ACQ Vol 13 no 2 2011

Assessment

Assessing speech and language in children with cerebral palsy A holistic approach Cristina Mei, Angela T. Morgan, and Sheena Reilly

Assessing the communicative abilities of children with cerebral palsy (CP) can be challenging. In addition to the physical impairments, children can present with a range of co-morbid conditions (e.g., cognitive, hearing, and visual impairments) that impact on speech and language development. A holistic approach to assessment is necessary to identify and reduce functional communication impairments. An overview is provided of how the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework can be used to guide the assessment of speech and language in children with CP. Issues that may arise during the assessment of each ICF-CY component are discussed. I t is widely acknowledged that communication impairments (i.e., those affecting speech and/or language) are common in children with cerebral palsy (CP) (Achilles, 1955; Parkes, Hill, Platt, & Donnelly, 2010). Much of the research available concerning the speech and language abilities of children with CP has focused at the impairment level. In comparison, relatively few studies have investigated the functional communicative abilities of children with CP (e.g., how children are able to use speech and language within their natural environments). The lack of available assessments measuring the functional impact of speech and language impairments (McLeod & Threats, 2008) may in part explain the paucity of research in this area. Given the dearth of assessments presently available, speech pathologists may turn to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY; WHO, 2007) to classify speech and language deficits both at an impairment and at a functional level. The ICF-CY The ICF-CY provides health professionals with a holistic view of a child. This is often not provided by commonly used speech and language assessments which are typically directed towards the impairment level. The ICF-CY is made

up of two parts: Part 1: Functioning and Disability consists of sections on Body Functions, Body Structures, and Activities and Participation; Part 2: Contextual Factors covers Environmental and Personal Factors. Each component is relevant to the field of speech pathology and to children with CP. Qualifiers are used at each level of the ICF-CY to classify the severity of the impairment or problem (i.e., no problem, mild, moderate, severe, or complete problem). While the application and importance of the ICF in the field of speech pathology has been well highlighted (e.g., Howe, 2008; McLeod & Bleile, 2004; Raghavendra, Bornman, Granlund, & Bjorck-Akesson, 2007), a survey conducted by McLeod (2004) involving 199 speech pathologists found that over 80% of those surveyed based their diagnosis of a speech impairment at the Body Functions level, with less than 10% of participants considering the child’s more functional abilities at an Activities and Participation level (McLeod & Threats, 2008). This reliance on the impairment level by speech pathologists is also noted by Thomas-Stonell, Oddson, Robertson, and Rosenbaum (2009) who found that parents were more likely to report Participation Restrictions and negative Personal Factors than speech pathologists. The following section provides an overview of how the components of the ICF-CY can be applied to the clinical assessment of speech and language in children with CP, enabling a holistic approach to management. Components Body functions Body Functions refers to the “physiological functions of body systems” (WHO, 2007, p. 45), and is largely considered to focus on the impairment level of speech and language function, which is traditionally used to identify speech and language deficits. The ICF-CY chapters Voice and speech functions (e.g., vocal quality and articulation) and Mental functions (e.g., comprehension and production of spoken, sign, and gestural language) are arguably most pertinent to speech pathologists for documenting the presence or absence of speech and language impairments, although other chapters should also be taken into consideration to document co-morbid conditions. Further relevant chapters include Sensory functions and pain (for hearing and vision impairments); Functions of the cardiovascular, haematological, immunological and

Keywords ASSESSMENT CEREBRAL

PALSY ICF-CY LANGUAGE SPEECH

This article has been peer- reviewed

Cristina Mei

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ACQ Volume 13, Number 2 2011

ACQ uiring Knowledge in Speech, Language and Hearing