Computer-Based instrument for Low motor Language Testing

Instrument Name: Computer-Based instrument for Low motor Language Testing

Abbreviation: C-BiLLT

Points for Consideration:

If this instrument can be used with other populations with severe motor impairments and AAC then that would be ideal. The alternative methods of response are important for a population whose motor function may be well below their cognitive or communication function.

Description of Tool:

The Computer-Based instrument for Low motor Language Testing is a PerfO developed to assess spoken language comprehension in unintelligible or non-speaking children with (severe) motoric impairment caused by cerebral palsy (CP) aged 1.5-7.0 years. May be used in older children or young adults when intellectual disability is suspected (Communication Disorders, Cerebral Palsy Cerebral Palsy).

Minimum Qualification Required by COA Administrator: MA or BA

Comment:

With its different access methods, the C-BiLLT enables reliable assessments in children with (severe) CP and provides valuable information to optimize the child’s language environment in daily activities and participation. Child responds to oral questions pertaining to visual stimuli presented on a personal computer, by using at least 5 alternative access methods requiring very limited motoric responses:
- touch screen operated by any body part (e.g., hand, foot, nose)
- input switch(es) adjusted to any body part
- child’s own wheelchair head support (used as an input switch)
- eye gaze to the touch screen interpreted by the examiner
- independent eye gaze computer control

Year: 2010

Objective of Development:

To assess spoken language comprehension in unintelligible or non-speaking children with (severe) motoric impairment caused by cerebral palsy (CP)

Population of Development: Age range (therapeutic indication):

1.5-7.0 years; May be used in older children or young adults when intellectual disability is suspected (Communication Disorders, Cerebral Palsy Cerebral Palsy)

Pediatric Population(s) in which COA has been used:

Nervous System Diseases

COA type:

Number of Items 87

Mode of Administration:

Data Collection Mode:

Time for Completion: None identified

Response Scales: Dichotomous: 1 (= correct identification) / 0 (= incorrect identification) Other: number of target objects identified in the pre-test (<5 objects = 0; ≥5 real objects or photographs = 1; ≥5 real objects and photographs = 2); if pre-test score = 0, the computer-based test is not administered

Summary of Scoring:

Available Scores:
Global score (including pre-test score, Part I (range 0-30) and Part II (range 0-56)): range 0-88
Scores by items: Pre-test (0-2)

- Scores are compared to norm data (in percentile scores, for children younger than 7.0 years, and in age equivalents for children older than 7.0 years)

Weighting:
No

Score Direction:
Higher score = Better comprehension of spoken language

Evidence of Literature Review: None identified

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: Yes

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period:

Evidence for Selection of Reponse Options: None identified

Evidence of cognitive interviewing of draft instrument in target patient population: None identified

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: None identified

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: Yes

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency:

Test-retest Reliability (ICC):

Geytenbeek JJ (2014)
76-item version
Intraclass Correlation Coefficient (ICC):
Children with TD: 0.97 (95%CI=0.94-0.99)
Children with CP: 0.97 (95%CI=0.95-0.99)
Was a definition of stability applied to identify stable patients: No
Time frame or interval between the two administrations: 2 weeks
Population/Disease: Children with TD (age range= 1 year 6 months - 6 years 10 months; n=137) or CP (age range= 1 year 11 months - 12 years; n=32)

Inter-rater/ inter-interviewer reliability (kappa):

Geytenbeek JJ (2014)
76-item version
Intraclass Correlation Coefficient (ICC):
Children with TD: 0.96 (95%CI=0.94-0.97)
Children with CP: 0.97 (95%CI=0.95-0.98)
Population/Disease: Children with TD (age range= 1 year 8 months - 7 years; n=37) or CP (age range= 1 year 7 months - 11 years 4 months; n=35)

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Geytenbeek JJ (2014)
76-item version
Correlation coefficient used: Pearson's correlation coefficient
Measure: Peabody Picture Vocabulary Test (PPVT-III)
Results: A high correlation was observed between the C-BiLLT and the PPVT-III scores in children with and without disabilities (p not stated):
Children with TD: r=0.88
Children with CP: r=0.87
Population/Disease: Children with TD (2 years 3 months - 7 years; n=117) or CP (3 years 2 months - 12 years; n=33)

Known-group validity:

