title: Reliability of the Dutch-language version of the Communication Function Classification System and its association with language comprehension and method of communication.
abstract: OBJECTIVE
  The aims of this study were to determine the intra- and interrater reliability of the Dutch-language 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).
  
  
  METHODS
  Participants were 93 children with CP (50 males, 43 females; mean age 7y, SD 2y 6mo, range 2y 9mo-12y 10mo; unilateral spastic [n=22], bilateral spastic [n=51], dyskinetic [n=15], ataxic [n=3], not specified [n=2]; Gross Motor Function Classification System level I [n=16], II [n=14], III, [n=7], IV [n=24], V [n=31], unknown [n=1]), 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.
  
  
  RESULTS
  Interrater 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).
  
  
  CONCLUSIONS
  These data suggest that the CFCS-NL is a valid and reliable clinical tool to classify 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.
authors.affiliation: Department of Rehabilitation, Via Reva Rehabilitation Center, Apeldoorn, the Netherlands.
authors.forename: Karlijn E
authors.initials: KE
authors.lastname: Vander Zwart
authors.affiliation: Department of Paediatric Rehabilitation Medicine, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Joke J
authors.initials: JJ
authors.lastname: Geytenbeek
authors.affiliation: Groot Klimmendaal - Rehabilitation, Arnhem, the Netherlands.
authors.forename: Maaike
authors.initials: M
authors.lastname: de Kleijn
authors.affiliation: Department of Paediatric Psychology, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Oostrom
authors.affiliation: CanChild Centre for Childhood Disability Research, Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
authors.forename: Jan Willem
authors.identifier: http://orcid.org/0000-0002-3012-2119
authors.initials: JW
authors.lastname: Gorter
authors.affiliation: Division of Communication Disorders, University of Wyoming Laramie, Laramie, WY, USA.
authors.forename: Mary Jo Cooley
authors.initials: MJ
authors.lastname: Hidecker
authors.affiliation: Department of Paediatric Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
mesh_terms: D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D032882:Comprehension / Q000502:physiology*; D005260:Female; D006801:Humans; D007802:Language; D007807:Language Tests / Q000592:standards*; D008297:Male; D009426:Netherlands; D015203:Reproducibility of Results; D012720:Severity of Illness Index