Measuring children's participation in recreation and leisure activities: construct validation of the CAPE and PAC

Occupational therapy home program for children with intellectual disabilities: a randomized, controlled trial

This study aimed to investigate the effectiveness of a proposed occupational therapy home program (OTHP) for children with intellectual disabilities (ID). Children with ID were randomly and equally assigned to OTHP or to no OTHP groups. The primary outcome measures were Canadian Occupational Performance, Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, and The Children's Assessment of Participation and Enjoyment scores at 10 and 20 weeks. The 20-week OTHP produced significant difference in fine motor function, activity participation, and parent satisfaction with performance, compared to those of no OTHP. Pediatricians can advise families to implement 20 weeks of OTHP with an average 15 min per session to facilitate functional changes of children with ID.

An exploration of the value of social interaction in a boys' group for adolescents with muscular dystrophy

BACKGROUND/AIM

  Engagement in peer-based social activities is a normal and important aspect of adolescence. Adolescent boys with muscular dystrophy typically lack opportunities for participation in peer-based recreation and socialization activities. 'MD Mafia' is a group which aims to reduce social isolation and offer social and recreational opportunities for adolescent boys with muscular dystrophy. This research is a qualitative exploration of the value of 'MD Mafia' and seeks to answer the question: "what does the experience of participating in 'MD Mafia', a group for adolescent boys with muscular dystrophy, mean to the boys and their parents?".

METHODS

  This research sought the views of the boys who participate in MD Mafia and their parents. The sample included seven boys and four mothers. Data collection methods included creative group activities, specifically chosen to match the participants' age, interests and skills, and online data collection. The theoretical perspective of symbolic interactionism guided the theoretical analysis of the data.

RESULTS

  Analysis of the data provided a description of the meaning and value of 'MD Mafia' from the participants' perspective. MD Mafia has a strong collective identity, which reflects ideals of masculinity and common interests. The group provides much valued opportunity for socialization in a safe and familiar environment, but parents also felt that MD Mafia could offer greater opportunities for skill development by increasing the challenge level of the activities and social environment. The theoretical analysis provides insight into the value of social interactions between participants in a group which has had positive implications for the boys as individuals and for MD Mafia as a group.

CONCLUSIONS

  The research supports a group model of service delivery for boys with muscular dystrophy and has implications for the development of the group into the future.

Two case study evaluations of an arts-based social skills intervention for adolescents with childhood brain disorder

OBJECTIVE

Arts-based programmes have been shown to be useful for individuals with disturbances in cognitive and behavioural functioning. The current case studies examined the feasibility and effectiveness of a theatre skills training programme to facilitate social skills and participation for adolescents with childhood brain disorder.

METHODS

A case study approach was used with two adolescent participants. Focus groups were conducted immediately post-intervention, while a battery of quantitative measures were administered pre- and post-treatment, as well as 8 months post-treatment.

RESULTS

Perceived and documented improvements in social skills and participation were observed from pre- to post-intervention and at follow-up.

CONCLUSION

Results support the use of an arts-based intervention for youth with brain injuries to facilitate social skills and participation. Findings also highlight the need for more sensitive measures of these skills for youth with childhood brain disorder, who may have impaired awareness of their abilities and/or impairments in memory and language comprehension.

Parents' actions, challenges, and needs while enabling participation of children with a physical disability: a scoping review

Background

Pediatric rehabilitation considers Family-centered service (FCS) as a way to increase participation of children with a physical disability in daily life. An important principal is that parents greatly contribute to their child’s participation at school, at home, and in the community. However, it is unclear what kind of information is available from literature about what parents actually do to support their child’s participation and what problems and needs they experience? Hence, the aim of this study was to provide an overview of the actions, challenges, and needs of parents in enabling participation of their child with a physical disability that is neurological and non-progressive in nature.

Methods

Scoping review with extensive literature search (September 2011) and a thematic analysis to synthesize findings.

Results

Fourteen relevant articles revealed two major themes: ‘parents enable and support performance of meaningful activities’ and ‘parents enable, change and use the environment’. Each theme holds a number of actions (e.g. choosing the right type of meaningful activities for facilitating social contacts) and challenges (e.g. negative attitudes of other people). Less information is available about the needs of parents.

Conclusions

This study indicates that parents apply a broad range of strategies to support participation of their children. They experience many challenges, especially as a result of constraints in the social and physical environments. However, this review also shows that little is known about needs of parents in facilitating participation. As Family-centered service (FCS) philosophy is all about the needs of the child and the family, it is essential to further investigate the needs of the parents and to understand if and to what extent they wish to be supported in enabling their child’s participation in daily life.

Activity participation intensity is associated with skeletal development in pre-pubertal children with developmental coordination disorder

PURPOSE

This study aimed (1) to compare the skeletal maturity and activity participation pattern between children with and without developmental coordination disorder (DCD); and (2) to determine whether activity participation pattern was associated with the skeletal development among children with DCD.

MATERIALS AND METHODS

Thirty-three children with DCD (mean age: 7.76 years) and 30 typically developing children (mean age: 7.60 years) were recruited. Skeletal maturity was assessed with the Sunlight BonAge system. Motor ability was evaluated by the Movement assessment battery for Children-2 (MABC-2). Participation patterns were evaluated using the Children Assessment of Participation and Enjoyment assessment. Analysis of variance was used to compare the outcome variables between the two groups. Multiple regression analysis was performed to examine the relationship between skeletal development, motor performance and activity participation intensity in children with DCD.

RESULTS

The DCD group had significantly delayed skeletal development, lower MABC-2 derived scores, and participated less intensely in various types of physical activities than their typically developing peers. After accounting for the effects of age and sex, activity participation intensity score remained significantly associated with delay in skeletal development, explaining 28.0% of the variance (F(change1, 29)=11.341, p=0.002).

CONCLUSION

Skeletal development is delayed in pre-pubertal children with DCD. Limited activity participation intensity appears to be one of the contributing factors.

Parent-reported participation in children with cerebral palsy: the contribution of recurrent musculoskeletal pain and child mental health problems

AIM

The aim of the study was to explore the contribution of recurrent musculoskeletal pain and mental health to aspects of participation in children with cerebral palsy (CP).

METHOD

A total of 105 participants (54 males, 51 females); mean age 14 y (SD 3) were assessed by clinical examination, interview, and parental questionnaires. CP type distribution was as follows: spastic unilateral, 37%; spastic bilateral, 56%; and dyskinetic, 7%. Motor function assessed using the Gross Motor Function Classification System was level I, 33%; level II, 40%; level III, 15%; and level IV/V, 11%. Parents reported child participation using the Assessment of Life Habits, child mental health problems using the Strengths and Difficulties Questionnaire, their own mental health using the General Health Questionnaire, and their socioeconomic status.

