Patterns and predictors of participation in leisure activities outside of school in children and adolescents with Cerebral Palsy

A Comparison of the Functioning and Disability Levels of Children With Hemiplegic and Diplegic Cerebral Palsy Based on ICF-CY Components

We compared children with hemiplegic and diplegic cerebral palsy (CP) using the conceptual framework of the International Classification of Functioning, Disability and Health: Child and Youth version (ICF-CY). We enrolled 42 children with CP aged 5 - 13 years old (M age = 9.57, SD = 2.8 years). We assessed their trunk control and dynamic balance with the Trunk Control Measurement Scale (TCMS) and the Timed Up and Go test (TUG), and we used ABILHAND-Kids and Assessment of Life Habits (Life-H) to assess their manual ability and participation with activities of daily living. We administered the European Child Environment Questionnaire (ECEQ) to identify relevant environmental factors. We employed structural equation modeling (SEM) to identify specific factors contributing to potential differences between these CP groups. Children with hemiplegic CP demonstrated significantly better outcomes in terms of trunk control, dynamic balance, and environmental factors compared to those with diplegic CP (p < .05). In contrast, children with diplegic CP demonstrated superior outcomes regarding manual ability, compared to those with hemiplegic CP (p < .001). In our structural equation models, trunk control strongly predicted both dynamic balance (0.75) and environmental factors (0.74). Moreover, the relationships between trunk control and participation in daily and social activities were 0.54 and 0.47, respectively. Impaired trunk control and dynamic balance were significant contributors to increased activity restrictions and environmental barriers in children with diplegic CP. This suggests that improving disability and functioning in children with diplegic CP requires a focus on trunk control training and dynamic balance exercises.

Leisure education in youth with developmental disabilities: Effects on individual quality of life, adaptive behavior, and family quality of life

Leisure participation enhances the learning of adaptive skills and the quality of life in youth with developmental disabilities. The goal of this study was to evaluate the effects of a leisure education program in individuals with developmental disabilities in terms of adaptive behavior and quality of life. Nine participants divided into two small groups and their families were included. A quasi-experimental design was employed to determine whether there was a program effect. The Adaptive Behavior Assessment System, the KIDSCREEN-27, and the Family Quality of Life Scale were administered before and after the intervention. There was a significant increase in social, home, and school skills as well as a better perception of quality of life in relationships with parents, social support, and school. In addition, the program affected the family's perception of practical and emotional support. Findings provide support for the application of this leisure program to enhance quality of life outcomes.

Facilitators and barriers to participation in physical activities in children and adolescents living with cerebral palsy: a scoping review

PURPOSE

This scoping review aimed to synthetize personal and environmental facilitators and barriers to participation in physical activities among youths living with cerebral palsy.

METHODS

A systematic literature search was performed in five databases: CINAHL, EMBASE, MEDLINE, PsycINFO, Cochrane, WEB OF SCIENCE. The studies were selected by two independent researchers based on inclusion and exclusion criteria. A semi-quantitative evaluation assessed the consistency of results for a given variable. Variables displaying consistent associations were classified based on the Physical Activity for people with Disability Model.

RESULTS

The electronic search yielded 10 795 articles, of which 57 were included. The main barriers to physical activity identified were motor impairments (30 studies), older age (15 studies), pain (6 studies), attendance in regular school (6 studies), and communication problems (4 studies). Barriers such as upper limb impairment and visual deficit were less frequently studied, while cognitive attributes, adapted physical environments and positive attitude, and family support were identified as facilitators.

CONCLUSION

Personal and environmental factors influencing physical activities behaviors among youths living with cerebral palsy are multiple and complex since they interact with each other. Rehabilitation interventions need to adopt a person-based approach to address barriers and reinforce facilitators.IMPLICATIONS FOR REHABILITATION:Physical activity participation among youths with cerebral palsy is a multidimensional phenomenon, dependent on different personal and environmental factors.Gross motor impairments, communication problems, and pain were the most common personal factors limiting physical activity participation.Environmental factors consistently associated with physical activity participation were school settings, physical environment such as transportation, and social and family support and attitude.Rehabilitation interventions to promote an active lifestyle should consider not only personal factors but their interaction with the child's environment.

I Would Like to Do It Very Much! Leisure Participation Patterns and Determinants of Brazilian Children and Adolescents With Physical Disabilities

PURPOSE

To describe the patterns, preferences, and predictors of participation in leisure activities of children and young people with physical disabilities from Brazil.

METHODS

This is a cross-sectional study that included 50 children/young people with physical disabilities from the southeast of Brazil. The children were assessed using the Children's Assessment of Participation and Enjoyment and Preferences for Activities.

RESULTS

Children/young people participated in an average of 38% of the activities, with a greater number and frequency of informal, recreational, social, and self-improvement activities. The average frequency of participation in the activities was twice in the previous 4 months. The enjoyment in the participated activities was high. There was a greater preference for recreational, social, and physical activities. Age and functional classification were predictors of participation.

