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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.

Background: Limited research exists to guide clinical decisions about trialling, selecting, implementing and evaluating eye-gaze control technology. This paper reports on the outcomes of a Delphi study that was conducted to build international stakeholder consensus to inform decision making about trialling and implementing eye-gaze control technology with people with cerebral palsy., Methods: A three-round online Delphi survey was conducted. In Round 1, 126 stakeholders responded to questions identified through an international stakeholder Advisory Panel and systematic reviews. In Round 2, 63 respondents rated the importance of 200 statements generated by in Round 1. In Round 3, 41 respondents rated the importance of the 105 highest ranked statements retained from Round 2., Results: Stakeholders achieved consensus on 94 of the original 200 statements. These statements related to person factors, support networks, the environment, and technical aspects to consider during assessment, trial, implementation and follow-up. Findings reinforced the importance of an individualised approach and that information gathered from the user, their support network and professionals are central when measuring outcomes. Information required to support an application for funding was obtained., Conclusion: This Delphi study has identified issues which are unique to eye-gaze control technology and will enhance its implementation with people with cerebral palsy.

This study evaluated the effects of a conversation-based intervention on the use of verbs, personal pronouns, bound morphemes and spontaneous clauses in adolescents with cerebral palsy who use augmentative and alternative communication (AAC). Four teenage girls aged from 14 to 18 years participated in the study. After a baseline period, a conversation-based intervention was provided for each participant in the context of a personal collage-building activity. The conversations were videotaped, transcribed, and analyzed using the Systematic Analysis of Language Transcripts (SALT™) . While the results are mixed, all four participants increased their use of at least one linguistic target, three increased their use of verbs and grammatically correct spontaneous clauses, two increased their use of personal pronouns, and one produced more bound morphemes during intervention than in baseline. These findings, and future research needs, are discussed.

Children with a clinical description of cerebral palsy (CP) commonly experience cognitive and sensory difficulties that co-occur with motor impairment, and for some children this can include impairments in social communication. While research has begun to examine theory of mind abilities in children with CP, relatively little is known about social communication difficulties in this population. Assessing theory of mind abilities in children with CP using traditional procedures such as the classic Sally-Anne task can be problematic if performance is affected by physical difficulties in signalling responses and/or by cognitive and language demands inherent to the task itself. The central aim of this study therefore was to examine the potential of using a new action anticipation task and eye-tracking technique to assess implicit true and false belief understanding in four developmentally young children with quadriplegic cerebral palsy who had little or no functional speech, and one language age matched child with Down syndrome who did not have severe motor impairment. All children in this study consistently demonstrated anticipatory gaze behaviours in the context of the true belief task. One child with CP and the child with Down syndrome demonstrated anticipatory gaze behaviours indicative of an ability to attribute false belief. The findings are discussed in relation to the application of action anticipation and eye-tracking paradigms in research and clinical practice., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The present study investigated the effects of different types of recasts and prompts on the rate of repair and spontaneous use of novel vocabulary by eight children with severe motor speech disabilities who used speech-generating technologies to communicate. Data came from 60 transcripts of clinical sessions that were part of a conversation-based intervention designed to teach them pronouns, verbs, and verb inflections. The results showed that, when presented alone, interrogative choice and declarative recasts led to the highest rates of child repair. The results also showed that when children were presented with recasts and prompts to repair, the rate of repair increased. Spontaneous use of linguistic targets was significantly and positively related to conversational sequences where the adult recast was followed by child repair. These findings suggest that using different recast types and prompts to repair may be beneficial for spontaneous use of linguistic targets in this population.