RESULTS

Recurrent musculoskeletal pain was associated with reduced accomplishment of daily activities (B=-1.22, p=0.02) and social roles (B=-1.17, p=0.03), and with reduced parental satisfaction with the accomplishment of daily activities (B=-1.14, p=0.03) and social roles (B=-1.48, p<0.01). Increasing levels of child mental health problems was associated with reduced accomplishment of daily activities (B=-0.10, p=0.02) and social roles (B=-0.11, p<0.01), and with reduced parental satisfaction with the accomplishment of social roles (B=-0.21, p<0.01).

INTERPRETATION

Pain and child mental health should be considered in most participation models in CP. Regarding participation as an objective outcome measure is questionable.

Development of a postacute hospital item bank for the new Pediatric Evaluation of Disability Inventory-Computer Adaptive Test

The PEDI-CAT is a new computer adaptive test (CAT)version of the Pediatric Evaluation of Disability Inventory(PEDI). Additional PEDI-CAT items specific to post acute pediatric hospital care were recently developed using expert reviews and cognitive interviewing techniques.Expert reviews established face and construct validity,providing positive feedback on domain content and response scale options. Cognitive interviews established content validity while 60% of items were revised or removed because of the items being unclear or ambiguous, not measuring what was intended or lack of therapeutic terminology. As a result, an item bank containing more than 110 items in the three domains of self-care, mobility, and social function has been constructed and is ready to be calibrated and tested in a CAT application. With the addition of items specific for an inpatient pediatric postacute hospital setting, the PEDI-CAT (postacute hospital) will provide clinicians with the opportunity to use a context-specific assessment of function to support quality evaluations during inpatient rehabilitation care.

The applicability of the short sensory profile for screening sensory processing disorders among Israeli children

The objective of this study was to examine the applicability of the short sensory profile (SSP) for screening sensory processing disorders (SPDs) among typical children in Israel, and to evaluate the relationship between SPDs and socio-demographic parameters. Participants were 395 Israeli children, aged 3 years to 10 years 11 months, with typical development. Parents of all children completed the SSP. Factor analysis found similarity between the Hebrew version of the SSP and the original SSP. About 15% of the children had SPD. Differences between age groups and sexes were found in several SSP sections. In conclusion,typical children may have SPD. The SSP may be appropriate for screening SPD among Israeli children.These results should be strengthened by additional studies conducted on children with typical development as well as children with disabilities in which sensory processing problems are involved.

Validating the Adolescent/Adult Sensory Profile and Examining its Ability to Screen Sensory Processing Difficulties among Israeli People

Purpose:

The purpose of this study was to (1) validate the Hebrew version of the Adolescent/Adult Sensory Profile (AASP); (2) screen sensory processing difficulties, as expressed in daily living in a vast range of ages of healthy Israeli adolescents, adults and older people; and (3) examine gender effect on sensory processing in the different age groups.

Findings:

Good internal consistency was found for each of the AASP quadrants, although factor analysis did not find total similarity between the Hebrew version of the AASP and the original AASP. Sensory processing difficulties were shown by 22–42% of the participants in the different age groups. Older participants had lower tendency for Sensation Seeking. Females were more sensitive than males in the age groups of 11–17 years and 18–64 years.

Conclusion:

In general, the Hebrew version of the AASP was found to be valid and succeeded in profiling sensory processing difficulties along the life span of typical Israeli adolescents and adults. Further studies should apply the Hebrew version of the AASP to screen sensory processing difficulties among individuals with disabilities and elaborate their impact on people's performance/participation in daily activities.

Can gymnastic teacher predict leisure activity preference among children with developmental coordination disorders (DCD)?

The aims of the study were to analyze: (1) whether significant differences exist between children with typical development and children with developmental coordination disorders (DCD) in their preference to participate in leisure activities (2) whether the teacher estimation of activity form (TEAF) evaluation predicts participation preference. Participants were 68 children, aged 6-9.83 years, 35 diagnosed as DCD by pediatrician and based on the Movement ABC (M-ABC) and 33 children with typical development. The controls were matched by age and gender to the DCD group. The children filled the preference for activities of children (PAC) and their sport teacher completed the TEAF. Significant differences were found between the groups in their participation preference based on the PAC items and subscales as well as in the TEAF scores. Significant correlations were found between the TEAF and PAC subscales. TEAF score significantly predicted children's preference to participate in leisure activities. Study results recommend using the TEAF for screening DCD and to further consider participation issues among children with DCD as a preventive aid for consequently socio-emotional implications of DCD.

Participation and quality of life in children with Duchenne muscular dystrophy using the International Classification of Functioning, Disability, and Health

Background

Duchenne muscular dystrophy (DMD) is characterized by muscle damage and progressive loss of muscle function in male children. DMD is one of the most devastating genetically linked neuromuscular diseases for which there is currently no cure. Most clinical studies for DMD utilize a standard protocol for measurement exploring pathophysiology, muscle strength and timed tasks. However, we propose that examining broader components of health as emphasized by the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) may be of great value to children and their families, and important outcomes for future clinical trials.

Methods

Fifty boys with DMD and 25 unaffected age-matched boys completed two self-report measures: the Children’s Assessment of Participation and Enjoyment and the Pediatric Quality of Life Inventory^TM 4.0. We investigated differences between the two groups with regard to participation in life activities and perceived quality of life (QoL). Additionally, we compared participation in activities and QoL in both cohorts of younger and older boys.

Results

Participation in physical activities was significantly lower in boys with DMD than unaffected boys. Perceived QoL was markedly diminished in children with DMD relative to unaffected controls, except in the emotional domain. The amount of time boys engage in an activity, as well as participation in social activities, declined for our older boys with DMD but no changes were observed for our older unaffected boys. For both groups, QoL remained constant over time.

Conclusions

The ICF-CY provides a conceptual framework and specific terminology that facilitates investigation of the consequences of impairment in children and youth. Our study is one of the first to explore participation in a cohort of boys with DMD. It was not surprising that activities of choice for boys with DMD were less physical in nature than unaffected boys their age, but the consequences of less social engagement as the boys with DMD age is of great concern. Results from our study underscore the need to further evaluate activities that children elect to participate in, with special emphasis on facilitators and barriers to participation and how participation changes throughout the course of a disease.