CONCLUSION

This study of children with disabilities from the southeast of Brazil supports studies in other low- and middle-income countries, demonstrating low diversity and intensity of participation in leisure activities, but with high levels of enjoyment.

On the feasibility of simple brain-computer interface systems for enabling children with severe physical disabilities to explore independent movement

Introduction

Children with severe physical disabilities are denied their fundamental right to move, restricting their development, independence, and participation in life. Brain-computer interfaces (BCIs) could enable children with complex physical needs to access power mobility (PM) devices, which could help them move safely and independently. BCIs have been studied for PM control for adults but remain unexamined in children. In this study, we explored the feasibility of BCI-enabled PM control for children with severe physical disabilities, assessing BCI performance, standard PM skills and tolerability of BCI.

Materials and methods

Patient-oriented pilot trial. Eight children with quadriplegic cerebral palsy attended two sessions where they used a simple, commercial-grade BCI system to activate a PM trainer device. Performance was assessed through controlled activation trials (holding the PM device still or activating it upon verbal and visual cueing), and basic PM skills (driving time, number of activations, stopping) were assessed through distance trials. Setup and calibration times, headset tolerability, workload, and patient/caregiver experience were also evaluated.

Results

All participants completed the study with favorable tolerability and no serious adverse events or technological challenges. Average control accuracy was 78.3 ± 12.1%, participants were more reliably able to activate (95.7 ± 11.3%) the device than hold still (62.1 ± 23.7%). Positive trends were observed between performance and prior BCI experience and age. Participants were able to drive the PM device continuously an average of 1.5 meters for 3.0 s. They were able to stop at a target 53.1 ± 23.3% of the time, with significant variability. Participants tolerated the headset well, experienced mild-to-moderate workload and setup/calibration times were found to be practical. Participants were proud of their performance and both participants and families were eager to participate in future power mobility sessions.

Discussion

BCI-enabled PM access appears feasible in disabled children based on evaluations of performance, tolerability, workload, and setup/calibration. Performance was comparable to existing pediatric BCI literature and surpasses established cut-off thresholds (70%) of “effective” BCI use. Participants exhibited PM skills that would categorize them as “emerging operational learners.” Continued exploration of BCI-enabled PM for children with severe physical disabilities is justified.

Physical Activity and Public Health among People with Disabilities: Research Gaps and Recommendations

Physical activity has become an integral component of public health systems modeling the public health core functions of assessment, policy development, and assurance. However, people with disabilities have often not been included in public health efforts to assess, develop policies, or evaluate the impact of physical activity interventions to promote health and prevent disease among people with disabilities. Addressing the core function of assessment, current physical activity epidemiology, and surveillance among people with disabilities across the globe highlights the paucity of surveillance systems that include physical activity estimates among people with disabilities. The status of valid and reliable physical activity measures among people with condition-specific disabilities is explored, including self-report measures along with wearable devices, and deficiencies in measurement of physical activity. The core functions of policy development and assurance are described in the context of community-based intervention strategies to promote physical activity among people with disabilities. The identification of research gaps in health behavior change, policy, and environmental approaches to promoting physical activity among people with disabilities is explored, along with recommendations based on the principles of inclusive and engaged research partnerships between investigators and the members of the disability community.

The Effects of Basic Photography Education on Quality of Life, Self-Esteem, Life Satisfaction and Moods in Children with Diplegic Cerebral Palsy: A Randomized Controlled Study

AIMS

To investigate the effects of basic photography education and practices on health-related-quality-of-life (HRQoL), self-esteem, life satisfaction, and moods of children with diplegic cerebral palsy (CP).

METHODS

Twenty children with diplegic CP who did not have an intellectual or communication disability were included in this prospective randomized controlled clinical study and divided into two equal groups using a computer-generated list of random numbers to receive either eight weeks of basic photographic training or a control group. Basic photography training including a total of 20 hours theoretical and 30 hours practice was given during the eight weeks in this study. HRQoL, self-esteem, life satisfaction, depression and anxiety were assessed at baseline and at the end of the training.

RESULTS

At the end of the treatment, statistically significant improvements were found for self-reported HRQoL, life satisfaction, and self-esteem in the basic photographic training group compared to the control group (p < 0.05). However, no statistically significant between group difference was found for parents' version of the HRQoL (p > 0.05).

CONCLUSIONS

The findings suggest that basic photography training can improve HRQoL, life satisfaction, and self-esteem in children with diplegic CP.

