Communication activity and participation research

Participation and communication are components of the International Classification of Functioning, Disability, and Health (ICF) framework. ‘Participation’ is involvement in daily life. Communication, listed as an ICF ‘activity’, includes sending and receiving messages (e.g. speaking, listening, reading, writing, and using augmentative and alternative communication). Adequate communication is essential to participate in many activities at home and in the community. However, the role of communication will vary by participation type, body structure ⁄ function requirements, potentially co-occurring activities, and contextual factors including settings and any communication partners. For example, minimal communication performance may be needed to participate in solitary leisure activities such as playing with a pet or completing a jigsaw puzzle. A person with communication challenges may be able to participate in life situations with familiar communication partners such as family and friends but not with unfamiliar communication partners. In contrast, skilled communication performance is needed in many school classes, vocations, and social leisure activities. For example, to participate in a science class, a student may need to move concurrently between laboratory stations, manipulate laboratory supplies, learn new concepts, and communicate verbally and ⁄or in writing. Voorman et al. note the unclear relationship between communication and social functioning, and participation of pre-adolescents and adolescents with cerebral palsy (CP). They explored associations between communication and social functioning and ICF body characteristics, mobility activity level, and contextual factors. Voorman et al. should be commended for grappling with these complex interactions. However, their results are limited by the choice of the Communication and the Socialization domains of the Vineland Adaptive Behavior Scales (VABS) as the measures of communication and social functioning. The VABS domain scores include questions regarding ICF body function areas of speech and expressive and receptive language skills. Some VABS questions, such as using a dictionary, a book’s index, or table of contents, and writing in cursive, may not be critical to the ICF communication concept. Few tools are available either to classify or assess communication at the ICF levels of activity or participation. At least six possible body function and structure impairment areas – voice, articulation, language, cognitive, fluency (e.g. stuttering), and hearing – may restrict communication activities and participation. Speech and language pathologists and audiologists often use a battery of assessments and outcomes to document body structure and function and communication levels. My colleagues and I are finalizing the Communication Function Classification System (CFCS) for individuals with CP, complementary to the Gross Motor Function Classification (GMFCS) and the Manual Ability Classification System (MACS). The CFCS classifies communication effectiveness by one’s performance of sending and receiving messages with familiar and unfamiliar communication partners. ‘Communicative participation’ has been defined as taking part in life situations where knowledge, information, ideas, or feelings are exchanged. It may take the form of speaking, listening, reading, writing or nonverbal means of communication . A communicative participation outcome measure is under construction for individuals with multiple sclerosis. A similar measure may be possible to use with adolescents and adults who have CP. Raghavendra et al. looking at a similar age range as Voorman et al., compared the participation and communicative participation of three groups: (1) people with communication