Patterns of participation and enjoyment in adolescents with Down syndrome

This study aimed to determine participation and enjoyment in young people with Down syndrome (DS) in Taiwan and to assess how participation varies across gender, cognitive, and motor function variables. Using the Children's Assessment of Participation and Enjoyment, data on participation were collected from 997 adolescents with DS and their families. Findings indicated limited diversity and intensity of participation, with proportionately greater involvement in informal activities. Youth with better cognitive and motor functions participated more often in activities and reported higher enjoyment and social engagement with these. These findings provide a foundation for an improved understanding of activity participation of youth with DS. Service providers and families could provide and plan activities to ensure more satisfying and meaningful participation.

Assessment tools and classification systems used for the upper extremity in children with cerebral palsy

BACKGROUND

Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and performance in children with cerebral palsy (CP) must choose from a wide range of tools.

QUESTIONS/PURPOSES

We systematically reviewed the literature for UE assessment and classification tools for children with CP to compare instrument content, methodology, and clinical use.

METHODS

We searched Health and Psychosocial Instruments (HaPI), US National Library of Medicine (PubMed), and Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) databases (1937 to the present) to identify UE assessment and outcomes tools. We identified 21 tools for further analysis and searched HaPI, PubMed, CINAHL Plus, and Google Scholar ( http://scholar.google.com/schhp?tab=ws ) databases to identify all validity and reliability studies, systematic reviews, and original references for each of the 21 tools.

RESULTS

The tools identified covered ages birth to adulthood. International Classification of Functioning, Disability and Health domains addressed by these tools included body function, body structure, activities and participation, and environmental factors. Eleven of the tools were patient or family report, seven were clinician-based observations, and three tools could be used in either fashion. All of the tools had published evidence of validity. Nine of the tools were specifically designed for use in subjects with CP. Two of the tools required formal certification before use. Ten of the tools were provided free of charge by the investigators or institution who developed them.

CONCLUSIONS

Familiarity with the psychometric and clinometric properties of assessment and classification tools for the UE in children with CP greatly enhances a clinician's ability to select and use these tools in daily clinical practice for both clinical decision-making and assessment of outcome.

Predictors of change in participation rates following acquired brain injury: results of a longitudinal study

AIM

The purpose of this study was (1) to examine the changes in participation rates over 1 year among children and adolescents after acquired brain injury and (2) to explore the effect of child and family factors on these changes.

METHOD

The participation levels of 136 children and young people (88 males; 48 females; age range 4y 11mo-17y 6mo; mean age 11y 6mo) after acquired brain injury (3≤ Glasgow Coma Scale score ≤15; mean 12.8) were assessed three times: at their return to school, and at 8 and 12 months after returning to school. The Children's Assessment of Participation and Enjoyment measured the participants' diversity and intensity of participation in out-of-school activities. At baseline, information on general family functioning and medical and demographic information was collected as possible predictors. Mixed-effect model analyses of participation scores were performed while controlling for child's age at injury.

RESULTS

The severity of the injury explained rates of change across time for participation intensity in recreational, physical, and social activities. Household income influenced changes in the intensity of recreational activities, whereas family functioning predicted changes in the diversity of skill-based activities.

INTERPRETATION

Participation is a relevant outcome of recovery that needs to be assessed and monitored post brain injury. Special attention can be directed to severity of injury and family functioning when developing intervention plans.

The pediatric physical therapist's role in promoting and measuring participation in children with disabilities

PURPOSE

The purposes of this article were to discuss participation relative to the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) model, evaluate 3 current pediatric participation measures that have been designed to assess participation, and review research findings relevant to participation in children and adolescents with disabilities.

KEY POINTS

The concept of participation has been challenging to define and measure. Successful participation of children and adolescents with disabilities in daily life activities is influenced by individual, family, and environmental factors. Currently available tools designed to measure participation of children and adolescents have strengths and limitations, which should be considered when selecting tools for use in clinical practice.

CONCLUSION

Pediatric physical therapists can increase participation of children and adolescents with disabilities by measuring and promoting meaningful outcomes in the individual, family, and environmental components of the ICF-CY.

Psychosocial outcomes among youth with spinal cord injury and their primary caregivers

BACKGROUND

Past research has found youth with disabilities to experience poor psychosocial outcomes, but little is known about factors related to psychosocial health among youth with spinal cord injury (SCI).

OBJECTIVE

To describe psychosocial health among youth with SCI, examine relationships between psychosocial outcomes and demographic and injury-related factors, and examine relationships between aspects of psychosocial health. Youth activity, participation, quality of life (QOL), coping, anxiety and depression, and caregiver mental health were included.

METHODS

Data were collected as part of a prospective study of 420 youth with SCI ages 1-18 and their primary caregivers. Activity data were also presented from a study developing a computerized adaptive testing (CAT) platform with 226 youth with SCI ages 8-21.

RESULTS

Although relationships varied by factor, youth outcomes were related to youth age, sex, age at injury/injury duration, and level/extent of injury. Caregiver mental health related to child age and age at injury. Further, relationships were uncovered between aspects of psychosocial health: aspects of youth mental health were related to youth participation and QOL, youth coping was related to youth mental health, participation, and QOL, and caregiver mental health was related to child mental health and QOL.

CONCLUSION

Psychosocial outcomes relate to each other and vary by child and injury-related factors and should be understood in a comprehensive, developmental context. Identifying best measures of activity and psychosocial functioning among youth with SCI and understanding factors related to their psychosocial health is critical to improving outcomes for the pediatric-onset SCI population.

Social participation of youths with cerebral palsy differed based on their self-perceived competence as a friend

BACKGROUND

Social participation with friends fosters development of meaningful relationships, life skills and psychosocial well-being. Youths with cerebral palsy (CP) face challenges to establishing social relationships with friends. The aim of this study was to explore whether social participation with friends differs among youths with CP based on their self-perceived competence as a friend.

METHODS

A total of 135 youths with CP, 13-21 years old (mean age 16 years, 50% were male), completed the measures Fulfillment in Social Roles and Children's Assessment of Participation and Enjoyment. Youths were assigned to high, middle and low groups defined by their self-perceived competence as a friend. Differences among the three groups in the number, total frequency and enjoyment of activities done with friends was examined by Kruskal-Wallis one-way analyses of variance. Post hoc analysis of significant effects was performed using a Mann-Whitney U-test or Kolmogorov-Smirnov test.

RESULTS

The number (χ(2) = 17.07, d.f. = 2, P < 0.001) and total frequency (χ(2) = 18.35, d.f. = 2, P < 0.001) of activities done with friends differed based on youths' self-perceived competence as a friend. Youths with high self-perceived competence as a friend did the greatest number of activities and participated most often with friends. Youths with low self-perceived competence did the fewest activities and participated least often with friends. No differences were found in the enjoyment of activities done with friends among the three groups (χ(2) = 1.86, d.f. = 2, P > 0.05).