Factors Affecting Participation of Children with Cerebral Palsy in Meaningful Activities: Systematic Review

This is a systematic review using PRISMA guidelines to review the factors affecting participation of children with cerebral palsy (CP), the most common childhood motor disability. Inclusion criteria consisted of publications in a peer-reviewed journal between 2000 and 2018, and at I, II, III, and IV levels of AOTA Evidence. After the title, abstract, and a full text screening, 31 articles met eligibility to be included. The studies examined ADLs (12), IADLs (9), play and leisure (19), and social participation (14), but only 3 in rest/sleep, 1 in work, and 8 in education. Gross motor and manual function, CP type, home, and community physical environment, were the most common factors affecting individuals' participation with CP. Results imply occupational therapists must evaluate clients on all factors shown to facilitate or inhibit participation to ensure an adequate intervention plan. However, evaluating every individual case in the occupational therapy process is time-consuming and difficult. Based on this study's findings, we suggest occupational therapists prioritize evaluating motor skills (gross and fine), the most influential of the factors in all areas of participation. Occupational therapists also could advocate for policy around community environmental barrier removal.

Environmental factors associated with participation and its related concepts among children and youth with cerebral palsy: a rapid review

PURPOSE

To provide an overview of environmental factors associated with participation and participation-related constructs in children and youth with cerebral palsy (CP).

METHODS

A rapid review following the principles from scoping methodology was performed with a literature search in September 2019. The CINAHL, Embase, Ovid MEDLINE and PsychINFO databases were searched to identify original articles which addressed participation in children and youth (aged 0-18) with CP.

RESULTS

In total, 9511 unique articles were identified, of which 34 met all inclusion criteria. Many different measures for environmental factors were used. Most common environmental factors associated with participation (i.e., attendance and involvement) were family ecology, type of school, and parental stress. Regarding participation-related constructs (activity competence, sense of self and preferences), most common factors were parental stress and the physical environment.

CONCLUSIONS

While environmental factors are found to be associated with participation attendance and activity competence in children with CP, there is a lack of research of environmental factors in relation to both participation involvement and other participation-related constructs. To increase impact in clinical practice, future research should involve structured assessments of the environment and focus more on modifiable factors, to help service providers develop treatment paradigms needed for meaningful participation outcomes.IMPLICATIONS FOR REHABILITATIONFamily ecology, type of school, and parental stress were the most common factors associated with participation.Future research should focus on modifiable factors associated with participation outcomes.Modifiable environmental factors associated with participation included parental stress, family activity and type of school.In clinical practice, environmental factors are to be assessed in a more systematic way in relation to current or future participation restrictions.

Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy

AIM

To compare participation in leisure physical activities in children with typical development (TD) and cerebral palsy (CP).

METHODS

A total of 170 children with TD (n = 101) and CP (n = 69) aged 8 to 18 years reported participation in 16 extracurricular physical activities. Non-parametric statistics examined differences between groups.

RESULTS

Children with TD participated more frequently in individual physical activities (p = .018), team sports (p = .026), and bicycling (p = .001), and less in horseback riding (p = .031) than children with CP in GMFCS II-V. The differences between children with TD and CP in GMFCS I and within the CP group were not statistically significant. We did not find differences between groups in enjoyment.

CONCLUSION

Children with CP in GMFCS II-V tend to participate less in leisure physical activities that require higher motor and perceptual skills. Support in the adaptation of physical recreation and sports may help improve participation.

Community Participation of School-Age Children: Who is at Risk of Restricted Participation?

AIMS

This study aimed to identify children with restricted community participation and examine the extent to which the child, family, and environmental factors were associated with restricted participation.

METHODS

A school-based sample of 92 children with disabilities and 391 children without disabilities aged 5-12 years was recruited in Hong Kong. Parents completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire. Moreover, children completed the Children's Depression Inventory. Rasch analysis was used to determine the criteria that differentiated between children with and without participation restriction, based on frequency of activities. Logistic regression was used to identify the factors associated with participation restriction.

RESULTS

One hundred seventy-three children (35.8% of the sample), including 42 with disabilities, were identified as having restricted participation. Participation restriction was associated with higher depressive symptoms in children (odds ratio (OR) = 1.05, 95% confidence interval (CI) [1.01, 1.08]), lower environmental resources (OR = 0.97, 95% CI [0.96, 0.99]), and coming from families with three or more children (OR = 2.80, 95% CI [1.44, 5.46]).

CONCLUSIONS

The results suggest that a sizable number of children are at risk for restricted participation in the community. Healthcare services and strategies that address the associated factors are needed to promote children's community participation.

The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa

Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers' capacity to support children's participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children's Assessment of Participation and Enjoyment (CAPE). One hundred caregiver-child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children's participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child's participation. These factors need to be considered when generalising results from different countries.

I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities

PURPOSE

To explore how children with cerebral palsy (CP) experience participation in leisure activities and to describe the environmental barriers and facilitators.

METHODS

Sixteen children with cerebral palsy aged 7 to 17 years participated in 3 focus groups. Data were analyzed thematically by 3 researchers on the basis of the International Classification of Functioning, Disability and Health.

