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Assessment
68
ACQ
Volume 13, Number 2 2011
ACQ
uiring Knowledge in Speech, Language and Hearing
Cristina Mei
This article
has been
peer-
reviewed
Keywords
ASSESSMENT
CEREBRAL
PALSY
ICF-CY
LANGUAGE
SPEECH
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
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
Assessing speech and
language in children
with cerebral palsy
A holistic approach
Cristina Mei, Angela T. Morgan, and Sheena Reilly