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NINDS CDE Notice of Copyright
Communication Function Classification System (CFCS)
Availability
Please visit this website for more information about the instrument:
OR
Please email the author for information about obtaining the instrument: Dr. Mary Jo Cooley Hidecker, maryjocooleyhidecker@uwyo.edu.
 
Classification
Supplemental – Highly Recommended: Cerebral Palsy (CP)
 
Short Description of Instrument
The Communication Function Classification System (CFCS) is a standardized system (Level I being most function to Level V being least functional) to classify communication function of children with Cerebral Palsy (CP) aged 2 to 18 years based on observation and experience with a child's communication with familiar and unfamiliar communication partners. The CFCS also lists communication methods used by the child. The CFCS has been included as part of a functional profile along with mobility Gross Motor Function Classification Scale (GMFCS) and hand function Manual Ability Classification System (MACS) classification.
 
Inter-rater reliability among professionals for scoring the CFCS level range from good (weighted kappa = .66) to excellent (weighted kappa= .98) (Hidecker et al., 2011; Himmelmann, Lindh,& Hidecker, 2013; Randall et al., 2013). The reliability of CFCS levels between professionals and parents ranged from moderate (weighted kappa = .49) to excellent (weighted kappa = .91) (Hidecker et al., 2011; Mutlu et al., 2013). Hidecker et al. (2011) demonstrated the CFCS had good test-retest reliability (weighted kappa = 0.82).
Comments/Special Instructions
Determining the CFCS level does not require testing, nor does it replace standardized communication assessments. The CFCS is not a test. The CFCS groups people by the effectiveness of current communication performance. It does not explain any underlying reasons for the degree of effectiveness such as cognitive, motivational, physical, speech, hearing, and/or language problems. The CFCS does not rate the person’s potential for improvement. The CFCS may be useful in research and service delivery, when classifying communication effectiveness is important. Examples include:
1) describing functional communication performance using a common language among professionals and laypersons,
2) recognizing the use of all effective methods of communication including AAC,
3) comparing how different communication environments, partners, and/or communication tasks might affect the level chosen,
4) choosing goals to improve the person’s communication effectiveness (Hidecker et al., 2011).
Scoring
Level I: Effective sending and receiving with unfamiliar and familiar partners  Level II: Effective, but slower-paced, sending and/or receiving with unfamiliar and familiar partners
Level III: Effective sending and receiving with familiar partners
Level IV: Inconsistent sending and/or receiving with familiar partners
Level V: Seldom effective sending and/or receiving with familiar partners
 
Communication Methods
Regardless of the number of communication methods used, only 1 CFCS level is assigned for the overall communication performance.
 
Communication Method(s) used include:
Speech; Sounds (such as an “aaaah” to get a partner’s attention); Eye gaze, facial expressions, gesturing, and/or pointing (e.g., with a body part, stick, laser); Manual signs Communication book, boards, and/or pictures; Voice output device or a speech-generating device; Other
 
See decision chart (p. 4 in Hidecker et al., 2011).
 
Rationale/Justification
The CFCS categorizes communication at the Activity Level of the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF WHO, 2007) regardless of the underlying speech, language, and/or hearing structures/functions (Rosenbaum et al., 2014). It can be performed quickly in a clinical setting without special equipment and can be performed by a clinical provider or reported by a parent/family member familiar with the child or youth.
 
The CFCS is a useful as part of a person’s ICF Activity Level profile along with mobility (Gross Motor Function Classification System, GMFCS), hand function (Manual Ability Classification System, MACS), and eating/drinking (Eating and Drinking Ability Classification System, EDACS) classifications (Hidecker et al., 2012; Rosenbaum et al., 2014).
References
Hidecker MJ, Paneth N, Rosenbaum PL, Kent RD, Lillie J, Eulenberg JB, Chester K, Jr., Johnson B, Michalsen L, Evatt M, Taylor K. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704–710.
 
Hidecker MJC, Paneth N, Rosenbaum PL, Kent RD, Lillie J, Eulenberg JB, Chester K, Johnson B, Michalsen L, Evatt M, Taylor K. Communication Function Classification System (CFCS) 2011 [cited 2016 6 July]. Available from: http://cfcs.us/wp-content/uploads/2014/02/CFCS_universal_2012_06_06.pdf.
 
World Health Organization. Activity Level of the World Health Organization’s International Classification of Functioning, Disability, and Health Geneva: World Health Organization; 2007 [cited 2016 18 August]. Available from: http://www.who.int/classifications/icf/en/.
 
Other References:
 
Hidecker MJ, Ho NT, Dodge N, Hurvitz EA, Slaughter J, Workinger MS, Kent RD, Rosenbaum P, Lenski M, Messaros BM, Vanderbeek SB, Deroos S, Paneth N. Inter-relationships of functional status in cerebral palsy: analyzing gross motor function, manual ability, and communication function classification systems in children. Dev Med Child Neurol. 2012;54(8):737–742.
 
Himmelmann K, Lindh K, Hidecker MJ. Communication ability in cerebral palsy: a study from the CP register of western Sweden. European J Paediatr Neurol. 2013;17(6):568–574.
 
Mutlu A, Kaya-Kara O, Kerem-Gunel M, Livaneligolu A, Karahan S, Hidecker MJC. (2013). Agreement between parents and clinicians for the Communication Function Classification System (CFCS) of children with cerebral palsy. Dev Med Child Neurol. 2013;55 (s3)(Suppl 3):76.
 
Randall M, Harvey A, Imms C, Reid S, Lee KJ, Reddihough D. Reliable classification of functional profiles and movement disorders of children with cerebral palsy. Phys Occup Ther Pediatr. 2013;33(3):342–352.
 
Rosenbaum P, Eliasson AC, Hidecker MJ, Palisano RJ. Classification in childhood disability: focusing on function in the 21st century. J Child Neurol. 2014;29(8):1036–1045.
 
Virella D, Pennington L, Andersen GL, Andrada Mda G, Greitane A, Himmelmann K, Prasauskiene A, Rackauskaite G, De La Cruz J, Colver A. Classification systems of communication for use in epidemiological surveillance of children with cerebral palsy. Dev Med Child Neurol. 2016;58(3):285–291.
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