Eina! Ouch! Eish! Professionals’ Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

Figures & data

Table I. Characteristics of the participants and their schools.

	School A	School B	School C	School D	School E
Type of school
Government school	X	X	X	X	X
School for specialized education	X	X	X	X	X
Ages of children
Younger than 6;0 (year;months)		X		X	X
6;0–9;11		X	X	X	X
10;0–12;11		X	X	X	X
13;0–15;0	X	X	X	X	X
16;0–18;0	X	X	X	X	X
18;0–21;11	X	X		X	X
Distribution of children
No. of children in school	506	403	329	372	270
Maximum children per class	14	16	12	12	15
No. of children with CP	16	106	126	241	100
Percentage of children with CP	3%	26%	38%	65%	37%
Skill levels of children
Gross motor skills level according   to GMFCS-E&R	Range from Level I–V	Range from Level I–V	Range from Level I–V	Range from Level I–V	Range from Level I–V
Hostel
Availability	Yes	Yes	No	Yes	No
No. of children in hostel	506	23	0	102	0
Proportion of children in hostel	100%	6%	—	27%	—
Staff
No. of teachers in the school	53	49	28	34	20
No. of children/teacher	9.5	8.2	11.8	10.9	13.5
No. of class assistants per class	0	2	0.33	1 - 2	1
No. of clinicians in school	7	21	6	?	8
No. of children/clinician	72.3	19.2	54.8	?	33.8
Type of clinician
Audiologist	X			X
Nurse	X	X	X	X	X
Occupational therapist	X	X	X	X	X
Physiotherapist	X	X	X		X
Psychologist		X		X
Psychometrist		X
Social worker	X	X	X
Speech language therapist	X	X	X	X
Other support disciplines	Orthotics prosthetics	Orthopedic surgeons, GP, pediatrician, seating expert, orthotist	ENT, orthopedic surgeon, plastic surgeon	Pediatric and orthopedic surgeon	Orthopedic surgeons, speech therapy students, oral hygiene students

CP, cerebral palsy; GMFCS-E&R, Gross Motor Functional Classification System Expanded and Revised; GP, general practitioner (medical doctor); ENT, ear, nose, and throat surgeon.

Table II. Coding categories and subcategories of professional observations that children with cerebral palsy were in pain.

Main category	Subcategory
Bodily expressions	Physiological effects Unintentional facial changes Positioning
Behavioral changes	Altered participation Clown behavior Escape
Message	Non-verbal Spoken Use of devices

Table III. Coding categories and subcategories of professional methods for communicating about pain with children.

Main category	Subcategory
Verbal questions	General questions Specific questions Clarifying questions
Symbols	Drawings Communication boards with mainly body parts
Pain scale	Faces pain scales No pain scale

Table IV. Coding categories and subcategories of methods used by children to communicate pain.

Main category	Subcategory
Verbal expressions	Vocalizations Words Phrases Talk about something else
Non-verbal communication	Intentional facial expressions No complaints
AAC strategies	Communication boards Drawings/symbols Spoken Speech generating devices Computer