RESULTS

A total of 38 International Classification of Functioning, Disability and Health categories were identified (4 linked to Body functions; 2 linked to Body structures; 8 linked to Activities & Participation, and 24 to Environmental factors: 10 facilitators and 14 barriers). The most mentioned categories were Voluntary movement control functions, Functions related to gait pattern, Structure of upper arm, Recreation and leisure, Nuclear family and finally, and Individual attitudes of acquaintances.

CONCLUSIONS

The main barriers identified by children with cerebral palsy highlight aspects of the physical, social, and attitudinal environment that could be modified to enhance participation in leisure activities.

Participation in Leisure Activities by Portuguese Children With Cerebral Palsy

Leisure participation contributes to the health and wellbeing of children with and without physical disabilities. In the present cross-sectional study, we aimed to assess the influence of child and family factors on leisure activity participation of children with cerebral palsy (CP) aged 8-18 years. A convenience sample of 69 participants with CP (M age = 12.75 years, SD = 2.95; 45 males) responded to the Children's Assessment of Participation and Enjoyment questionnaire to report participation diversity, frequency, companies, environment and enjoyment in leisure activities. From these questionnaires, we used descriptive statistics to summarize overall participation, two activity domains (formal and informal) and five activity types (recreational, social, active physical, skill-based, and self-improvement). Regression analysis assessed child and family factors' influence on participation. On average, children with CP were involved in 21 leisure activities in the last four months. Within activity types, social and recreational activities were the most frequently reported. Participation in physical and skill-based activities was low. Overall children with CP experienced high enjoyment with engagement in leisure activities. Collectively, factors of age, cognitive function, gross motor function, and mother's education level predicted 33% of activity diversity and 30% of activity frequency. We concluded that children with CP show diverse leisure activity participation and high leisure activity enjoyment. Health, education and sports professionals should consider the child's functional profile and family context when promoting participation.

Participation in leisure-time activities and the role of individual factors in children and adolescents with cerebral palsy

Background/Aims

This study evaluated the role of individual factors of children and adolescents with cerebral palsy in the prediction of leisure participation.

Methods

A cross-sectional study design was used. A group of children and adolescents with cerebral palsy were selected to complete the Children's Assessment of Participation and Enjoyment. Participants' cognitive levels were assessed based on the Study of Participation of Children with Cerebral Palsy Living in Europe estimated cognitive levels.

Findings

The models could best predict up to 31.8% of the variance in the participation rates, 28.4% of the variance in the frequency scores and 33.5% of the variance in the enjoyment scores of leisure domains. The type of cerebral palsy was one of the most significant predictive factors of leisure participation (β ranged from −0.177 to −0.525 for quadriplegia).

Conclusions

Therapists and rehabilitation specialists may consider individual factors to predict a proportion of leisure participation subscales before planning for interventions aimed at promoting the leisure participation of children and adolescents with cerebral palsy.

Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth

Purpose: To adapt the Participation and Environment Measure for Children and Youth for use with Chinese children and youths, and to investigate its psychometric properties.Materials and methods: The Participation and Environment Measure for Children and Youth was translated into Chinese using a cultural adaptation process. Parents of 69 children aged 5-12 years with disabilities and 319 children without disabilities completed the questionnaires. Internal consistency, test-retest reliability, factorial structure, and known-group validity were examined using Cronbach's alpha, intraclass correlation coefficient, confirmatory factor analysis and t-test, respectively.Results: We added and/or replaced activities with culturally-relevant activities in the Chinese version. Internal consistency was acceptable for most of the scales (0.55-0.86). Test-retest reliability of the summary scores was moderate to high (0.70-0.84). Data-model fit was confirmed in a one-factor structure for the participation scales and a two-factor structure for the environment scales. There were also significant differences in the summary scores between 65 gender- and age-matched pairs of children with and without disabilities on the school participation scales and all the environment scales.Conclusion: This study provides psychometric evidence supporting the use of the Participation and Environment Measure for Children and Youth to assess Chinese children's participation and environmental supports/barriers.Implications for rehabilitationThe Chinese version of the Participation and Environment Measure for Children and Youth was developed through a rigorous translation and cultural adaptation process.There is evidence for the reliability (internal consistency and test-retest reliability) and construct validity (factorial structure and known-group validity) of the Chinese version of the Participation and Environment Measure for Children and Youth.The Chinese version of the Participation and Environment Measure for Children and Youth can be used to assess children's participation in home, school and community settings and to identify environmental barriers that require further intervention.

Comparative study of home and community participation among children with and without cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) are at increased risk of reduced participation. Parental evaluation of child's participation is often the decision-making factor in the process of special education and/or rehabilitation.

AIMS

Examine and compare home and community participation of children with CP and typical development (TD) and the associations between their parents' desire for change and participation dimensions in both settings.

METHODS AND PROCEDURES

This cross-sectional study included a convenience sample of 110 children with CP (55% males; mean age 12.7 years) and 134 children with TD (49% males; mean age 12.1 years). The Participation and Environment Measure for Children and Youth (PEM-CY) was used.

