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

Abstract

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.

What do the relationships between functional classification systems of children with cerebral palsy tell us?

“…In a study by van der Zwart, CFCS and GMFCS were moderately correlated10 ) . In addition, the communication performance was strongly correlated with the level of spoken comprehension and methods of communication.…”

“…In addition, the communication performance was strongly correlated with the level of spoken comprehension and methods of communication. They concluded that the method of communication, such as verbal and nonverbal communication and the level of spoken language of a child with CP, were most strongly related to everyday communication performance10 ) . Our study did not investigate this relationship.…”

“…In addition, these three classification systems have been translated into more than 15 different languages. Their validity, reliability, and a range of other attributes have been assessed by studies in various languages, contributing rapidly to increased, new and important scientific knowledge9,10,11 ) . A previous study investigated the relationship between these classification systems and found a moderate to strong relationship3 ) .…”

Overview of Four Functional Classification Systems Commonly Used in Cerebral Palsy

“…Overall, the CFCS had good test-retest reliability and professional inter-rater reliability, with slightly less parent-professional inter-rater reliability [22]. The CFCS has been translated into Dutch and Farsi and these measures have also demonstrated good reliability [23,24]. …”

Classifying communication ability in cerebral palsy

“…In addition to exploring the validity of a Dutch version of the CFCS, the article by Vander Zwart et al 4 attempts to tease out some of the factors that contribute to the composite level of function. The advantage conferred by intelligible speech is clearly seen when focusing on a child's ability to communicate effectively with unfamiliar partners.…”