CONCLUSIONS

For youths with CP, the number and frequency of activities done with friends differed based on self-perceived competence as a friend, but not enjoyment of activities. The results suggest a positive link between social participation and self-perceived competence. Healthcare providers have a role to support youths' efforts to engage with friends by enhancing community opportunities, developing and providing interventions in natural social environments and incorporating peer support into service delivery.

Cultural validity of the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC)

OBJECTIVE

The aim was to evaluate whether the activity items of the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC) were relevant for Swedish children.

SUBJECTS

A total of 337 typically developed children aged 6-17 years old.

METHODS

The CAPE/PAC was translated into Swedish in accordance with accepted translation procedures. By means of 14 group interviews with children with and without disabilities aged 6-15 years old and parents, available leisure activities were listed. These were matched to the items in the CAPE/PAC. Sixteen new potential activities were added and tested on 337 typical developed children from different regions of Sweden. A cutoff level of activities performed by >10% was set to identify relevant activities. Differences between the original and a proposed Swedish version were analysed using paired-samples t-tests of standardized mean scores.

RESULTS

Three new activity items were included, for 10 items new activity examples were added, and three not relevant items were excluded. In the Swedish version the outcome of standardized mean diversity score was significantly higher compared with the outcome of the original version.

CONCLUSIONS

When using instruments in new contexts, it is not enough simply to translate; validation of the item relevance to the new context is essential.

International Classification of Functioning, Disability and Health in children with cerebral palsy

PURPOSE

We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications.

METHOD

We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP.

RESULTS

Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors.

CONCLUSION

Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children's needs.

Motor ability and weight status are determinants of out-of-school activity participation for children with developmental coordination disorder

According to the International Classification of Functioning, Disability and Health model endorsed by the World Health Organization, participation in everyday activities is integral to normal child development. However, little is known about the influence of motor ability and weight status on physical activity participation in children with developmental coordination disorder (DCD). This study aimed to (1) compare motor performance, weight status and pattern of out-of-school activity participation between children with DCD and those without; and (2) identify whether motor ability and weight status were determinants of participation patterns among children with DCD. We enrolled 81 children with DCD (boys, n = 63; girls, n = 18; mean age, 8.07 ± 1.5 years) and 67 typically developing children (boys, n = 48; girls, n = 19; mean age, 8.25 ± 1.6 years). Participation patterns (diversity, intensity, companionship, location, and enjoyment) were evaluated with the Children Assessment of Participation and Enjoyment. Motor ability was evaluated with the Movement Assessment Battery for Children, second edition (MABC-2). Other factors that may influence participation such as age, gender, and body weight were also recorded. Analysis of variance was used to compare outcome variables of the two groups, and significant determinants of activity participation were identified by multiple regression analysis. Children with DCD participated in fewer activities (i.e., limited participation diversity) and participated less frequently (i.e., limited participation intensity) than their typically developing peers; however, companionship, location of participation, and enjoyment level did not differ between the two groups. Children in the DCD group demonstrated significantly worse motor ability as assessed by the MABC-2. Further, a greater proportion of children in the DCD group were in the overweight/obese category compared with their typically developing peers. After accounting for the effects of age and gender, motor ability and weight category explained 7.6% and 5.0% of the variance in participation diversity, respectively, for children with DCD. Children with DCD showed less diverse and less intense out-of-school activity participation than typically developing children. Motor impairment and weight status were independently associated with the lower participation diversity. Interventions aiming at improving participation for children with DCD should target weight control and training in motor proficiency. Further study is needed to identify other factors that may hinder participation in this group of children.

Correlations of sensory processing and visual organization ability with participation in school-aged children with Down syndrome

Previous work has highlighted delays and differences in cognitive, language, and sensorimotor functions in children diagnosed with Down syndrome (DS). However, sensory processing and visual organization abilities have not been well-examined in DS to date. This study aimed to investigate the developmental profile of sensory processing and visual organization abilities, body functions classified by the World Health Organization's ICF model, and their impacts on participation in DS to guide research and evidence-based practices. Two hundred and six children (101 boys, 105 girls) with DS (age range = 6 years 1 month to 12 years 10 months; mean age = 8 years 1 month) were assessed on measures of sensory processing (Sensory Profile), visual organization ability (Hooper Visual Organization Test), and activity participation (Vineland Adaptive Behavior Scale, School Function Assessment). Our findings characterized the developmental continuum of body functions (sensory processing and visual organization) of children with DS, and revealed their correlations with activity participation. Interventions focused on improving body functions is needed while stressing the acquisition of functional skills that increase participation in age-appropriate activities.

Determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy

OBJECTIVE

To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP).

DESIGN

Prospective cohort study.

SETTING

Children's hospitals (N=7).

PARTICIPANTS

Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Youth completed the Children's Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire.

RESULTS

Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P ≤ .05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant.

CONCLUSIONS

Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.

Exploring the Relationship between Affect and Sensory Processing Patterns in Adults

Purpose:

Growing evidence exists regarding the relationship between sensory processing and affective disorders. However, most of this evidence relates to children. This study aimed to explore the relationship between positive/negative affect and sensory processing patterns as expressed in daily situations among healthy adults.

Procedure:

Two hundred and thirteen healthy individuals aged 18–50 years completed the Adolescent/Adult Sensory Profile (AASP) and the Positive and Negative Affect Schedule (PANAS).

Results:

Negative affect correlated positively with Sensory Sensitivity, Sensation Avoiding and Low Registration. Positive affect correlated with Sensation Seeking.

Conclusion:

Sensory processing patterns might be related to the person's affect. In practical terms, this relationship among typical individuals suggests that people could benefit from knowledge about the impact of their sensory processing patterns on everyday life or, in some cases, from occupational therapy intervention. Nevertheless, further studies are needed to elucidate this relationship and its impacts on participation, quality of life and wellbeing.

Participation in leisure activities and sensory modulation deficiencies of children with atopic dermatitis

AIM

To examine whether the complexity of atopic dermatitis (AD) symptoms and the sensory modulation deficiencies (SMD) that accompany it may limit child's preference to participate in leisure activities.

METHODS

Thirty-seven children diagnosed with AD and 104 healthy peers aged 6-11 years participated in this study. Disease severity was assessed using SCORAD scores. Both groups were compared in regard to their sensory modulation abilities measured by the 'Short Sensory Profile' (SSP) and in regard to their activity preference measured by the 'Preference for Activities of Children' (PAC).