OUTCOMES AND RESULTS

Home and community participation and environmental supportiveness of children with CP were lower compared to children with TD (p < .001, family income controlled). The effect sizes indicated that there may be no clinically important difference in participation frequency. Parents of children with CP desired change if participation was less diverse at home, less frequent in the community, or if involvement was lower in both settings (environmental supportiveness and income controlled).

CONCLUSIONS AND IMPLICATIONS

At home, parents expressed a desire for change more intensely through the range of activities, while parents of children with TD emphasized participation frequency. In the community, parents of children with CP equally perceived participation diversity and focused more on frequency and involvement.

Reliability and Validity of the European Child Environment Questionnaire (ECEQ) in Children and Adolescents with Cerebral Palsy: Persian Version

The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach’s alpha (N = 332) and after two weeks’ test–retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach’s alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.

Comparing parent and child reports of health-related quality of life and their relationship with leisure participation in children and adolescents with Cerebral Palsy

The aim of this study was to examine the level of agreement between reports of health-related quality of life (HR-QoL) obtained from children and adolescents with cerebral palsy (CP) and their parents. We also examined the relationships between child and parent perception of the different domains of HR-QoL and participation dimensions. Sixty-nine children and adolescents with CP and their parents separately completed parallel forms of the KIDSCREEN questionnaire. The Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE) was completed by the child/adolescent. Concordance between the children's and the parents' HR-QoL scores was analyzed via Pearson and intraclass correlations. Differences in means were tested using paired Student's t-tests. Chi-square tests were using to assess the incidence of personal variables in the agreement and disagreement of children-parents' responses. The relationships between HR-QoL and leisure participation was confirmed with Pearson's correlation coefficients. Correlations between child and parent HR-QoL scores were small in 7 domains, medium in 2 and large in the Social Support & Peers domain. Children reported significantly better HR-QoL than their parents did. Participation was positively associated with specific domains of HR-QoL, but only weakly, and there were discrepancies between parent and child reports of HR-QoL. These findings provide interesting information about the importance of hearing the voices of children and adolescents with CP to promote HR-QoL and leisure participation.

Differences in patterns of physical participation in recreational activities between children with and without intellectual and developmental disability

BACKGROUND

Children with intellectual and developmental disability (IDD) are at risk of experiencing limited participation in recreational activities, where they may be present but not physically engaged.

AIM

To compare patterns of physical engagement in recreational activities between children with and without IDD.

METHODS AND PROCEDURES

Fifty children with IDD (26 boys, 24 girls; mean age 8.7 years) were matched for age and sex with 50 typically developing children. Parents completed a questionnaire which captured participation in 11 recreational activities involving hand use as an indication of physical engagement.

OUTCOME AND RESULTS

More than 80% of children in both groups participated physically in eight recreational activities, but fewer children with IDD participated in six activities when compared with typically developing children. Children with IDD also participated less frequently in five activities and required more assistance to participate in all the 11 activities. Parents wanted their child with IDD to participate in 10 recreational activities with less assistance.

CONCLUSIONS AND IMPLICATIONS

The difference between the groups related to participation frequency, independence, and parents' desire for changes in their child's participation. Greater efforts are needed to address these differences and to support recreational participation in children with IDD.

Leisure Participation Patterns of Children With Movement Impairments in New Zealand

PURPOSE

To investigate the leisure participation patterns of children with movement impairments in New Zealand.

METHODS

A cross-sectional survey was conducted with children with movement impairments aged 6 to 12 years using the Children's Assessment of Participation and Enjoyment questionnaire. Descriptive statistics were used to analyze the data.

RESULTS

Children participated in an average of 57.3% of activities, with a greater number and frequency of recreational, social, and self-improvement activities as compared with skill-based and physical activities. Children performed nearly 50% of activities with family and 13% of activities with friends. Approximately 50% of activities were performed at home and 50% of activities were performed outside the home.

CONCLUSIONS

Children with movement impairments participated in diverse leisure activities. However, reduced involvement in physical activities needs further investigation to identify the actual level of physical exertion, barriers faced, and how increased opportunities for regular physical activity could be instigated.

The Comparison of Participation in School-Aged Cerebral Palsy Children and Normal Peers: A Preliminary Study

Background

Participation in daily activities during childhood is an important aspect for health and social development.

Objectives

This study was designed to investigate the participation of children with cerebral palsy aged 8 to 14 years, and their normal peers.

Patients and Methods

In this cross-sectional study, 30 children with cerebral palsy, and 30 normal children were selected via the non-probability convenience sampling. Their participation was evaluated with children’s assessment of participation and enjoyment (CAPE) through interviews.

