Classification systems of communication for use in epidemiological surveillance of children with cerebral palsy.
OBJECTIVE
Children with cerebral palsy (CP) often experience communication difficulties. We aimed to identify a classification system for communication of children with CP suitable for epidemiological surveillance.


METHODS
Systems to classify the communication of children with CP were identified. The Communication Function Classification System (CFCS), Functional Communication Classification System (FCCS), and Viking Speech Scale (VSS) were chosen for further investigation and translated. They were administered to 155 children aged 4 to 13 years with CP (across all motor severity levels) from eight European countries. Children's parents/carers, speech therapists, and other health professionals applied the systems through direct observation. Other professionals applied them from case notes only. The systems were assessed for agreement, stability, ease, and feasibility of application.


RESULTS
Test-retest stability was moderate-to-high for VSS (k=0.66-0.88), CFCS (k=uncomputed-0.91), and FCCS (k=0.52-0.91). Overall interrater agreement was fair to very good for every classification system. VSS achieved the best agreement between parents/carers and speech therapists. VSS was considered the easiest instrument to apply.


CONCLUSIONS
Because of its ease of use by a range of healthcare professionals, the VSS should be considered for CP registers which intend to survey speech intelligibility. For a wider assessment of communication, the CFCS or FCC should be considered.
Epidemiology and Statistics Office of the Research Unit and Área de Pediatria Médica do Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Daniel
D
Virella
Institute of Health and Society, Royal Victoria Infirmary, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Lindsay
L
Pennington
The Cerebral Palsy Register of Norway, Vestfold Hospital Trust and Department of Laboratory Medicine, Women's and Children's Health, The Norwegian University of Science and Technology, Trondheim, Norway.
Guro L
GL
Andersen
Federação das Associações Portuguesas de Paralisia Cerebral, Avenida Rainha Dona Amélia, Lisbon, Portugal.
Maria da Graça
Mda G
Andrada
Rehabilitation Center 'Mes esam lidzas', Riga, Latvia.
Andra
A
Greitane
Department of Paediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
Kate
K
Himmelmann
Children's Rehabilitation Hospital affiliated to the Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
Audrone
A
Prasauskiene
Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.
Gija
G
Rackauskaite
Clinical Research Unit, Imas12-Ciberesp, Hospital 12 Octubre, Madrid, Spain.
Javier
J
De La Cruz
Institute of Health and Society, Royal Victoria Infirmary, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Allan
A
Colver
D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003147:Communication Disorders / Q000145:classification* / Q000209:etiology; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results