RESULTS

Children with AD showed lower preference to participate in leisure activities as compared with healthy peers (F = 4.63, p < 0.0001). Among children with AD, significant correlations were found between SMD in several modalities and preference to participate in specific leisure activities. No significant correlations were found between AD severity and the child's preferred activities.

CONCLUSIONS

Children with AD may show lower preference to participate in activities in comparison with their typical peers. This lower preference may be impacted by their SMD. Multidisciplinary intervention may be beneficial for children with AD. This intervention should refer to AD symptoms and considers the child's sensory profile and participation in daily living.

Parent perspectives to inform development of measures of children's participation and environment

OBJECTIVE

To obtain parents' perspectives on children's participation and environment to inform the development of new measures.

DESIGN

Descriptive design using qualitative methods with focus groups and semistructured interviews.

SETTING

Focus groups and interviews with parents of children with disabilities were held on campus, in the home, and at community agencies; interviews with parents of children without disabilities were conducted in their homes.

PARTICIPANTS

Parents (N=42): parents of children with disabilities (n=25) from the United States (n=14) and Canada (n=11) and parents of children without disabilities (n=17) from the United States. Most children (93%) were aged 5 to 16 years. Children with disabilities had diagnoses characterized by psychosocial, learning, attention, and sensory-processing difficulties.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Not applicable.

RESULTS

Parents described common life activities and environmental factors that were similar to and expanded on categories currently reported in the literature. Differences identified among parents mainly focused on impairments and challenges of children with disabilities and concerns related to activities and programs designed for them. Parents spontaneously talked about participation and environmental factors together. Their descriptions consistently included information about features of the physical and social environment and other factors that influenced their child's participation, such as demands of the activity, parent strategies, and the child's age, preferences, and abilities. Parents' standards and expectations for their child's participation often varied depending on the specific setting, activity, and situation.

CONCLUSIONS

Findings have informed the development of a parent-report measure that explicitly links participation and environmental factors specific to home, school, and community settings. Having 1 measure to assess participation and environment rather than using distinct tools to assess each construct separately should situate the child's participation in real-life contexts.

Participation patterns of school-aged children with and without DCD

Participation is recognized as a key to one's health and well-being and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children with and without Developmental Coordination Disorder (DCD) in their out-of-school-time (OST) activities, and to see whether there is a relationship between the children's motor abilities and their choices and participation.

METHODS

50 children (5-7 years old), 25 who met diagnostic criteria of DCD and 25 without DCD, completed the Children Assessment of Participation and Enjoyment (CAPE) and were administered the Motor Assessment Battery for Children (MABC) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).

RESULTS

A relationship was found between participation patterns and motor ability. Children with DCD had limited participation diversity in which they participated less frequently, and chose activities that were quieter and more socially isolated compared to children without DCD; there were no differences in their levels of enjoyment.

CONCLUSIONS

The present study emphasizes the importance of looking at the children's participation from a broad perspective, and the many difficulties children with DCD experience in OST participation. Future studies might consider other factors (e.g., environment) while examining participation among children with DCD.

Aspects of activities and participation of 7-8 year-old children with an obstetric brachial plexus injury

BACKGROUND

Children with an obstetric brachial plexus injury (OBPI) can experience problems in the performance of meaningful activities such as writing, bimanual activities, and participation in sports and leisure activities.

AIMS

To quantify the everyday functioning and participation of 7-8 year-old children with an OBPI, with special emphasis on writing, and to investigate associated characteristics.

METHODS

Parents of children with an OBPI were sent a self-report questionnaire regarding the school performance, writing abilities, bimanual hand use, and participation in sports and leisure activities of their child, assessed with the Vineland Adaptive Behavior Scales (VABS sub-scale writing), the ABILHAND-kids, and the Children's Assessment of Participation and Enjoyment (CAPE). Furthermore, questions were asked about socio-demographic variables, medical history, pain, and the use of assistive devices.

RESULTS

Fifty three questionnaires were filled in (response 61%). According to the parents, 66% of their children were almost completely recovered, and 58% had a near normal arm function. Most of the children preferred to use their non-involved hand. More than 45% of the children complained about pain, and 39.6% had difficulties with writing, which resulted in a mean developmental delay of 8 months on the VABS sub-scale. Children with writing problems significantly more often had neurosurgery, were living with a single parent, more often received assistance at school, and had a significantly lower ABILHAND-kids score, compared to children with no writing problems.

CONCLUSIONS

Large percentages of 7-8 year-old children with an OBPI experience difficulties with writing and have musculoskeletal pain. Restrictions in participation were less pronounced.

Measurement of habitual physical activity performance in adolescents with cerebral palsy: a systematic review

AIM

This systematic review compares the validity, reliability, and clinical use of habitual physical activity (HPA) performance measures in adolescents with cerebral palsy (CP).

METHOD

Measures of HPA across Gross Motor Function Classification System (GMFCS) levels I-V for adolescents (10-18 y) with CP were included if at least 60% of items reported HPA performance in the domains of intensity, frequency, duration, and mode.

RESULTS

Seven measures of HPA performance met the criteria: StepWatch, pedometers, Uptimer, heart rate flex method, accelerometers, and self-report measures including the Children's Activity Participation and Enjoyment (CAPE) scale and the Physical Activity Questionnaire for Adolescents. The CAPE scale had the strongest validity and reliability but was limited by its inability to measure activity intensity. No study was identified that evaluated the psychometric properties of physical activity measures in non-ambulant adolescents with CP (GMFCS levels IV and V).

INTERPRETATION

When deciding on an appropriate measure of HPA in adolescents with CP, clinicians need to consider their research question including the domains of HPA they are evaluating and the population they wish to assess. Accelerometers provide the most robust information about the patterns of HPA, with some evidence of validity but limited data on reliability. Further research is needed to compare the use of tri- and uniaxial accelerometers.

How does participation of youth with spina bifida vary by age?

BACKGROUND

Youth with disabilities are at risk for decreased participation in community activities. However, little is known about participation at different developmental periods of childhood and adolescence among youth with spina bifida (SB) or whether child, family, and SB-associated factors influence participation.

QUESTIONS/PURPOSES

Our cross-sectional study examined participation among youth with SB and assessed how participation differs between youth ages 2-5, 6-12, and 13-18; how participation relates to child (gender) and family (caregiver marital status, education, and employment) characteristics; and how participation relates to SB-related factors (motor level, hydrocephalus, ambulation, medical issues, and bladder/bowel needs).

