Provision of augmentative and alternative communication interventions to Norwegian preschool children with cerebral palsy: are the right children receiving interventions?

Figures & data

Figure 1. Participants included in study (N = 95).

Table 1. Characteristics of 95 children included and 35 children not included in the study.

Characteristics	Participants (n = 95)		Non-participants (n = 35)
	n	%	n	%
Sex
Female	42	(44.2)	15	(42.9)
Male	53	(55.8)	19	(54.3)
Age distribution
13–24 months	6	(6.3)	2	(5.7)
25–36 months	35	(36.8)	11	(31.4)
37–61 months	54	(56.8)	22	(62.9)
CP subtype
Spastic unilateral	44	(46.3)	23	(65.7)
Spastic bilateral	45	(47.4)	10	(28.6)
Dyskinetic and ataxic	5	(5.3)	2	(5.8)
Not classified	1	(1.1)	0	(0)
Gross Motor Function Classification System (GMFCS) levels
I	42	(44.2)	19	(54.3)
II	15	(15.8)	9	(25.7)
III	13	(13.7)	3	(8.6)
IV	15	(15.8)	3	(8.6)
V	9	(9.5)	0	(0)
Not classified	1	(1.1)	1	(2.9)
Manual Ability Classification System (MACS) levels
I	21	(22.1)	9	(25.7)
II	41	(43.2)	23	(65.7)
III	19	(20.0)	1	(2.9)
IV	5	(5.3)	2	(5.7)
V	8	(8.4)	0	(0)
Not classified	1	(1.1)	0	(0)
Communication Function Classification System (CFCS) levels
I	29	(30.5)	N/A
II	14	(14.7)	N/A
III	16	(16.8)	N/A
IV	16	(16.8)	N/A
V	4	(4.2)	N/A
Not classified	16	(16.8)
Viking Speech Scale (VSS) levels
I	24	(30.8)	N/A
II	21	(26.9)	N/A
III	12	(15.4)	N/A
IV	6	(7.7)	N/A
Not classified or missing data	32	(33.7)
Vision (n = 92, 29)
Yes	26	(28.3)	7	(24.1)
No	50	(54.3)	18	(62.1)
Unknown	16	(17.4)	4	(13.8)
Cognitive impairments (n = 83, 29)
Yes	14	(16.9)	2	(6.9)
No	39	(47.0)	20	(69.0)
Unknown	30	(36.1)	7	(24.1)
Epilepsy (n = 93, 31)
Yes	17	(18.3)	4	(12.9)
No	72	(77.4)	27	(87.1)
Unknown	4	(4.3)	0	(0)

N/A: not available

Table 2. Description of Communication Function Classification System and Viking Speech Scale.

The five levels of the communication Function Classification System (CFCS)		The four levels of Viking Speech Scale (VSS)
I	Effective sender and receiver with familiar and unfamiliar partners.	I	Speech is not affected by motor disorder.
II	Effective but slower paced sender and/or receiver with familiar and unfamiliar partners.	II	Speech is imprecise but usually understandable to unfamiliar listeners.
III	Effective sender and receiver with familiar partners.	III	Speech is unclear and not usually understandable to unfamiliar listeners out of context
IV	Sometimes effective sender and receiver with familiar partners.	IV	No understandable speech.
V	Seldom effective sender and receiver with familiar partners.

Figure 2. Children’s need of augmentative and alternative communication (AAC)¹ (n = 95), based upon classification on Communication Function Classification System (CFCS) and Viking Speech Scale (VSS), and provision of a communication aid (n = 14). ¹Need for AAC was defined as a classification at CFCS Levels III–V without simultaneous classification at VSS Level I, and/or classification at VSS Levels III–IV.

Table 3. Distribution of children classified with Communication Function Classification System (CFCS) in relation to their age.

