Bringing the Computer-Based Instrument for Low Motor Language Testing to Canada: A Survey of Caregiver and Clinician Perspectives.

backgroundAccurate assessment of language comprehension is crucial to positive outcomes for children with cerebral palsy (CP) but is difficult for those with significant speech and physical impairments (SSPI). Standardized tools that typically require these children to speak, vocalize or select directly pose particular challenges.

aimTo describe Canadian caregivers' and clinicians' language comprehension assessment experiences and needs for children with CP and SSPI prior to soliciting feedback to advance the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), a standardized and accessible tool designed specifically for these children. METHODS AND PROCEDURES: Recruiting from Canadian children's treatment centres, augmentative and alternative communication clinics, and via social media, we conducted an environmental scan of caregivers of and clinicians providing services to children with CP and SSPI. Surveys designed using the Knowledge to Action Framework solicited both quantitative and qualitative data, summarized using descriptive statistics and inductive content analysis, respectively. OUTCOMES AND

resultsTwenty-two caregivers (21 females, 1 male; mean age = 42 years) and 39 clinicians (36 females, 3 males; mean age = 41 years) from 7 Canadian provinces completed the survey. Most caregivers had experienced language comprehension assessment but were typically only 'somewhat confident' in the results, despite considering accuracy 'very important.' Most clinicians were involved in language comprehension assessment and overwhelmingly relied on non-standardized tools despite feeling at best 'fairly confident' in their results. Qualitative comments indicated the utility of a population-specific test/testing procedures and/or associated normative data to complement non-standardized tools. Participants indicated that the C-BiLLT-CAN could be improved by expanding available response methods and supporting visual and auditory access modifications to promote customization. Anticipated benefits of the C-BiLLT-CAN included improved interaction with, participation for, and understanding of the abilities of children with CP and SSPI; and improved interventions and outcomes for these children and their families. CONCLUSIONS AND IMPLICATIONS: The C-BiLLT-CAN could fill a critical gap in services available to Canadian children with CP and SSPI. Caregivers and clinicians recognized the benefits of incorporating a reliable and valid standardized tool as part of a comprehensive language comprehension assessment battery for this population but valued additional response methods and features to support access and implementation. Integration of the additional response methods and customization options recommended by end users is expected to further increase the usefulness and feasibility of the C-BiLLT-CAN in the Canadian clinical context. WHAT THIS PAPER ADDS: What is already known on this subject Accurate assessment of language comprehension is crucial to positive outcomes for children with cerebral palsy (CP), but is especially difficult for those with significant speech and physical impairments (SSPI). Standardized tools that typically require these children to speak, vocalize or select directly pose particular challenges. What this paper adds to existing knowledge This environmental scan describes Canadian caregivers' and clinicians' language comprehension assessment experiences and needs for children with CP and SSPI and solicits feedback to advance the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), a standardized and accessible language comprehension assessment tool designed specifically for these children. What are the potential or actual clinical implications of this work? With the incorporation of an expanded breadth of response methods and customization options, the C-BiLLT-CAN could fill a critical gap in services available to Canadian children with CP and SSPI. Caregivers and clinicians recognize the benefits of incorporating a reliable and valid standardized tool along with commonly used non-standardized techniques as part of a comprehensive language comprehension assessment battery for this population.