PATIENTS AND METHODS

Sixty-three youth ages 2-18 years and/or their caregivers completed age-appropriate measures of participation for youth with disabilities. The patients had an average age of 9.52 years (SD = 5.22), 83% had a shunt, 34% had a motor level of L2 or higher, and 66% L3 or lower.

RESULTS

A comparison of youth ages 2-5 (n = 19), 6-12 (n = 21), and 13-18 (n = 23) revealed older youth participated less in recreational, physical, and skill-based activities. Caregiver employment facilitated participation in social activities. Youth who did not have a shunt participated more often in physical and skill-based activities. Youth without recent major medical issues participated more often in physical and social activities. More caregivers reported bladder and bowel needs as barriers to participation for youth ages 6-12 than those ages 2-5 or 13-18.

CONCLUSIONS

Participation of youth with SB varies by age and across child and caregiver factors and should be understood in a developmental and situational context.

Outcomes in pediatric neurology: a review of conceptual issues and recommendationsThe 2010 Ronnie Mac Keith Lecture

This paper discusses how to evaluate whether, and in what ways, treatments affect the lives of children with neurological conditions and their families. We argue that professionals should incorporate perspectives from patients and families to help them make decisions about what 'outcomes' are important, and we discuss how those outcomes might be assessed. A case vignette illustrates the differences and complementarity between the perspectives of clinicians and those of children and their parents. We recommend methods for expanding the range of relevant health outcomes in child neurology to include those that reflect the ways patients and families view their conditions and our interventions. We explore the added value of a 'non-categorical' approach to the choice of outcomes. The International Classification of Functioning, Disability and Health is a useful biopsychosocial framework to 'rule in' relevant aspects of child and family issues to create a dynamic system of possible influences on outcomes. We examine the meaning of 'health', 'health-related quality of life', and 'quality of life' as related but conceptually distinct outcomes. Specific issues are discussed about the construction, validation, and appraisal of outcome measures, as well as practical recommendations on how to select outcome measures in the clinical setting and research.

Determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy

AIM

To test a model of child, family, and service determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy (CP).

METHOD

Participants were 288 children with CP, age range 6 to 12 years (mean 9y 8mo, SD 2y), and their parents from seven children's hospitals. The sample comprised 166 (57.6%) males and 122 (42.4%) females, and between 40 (13.9%) and 74 (25.7%) children in each of the five levels of the Gross Motor Function Classification System. Children completed the Children's Assessment of Participation and Enjoyment by interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, and two questionnaires. Structural equation modeling was used to test the model.

RESULTS

Fit statistics indicated a good model fit. The model explains 32% of the variance in intensity of participation. Path coefficients (p ≤ 0.05) indicate that higher gross motor function, higher enjoyment, more effective adaptive behavior, younger age, and higher family activity orientation are associated with higher intensity of participation. The path between services and participation was not significant.

INTERPRETATION

Intensity of participation of children with CP is influenced by multiple child and family determinants. Children's gross motor function and behavior in life situations are important for participation; knowledge of activities the child and family enjoy has implications for opportunities for participation. Professionals are encouraged to address priorities for leisure and recreation identified by children with CP and their families.

Determinants of social participation--with friends and others who are not family members--for youths with cerebral palsy

BACKGROUND

Social participation provides youths with opportunities to develop their self-concept, friendships, and meaning in life. Youths with cerebral palsy (CP) have been reported to participate more in home-based leisure activities and to have fewer social experiences with friends and others than youths without disabilities.

OBJECTIVE

The objective of this study was to identify youth, family, and service determinants of the participation of youths with CP in leisure activities with friends and others who are not family members.

DESIGN

The study design was a cross-sectional analysis.

METHODS

The participants were 209 youths who were 13 to 21 years old (52% male), had CP, and were classified in Gross Motor Function Classification System (GMFCS) levels I to V as well as their parents. The participants were recruited from 7 children's hospitals in 6 different states. Youths completed the Children's Assessment of Participation and Enjoyment in structured interviews. Parents completed the Coping Inventory, Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Measure of Processes of Care, and demographic and service questionnaires. Researchers determined GMFCS levels. A sequential multiple regression analysis was used to determine the youth, family, and service variables that predicted participation with friends and with others who were not family members.

RESULTS

Sports and physical function, communication or speech problems, educational program, and the extent to which the desired community recreational activities were obtained explained 45.8% of the variance in the number of activities engaged in with friends. A higher level of parental education explained 6.3% of the variance in the number of activities engaged in with others who were not family members. Limitations The youths' activity preferences and intensity of participation were not examined.

CONCLUSIONS

/b> Youth and service characteristics were determinants of participation with friends but not others who were not family members. The findings have implications for the role of physical therapists in promoting sports and physical and communication abilities and enhancing community opportunities to optimize the social participation of youths with CP.

Differences in leisure activities between children with allergic rhinitis and healthy peers

OBJECTIVE

The symptoms of allergic rhinitis (AR) are frequently evoked when individuals with AR perform daily activities. Thus, AR may interfere the optimal participation in daily life, negatively impact the patient's productivity and quality of life (QOL). While most studies refer to adult with AR, this pilot study examined participation of children with AR as expressed in their daily activity preferences.

METHODS

Participants were 31 children with AR and 31 healthy children, aged 5-11 years. All children completed the Preference for Activities of Children (PAC).

RESULTS

Children with AR showed significantly lower preference to participate in skill-based, social and informal activities, as compared to their healthy peers (F(7,53)=2.61, p=0.02, ES-η(2)=0.27). Children with AR showed 5-20% lower preference to participate in activity than their typical peers.

CONCLUSIONS

AR may negatively impact children's preference to participate in daily activities. Treatment of children with AR should consider a multi-disciplinary intervention for encouraging their optimal development, improve their well-being and QOL.

LEARN 2 MOVE 2-3: a randomized controlled trial on the efficacy of child-focused intervention and context-focused intervention in preschool children with cerebral palsy

Background

Little is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP). In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years) with CP and their families: a child-focused intervention approach and a context-focused intervention approach.

Methods/Design

A multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS) level I-IV; age 2 to 3 years), their parents, and service providers (physical and occupational therapists) will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI). Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY), including body function and structure, activities (gross motor capacity and performance of daily activities), social participation, environmental variables (family functioning, parental empowerment).

Discussion

This paper presents the background information, design, description of interventions and protocol for this study on the efficacy and working mechanisms of child-focused intervention approach and context-focused intervention approach compared to regular care intervention in mobility and self-care skills of children (2-3 years) with CP.

