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

Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists

PURPOSE

To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework.

METHODS

A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories.

RESULTS

A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments = decreased strength (17.9%), activity limitations = limited walking (22.5%), and participation restrictions = restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training.

CONCLUSIONS

Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.

Quality of life, functioning and participation of children and adolescents with visual impairment: A scoping review

BACKGROUND

Vision has a key role in children's neuromotor, cognitive and social development. Children with visual impairment attain developmental milestones at later stages and are at higher risk of developing psychological disorders and social withdrawn.

AIMS

We performed a scoping review to summarize the mostly used instruments assessing the impact of visual impairment on quality of life, functioning and participation of children and adolescents. In addition, the main findings of the included studies are discussed.

METHODS AND PROCEDURES

We searched for papers assessing quality of life, functioning and participation of children and adolescents with visual impairment from 0 to 18 years old conducted between 2000 and 2023.

OUTCOMES AND RESULTS

In total, 69 studies met the inclusion criteria and were included in the review. Child self-report, caregivers-proxy and self-report questionnaires as well as interviews were used. The results showed that quality of life, functioning and participation are significantly reduced in children and adolescents with visual impairment, and that the impact depends on different factors (e.g., severity of the impairment, age).

CONCLUSIONS AND IMPLICATIONS

Considering the significant impact of visual impairment on quality of life, functioning and participation on this population, it is fundamental to develop integrated and multi-dimensional assessment programs that evaluate the impact of visual impairment on those dimensions considering different contexts of life (e.g., family, school, leisure time). WHAT THIS PAPER ADDS?: The present review aims to give an overview of what is known about the impact of visual impairment on quality of life, functioning and participation of children and adolescents. We assumed a biopsychosocial perspective which, in line with the definition of health by the International Classification of Functioning, Disability and Health (WHO, 2001), considered how body functions and structures, functioning, participation and environmental factors dynamically interact to define the health, or the disease, status of a person at a certain moment of life. We reported the most used instruments for the assessment of quality of life, participation, and functioning, with a specific interest on Patient-Reported Outcome Measures and self-report measures. By reporting the different instruments used, we gave a broad overview about the available tools that can be used in clinical as well as in research field to assess quality of life, functioning and participation in this population. Additionally, the review of the existing literature allowed us to demonstrate that those dimensions are negatively impacted by visual impairment and thus they should be considered in the assessment programs. Specifically, there is the need to provide more integrated assessment programs that investigate the impact of visual impairment on children and adolescents' social and emotional wellbeing, everyday functioning and social relationship, considering their subjective experience together with the one of caregivers, teachers, health care professionals, and other relevant adults involved in their life. Additionally, it is essential to plan and implement multidimensional assessment programs that consider how all areas of life are differently impacted by visual impairment.

Participation measures that evaluate attendance and involvement for young people aged 15 to 25 years with cerebral palsy: a systematic review

PURPOSE

To identify participation-focused measures used for young people with cerebral palsy (CP), evaluate their psychometric evidence, and map item content to the International Classification of Functioning, Disability, and Health (ICF), and family of Participation-Related Constructs (fPRC) frameworks.

METHODS

Four databases (PubMed, Embase, Web of Science, CINAHL) were searched for papers that involved young people with CP aged 15 to 25 years and reported original data from a participation measure. Each measure was examined for validity, reliability, responsiveness (using the COSMIN checklist), clinical utility, the inclusion of accessible design features, self- and/or proxy-report from people with communication support needs, and item content according to ICF and fPRC.

RESULTS

Of 895 papers, 80 were included for review. From these, 26 measures were identified. Seven measures (27 papers/resources) were participation-focused, capable of producing a score for participation Attendance and/or Involvement. Of these, all measured Attendance (n = 7) but fewer than half measured Involvement (n = 3). Few included studies (37%) reported including some self-report of people with communication support needs.

CONCLUSIONS

Participation measures for young people with CP are evolving but require more: (i) emphasis on measurement of involvement; (ii) investigation of psychometric properties; and (iii) adaptation to enable self-report by young people with communication support needs.

Exploring Physical Activity in Children and Adolescents with Disabilities: A Bibliometric Review of Current Status, Guidelines, Perceived Barriers, and Facilitators and Future Directions

BACKGROUND

Physical activity contributes to both physiological and psychosocial benefits for children and adolescents with disabilities. However, the prevalence of physical inactivity is notably higher among disabled young people compared to their healthy peers. Despite this, there is a lack of constructed knowledge structure, evolutionary path, research hotspots, and frontiers in studies related to physical activity in young people with disabilities.

