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Caynes KD, Rose TA, Ware RS, Johnston LM. Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 38379211 DOI: 10.1080/17549507.2023.2287991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP). METHOD Twenty-one clinicians (speech-language pathologists [SLPs] n = 11; physiotherapists [PTs] n = 5; occupational therapists [OTs] n = 5) novice to the Viking Speech Scale (VSS), Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) rated eight unfamiliar children with CP (8-16 years) following classification orientation. Inter-rater agreement was examined between (a) novices, (b) novice SLPs vs. PTs and OTs, and (c) novice vs. expert (kappa statistics). Utility perceptions were scored regarding classification terminology, ease of use, assistive decision-making resources, and construct validity and were analysed using Kruskal-Wallis H-tests. RESULT Rating agreement between novices was substantial (VSS, k = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, k = 0.44, 95% CI [0.23-0.65]; CFCS, k = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, kw = 0.89, 95% CI [0.86-0.92]; FCCS, kw = 0.89, 95% CI [0.86-0.92]; CFCS, kw = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; p = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; p = 0.009), and construct validity (FCCS, CFCS, VSS; p < 0.001). CONCLUSION Novice raters achieved substantial agreement for speech classification, supporting utilisation in clinical, research, and CP register activities. Orientation to communication classification constructs, content, and instructions is recommended for novice raters.
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Affiliation(s)
- Katy D Caynes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
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Bootsma JN, Phoenix M, Geytenbeek JJM, Stadskleiv K, Gorter JW, Fiske S, Cunningham BJ. Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change. BMC Health Serv Res 2022; 22:1421. [PMCID: PMC9702652 DOI: 10.1186/s12913-022-08803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians’ implementation of the C-BILLT in practice in the Netherlands and Norway.
Materials and methods
A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians’ capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.
Results
Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.
Conclusion
This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.
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Spaans IEM, Geytenbeek JJM, Vaillant E, de Kleijn MAMC, Buizer AI, Pennington L. Reliability and validity of the Dutch-language version of the Viking Speech Scale in children with cerebral palsy. Child Care Health Dev 2022; 49:605-616. [PMID: 36327098 DOI: 10.1111/cch.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/11/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The Viking Speech Scale is used to classify speech performance in children with cerebral palsy (CP). A Dutch-language version (VSS-NL) has recently become available. This study aimed to determine the reliability and validity of the VSS-NL and the association with motor type of CP, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Communication Function Classification System (CFCS). METHODS A total of 90 children with CP, recruited throughout the Netherlands, took part in the study. VSS-NL classifications by speech and language therapists unfamiliar (SLT1) and familiar (SLT2) with the child, parents and physicians were compared. Convergent and discriminant validity were determined with the Intelligibility in Context Scale-Dutch (ICS-NL) and the Computer Based Instrument for Low Motor Language Testing (C-BiLLT). Inter- and intrarater reliability were determined by weighted Kappa (ƙw ). Validity and associations between VSS-NL and GMFCS, MACS and CFCS were determined with Spearman's coefficient. Association between VSS-NL and motor type of CP was determined with Fisher's exact test. RESULTS Interrater reliability was excellent between SLT1-SLT2 (ƙw = 0.93, 95% confidence interval [CI] 0.87-0.99), good between SLT1-parent (ƙw = 0.71, 95% CI 0.60-0.83), SLT1-physician (ƙw = 0.70, 95% CI 0.58-0.81), SLT2-parent (ƙw = 0.71, 95% CI 0.57-0.84), SLT2-physician (ƙw = 0.73, 95% CI 0.62-0.85) and parent-physician (ƙ = 0.72, 95% CI 0.60-0.85). Intrarater reliability was excellent for SLTs familiar and unfamiliar to the child (ƙw = 1.00, 95% CI 1.00-1.00), and very good for physicians (ƙw = 0.89, 95% CI 0.75-1.00) and parents (ƙw = 0.72, 95% CI 0.62-1.00). Convergent validity was very strong (r = -0.81, p < 0.001) and discriminant validity moderate (r = -0.56, p < 0.001). Association with motor type of CP was significant (χ2 = 27.558, p < 0.001) and strong with GMFCS (r = 0.62, p < 0.001), MACS (r = 0.63, p < 0.01) and CFCS (r = 0.69, p < 0.001). CONCLUSION The VSS-NL is a reliable and valid system to classify speech performance in children with cerebral palsy. Classifications can be performed by SLTs, parents and physicians.