Purpose: Little is known about how children learn to control eye-gaze technology, and clinicians lack information to guide decision-making. This paper examines whether typically developing 2–3 year olds can infer for themselves the causal mechanisms by which eye-gaze technology is controlled, whether a teaching intervention based on causal language improves performance and how their performance compares to the same task accessed via a touchscreen. Methods and materials: Typically developing children's (n = 9, Mean Age 28.7 months) performance on a cause and effect game presented on eye-gaze and touchscreen devices was compared. The game was presented first with no specific instruction on how to control the devices. This was followed by a subsequent presentation with explicit instruction about how the access methods worked, using a causal language approach. A final presentation examined whether children had retained any learning. Results: Performance in the eye-gaze condition without instruction (42.5% successful trials) was significantly below performance in the corresponding touchscreen condition (75%). However, when causal language instruction was added, performance with both access methods rose to comparable levels (90.7% eye-gaze and 94.6% touchscreen success). Performance gains were not retained post-intervention. Conclusions: Although 2–3 years in the study could make use of eye-gaze technology with support, this study found no evidence that these children could infer the causal mechanisms of control independently or intuitively. The lack of spatial contiguity and the comparative lack of feedback from eye-gaze devices are discussed as possible contributory factors. IMPLICATIONS FOR REHABILITATION: There are challenges in young children inferring for themselves the causal link between eye movements and control of an eye-gaze device. Explicit instruction may improve children's performance in a specific task, but it is debatable whether this translates to the establishment of causal mechanisms for control of the device. Clinicians should be cautious of making assumptions about what children are learning from activities claiming to teach cause and effect or other foundational eye-gaze control skills. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONResearch suggests that rates for autism may be higher in cerebral palsy than in the general population. For those with severe bilateral physical impairment (GMFCS level IV and V) and little or no speech, describing a profile of social communication skills has been difficult because there are currently no assessments for early social communication specifically tailored for these children. Our aim was to explore the assessment of aspects of joint attention and social reciprocity in this group of children with CP.We compared the performance of children with bilateral CP on carefully designed assessments of joint attention and social responsiveness with groups of children with Down syndrome and autism. All three groups were matched for chronological age and mental age.Approximately 30% of the children with bilateral CP had early social communication scores similar to the autistic children. The remaining 70% of children with CP had a range of early social communication scores similar to the children with Down syndrome.It is possible to assess key early social communication skills in non-speaking children with bilateral motor disability. This could provide insights to help clinicians and caregivers as they discuss abilities and explore potential areas for intervention.With carefully designed activities, which do not rely on motor skills or verbal exchanges, it was possible to assess joint attention and social responsiveness skills in a group of non-speaking children with bilateral motor disability.We were able to identify a subgroup of non-speaking children with severe motor disability (approximately 30% of our cohort) whose scores on our assessments were similar to a group of autistic children.The ability to describe key early social communication skills should provide insights to help clinicians and caregivers as they discuss abilities and explore potential areas for intervention.With carefully designed activities, which do not rely on motor skills or verbal exchanges, it was possible to assess joint attention and social responsiveness skills in a group of non-speaking children with bilateral motor disability.We were able to identify a subgroup of non-speaking children with severe motor disability (approximately 30% of our cohort) whose scores on our assessments were similar to a group of autistic children.The ability to describe key early social communication skills should provide insights to help clinicians and caregivers as they discuss abilities and explore potential areas for intervention. [ABSTRACT FROM AUTHOR]

This paper explores whether a structured history-taking tool yields useful descriptions of children's looking skills. Parents of 32 children referred to a specialist communication clinic reported their child's looking skills using the Functional Vision for Communication Questionnaire (FVC-Q), providing descriptions of single object fixation, fixation shifts between objects and fixation shifts from object to person. Descriptions were compared with clinical assessment. 24/32 children were reported to have some limitation in fixation. Limitation was subsequently seen in 30/32 children. Parental report and assessment agreed fully in 23/32 (72%). The largest area of discrepancy was object-person fixation shifts, with five children not observed to show this behavior despite its being reported. Findings indicate a structured questionnaire yields description of fixations, which correspond well with clinical assessment. Descriptions supported discussion between parents and clinicians. It is proposed that the FVC-Q is a valuable tool in supporting clinicians in eliciting information about fixation skills. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of a conversation-based intervention on the use of verbs, personal pronouns, bound morphemes and spontaneous clauses in adolescents with cerebral palsy who use augmentative and alternative communication (AAC). Four teenage girls aged from 14 to 18 years participated in the study. After a baseline period, a conversation-based intervention was provided for each participant in the context of a personal collage-building activity. The conversations were videotaped, transcribed, and analyzed using the Systematic Analysis of Language Transcripts (SALT™). While the results are mixed, all four participants increased their use of at least one linguistic target, three increased their use of verbs and grammatically correct spontaneous clauses, two increased their use of personal pronouns, and one produced more bound morphemes during intervention than in baseline. These findings, and future research needs, are discussed. [ABSTRACT FROM AUTHOR]