METHODS

The literature related to the research of physical activity in children and adolescents with disabilities was retrieved from the core collection of the Web of Science. The annual publication numbers and the timing, frequency, and centrality of the co-occurrence network with respect to journals, countries, institutions, authors, references, and keywords were analyzed. Additionally, clustering analysis and burst analysis were performed on the references and keywords. All analyses were conducted using CiteSpace.

RESULTS

A total of 1308 related articles were included. The knowledge structure of research on the physical activity of disabled children and adolescents, including annual publication numbers, influencing journals, countries, institutions, authors, references, and keywords along with their respective collaborative networks, has been constructed. Furthermore, the research foundation, current hot topics, and research frontiers have been identified by analyzing references and keywords.

CONCLUSIONS

Current research hotspots include interventions, therapies, and programs aimed at enhancing specific skills, as well as addressing the satisfaction of competence to improve motivation and the effectiveness of physical activity. There is also a focus on the development of scales for quantitative studies. Future directions may be toward personalized interventions or programs to enhance physical activity levels among youth with disabilities.

Musical instrument classifier for early childhood percussion instruments

While the musical instrument classification task is well-studied, there remains a gap in identifying non-pitched percussion instruments which have greater overlaps in frequency bands and variation in sound quality and play style than pitched instruments. In this paper, we present a musical instrument classifier for detecting tambourines, maracas and castanets, instruments that are often used in early childhood music education. We generated a dataset with diverse instruments (e.g., brand, materials, construction) played in different locations with varying background noise and play styles. We conducted sensitivity analyses to optimize feature selection, windowing time, and model selection. We deployed and evaluated our best model in a mixed reality music application with 12 families in a home setting. Our dataset was comprised of over 369,000 samples recorded in-lab and 35,361 samples recorded with families in a home setting. We observed the Light Gradient Boosting Machine (LGBM) model to perform best using an approximate 93 ms window with only 12 mel-frequency cepstral coefficients (MFCCs) and signal entropy. Our best LGBM model was observed to perform with over 84% accuracy across all three instrument families in-lab and over 73% accuracy when deployed to the home. To our knowledge, the dataset compiled of 369,000 samples of non-pitched instruments is first of its kind. This work also suggests that a low feature space is sufficient for the recognition of non-pitched instruments. Lastly, real-world deployment and testing of the algorithms created with participants of diverse physical and cognitive abilities was also an important contribution towards more inclusive design practices. This paper lays the technological groundwork for a mixed reality music application that can detect children's use of non-pitched, percussion instruments to support early childhood music education and play.

Clinical outcomes measurement in pediatric lower limb prosthetics: A scoping review

OBJECTIVE

This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure.

METHODS

First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP.

RESULTS

Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP.

CONCLUSIONS

Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP.

Understanding factors that influence physical activity behavior in people with developmental coordination disorder (DCD): a mixed-methods convergent integrated systematic review

This systematic review synthesizes the literature on physical activity amongst people with DCD using the COM-B framework. The review questions were: (1) what is the Capability (C), Opportunity (O) and Motivation (M) for physical activity and (2) what does physical activity behavior (B) look like? A mixed-methods systematic review was conducted by searching eight databases (PubMed, APA PsycINFO, EMBASE, Scopus, Child Development and Adolescent Studies, Cochrane Library, Web of Science, CINAHL) up to July 2023. Data were extracted, thematically analyzed, and mapped to the COM-B model. The quality of studies was assessed with the Joanna Briggs Institute (JBI) critical appraisal tool. The protocol was registered with PROSPERO (CRD42022319127). Forty-three papers, 42 of which related to children, were included. Fifteen aligned with physical activity behavior, nine with physical capability, thirteen with psychological capability, one with social opportunity, one with physical opportunity, one with reflective motivation and three with automatic motivation. Pre-school-aged children with DCD engage in comparable levels of physical activity behavior, but differences emerge from 6 years of age. Characteristics of DCD result in reduced physical capability and less varied participation in physical activity. This impacts psychological capability, whereby lower self-perceptions result in a negative feedback loop and reduce the motivation to participate. Barriers relating to social opportunities may result in poor reflective and automatic motivation, although there is evidence that interventions can enhance enjoyment in the short term.

