Communication Functions and Communicative Behaviours in Children With Cerebral Palsy

Children with cerebral palsy (CP) frequently experience communication difficulties that limit their participation and social interaction. While previous studies have addressed communication in CP, few have systematically examined communication functions and communicative behaviours using the structured framework of the Communication Matrix, particularly in contexts where augmentative and alternative communication (AAC) is underutilized.

This study aimed to examine the communication functions and communicative behaviours of Turkish children with CP using the Communication Matrix and to investigate how these outcomes differ according to levels of gross motor function.

This cross-sectional study included 64 children with CP aged 4-18 years who attended special education and rehabilitation centres in Türkiye. Data were collected using the Communication Matrix, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Viking Speech Scale (VSS) and Communication Function Classification System (CFCS). Descriptive statistics were obtained. Given the violation of normality assumptions, non-parametric analyses (Mann-Whitney U and Kruskal-Wallis tests with Bonferroni correction) were employed to compare communication outcomes across GMFCS levels.

Among communication functions, obtaining and social interaction were the most prominent, while refusal and providing information were less frequently observed. Visual behaviours (41.88%) and conventional gestures (37.75%) were most common, whereas abstract symbols (9.51%), concrete symbols (19.53%) and body movements (13.45%) were less frequently employed. Across GMFCS levels, children at Level V showed significantly lower abstract symbols and language use than those at Levels I-IV (p = 0.003) and also demonstrated markedly lower scores across all communication functions (refusal, obtaining, social interaction, and providing information) compared to Levels I-IV (p < 0.01). Overall communicative competence decreased in parallel with increasing severity of motor impairment.

The findings indicate that children with CP predominantly rely on nonverbal strategies such as gestures and visual behaviours, while symbolic communication is considerably limited, especially among those with severe motor impairments. In addition, communication functions showed a similar pattern: higher-level functions such as providing information were used much less frequently than obtaining or social interaction and all functions declined with increasing GMFCS level. The results underscore the strong link between gross motor functioning and communicative complexity and highlight the importance of early interventions and AAC integration.

What is already known on this subject Children with cerebral palsy (CP) often experience significant communication difficulties that restrict their participation in daily life. Previous research has documented the reliance of children with CP on nonverbal communication modes and the association between motor severity and communication outcomes, but systematic analyses using the structured framework of the Communication Matrix are scarce, particularly in Türkiye where AAC use is limited. What this paper adds to existing knowledge This study systematically examined communicative functions and behaviours in Turkish children with cerebral palsy using the Communication Matrix. The findings showed that obtaining and social interaction were the most frequently observed communicative functions, whereas refusal and providing information were less common. Symbolic communication, particularly abstract symbols and spoken language, was markedly limited, especially among children with severe motor impairments. These results highlight the close association between motor severity and communicative complexity, offering valuable evidence to inform both clinical practice and future research. What are the potential or actual clinical implications of this work? The findings underscore the urgent need to integrate augmentative and alternative communication (AAC) strategies into rehabilitation and educational services in Türkiye. The Communication Matrix is demonstrated as a practical tool for identifying individualized communication targets and monitoring progress, supporting more effective clinical decision-making and intervention planning.