Functional Communication Classification System Validated for Utility in Young CP Patients, Study Says

The Functional Communication Classification System is a clinically reliable and useful survey for assessing speech in children ages 5-18 with cerebral palsy, a new study says.

This survey is suitable for monitoring cerebral palsy patients during disease progression and for examining the effectiveness of therapeutics to maximize patient care.

The research article, “The Functional Communication Classification System: extended reliability and concurrent validity for children with cerebral palsy aged 5 to 18 years,” was published in Developmental Medicine & Child Neurology.

Communication is a complex process, facilitated by the coordination of language skills and motor movements to produce speech. Communication difficulties are common among children with cerebral palsy.

In the past decade, several classification systems have been developed to help provide an understanding of the level of speech and communication function of individuals and populations of children with cerebral palsy. The differences between these systems may contribute key information to understanding a child’s communication abilities.

However, cerebral palsy studies have inconsistently reported the prevalence of speech impairment because of disparities in classification systems. Unified classification systems supported by research are needed for the evaluation of how specific communication impairments and ability to interact affect a child’s use of overall communication.

One such system is called the Functional Communication Classification System (FCCS). This system is meant to capture the “pragmatic ability” or the “social, emotional and communicative aspects of social language” that vary according to communication contexts and partner.

Based on current research and identified gaps, researchers from the University of Queensland investigated the clinical reliability and usefulness of the FCCS.

To do so, the team enrolled 82 children (38 boys, 44 girls) with cerebral palsy in six age groups: 5 years (15 children), 8 years (14 children), 10 years (14 children), 12 years (14 children), 15 years (11 children) and 17 years (14 children).

These participants were assessed by a speech-language pathologist and a parent using the FCCS ratings. To guide the clinician-child interaction in this study, a pragmatics elicitation protocol was used.

To test the practicality of using this exam, the researchers looked at how similar the completed FCCS results were between the speech-language pathologists and parents of these participants.

The FCCS ratings done by the speech-language pathologists and parents were almost in perfect agreement. The researchers point out that this consistency is higher compared to past studies. They attribute this to improved methodological consistency in data collection by implementing the pragmatics elicitation protocol, developed by the researchers based on pragmatic assessment approaches.

“The [pragmatics elicitation protocol] is structured as a play-based observation that enables a rater to observe a sample of basic everyday communication functions to determine what a child ‘does do’ when participating without facilitation,” researchers explained.

To see how well FCCS scores captured different aspects of communication, the researchers next investigated FCCS scores with other clinical surveys relevant to cerebral palsy. Specifically, they looked at how FCCS scored associated with:

• Motor speech, gross and fine motor function;
• Associated impairments, including epilepsy, intelligence, hearing, and vision;
• A measure of functional communication called Clinical Evaluation of Language Fundamentals – Fourth Edition Pragmatics Profile (CELF-4 PP).

The CELF-4 PP provides information about language use and social communication for the same age range of the FCCS. Just like FCCS, CELF-4 PP “addresses … social, operational, linguistic, and strategic competencies by observing ritual and conversational skills; the ability to ask for, give, and respond to information; and non-verbal communication skills,” researchers explained.

Not surprisingly, the team found that functional communication and motor speech performance decreased together in cerebral palsy children ages 5-18.

The FCCS revealed a strong connection of functional communication with intellectual impairment and was higher with other commonly associated impairments, such as vision, hearing, and epilepsy. Additionally, the odds of a higher FCCS level (i.e. poorer communication function) were found to increase with the presence of any of these associated impairments.

Significantly, this is the first study to directly compare the FCCS with the CELF-4 PP in the same group of patients. The excellent correlation between the FCCS and CELF-4 PP supports the FCCS level descriptors as accurate descriptions of a child’s communication performance in everyday contexts with a variety of communication partners.

Finally, no relationship between FCCS rating and age was found, indicating that the FCCS level descriptors are applicable from early childhood through to early adulthood (i.e. up to 18 years), independent of a child’s age.

As expected, the FCCS level increased (i.e. poorer communication function) as the CELF-4 PP total score decreased (i.e. decreased communication skills), correctly reflecting communication limitations both with familiar and unfamiliar partners.

The researchers propose the use of the FCCS as a valid and reliable functional communication classification tool for children ages 5-18 with cerebral palsy.

“Research to support use of the Functional Communication Classification System with younger children aged 2 to 4 years is now needed,” researchers said. “Access to a validated communication classification tool from early childhood through to adulthood will support international research, cerebral palsy register implementation, and inform targeted communication and participation intervention for children and young people with cerebral palsy.”