Measuring psychological, cognitive, and social domains of physical literacy in school-aged children with neurodevelopmental disabilities: a systematic review and decision tree

PURPOSE

To identify and assess the clinimetric properties of psychological, cognitive, and social competence assessment tools relevant to physical activity for school-aged children (5-17 years) with neurodevelopmental disabilities.

METHODS

Seven electronic databases were searched. Study findings and methodologies were evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Psychometric strength of assessment tools was determined using Grading of Recommendations Assessment, Development and Evaluation principles (GRADE) (Trial registration: CRD42020180616).

RESULTS

Study criteria were met by eight subscales from the BRIEF2, DMQ17, QI-Disability, SAID, and SDQ. Most subscales examined psychological competence (n = 5), with fewer addressing social competence (n = 2), or cognitive competence (n = 1). Validity was moderate to high strength for most subscales. Reliability was of moderate and unclear strength for two subscales. A five-level decision tree was devised to summarise: (1) physical literacy domains/elements, (2) populations, (3) assessment focus, (4) required resources, and (5) psychometric evidence.

CONCLUSIONS

Subscales are available to assess psychological, cognitive, or social competence. For school-aged children with neurodevelopmental disabilities, these have moderate to high strength psychometric support. A decision tree will assist practitioners in subscale selection. Future studies are needed to establish gold standard assessment of physical literacy for this population.IMPLICATIONS FOR REHABILITATIONPsychological Activity Competence can be measured for children with neurodevelopmental disabilities, subscales from The Behaviour Rating Inventory of Executive Function, Second Edition (BRIEF2; The Dimensions of Mastery Questionnaire 17.0 (DMQ17); and The Quality of Life Inventory-Disability (QI-Disability).Cognitive Activity Competence can be measured using a subscale from The Scale of Attention in Intellectual Disability (SAID).Social Activity Competence can be measured using subscales from the BRIEF2, and The Strengths and Difficulties Questionnaire (SDQ).Clinicians can use the Physical Literacy decision tree to guide selection of these tools.

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.

Reinforcing value of food, enriched home environment, and changes in percent overweight in children

OBJECTIVE

The decision to eat is often a choice made in the context of food and non-food alternatives. However, no research, to the authors' knowledge, has assessed the combination of the motivation to eat, as indexed by the relative reinforcing value of food (RRV_FOOD ), and the enriched home environment, i.e., access to activities that can serve as alternatives to eating on weight gain.

METHODS

This study used a cross-sectional design to study how RRV_FOOD and the enriched home environment predict percent overweight change over 2 years in 291 children aged 6 to 9 years and of varying socioeconomic status.

RESULTS

Results showed that RRV_FOOD and access to food were positively associated with baseline percent overweight, and an enriched home environment was negatively related to baseline percent overweight. RRV_FOOD and an enriched home environment interacted to predict change in percent overweight. Children with a high relative RRV_FOOD and a relatively non-enriched environment showed the greatest relative weight gain.

CONCLUSIONS

These results suggest that providing an enriched home environment may reduce the effects of food reinforcement and being motivated to eat on weight gain in childhood, and this represents a novel approach to intervention that can be used to strengthen current behavioral approaches to prevent obesity in children.

Systematic review of the psychometric properties of cultural adaptations and translations of the Children's Assessment of Participation and Enjoyment (CAPE)

BACKGROUND

The Children's Assessment of Participation and Enjoyment (CAPE) is the most widely used questionnaire for the assessment of children participation. While several cultural adaptations and translations exist, the quality of the methods used to produce them, as well as their psychometric properties, remains unclear. The aim of this systematic review was to evaluate the different translated and/or culturally adapted versions of the CAPE for children and youth with and without disabilities.

METHOD

A search was performed in five electronic databases CINAHL (EBSCO), MEDLINE (OVID), EMBASE (ELSEVIER), PSYCINFO (OVID), and WEB OF SCIENCE Core Collection (CLARIVATE), for articles available in French or English with the last update in July 2022. All studies related to a cultural adaptation and/or translation of the CAPE were retained and evaluated based on established guidelines for cross-cultural adaptations and measurement properties. The extraction was done independently by two authors. A critical appraisal of translation and psychometric properties methods was performed. Critical appraisal of the articles was done using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

RESULTS

The search identified 642 studies (321 duplicates removed), 16 of which underwent full-text review. Nine studies met all inclusion criteria and underwent analysis. According to the recommended steps for cross-cultural adaptations, one study performed 100% of the steps and two others performed 80%. None of the studies met all the recommendations for the evaluation of psychometric properties. A full evaluation of reliability and internal consistency were reported by 74% of studies. None of the studies reported a full evaluation of responsiveness, agreement and/or construct validity.

