COMMUNICATION PERFORMANCE OF CHILDREN WITH CEREBRAL PALSY: APPLYING A WHO ICF MODEL

1. COMMUNICATION PERFORMANCE OF CHILDREN WITH CEREBRAL PALSY: APPLYING A WHO ICF MODEL Megan Scott, M.S., CFY-SLP Mary Jo Cooley Hidecker, PhD, CCC-A/SLP mjchidecker@uca.edu Department of Speech-Language Pathology, University of Central Arkansas Conway, USA

2. Cerebral Palsy (CP) • 2.5 in every 1000 live births (Fauconnier et al 2009) • Often associated with other developmental disorders (Bumin and Kayihan, 2001) • Neural damage may affect communication development • Speech production (e.g., dysarthrias) • Language comprehension and expression • Auditory perception

3. WHO ICF Model The World Health Organization’s (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

4. CP communication & ICF model • Impaired Body Structures & Functions • Often cognitive, visual, hearing, speech and/or language impairments (Hodge, 1999) • Decreased Activities and Participation • Physical and communication impairments (Bumin and Kayihan, 2001) • Fewer opportunity in education, vocation, social interaction, and community involvement (Fauconnier et al, 2009)

5. CP communication & ICF model • Communication • Co-construction of meaning • Consider all the information available especially when ineffective speech/language/hearing signal

6. CP communication & ICF model • Contextual factors • Environment • Communication Partner • Familiar to unfamiliar • Setting • Home, school, work, community, and so on • Personal Factors • Gender • Age

7. Research Aims • Analyze CP communication using ICF model • In communication from children with CP: • Measure some ICF elements Body structures & functions Activities & Participation Environmental Factors Personal Factors • Explore associations between ICF elements

8. Participants • 17 children diagnosed with CP • 7 girls and 10 boys, ages 2 to 12 years • Familiar partner selected by parent/guardian • Usually parent/guardian • Older sibling or Teacher • Unfamiliar partner • Usually speech-language pathologist (MJCH) • Graduate student in speech-language pathology • IRB Approval - Parental Consent – Child Assent

9. Communication Samples • Video taped child and partner communication for approximately 10 minutes. • Familiar partners were asked to interact with the child as they typically did • Unfamiliar partners used Hadley’s Language Sampling Protocol for Eliciting Text-Level Discourse (with modifications as necessary) • Videos transcribed by graduate and undergraduate students

10. Analysis using WHO ICF Model Health Condition (Disorder or Disease)Cerebral Palsy (CP) Body Functions & StructuresLanguage Subsystems:pragmatics, semantics, syntax, morphology Participation ActivityCFCS Level Environmental FactorsPartner Familiarity Personal Factors Child’s Age, Sex WHO, 2001

11. Communication Function Classification System (CFCS)

12. CFCS Levels • Level I Effective Sender/Receiver with all (n=5) • Level II Effective (slower) Communication (n=1) • Level III Effective with familiar partners (n=3) • Level IV Inconsistent Sender/Receiver (n=6) • Level V Seldom Effective even with familiar (n=1)

13. Language Sample Results • With familiar partners • Range: 51 to 111 child utterances per conversation • Mean = 83 child utterances, s.d.=16 • With unfamiliar partners • Range: 41 to 128 child utterances per conversation • Mean = 80 child utterances, s.d.=30 • Mean length of utterances (MLU) • Not vary by partner type • Increased with CFCS effectiveness level.

14. Speech Comprehensibility Results • Speech Comprehensibility Definition:the degree to which the listener understands on the basis of acoustic signal plus all other information that may contribute to understanding what has been said (Duffy, 2005) • With familiar partners • Mean = 69% comprehended, s.d.=33% • With unfamiliar partners • UP mean = 72% comprehended, s.d.=32%

15. Pragmatic Results • Mean Turn Length of Utterances: Average number of utterances for the child’s turn. • With familiar partners • Mean = 1.1 utterances, s.d.=.1 • With unfamiliar partners • UP mean = 1.1 utterances, s.d.=.1

16. Semantic Variety Results • Type-Token Ratio (TTR) : • With familiar partners • Mean = 3.7, s.d.=12.5% • With unfamiliar partners • UP mean = 4.8, s.d.=16.2%

17. Preliminary findings • Body structure/function, as captured by language sample analysis components, • did not correspond to activity and participation levels as represented in CFCS levels • did not vary by environmental factor of partner type

18. Future research • Increase number of children per CFCS Level • Group children by chronological age • Evaluate using conversational analysis • Focus on multiple modes and environmental cues

19. Acknowledgements Thank you to the family and children who participated. Research Team: 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, Morgan Poole, Tiffany Quast, Kristen Raabis, Brittany Reed, Marliese Sharp, Renée Smith, Archie Soelaeman, Kara Taylor, Katie VanLandschoot, Lauren Werner, Jacqueline Wilson This research was 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.

20. For more information Mary Jo Cooley HideckerMJCHidecker@uca.edu Accepting graduate and postdoctoral students CFCS Websitehttp://cfcs.us

21. CFCS Level Identification Chart