ACQ Vol 13 no 2 2011

Body structures The Body Structures component of the ICF-CY is closely related to the Body Functions level as it identifies structural deficits underlying the physiological impairments. Body Structures is defined as the “anatomical parts of the body such as organs, limbs, and their components” (WHO, 2007, p. 107). An example of this relating to children with CP includes large ranges of jaw movement and impaired velopharyngeal closure (Kent & Netsell, 1978). Chapters within this component relevant to children with CP include Structures involved in voice and speech (e.g., hard/soft palate, tongue, lips); Structures of the nervous system (e.g., basal ganglia, cerebellum); The eye, ear and related structures (e.g., middle/inner ear); Structures of the cardiovascular, immunological and respiratory systems (e.g., muscles of respiration); Structures related to the digestive, metabolic and endocrine systems (e.g., salivary glands, oesophagus); and Structures related to movement (e.g., muscles of the head and neck region, structure of the trunk). The qualifiers used at the Body Functions level also apply to the Body Structures component to indicate the severity of the impairment. Two additional qualifiers may also be used at this level: one uses a 10-point scale to indicate the nature of the change in the body structure (e.g., no change in structure, partial absence, deviating position), while the remaining qualifier can be used to indicate the location of the impairment (e.g., right, left, or bilateral). Considering that up to 90% of children with CP demonstrate oral motor impairments (Reilly, Skuse, & Poblete, 1996), assessment of the oral structures at rest and during movement is an important component of the clinical assessment of children. Children with sufficient cognitive abilities may be able to complete commonly used standardised oral motor assessments such as the Verbal Motor Production Assessment for Children (Hayden & Square, 1999). Formally assessing the oral motor abilities of children with severe intellectual disabilities may be difficult and speech pathologists may need to rely on informal observations of the child at rest and during feeding. Activities and participation While Body Functions and Structures address the impairment level, the Activities and Participation component aims to identify possible limitations or restrictions in the child’s ability to function. The ICF-CY defines Activities as the “execution of a task or action by an individual” (WHO, 2007, p. 9), while Participation relates to a child’s “involvement in a life situation” (WHO, 2007, p. 9). All of the Activity and Participation domains are important to consider for children with CP with a speech and/ or language impairment. These include Learning and applying knowledge (e.g., thinking and problem-solving skills); General tasks and demands (e.g., performing single/multiple tasks, following routines); Communication (e.g., receiving and producing spoken and nonverbal messages), Mobility (e.g., gross and fine motor skills); Self-care (e.g., eating and drinking); Domestic life (e.g., maintaining assistive devices); Interpersonal interactions and relationships (e.g., interacting with family members and peers); Major life areas (e.g., engagement in play and school activities); and Community, social and civic life (e.g., engagement in community activities). Due to poor consensus in differentiating between domains relating to Activities versus Participation (WHO,

respiratory systems (to document deficits in respiration for speech); Functions of the digestive, metabolic and endocrine systems (for recording feeding/swallowing impairments and excessive drooling); and Neuromusculoskeletal and movement related functions (for classifying the physical abilities of children). The following qualifiers are used to classify the severity of an impairment at the Body Functions level: 0: no impairment; 1: mild impairment; 2: moderate impairment; 3: severe impairment; and 4: complete impairment (WHO, 2007). When determining the most appropriate speech and/ or language assessment to administer to a child, speech pathologists must take into consideration the child’s motor, cognitive, visual, hearing, and communicative abilities. Commonly used articulation assessments may be administered (where appropriate) with no motor modifications, although visual modifications (e.g., positioning test stimuli close to the child’s face) may be necessary in some cases. Formally assessing the language abilities of children with impaired upper limb function may prove to be more difficult considering the high reliance on fine motor movements (e.g., object manipulation, pointing) to indicate responses. Hustad, Gorton, and Lee (2010) reported that only 32% (11/34) of their sample involving children aged four years with varying types and severity of CP were able to complete a standardised comprehension assessment. Yet Love, Hagerman, and Taimi (1980) found that most children and adults (i.e., 78%, 47/60) aged 3 to 26 years, who varied in gross motor abilities, were able to complete the Peabody Picture Vocabulary Test (Dunn, 1965). Even if a child is capable of completing standardised assessments, establishing the reliability of a child’s score may be complicated by difficulties in determining whether a child’s inability to respond to a task represents a true receptive language deficit or reflects a child’s inability to execute the physical component of the task (Hustad et al., 2010). Unfortunately, commonly used language assessments are not specifically designed to be used with children with physical impairments. Modifications to assessment procedures are often necessary for children with severe speech and physical impairments. Results obtained using adapted procedures need to be interpreted with caution, however, as they may alter the psychometric properties of the assessment, reduce the child’s motivation (Geytenbeek et al., 2010), and increase the cognitive load of the task (Pennington, 2008). Recently, Geytenbeek et al. (2010) conducted a systematic review to determine the most appropriate comprehension test to use with children with CP who demonstrate severe dysarthria (defined as unintelligible speech) or anarthria (i.e., the absence of speech). The authors reviewed 12 standardised tests and found that no test was sufficiently suitable to use with this population. Of the tests reviewed, the Peabody Picture Vocabulary Test – Revised (Dunn & Dunn, 1981) was the most commonly used instrument and most feasible to administer to children over 9 years of age, although it may be used with younger children provided that modifications are made for those with reduced upper limb mobility. The authors concluded that there was a need for the development of an assessment measuring comprehension specifically designed for children with severe CP and dysarthria or anarthria (Geytenbeek et al., 2010).

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ACQ Volume 13, Number 2 2011

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