CONCLUSIONS

This review demonstrated limitations in the robustness of the methods used to develop and evaluate translated and culturally adapted versions of CAPE. To ensure valid and reliable results when conducting future research using the CAPE, it is recommended to fully evaluate the psychometric properties of the existing versions and to produce other translated and culturally adapted versions of the questionnaire.

Validation of Image Descriptions for the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children: A Delphi Study

Introduction: The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) are useful measures to assess how children with visual impairments are meeting the nine areas of the expanded core curriculum (ECC). Each item of the CAPE and PAC includes an activity with an accompanied image to illustrate it. However, the measures do not provide standardized image descriptions for each item, which limits its validity and reliability for this population. Thus, the purpose of this Delphi study was to validate and standardize image descriptions for the CAPE and PAC so they can be used more effectively with children with visual impairments. Methods: The expert panel consisted of 11 professionals with extensive knowledge and experience with individuals with visual impairments and six dyads of parents and their child with a visual impairment. Each panel member assessed the accuracy of wording for 57 image descriptions on a 4-point Likert scale and provided feedback on items rated below 3. Results: Consensus on all image descriptions was reached after two rounds. Discussion: The results of this study help to increase the validity and reliability of the CAPE and PAC for children with visual impairments. Implications for Practitioners: The CAPE and PAC can be used more effectively by practitioners and researchers to assess the areas of the ECC for children with visual impairments.

An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review

A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.

Using Social Network Analysis to Measure Social Inclusion for Individuals with Intellectual and Developmental Disabilities

The aim of this perspective is to describe the theory and practical steps of using principles of social network analysis to help measure the social inclusion of individuals with intellectual and developmental disabilities (IDD). Social inclusion for those with disabilities has become an important area of focus of rehabilitative professionals in the past decade. Social inclusion is comprised of the domains participation and social interaction. Decreased social inclusion can negatively impact quality of life and health. Individuals with IDD continue to experience barriers to social inclusion such as limited opportunities to socialize and participate in community groups, physical barriers, and the lack of available valued social roles. There are limited methods for measuring social inclusion for individuals with IDD. Social network analysis is one way to analyze and understand social relationships to better understand the social inclusion of individuals with IDD. Providing a way to measure social inclusion may help answer questions about the effectiveness of interventions, ultimately leading to increased social inclusion for individuals with IDD.

Quality of Life, Participation, and Individualized Support in a Community-Based Yoga Class: A Case Series

PURPOSE

To assess quality of life and participation in children with disabilities following a community-based yoga class, to examine the feasibility of implementing a community-based program with individualized support, and to make recommendations for the development of future programs.

SUMMARY OF KEY POINTS

Four children participated in a 10-week yoga class, with doctor of physical therapy students providing individualized physical and behavioral support. Children improved in components of the Children's Assessment of Participation and Enjoyment (CAPE) following the program; however, changes in quality of life on the Pediatric Quality of Life Inventory (PedsQL) were inconsistent. Parents provided feedback regarding the family's experience and reported that the children improved behavior, communication, and relationships following the yoga class.

WHAT THIS CASE ADDS TO EVIDENCEBASED PRACTICE

A community-based yoga class for children with disabilities using individualized support is feasible and can improve participation and enjoyment in recreational activities.

The Effects of an Online-Offline Hybrid Exercise Program on the Lives of Children with Cerebral Palsy Using Wheelchairs during the COVID-19 Pandemic in Korea

Due to the ongoing COVID-19 pandemic, many online programs for social meetings, education, leisure, and physical activities have been developed and provided; however, children with cerebral palsy (CP) cannot enjoy online programs in the same way that those without disabilities can. The aim of this study was to investigate the differences in reintegration to normal living (RNL), social interaction, and quality of life among school-age children with CP after participation in a game-based online−offline hybrid group exercise program. The current study was conducted on 26 children with CP who participated in a hybrid exercise program. The RNL, social interaction, and quality of life were measured before and after the six-week program. The scores of RNL and quality of life were improved (p < 0.05) after program participation. Online or hybrid exercise programs incorporating interactive methods (i.e., competition and cooperating) could enhance RNL and quality of life of children with CP. Thus, well-designed online or hybrid exercise programs should be developed and provided for children with CP to enhance overall quality of life during the pandemic.