Geytenbeek JJ (2014)
76-item version
Measure/Groups of patients: Age
A priori hypotheses: A higher correlation between the C-BiLLT and age should be observed in children with TD than in children with CP and complex communication needs because of a wider variation in language comprehension skills in the latter
Were hypotheses confirmed: Yes
-Results: Pearson's correlation coefficient :
Children with TD: r=0.82 (p not stated)
Children with CP: r=0.36; p<0.0001 Population/Disease: Children with TD (n=806) or CP (n=87) aged 1.5-12 years Known-groups validity - 76-item version 1) Measure/Groups of patients: Children with TD: n=806 Children with CP: n=87 A priori hypotheses: A significant difference should be observed between the mean scores on the C-BiLLT of children with TD and children with CP and complex communication needs, with the latter group receiving lower scores on average Were hypotheses confirmed: Yes Results: A significant difference was observed between both groups (t-test: data not shown; p<0.0001): Children with TD: mean (SD) score = 59.72 (13.19); CI=58.81-60.63 Children with CP: mean (SD) score = 36.38 (25.08); CI=31.03-41.72 Population/Disease: Children with TP or CP aged 1.5-12 years; n=893 2) Measure/Groups of patients: Age (years;months): 1 - 1;11: n=45 2 - 2;11: n=129 3 - 3;11: n=137 4 - 4;11: n=191 5 - 5;11: n=202 6 - 6;11: n=91 7 - 7;5: n=11 A priori hypotheses: A significant difference should be observed between the mean scores on the C-BiLLT of children with TD within age groups Were hypotheses confirmed: Yes Results: The Mean (SD) C-BiLLT scores [95%CI] increased with age and the difference between age intervals is significant (univariate ANOVA: data not shown; p<0.0001) 1 - 1;11: 23.84 (11.19) [20.84-27.21] 2 - 2;11: 46.24 (9.04) [44.68-47.83] 3 - 3;11: 57.91 (5.88) [56.92-58.90] 4 - 4;11: 64.35 (4.70) [63.68-65.02] 5 - 5;11: 67.55 (4.27) [66.96-68.14] 6 - 6;11: 70.64 (3.34) [69.94-71.33] 7 - 7;5: 72.18 (1.60) [71.11-73.26] Comparison of mean score differences [95%CI] using Bonferoni correction, showed that the C-BiLLT significantly discriminated between age groups of children with TD until 6 years (p<0.001): Age 2 versus 1 years: 22.41 [19.31-25.51] Age 3 vs 2 y: 11.66 [9.46-13.85] Age 4 vs 3 y: 6.43 [4.43-8.44] Age 5 vs 4 y: 3.20 [1.40-5.01] Age 6 vs 5 y: 3.25 [1.08-5.43] Population/Disease: Children with TD (age range= 1 year 8 months - 7 years); n=806 Geytenbeek JJ (2015) 1- Measure/Groups of patients: Type of CP Spastic CP: n=47 Dyskinetic CP: n=40 A priori hypotheses: Not stated Were hypotheses confirmed: Not applicable Results: A significant difference was observed in the mean (SD) C-BiLLT raw scores between both types of CP, with lower scores in children with spastic CP: Spastic CP: 29.09 (24.01) [95%CI=22.04-36.13] Dyskinetic CP: 44.98 (23.78) [95%CI=37.37-52.58] t-test: t=-3.092; CI=-26.14 to -5.68; p=0.003 In children < 6 years 6 months, the C-BiLLT z-scores were lower in the spastic group, as shown by the significant difference in the proportions of children with z-scores ≥-1.6 (average to mild disability) and <-1.6 (moderate to severe disability): Spastic CP (n=21): 100% with a z-score <-1.6 Dyskinetic CP (n=21): 47.6% with a z-score <-1.6 and 52.4% with a z-score ≥-1.6 Fisher's exact test: F=14.903; p<0.001 In children > 6 years 6 months, the C-BiLLT age-equivalent (AE) scores were lower in the spastic group, as shown by the significant difference in the proportions of children with AE scores < and ≥ 6 years: Spastic CP (n=26): 96.2% with AE < 6 years and 3.8% with AE ≥ 6 years Dyskinetic CP (n=19): 68.4% with AE < 6 years and 31.6% with AE ≥ 6 years Fisher's exact test: F=6.428; p=0.031 Population/Disease: Children with CP (age range 1y 9mo–12y, mean age 6y 8mo [SD 2y 11mo]); n=87 2- Measure/Groups of patients: Levels of Gross Motor Function Classification System (GMFCS) Level IV: n=34 Level V: n=53 A priori hypotheses: Not stated Were hypotheses confirmed: Not applicable Results: A significant difference in the mean (SD) C-BiLLT raw scores was observed between both levels of GMFCS, with higher scores in children with level IV: Level IV: 43.33 (21.63) [95%CI=35.67-51.00] Level V: 31.60 (26.23) [95%CI=24.37-38.83] t-test: t=2.270; CI=1.518 to 22.921; p=0.026 In children < 6 years 6 months, significant differences in the C-BiLLT z-scores were observed between GMFCS levels: Level IV (n=19): 57.9%% with a z-score <-1.6 (moderate to severe disability) and 42.1% with a z-score ≥-1.6 (average to mild disability) Level V (n=23): 87.0% with a z-score <-1.6 and 13.0% with a z-score ≥-1.6 Fisher's exact test: F=4.546; p=0.043 Population/Disease: Children with CP (age range 1y 9mo–12y, mean age 6y 8mo [SD 2y 11mo]); n=87