Results

Significant differences were found between the means of the two groups regarding the diversity, intensity, overall participation (P = 0.000) and all types of the activities except the recreational activities. The children with cerebral palsy took part in the skill-based activities and overall activities individually compared to the normal peers. The children with cerebral palsy, in comparison with their normal peers, often performed most of the activities inside the house. The main effect of gender and the interaction between gender and groups were not statistically significant in any of the variables of the CAPE test.

Conclusions

Physical disability can influence the children’s daily activities and socialization. Understanding the participation of physically disabled children can help health care professionals in designing and introducing appropriate treatment according to their needs.

Correlates of physical activity in children and adolescents with physical disabilities: A systematic review

BACKGROUND

The benefits of physical activity (PA) for children with disabilities are well documented, and children with physical disabilities (PD) are often less active than peers with other disability types. Various correlates associated with PA in children with PD have been identified in separate studies, and a thorough analysis of these correlates could aid in understanding and designing interventions that promote children with PD to be more physically active. The purpose of this systematic review was to provide a comprehensive summary of the correlates of PA in children with PD.

METHOD

A systematic search using PubMed, CINAHL, Cochrane Library, PsychINFO, Eric, and EMbase was initiated in October 2014 to identify studies examining the correlates of PA in children with PD aged 6-18years. Two researchers independently screened studies, assessed their methodological quality, and extracted relevant data. The correlates were synthesized and further assessed semi-quantitatively.

RESULTS

A total of 45 articles were included in the detailed review. Several modifiable physical, psychological, and environmental correlates were consistently and positively associated with PA in children with PD. Some non-modifiable correlates (e.g., intellectual ability, parents' ethnicity) were found to be consistently and negatively associated with PA.

CONCLUSIONS

The correlates of PA in children with PD are multifaceted and along many dimensions. This review can have implications for future studies and these may confirm the consistency of variables related to PA. Insights derived from the outcomes may also foster the measurement of the magnitude of associations that could assist the development of future interventions.

The spectrum of long-term cognitive and functional outcome after hemispherectomy in childhood

PURPOSE

To evaluate cognition, behavior, daily functioning and health-related quality of life (HrQoL) five years to more than a decade after hemispherectomy (HE) in childhood.

METHODS

This countrywide Dutch cohort study of 31 patients, who underwent HE between 1994 and 2009, included a semi-structured interview with parents, an assessment of cognition, and screening of behavioral problems and HrQoL.

RESULTS

Twenty-two school-age children and young adults [median age 13.8 years (0.5 at epilepsy onset, 5.3 at HE)] were assessed with age-appropriate cognitive tests. IQ ranged from 45 to 82 (median 61). Despite performing below mean norm scores, these participants could learn and remember, sustain attention, inhibit irrelevant responses, read and write. Nine more children [median age 9.7 years (0.25 at epilepsy onset, 1.4 at HE)] were so mentally retarded that age-appropriate testing was impossible. This group was almost totally dependent on others in daily activities, had the highest proportion of pre-existing contralateral MRI-abnormalities and after HE the highest rates of seizure recurrence and behavioral problems. Parents in both groups rated HrQoL surprisingly positively (mean VAS-score 72.5), with a scarce low rating (40). All parents reported problems with respect to their children's self-care, daily activities and mobility.

CONCLUSION

At least five years after HE, cognitive, behavioral and daily functioning encompasses a broad spectrum that varies from profound retardation and almost total dependence to low normal cognition and a reasonably independent existence. Pre-existing contralateral MRI abnormalities reflect a more generally affected brain with a limited ability to mediate development after HE.

The extent, context and experience of participation in out-of-school activities among children with disability

BACKGROUND

A growing literature describes the participation of children with disability, but less is known about the effect of disability type, severity and environmental factors on participation.

AIM

To investigate the extent, context, experience and preferences for participation in out-of-school activities among children with disability in Victoria, Australia.

METHODS AND PROCEDURES

Two-hundred and eighty-six children (177 boys, 109 girls; mean age 11.5 years) with physical (n=77), intellectual (n=67), multiple (n=93), and other disabilities (n=49) took part. Data were collected using the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) questionnaires.

OUTCOMES AND RESULTS

Children with disability participated in 28 out of 55 activities (SD 6 activities), 2-3 times per month, on average. Preference was the most important predictor of participation diversity for all activity types. Disability type was a predictor of participation diversity in active-physical activities only. Severity was a predictor of participation diversity overall, and of participation in formal and informal activities. Age, severity and preference accounted for almost 50% of the variance of diversity of recreational activities.

CONCLUSIONS AND IMPLICATIONS

These results underscore the importance of taking a child's activity preferences into account when implementing interventions to increase participation in out-of-school activities.

Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed-Methods Study to Generate Evidence for Developing an Intervention

BACKGROUND

Participation in physical play/leisure (PPP) is an important therapy goal of children with motor impairments. Evidence for interventions promoting PPP in these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions.

OBJECTIVE

The study objective was to identify, in children with motor impairments, body function and structure, activity, environmental, and personal factors related to PPP and modifiable by therapists.