Social participation interventions targeting relational outcomes for young people with physical and developmental disabilities: an umbrella review and narrative synthesis

Purpose: To synthesize knowledge about social participation interventions targeting relational outcomes for young people with physical and developmental disabilities.Method: An umbrella review with a narrative synthesis was conducted to integrate findings of review articles examining social participation interventions targeting relational outcomes (e.g., peer interaction and friendships). Six databases were searched to identify reviews published between 2010 and 2021.Results: Five reviews were identified, examining participation interventions, social/community integration interventions, recreational sport programs, online peer mentorship programs, and augmentative and alternative communication interventions to promote social interaction with peers. Interventions associated with improvements in relational outcomes included group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions. Recommendations for future research included better description of interventions to identify active ingredients and key mechanisms, measurement of participants' experiences, and the need for interventions to be aligned with the nature of the outcomes examined. Preliminary intervention principles are proposed to guide the design of social participation interventions: individualizing, contextualizing, and immersion in social settings.Conclusions: There are multiple pathways by which to influence the relational outcomes of young people with disabilities. There are implications for the design of social participation interventions based on an ecological/experiential and relational perspective.IMPLICATIONS FOR REHABILITATIONImprovements in relational outcomes are associated with participation in group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions.Three evidence-informed principles can help guide the design of social participation interventions: (1) personalizing, (2) contextualizing, and (3) immersion in social settings.Greater attention to aligning the nature of intervention with desired outcomes is needed to more effectively measure and promote relational outcomes.

Physical activity and functional body image in youth with and without visual impairments

Recent research has found a positive relationship between functional body image and physical activity in typically developing youth; however, functional body image has not been studied in youth with visual impairments. Youth with visual impairments tend to have a lower body image and engage in less physical activity than their sighted peers. The purpose of this study was to determine differences in functional body image between youth with and without visual impairments and the relationship between functional body image and physical activity in youth with visual impairments. Twenty youth with visual impairments and 20 youth without disabilities completed the embodied image scale and the organized sport (OS) and active physical recreation (AR) activity categories of the Children’s Assessment of Participation and Enjoyment, which measures five dimensions of activity participation. Mann–Whitney U tests revealed that participants with visual impairments had lower functional satisfaction ( p = .006) and marginally lower functional investment ( p = .059) than participants without disabilities. The correlation analysis revealed several significant positive relationships: functional values with AR where ( r = .472), functional satisfaction with AR intensity ( r = .459) and AR enjoyment ( r = .501), and functional investment with AR ( r = .554) and OS enjoyment ( r = .655). There were significant negative relationships between functional investment and AR diversity ( r = −.475) and intensity ( r = −.501). This suggests that youth with visual impairments have lower satisfaction and investment in their functional body image; however, those who enjoyed OS and AR activities tended to be more satisfied and invest more in their functional body image.

PreEMPT (Preterm infant Early intervention for Movement and Participation Trial): Feasibility outcomes of a randomised controlled trial

PURPOSE

Investigate feasibility of PreEMPT: a novel participation-focused, early physiotherapy intervention for preterm infants in regional Australia.

MATERIALS AND METHODS

Participants were infants born <35 weeks, residing in regional Australia. Sixteen infants were recruited then randomised to usual physiotherapy care (UPC: n = 8) or PreEMPT (n = 8). PreEMPT involved 14-weeks of alternating clinic- or telehealth-based, participation-focused intervention. Feasibility was evaluated by: demand, practicality, acceptability, implementation and limited efficacy testing for infants (motor, participation) and parents (mental well-being, self-efficacy).

RESULTS

Demand was lower than expected (45% recruitment rate). For practicality, attrition was high in the PreEMPT group (mean assessment attendance 3.8/5 sessions, range 2-5) compared to UPC (4.8/5 sessions, range 4-5). In addition, mean PreEMPT treatment dose received was approximately half intended (overall: 7.3/14 sessions, range 0-12; equivalent for face-to-face: 3.9/7, range 0-6, versus telehealth 3.4/7, range 0-6). The most common reason cited for treatment non-attendance was maternal mental health (22 sessions). Treatment acceptability for parents was high, with PreEMPT parents reporting they were offered choices in sessions (p = .02), and increased their knowledge (p = .01) and confidence (p = .009). There was a large effect size in favour of PreEMPT for increased parental self-efficacy (p = .021, ES = 1.34).

