Development and testing of the eye-pointing classification scale for children with cerebral palsy
Michael T Clarke1, Jenefer Sargent2, Rosemary Cooper1
1Department of Language and Cognition, University College London, London, UK.
Insights
A new Eye-pointing Classification Scale (EpCS) was developed to describe looking behaviors in children with cerebral palsy. The scale demonstrated excellent reliability and identified links between motor and language abilities and eye-pointing classification.
Area of Science:
- Rehabilitation science
- Clinical assessment
- Assistive technology
Background:
- Non-speaking children with severe cerebral palsy often use eye-pointing for communication.
- There is a lack of consensus on classifying these looking behaviors.
- A standardized tool is needed for clinical management and research.
Purpose of the Study:
- To develop and validate the Eye-pointing Classification Scale (EpCS).
- To describe looking behaviors (gaze fixations, gaze shifts) related to eye-pointing.
- To assess the reliability and clinical utility of the EpCS.
Main Methods:
- The scale was developed in two phases: initial drafting and multi-disciplinary review, followed by expert evaluation.
- Scale reliability and relationships with child characteristics were examined in Phase 2.
- Established procedures for scale construction and evaluation were followed.
Main Results:
- The Eye-pointing Classification Scale (EpCS) was refined through international evaluation.
- The scale demonstrated excellent reliability in clinical testing.
- Significant relationships were found between motor ability, language understanding, and EpCS classification.
Conclusions:
- The Eye-pointing Classification Scale (EpCS) is a robust new tool for assessing eye-pointing behaviors.
- The EpCS can aid in the clinical management and research of children with cerebral palsy.
- The scale helps standardize the description of looking behaviors for communication in this population.
Purpose:
The aim of this study was to develop and test a new classification scale to describe looking behaviours (gaze fixations and gaze shifts) in relation to eye-pointing.
Methods:
The Eye-pointing Classification Scale (EpCS) was developed and tested following established procedures for the construction and evaluation of equivalent scales, and involved 2 phases: Drawing on research literature, Phase 1 involved initial drafting of the scale through a series of multi-disciplinary group discussions; evaluation of the scale through a survey procedure, and subsequent expert group evaluation. Phase 2, was an examination of scale reliability and relationships between child characteristics and level of EpCS classification.
Results:
In Phase 1, an initial draft of the scale was developed and then evaluated by 52 participants in 10 countries, leading to its refinement. Subsequent expert evaluation of content, style and structure indicated that no further refinement was required. In Phase 2, the scale achieved excellent levels of reliability in clinical testing. A significant relationship was identified between level of child motor ability and EpCS classification, and level of child language understanding and EpCS classification.Implications for rehabilitationNon-speaking children with severe bilateral cerebral palsy who have limited upper limb movement may communicate by using controlled looking behaviours to point to objects and people, referred to as eye-pointing.However, there is little consensus as to which looking behaviours represent eye-pointing and which do not.The Eye-pointing Classification Scale (EpCS) was developed to describe looking behaviours related to eye-pointing in this population of childrenThe EpCS provides a new robust tool for clinical management and research with children with cerebral palsy.