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: Yes

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: None identified

Ability to detect change (Responsiveness):

None identified

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Geytenbeek JJ, Oostrom KJ, Harlaar L, Becher JG, Knol DL, Barkhof F, Pinto PS, Vermeulen RJ. Language comprehension in nonspeaking children with severe cerebral palsy: Neuroanatomical substrate? Eur J Paediatr Neurol. 2015 Sep;19(5):510-20
PubMed abstract: https://pubmed.ncbi.nlm.nih.gov/26112263/

Geytenbeek JJ, Vermeulen RJ, Becher JG, Oostrom KJ. Comprehension of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities. Dev Med Child Neurol. 2015 Mar;57(3):294-300
Full-text article: https://onlinelibrary.wiley.com/doi/10.1111/dmcn.12619

Geytenbeek JJ, Mokkink LB, Knol DL, et al. Reliability and validity of the C-BiLLT: a new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs. Augment Altern Commun. 2014 Sep;30(3):252-66
PubMed abstract: https://pubmed.ncbi.nlm.nih.gov/24948533/

Harlaar L, Pouwels PJ, Geytenbeek J, et al. Language comprehension in young people with severe cerebral palsy in relation to language tracts: a diffusion tensor imaging study. Neuropediatrics. 2013 Oct;44(5):286-90
PubMed abstract: https://pubmed.ncbi.nlm.nih.gov/23564318/

Geytenbeek JJ, Heim MM, Vermeulen RJ, et al. Assessing comprehension of spoken language in nonspeaking children with cerebral palsy: application of a newly developed computer-based instrument. Augment Altern Commun. 2010 Jun;26(2):97-107
PubMed abstract: https://pubmed.ncbi.nlm.nih.gov/20497073/

C-BiLLT website: https://c-billt.com/

See (PubMed results)
https://pubmed.ncbi.nlm.nih.gov/?term=(C-BiLLT%5BTitle%2FAbstract%5D)+AND+((%222010%22%5BDate+-+Publication%5D+%3A+%223000%22%5BDate+-+Publication%5D))&sort=

CanChild website: https://www.canchild.ca/en/research-in-practice/current-studies/c-billt

None identified

Original language:
Dutch for the Netherlands

Translations:
Dutch for Belgium
English for Canada
English for the UK
French
German
Norwegian for Norway
Romanian
Swedish

Norwegian:
Fiske SI, Haddeland AL, Skipar I, Bootsma JN, Geytenbeek JJ, Stadskleiv K. Assessing language comprehension in motor impaired children needing AAC: validity and reliability of the Norwegian version of the receptive language test C-BiLLT. Augment Altern Commun. 2020 Jun;36(2):95-106

Author:
Dr. Johanna Geytenbeek, PhD, SLP, Clinical researcher
Amsterdam UMC
The Netherlands
E-mail: J.geytenbeek@amsterdamumc.nl

Copyright:
Instrument copyrighted by the Amsterdam UMC including the authors and developers of the C-BiLLT

Conditions of use:
To access the test environment (see on the website www.c-billt.com)apersonal login codegives access to the test environmentof the C-BiLLT. This login codecan only be obtained by followingaC-BiLLT training. So speech-language therapists(SLT’s)and other professionals, such as psychologists who want to use the C-BiLLT, first need to follow this training to become certified users of the C-BiLLT©. The courseis a two-days training (first day 8 hours and 8 weeks later a second day, including apresentation of the assignment that each participants needs to do). The registration fee of the trainingin the Netherlands is 550 europer person, including the 2-days training and access to the test environment of the Web-site. This course can be arranged by every country itself, so no costs are calculated for the C-BiLLT foundation or website. So for instance, when the study of the validity and reliability of the translatedversion is completed and proven to be validand ready to be implemented in the country, the original developers of the C-BiLLT(Johanna Geytenbeek and a colleague) will givethe training and its contentto the personsor organisationwho isgoing to organise the training and implementation of the C-BiLLT in that country(a so called “teach the teacher”).As soon as this traininghas been transferred to the organisation that will implement the C-BiLLT in the country concerned, the organisation is free and on theirown how to arrange the trainingand determine the registration feein their countryfor SLT’s and other professionals

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