Trial registration

This study is registered in the Dutch Trial Register as NTR1900

LEARN 2 MOVE 7-12 years: a randomized controlled trial on the effects of a physical activity stimulation program in children with cerebral palsy

BACKGROUND

Regular participation in physical activities is important for all children to stay fit and healthy. Children with cerebral palsy have reduced levels of physical activity, compared to typically developing children. The aim of the LEARN 2 MOVE 7-12 study is to improve physical activity by means of a physical activity stimulation program, consisting of a lifestyle intervention and a fitness training program.

METHODS/DESIGN

This study will be a 6-month single-blinded randomized controlled trial with a 6-month follow up. Fifty children with spastic cerebral palsy, aged 7 to 12 years, with Gross Motor Function Classification System levels I-III, will be recruited in pediatric physiotherapy practices and special schools for children with disabilities. The children will be randomly assigned to either the intervention group or control group. The children in the control group will continue with their regular pediatric physiotherapy, and the children in the intervention group will participate in a 6-month physical activity stimulation program. The physical activity stimulation program consists of a 6-month lifestyle intervention, in combination with a 4-month fitness training program. The lifestyle intervention includes counseling the child and the parents to adopt an active lifestyle through Motivational Interviewing, and home-based physiotherapy to practise mobility-related activities in the daily situation. Data will be collected just before the start of the intervention (T0), after the 4-month fitness training program (T4), after the 6-month lifestyle intervention (T6), and after six months of follow-up (T12). Primary outcomes are physical activity, measured with the StepWatch Activity Monitor and with self-reports. Secondary outcomes are fitness, capacity of mobility, social participation and health-related quality of life. A random coefficient analysis will be performed to determine differences in treatment effect between the control group and the intervention group, with primary outcomes and secondary outcomes as the dependent variables.

DISCUSSION

This is the first study that investigates the effect of a combined lifestyle intervention and fitness training on physical activity. Temporary effects of the fitness training are expected to be maintained by changes to an active lifestyle in daily life and in the home situation.

TRIAL REGISTRATION

This study is registered in the Dutch Trial Register as NTR2099.

Physical activity measurement instruments for children with cerebral palsy: a systematic review

AIM

this paper is a systematic review of physical activity measurement instruments for field-based studies involving children with cerebral palsy (CP).

METHOD

database searches using PubMed Central, MEDLINE, CINAHL Plus, PsycINFO, EMBASE, Cochrane Library, and PEDro located 12 research papers, identifying seven instruments that met the inclusion criteria of (1) having been developed for children aged 0 to 18 years, (2) having been used to evaluate a physical activity dimension, and (3) having been used in a field-based study involving children with CP. The instruments reviewed were the Activities Scale for Kids - Performance version (ASKp), the Canada Fitness Survey, the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the Compendium of Physical Activities, the Physical Activity Questionnaire - Adolescents (PAQ-A), StepWatch, and the Uptimer. Second-round searches yielded 11 more papers, providing reliability and validity evidence for the instruments.

RESULTS

the instruments measure physical activity frequency, mode, domain, and duration. Although most instruments demonstrated adequate reliability and validity, only the ASKp and CAPE/PAC have established reliability and validity for children with physical disabilities; the Uptimer has established concurrent validity. No instrument measuring intensity in free-living has been validated or found reliable for children with CP.

INTERPRETATION

the findings suggest that further studies are needed to examine the methodological properties of physical activity measurement in children with CP. Combining subjective and objective instruments is recommended to achieve better understanding of physical activity participation.

Childhood Participation in After-School Activities: What is to be Expected?

Participation is recognised as a key to health and wellbeing and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children and adolescents in their time outside formal school. More specifically, the influence of age and gender on after-school participation patterns was explored.

Method:

Three hundred and thirty-two children and adolescents (5 to 18 years old) were divided into five age groups and completed the Children's Assessment of Participation and Enjoyment (CAPE). To test the interaction effect of gender and age on participation measures, ANOVAs were conducted.

Results:

The results indicated differences with moderate to high effect size in participation patterns across age, where a decline in participation was detected as children made the transition to adolescence. Differences with negligible effect size in participation were found between boys and girls in some of the activity types. No interaction effect between age and gender was observed.

Conclusion:

Participation patterns change with age, particularly as children make the transition to adolescence; however, this change does not depend on gender. Intervention strategies might take into account these inherent changes. Future studies might consider additional factors (for example, environment) while examining participation throughout age.

Cross-cultural validation and psychometric evaluation of the Dutch language version of the Children’s Assessment of Participation and Enjoyment (CAPE) in children with and without physical disabilities

Objective: To assess construct validity, test—retest reliability and inter-interviewer reliability of the intensity dimension of the Children’s Assessment of Participation and Enjoyment (CAPE) for children with and without physical disabilities in the Netherlands.

Subjects: In total, 232 children aged 6—18 years (110 male, 122 female) participated. Seventy-four children with various physical disabilities and 158 without a disability.

Design: Participants completed the CAPE and the Peabody Picture Vocabulary Test. In addition, parents of 142 children were interviewed using the Vineland Adaptive Behavior Scales and the Family Environment Scale. For 71 children test— retest reliability and for 60 children inter-interviewer reliability were assessed. Validity was examined by assessing differences in participation intensity in children with disabilities versus without a physical disability, boys versus girls, and younger versus older children. In addition, 13 hypotheses regarding participation, child and family variables were examined.

Results: Validity of the CAPE was supported by significant differences in participation for subgroups. Participation differed significantly in children with and without disabilities. Girls participated more in all activities. Older children participated more in social activities and self-improvement activities, younger children participated more in recreational activities. Validity of the CAPE was further supported with significant correlation coefficients in 8 out of 13 hypotheses. Both test—retest and inter-interviewer reliability were good to excellent.

Conclusions: The findings indicate that the Dutch language version of the CAPE is a reliable and valid instrument to measure participation in recreation and leisure activities for children with and without physical disabilities aged 6—18 years.

Assessing patterns of participation and enjoyment in children with spinal cord injury

AIM

To determine patterns of participation and levels of enjoyment in young people with spinal cord injuries (SCI) and to assess how informal and formal participation varies across child, injury-related, household, and community variables.

METHOD

One hundred and ninety-four participants (106 males, 88 females; mean age 13y 2mo, SD 3y 8mo, range 6-18y) with SCI and their primary caregivers completed a demographics questionnaire and a standardized measure of participation (the Children's Assessment of Participation and Enjoyment, [CAPE]) at three pediatric SCI centers in a single hospital system in the United States. Their mean age at injury was 7 years 2 months (SD 5y 8mo, range 0-17y); 71% had paraplegia, and 58% had complete injuries.