CFCS level	Age group
	15–24 months	25–36 months	37–61 months	Total
I	1	9	19	29
II	1	5^a	8^a	14
III	1	6^a	9^a	16
IV	2^a	9^a	5^b	16
V	0	3^a	1^a	4
Total	5	32	42	79

^aOne child (in relevant age group/CFCS level) had received a communication aid.

^bThree children (in the relevant age group/CFCS level) had received communication aids.

Table 4. Distribution of children (n = 53) classified with Communication Function Classification System (CFCS) and Viking Speech Scale (VSS), children provided with a communication aid and defined as in need of augmentative and alternative communication (AAC).

CFCS Level	VSS Level
	I	II	III	IV	Total
I	15	4	0	0	19
II	1a	6	2	0	9
III	2	4^a	5	1^a	12
IV	0	5^a	4	2	11
V	1	0	0	1^a	2
Total	19	19	11	4	53

^aOne child (at the relevant CFCS/VSS level) had received a communication aid; Grey area indicates children defined as being in need of AAC (i.e., the 24 children classified at CFCS Levels III–V and not simultaneously at VSS level I, and/or classified at VSS Levels III–IV)

Table 5. Provision, frequency, setting, and child benefits of AAC interventions.

Items		Parents of participants (n = 95)		Parents of participants who had received communication aids^a (n = 14)
		n	(%)	n	(%)
AAC training provided to child
	Yes	37	(39)	12	(86)
	No	56	(59)	2	(14)
	Missing response	2	(2)	0	(0)
Frequency of AAC training and AAC use^b
	1–2 times pr week	4	(11)	1	(7)
	3–5 times pr week	4	(11)	0	(0)
	6–7 times pr week	4	(11)	1	(7)
	Several times daily	21	(57)	10	(71)
	Do not know/missing	4	(11)	2	(14)
Setting of AAC use^b,^c
	Home	27	(73)	10	(71)
	Kindergarten	35	(95)	12	(86)
	Habilitation unit	3	(8)	2	(14)
	Swimming pool	3	(8)	0	(0)
	Other	1	(3)	0	(0)
Child benefits of AAC^b
	Unsure/no/small	16	(43)	4	(29)
	Large/very large	20	(54)	8	(57)
	Missing response	1	(3)	2	(14)

^aCommunication aids include both low-tech/high-tech digital devices and communication books.

^bResponses from parents of children who had received AAC training (n = 37) or a communication aid (N = 14).

^cMore than one box could be checked for this item.

Table 6. Associations between receiving an AAC intervention and characteristics of the child and parent’s education.

Characteristics of child and parent	n	Symmetric measure	p
Child characteristics
Manual Ability Classification System (MACS)^a	93	0.302^d	.007*
Cognitive impairment	83	0.183^e	.250
Epilepsy	93	0.428^e	<.001*
Visual impairment	92	0.207^e	.140
Viking Speech Scale (VSS)^b	63	0.250^d	.090
Communication Function Classification Scale (CFCS)^c	78	0.327^d	.035*
Parent characteristics
Mothers’ education	92	−0.130^d	.999
Fathers’ education	84	0.146^d	.260

^aCollapsed variable MACS (I–II, III–V).

^bCollapsed variable VSS (I–II, III–IV).

^cCollapsed variable CFCS (I–II, III–V).

^dPhi coefficient value used for 2 × 2 table.

^eCramer’s V used for 2 × 3 tables.

*p < 0.05 (2- tailed)

Table 7. Association between child characteristics and the likelihood of parents to report receiving an AAC intervention.^a

Characteristics			95% CI
	n	Odds ratio	Lower	Upper	p
Age (months)	95	0.96	0.91	1.01	.08
Epilepsy
No	72	1.0
Yes	17	8.85	2.14	36.53	.01*
Manual Ability Classification System (MACS) level
I–II	57	1.0
III–V	32	3.39	1.18	9.70	.02*

^aParents of 39 children reported “yes” and parents of 55 children reported “no.”

*p < 0.05