DESIGN

This was a mixed-methods, intervention development study. The World Health Organization framework International Classification of Functioning, Disability and Health was used.

METHODS

Participants were children (6-8 years old) with motor impairments, mobilizing independently with or without equipment and seen by physical therapists or occupational therapists in 6 regions in the United Kingdom, and their parents. Self-reported PPP was assessed with the Children's Assessment of Participation and Enjoyment. Modifiable-factor data were collected with therapists' observations, parent questionnaires, and child-friendly interviews. The Children's Assessment of Participation and Enjoyment, therapist, and parent data were analyzed using descriptive statistics and linear regression. Interview data were analyzed for emerging themes.

RESULTS

Children's (n=195) PPP (X=18 times per week, interquartile range=11-25) was mainly 'recreational' (eg, pretend play, playing with pets) rather than 'active physical' (eg, riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but various levels of family PPP. Therapists reported 23 unique impairments (eg, muscle tone), 16 activity limitations (eg, walking), and 3 personal factors (eg, child's PPP confidence). Children interviewed (n=17) reported a strong preference for active play but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of the variation in PPP. Family PPP explained most of the variation.

LIMITATIONS

It is likely that the study had a degree of self-selection bias, and caution must be taken in generalizing the results to children whose parents have less positive views about PPP.

CONCLUSIONS

The results converge with wider literature about the child's social context as a PPP intervention target. In addition, the results question therapists' observations in explaining PPP.

Participation in Leisure Activities by Children and Adolescents with Juvenile Idiopathic Arthritis

Objective.

To describe leisure activities of children and adolescents with juvenile idiopathic arthritis (JIA) in terms of diversity, intensity, and enjoyment, and to identify potential determinants.

Methods.

One hundred seven children and adolescents aged 8–17 years diagnosed with JIA and their families participated in this cross-sectional study. Participants answered the Children’s Assessment of Participation and Enjoyment, which measures involvement in leisure (recreation, active physical, social, skill-based, self-improvement). Disease characteristics and sociodemographic factors were abstracted from the child’s medical file.

Results.

In terms of intensity, individuals with JIA were more often engaged in informal rather than formal leisure activities [t(106) = 45.5, p < 0.0001]. When intensity scores were compared across activity type, results showed that participants with JIA were most often involved in social and recreational activities (p < 0.001). The level of enjoyment was highest for social activities and lowest for self-improvement activities (p < 0.001). Those with active arthritis displayed less diverse (p = 0.016) and less intense (p = 0.011) participation in active physical activities, and less frequent involvement in informal activities (p = 0.043) compared with those who were asymptomatic.

Conclusion.

Children and adolescents with JIA tend to participate more in sedentary types of activities. Greater disease activity may dissuade children and adolescents from participating in more active pursuits, which places them at greater risk for adopting sedentary lifestyles. The identification of determinants of leisure activities in children and adolescents with arthritis may allow healthcare professionals to assess children’s health needs with more precision and promote a healthier lifestyle.

Association between motor functioning and leisure participation of children with physical disability: an integrative review

AIM

The aim of this integrative review is to synthesize the evidence of association between motor functioning and leisure participation of children with physical disability.

METHOD

We conducted a systematic electronic search of key databases from the period 1 January 2001 to 30 April 2014 using relevant keywords. The Mixed Method Appraisal Tool was used to assess the quality of the qualitative and quantitative studies included and carried out in children with physical disability aged 6 to 12 years. We synthesized and compared information from both type of studies to identify the extent, and way by which, motor functioning influences leisure participation.

RESULTS

Thirty-five studies were included and analyzed for this review. Twenty-four studies used quantitative and 11 studies used qualitative methodology. We identified the association between motor functioning and six dimensions of participation including diversity, intensity, context, preferences, enjoyment and quality of participation. Motor functioning was found to have a weak to moderate association with involvement in specific leisure activity types and dimensions. We developed a conceptual framework to illustrate the influence of motor functioning on leisure participation from this review.

INTERPRETATION

Whether motor functioning poses a barrier to leisure participation for children with physical disability appears to depend on the functional movement required to participate in a particular leisure activity.

Promoting leisure participation as part of health and well-being in children and youth with cerebral palsy

Participation in leisure is a human right and is central to the health of children and youth. The World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth supported a change in thinking about what outcomes are most relevant in the context of children's health and places participation as one of the constituent elements of health. Participation is also a fundamental rehabilitation and health promotion outcome for children with cerebral palsy as identified by youth, parents, and health professionals. Several studies have identified individual and environmental factors related to participation in leisure; new studies are now determining the best interventions to promote participation. This article summarizes recent findings and proposes important topics for neurologists to consider in exploring leisure pursuits with children with cerebral palsy and their families and in working with rehabilitation professionals to promote engagement in leisure opportunities as part of integrated care.