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Affiliation(s)
- Irene E M Spaans
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - Joke J M Geytenbeek
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Emma Vaillant
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Vaillant E, Geytenbeek JJM, Oostrom KJ, Beckerman H, Vermeulen RJ, Buizer AI. Determinants of spoken language comprehension in children with cerebral palsy. Disabil Rehabil 2022; 45:1667-1679. [PMID: 35574615 DOI: 10.1080/09638288.2022.2072960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify determinants of spoken language comprehension (SLC) in children with cerebral palsy (CP). MATERIALS AND METHODS Cross-sectional data of 207 children with CP were included: 82 toddlers (18 months-3;11 years), 59 preschool children (4;0-5;11 years), and 66 schoolchildren (6;0-8;11 years), across all Gross Motor Function Classification System (GMFCS) levels. SLC was assessed using the Computer-Based instrument for Low motor Language Testing (C-BiLLT). Potential determinants were retrieved from medical files and through parental questionnaires. Per developmental stage, multivariable regression analyses were used to assess determinants of SLC. RESULTS Fifty-nine percent of the children showed below average SLC. Significant determinants for SLC differed per developmental stage. In toddlers: age, motor type, functional communication and speech function (R2 = 0.637); in preschool children: functional communication, speech function and language activities (R2 = 0.820), and in schoolchildren: functional communication, intellectual functioning and arm-hand functioning (R2 = 0.807). For all developmental stages, functional mobility was not a significant determinant. CONCLUSIONS A large proportion of children with CP across all GMFCS levels have SLC impairments. Findings indicate that SLC is strongly determined by functional communication classified with CFCS. We recommend standardized assessment and monitoring of SLC in all children with CP. IMPLICATIONS FOR REHABILITATIONChildren across all GMFCS levels can experience difficulties in spoken language comprehension.At all developmental stages, functional communication (classified with CFCS) is an important determinant of spoken language comprehension.Standardized assessment and monitoring of spoken language comprehension, language production, speech, and communication of all children with CP, is strongly recommended.When children show below average performances, especially in spoken language comprehension, intervening with speech and language therapy and guidance for parents, is advised.
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Affiliation(s)
- Emma Vaillant
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Johanna J. M. Geytenbeek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Kim J. Oostrom
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - R. Jeroen Vermeulen
- Department of Neurology, School of Mental Health and Neuro Science, Maastricht UMC+, Maastricht, Netherlands
| | - Annemieke I. Buizer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, University of Amsterdam, Amsterdam, Netherlands
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Peter B, Lancaster H, Vose C, Fares A, Schrauwen I, Huentelman M. Two unrelated children with overlapping 6q25.3 deletions, motor speech disorders, and language delays. Am J Med Genet A 2017; 173:2659-2669. [DOI: 10.1002/ajmg.a.38385] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/02/2017] [Accepted: 07/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Beate Peter
- Arizona State University; Tempe Arizona
- Saint Louis University; Saint Louis Missouri
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Chorna O, Hamm E, Cummings C, Fetters A, Maitre NL. Speech and language interventions for infants aged 0 to 2 years at high risk for cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:355-360. [PMID: 27897320 PMCID: PMC5395422 DOI: 10.1111/dmcn.13342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
AIM We evaluated the level of evidence of speech, language, and communication interventions for infants at high-risk for, or with a diagnosis of, cerebral palsy (CP) from 0 to 2 years old. METHOD We performed a systematic review of relevant terms. Articles were evaluated based on the level of methodological quality and evidence according to A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS The search terms provided 17 publications consisting of speech or language interventions. There were no interventions in the high level of evidence category. The overall level of evidence was very low. Promising interventions included Responsivity and Prelinguistic Milieu Teaching and other parent-infant transaction frameworks. INTERPRETATION There are few evidence-based interventions addressing speech, language, and communication needs of infants and toddlers at high risk for CP, and none for infants diagnosed with CP. Recommendation guidelines include parent-infant transaction programs.
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Affiliation(s)
- Olena Chorna
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Ellyn Hamm
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Caitlin Cummings
- Division of Clinical Therapies, Department of Speech-Language Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Ashley Fetters
- Division of Clinical Therapies, Department of Speech-Language Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Nathalie L Maitre
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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