoken language comprehension, and Fisher's exact test was used to examine the association between the CFCS level and method of communication. METHOD RESULTSInterrater reliability of the CFCS-NL between parents and SLTs was fair (r=0.54), between SLTs good (r=0.78), and the intrarater (SLT) reliability very good (r=0.85). The association between the CFCS and spoken language comprehension was strong for SLTs (r=0.63) and moderate for parents (r=0.51). There was a statistically significant difference between the CFCS level and the preferred method of communication of the child (p<0.01). Also, CFCS level classification showed a statistically significant difference between parents and SLTs (p<0.01). INTERPRETATION These data suggest that the CFCS-NL is a valid and reliable clinical tool toclassify everyday communication in children with CP. Preferably, professionals should classify the child's CFCS level in collaboration with the parents to acquire the most comprehensive information about the everyday communication of the child in various situations both with familiar and with unfamiliar partners.Within the activity level of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), communication is described as transmitting and receiving messages in different environments using multiple means including listening, speaking, reading, and writing.1 Functional communication is defined as the ability to receive or convey a message regardless of the method of communication, and to communicate effectively and independently in a given environment.1 Thus, communication also encompasses conversation and the use of communication aids and techniques, namely augmentative and alternative communication (AAC). Moreover, to operate both as a listener and as a speaker in communicative exchanges, children must develop functional communication skills that include the ability to comprehend and produce language.2 Expressive communication refers to transmitting messages using gesture, production of speech, writing, AAC, or signing. Receptive communication refers to receiving messages, using comprehension of signs or symbols reading, and spoken language.

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Section: Discussion Cfcs-nlsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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

Zwart¹,

Geytenbeek

Kleijn³

et al. 2015

Develop Med Child Neuro

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“…The study from Hidecker et al presents the results for three scales: the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). 2 A clinical series of 222 children with CP were assessed, half of whom were born very preterm. Examples of the advantages of knowing each child's functional profile are given, as well as excellent demonstrations of how awareness of these children's needs might be increased and care improved when using information from these three scales.…”

mentioning

confidence: 99%

Description of children with cerebral palsy: steps for the future

Cans

2012

Develop Med Child Neuro

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This commentary is on the original article by Hidecker et al. on pages 737-742 of this issue.Describing children with cerebral palsy (CP) has long been a challenge for both clinicians and researchers, from the neurological (spastic, dyskinetic, ataxic) to the topographical subtypes (unilateral or bilateral, upper and ⁄ or lower limbs), and to the description of the accompanying impairments. 1 More recently, several ordinal scales have been proposed related to the activity limitations of children with CP based on International Classification of Functioning, Disability and Health concepts. The study from Hidecker et al. presents the results for three scales: the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS).2 A clinical series of 222 children with CP were assessed, half of whom were born very preterm. Examples of the advantages of knowing each child's functional profile are given, as well as excellent demonstrations of how awareness of these children's needs might be increased and care improved when using information from these three scales. In addition, the reliability of describing groups of children with CP might also be improved. As CP is an umbrella term, with many different types, good reliability in describing subgroups of these children is useful for (1) clinical research trials conducted on CP subgroups, (2) longer-term evaluation of new therapies, and (3) epidemiological studies comparing data between registries or population-based surveys.The authors hypothesized that the three scales would not be strongly correlated. This weak correlation most probably results from combining different types of CP. For instance, the observed high correlation of GMFCS and MACS could have been expected in the group of children assigned to the quadriplegia type, with similar scores on the MACS and GMFCS. A lower correlation between MACS and GMFCS in the group labeled diplegic was observed and expected. The terms 'diplegia' and 'quadriplegia' raise questions because they differ in the number of limbs involved or predominantly involved, with this inaccuracy already mentioned several times.3 Controversy on this issue persists in the literature, 4 probably unnecessarily. At the individual level of a child with CP, all professionals will agree that more detailed knowledge than 'the child has a bilateral spastic CP subtype' is useful; but when used to describe a group of children with CP in clinical or epidemiological studies the reliability of the terms diplegia and quadriplegia are severely limited. The expertise of referral physicians in classifying the child by neurological ⁄ topographical subtype might differ greatly. Consequently, if the GMFCS and MACS were used as a proxy for lower and upper limbs involvement respectively, the reliability of a high GMFCS score and a low MACS score is likely to be much better than the reliability of the term diplegia. The GMFCS and MACS correlation results in the Hidecker et a...

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“…In some studies, significant moderate to high correlation was found, another study presented nonsignificant correlation. 3,[5][6][7] Thus, the aim of this study was to discover the correlation between GMFCS and CFCS with sample taken from Dr. Hasan Sadikin General Hospital (RSHS) Bandung, a tertiary health care facility with a high number of children with CP…”

Section: Introductionmentioning

confidence: 99%

Correlation between Gross Motor Function Classification System and Communication Function Classification System in Children with Cerebral Palsy

Margaretha¹,

Prananta²,

Alam³

2017

amj

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Background: Cerebral Palsy (CP) is a group of movement and posture disorder commonly accompanied by comorbidities such as sensation, cognition, communication abnormalities and many more. This study aimed to identify the correlation between gross motor function(measured by Gross Motor Function Classification System, GMFCS) and communication function (measured by Communication Function Classification System, CFCS) in children with CP. Methods: Thirty six children with CP aged 0-12 years were examined. Samples were taken from Department of Physical Medicine and Rehabilitation Dr. Hasan Sadikin General Hospital Bandung on September to October 2015. Patients' descriptive data, levels of GMFCS and CFCS were collected by the researcher and residents previously standardized. Kendall's tau b correlation coefficient was used to analyze the interrelationship between the GMFCS and CFCS. Results: Levels of GMFCS and CFCS in all samples were moderately correlated (r=0.405; p=0.004). In patients with spastic quadripledic type, correlation were found moderate(r=0.495; p=0.014). No significant correlation was found when CP spastic quadriplegic patients were excluded (r=0.048, p=0.829). Conclusions: : Levels of GMFCS and CFCS should be described to provide the complete gross motor and communication picture of CP children.Gross motor function in a child with spastic quadriplegic CP might be correctly predicted from his/ her communication function and vice versa.

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Inter‐relationships of functional status in cerebral palsy: analyzing gross motor function, manual ability, and communication function classification systems in children

Cited by 97 publications

References 22 publications

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

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

Description of children with cerebral palsy: steps for the future

Correlation between Gross Motor Function Classification System and Communication Function Classification System in Children with Cerebral Palsy

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