European study of frequency of participation of adolescents with and without cerebral palsy

Children with cerebral palsy participate less in everyday activities than children in the general populations. During adolescence, rapid physical and psychological changes occur which may be more difficult for adolescents with impairments. Within the European SPARCLE project we measured frequency of participation of adolescents with cerebral palsy by administering the Questionnaire of Young People's Participation to 667 adolescents with cerebral palsy or their parents from nine European regions and to 4666 adolescents from the corresponding general populations. Domains and single items were analysed using respectively linear and logistic regression. Adolescents with cerebral palsy spent less time with friends and had less autonomy in their daily life than adolescents in the general populations. Adolescents with cerebral palsy participated much less in sport but played electronic games at least as often as adolescents in the general populations. Severity of motor and intellectual impairment had a significant impact on frequency of participation, the more severely impaired being more disadvantaged. Adolescents with an only slight impairment participated in some domains as often as adolescents in the general populations. Regional variation existed. For example adolescents with cerebral palsy in central Italy were most disadvantaged according to decisional autonomy, while adolescents with cerebral palsy in east Denmark and northern England played sports as often as their general populations. Participation is an important health outcome. Personal and environmental predictors of participation of adolescents with cerebral palsy need to be identified in order to design interventions directed to such predictors; and in order to inform the content of services.

Household task participation of children and adolescents with cerebral palsy, Down syndrome and typical development

This cross-sectional study compared patterns of household task participation (e.g., performance, assistance and independence) of youth with cerebral palsy (CP), Down syndrome (DS) and typical development (TD). Parents of 75 children and adolescents were interviewed to report on their youths' active engagement in daily self-care and family-care tasks, using the children helping out: responsibilities, expectations and supports (CHORES) questionnaire. Groups were equivalent in age (mean=9.3 years; SD=2.2 years), sex (male=39; female=36), respondent education, presence of maid, and number of siblings at home, but differed on child cognitive function and family socioeconomic status, with the DS and the CP groups scoring lower than the TD group but not different from each other. ANOVA revealed group differences on CHORES performance of self-care tasks (p=0.004), on total participation score (p=0.04) and on assistance scores (p<0.02). Post hoc comparisons showed that TD group scored higher than CP and DS groups on performance and assistance in self-care tasks and total assistance; TD and CP groups were similar on total performance and assistance in family-care tasks. The groups also differed on independence indices; the TD index was greater than the CP and DS, and the CP index was greater than the DS. Parents from the three groups did not differ on ratings of importance regarding their children's household participation (p=0.416). In spite of observed differences, children and adolescents with CP and DS are actively engaged in daily self-care and family-care tasks; their participation at home is not prevented by the presence of their disabilities.

The influence of participation in leisure activities on quality of life in Spanish children and adolescents with Cerebral Palsy

Participation is an important modifiable quality of life (QOL) determinant and a key outcome measure. The aim of this study was to confirm if participation in leisure activities affects the QOL domains in children and adolescents with Cerebral Palsy (CP) in Spain. A total of 206 children and adolescents with CP (and their parents), 115 boys and 91 girls, mean age of 11.96 years (SD=3.00; range 8-18 years) participated in the study. Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% Level I, 18% Level II, 18% Level III, 12.6% Level IV, and 27.2% Level V. Participation in leisure activities was assessed using the Spanish version of Children's Assessment of Participation and Enjoyment (CAPE) and QOL using the KIDSCREEN parents' version. Diversity, intensity and enjoyment of participation explained the levels of QOL in the Physical well-being, Psychological well-being, Autonomy, Parent relation & home life and Social support & peers domains, independently of gender, age and level of impairment (motor and intellectual). We also found that intensity and enjoyment of participation in informal activities had more influence on the different QOL domains. The most influenced domain by the enjoyment of participation in all domains and types of CAPE activities was Psychological well-being. The participation in leisure activities had a positive effect on the QOL of the Spanish children and adolescents with CP.

Comparing participation patterns in out-of-school activities between Israeli Jewish and Muslim children

OBJECTIVES

(1) To compare participation patterns in out-of-school activities of Israeli Jewish and Muslim children in order to better understand the effect of culture on participation.

METHODS AND RESULTS

Participants were 111 Jewish children and 134 Muslim children with typical development, aged between six and 11 years, who completed the CAPE. Muslim children showed significantly higher total participation diversity, and specifically in informal and recreational activities. Muslim children also showed higher participation intensity and higher enjoyment. They performed more activities with someone else and fewer activities in the community. In both cultures, sociodemographic factors including age, gender, parents' education, and familial socioeconomic level were related to the child's participation.

CONCLUSIONS

Children's participation in out-of-school activities may be related to culture, gender, and other sociodemographic factors. Clinicians should integrate cultural values into therapeutic interventions and consider environmental opportunities or barriers when interpreting participation patterns in order to meet the person's needs and optimize intervention outcomes.