RESULTS

Young people participated more often in informal activities (t((174))=29.84, p<0.001) and reported higher enjoyment with these (t((174))=2.01, p=0.046). However, when engaging in formal activities, they participated with a more diverse group (t((174))=-16.26, p<0.001) and further from home (t((174))=-16.08, p<0.001). Aspects of informal participation were related to the child's age, sex, and injury level, and formal participation to the child's age and caregiver education. Caregiver education was more critical to formal participation among young people with tetraplegia than among those with paraplegia (F((4,151))=2.67, p=0.034).

INTERPRETATION

Points of intervention include providing more participation opportunities for young people with tetraplegia and giving caregivers the resources necessary to enhance their children's formal participation.

Participation in home, extracurricular, and community activities among children and young people with cerebral palsy

AIM

Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP.

METHOD

Five hundred participants (277 males, 223 females) were grouped by age and Gross Motor Function Classification System (GMFCS) level. There were 291 children aged 6 to 12 years and 209 young people aged 13 to 21 years. There were 128 participants in GMFCS level I, 220 in levels II/III, and 152 in levels IV/V. Participants completed the Children's Assessment of Participation and Enjoyment to measure number of activities (diversity) and how often they were performed (intensity) in the past 4 months.

RESULTS

Children had higher overall participation diversity and intensity than young people (p<0.001). Children and young people in GMFCS level I had the highest overall participation, followed by children and young people in levels II/III and IV/V. Children had higher participation in recreational (p<0.001) but not formal (such as team sports or clubs) or physical activities. Children (p<0.01) and young people (p<0.001) in level I had the highest participation in physical activities; diversity and intensity were generally low.

INTERPRETATION

The findings provide evidence of the effect of age and gross motor function on participation of children and young people with CP. Low participation in physical activities may have implications for fitness and health, especially for children and young people in GMFCS levels IV and V.

Leisure activity preferences for 6- to 12-year-old children with cerebral palsy

AIM

The objective was to describe leisure activity preferences of children with cerebral palsy (CP) and their relationship to participation. Factors associated with greater interest in leisure activities were identified.

METHOD

Fifty-five school-aged children (36 males, 19 females; mean age 9 y 11 mo; range 6 y 1 mo-12 y 11 mo) with CP (Gross Motor Function Classification System [GMFCS]) level I 62%, level II 22%, level III-IV 16%; 33.3% hemiplegia, 29.6% diplegia, 25.9% quadriplegia, 11.2% other) who could complete the Preferences for Activities of Children (PAC) were recruited.

RESULTS

Social and recreational activities were most preferred, and self-improvement activities were least preferred. Younger age, higher motivation, and IQ predicted interest in active-physical activities (r(2)=0.39). Negative reaction to failure was associated with less preference for social activities (r(2)=0.16), whereas increased prosocial behaviours were related to greater preference for recreational (r(2)=0.13) and self-improvement activities; the latter is also predicted by older age (r(2)=0.24). Interest in skill-based activities was greater in females and in children who were highly motivated, younger, and had greater motor limitations (r(2)=0.51). The findings suggest that personal factors and functional abilities influence leisure activity preferences. High preference for certain activities was not always associated with involvement in these activities.

INTERPRETATION

Determination of preferences is inherent to child-centred practice and should, therefore, be part of the evaluation process. Rehabilitation strategies can minimize barriers to leisure participation, such as fear of failure, low motivation, or environmental obstacles.

INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

BACKGROUND

Congenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia.

METHODS/DESIGN

A matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs) will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days). A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking), cortical excitability using Transcranial Magnetic Stimulation (TMS), functional use of the hand in everyday tasks (Manual Ability Classification System) and Gross Motor Function Classification System (GMFCS). Outcomes will address neurovascular changes (functional MRI, functional connectivity), and brain (re)organisation (TMS), body structure and function (range of motion, spasticity, strength and sensation), activity limitations (upper limb unimanual capacity and bimanual motor coordination), participation restrictions (in home, school and recreation), environmental (barriers and facilitators to participation) and quality of life.

DISCUSSION

This paper outlines the theoretical basis, study hypotheses and outcome measures for a matched pairs randomised trial comparing CIMT and BIM training to improve outcomes across the ICF.

TRIAL REGISTRATION

ACTRN12609000912280.

Environmental determinants of participation in tourism and recreation of people with varying degrees of disability

Environmental determinants for participation of disabled subjects in tourism and recreation comprise an important social problem. The amount and use of free time for individuals with disabilities in daily life, holidays, and vacation leave and the location for tourism and recreation were examined. Seven hundred and fifty individuals, aged 16-75 yr, with varying degrees of disability, from three eastern provinces of Poland: Podlaskie, Lubelskie and Podkarpackie were investigated. In these studies, a diagnostic survey method with the use of questionnaire, interviews, and analysis of data was carried out. It was found that individuals with disabilities have a significant amount of free time, which is usually spent with family and friends. Among the specific benefits of participation in physical activities are well-being, health improvement, and making new acquaintances. The main factors determining participation in tourism and recreation were price, a friendly group, and doctor recommendations.

Social and community participation of children and youth with cerebral palsy is associated with age and gross motor function classification

BACKGROUND

Through social and community participation, children and youth with cerebral palsy (CP) form friendships, gain knowledge, learn skills, express creativity, and determine meaning and purpose in life.

OBJECTIVE

The purposes of this study were: (1) to determine whether social and community participation of children and youth with CP differ based on age, sex, and gross motor function, and (2) to identify the types of activities in which social and community participation are highest.

DESIGN AND METHODS

A prospective cross-sectional analytic design was used. The participants were a sample of convenience of 291 children (6-12 years of age) and 209 youth (13-21 years of age) with CP (55.4% males, 44.6% females) receiving services from 7 children's hospitals. Participants completed the Children's Assessment of Participation and Enjoyment (CAPE) by structured interview. Gross Motor Function Classification System (GMFCS) level was determined by the researchers.

RESULTS

Youth did a higher percentage of activities with friends and others and outside the home than children. Children and youth in level I did a higher percentage of activities with friends and others compared with children and youth in levels II and III and in levels IV and V. Children and youth in level I and in levels IV and V did a higher percentage of activities outside the home than children and youth in levels II and III. Differences were not found between females and males. The percentage of activities done with friends and others and outside the home was highest for physical and skill-based activities.

LIMITATIONS

Findings cannot be attributed only to GMFCS level.

CONCLUSIONS

The ability to walk without restrictions is desirable for social and community participation. For children and youth with CP who have limitations in mobility, physical therapists have roles as consultants for accessibility, activity accommodations, and assistive technology and as advocates for inclusive environments.