CONCLUSION

Early post-discharge physiotherapy for preterm infants in regional Australia is beneficial according to families but logistically challenging.

The Catalogue of Leisure Activities: A New Structured Values and Content Based Instrument for Leisure Research Usable for Social Development and Community Planning

Leisure is a phenomenon that undergoes constant change. These changes are sometimes global, but more often, they are localized. For this reason, the capturing of leisure and leisure activities poses a major challenge for researchers. In particular, they struggle to capture measurements for leisure activities in such a way that these measurement results can be compared over time, in different places, and in different communities. We have therefore identified the need for a tool that makes it possible to compare both time- and place-specific measurements. Based on our long-term research, we have created the Catalogue of Leisure Activities (CaLA), which is built on two pillars—content proximity and value consequences of leisure activities. Therefore, the CaLA allows for the capturing of the complexity of leisure activities and using the data thus measured as variables in statistical hypotheses, longitudinal comparisons of research across locations, over time, and across population groups (e.g., children, adults, etc.). It also allows measurements of other secondary characteristics (e.g., favor rate, duration, etc.) to be linked to the activities found. The results of measuring leisure activities using the CaLA can be used in research as a dependent or independent variable. As a result, we can detect many hitherto hidden relationships that significantly influence leisure experience and its quality. The CaLA also opens up many more possibilities for a wider range of applications in practice, e.g., in counseling, psychology, and coaching in support of individual development, in helping professions, social work and pedagogy when working with students and clients, and among managers when planning the development and maintaining the competitiveness of leisure facilities. Last but not least, the CaLA can be used by community leaders and politicians when designing public policies or developing a sustainable society.

Adoption of patient-reported outcome measures with youth with intellectual/developmental disabilities: Contextual influences and practice patterns

BACKGROUND

The purpose of this study was to identify potential barriers to patient reported outcome measure (PROM) adoption with youth and young adults with intellectual and/or developmental disabilities (IDD) and to understand current PROM adoption patterns of paediatric practitioners working with this population.

METHODS

We used a web-based survey to collect data from paediatric practitioners who work with youth with IDD about factors influencing the adoption of PROMs and the frequency of PROM use across age groups (elementary, middle school and high school/transition age) and practice settings (school and rehabilitation).

RESULTS

A total of 113 paediatric practitioners (occupational therapist = 48, physical therapist = 32, physician = 16, other = 17) responded to the survey with an average of 15 years of experience working with youth ages 8-21 with IDD. Accessibility and appropriateness, psychometric evidence, and time were most frequently ranked among the top three factors that influence practitioners' adoption of PROMs. Practitioners reported 'never or rarely' using PROMs 39%-65% of the time across age groups.

CONCLUSIONS

Our results suggest that paediatric practitioners may be infrequently using PROMs with youth with IDD because of perceived inaccessibility and time requirements of PROMs and practice-environment barriers, including access to evidence and caseload demands. Because PROMs can facilitate client-centred care, addressing these potential barriers to adoption may improve paediatric rehabilitation.

Motor Skills and Participation in Middle Childhood: A Direct Path for Boys, a Mediated Path for Girls

BACKGROUND

Beyond the often examined perceptions of competence and motor skill proficiency, perceived value and children's expectations for success are thought to affect engagement in physical activities. We used parallel mediation models to examine the direct effect of motor skill proficiency on participation in physical activities, as well as whether children's beliefs and value for physical activities mediated this relationship.

METHODS

The participants in this cross-sectional study were a total of 398 grade 3 children (201 girls) from 8 schools. Motor skills were assessed using the Test of Gross Motor Development-2, the Value Expectancy Questionnaire measured the psychological variables, and the Children's Assessment of Participation and Enjoyment measured physical activities.

RESULTS

Motor skill proficiency predicted all 3 psychological constructs for the boys and the girls, and boys' participation in physical activities. However, the psychological variables did not mediate the relationship between motor skills and participation among the boys. For the girls, task value mediated the relationship between motor skills and physical activity participation.

CONCLUSION

It is possible that the girls are further along in their ability to reflect on their competence, successes, and failures; it is also possible that the lower motor skill levels of girls had a deleterious effect on their feelings about participating.

Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications

Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.

Validity and reliability of the 'Leisure Participation Observation' among adults with intellectual disabilities: A pilot study

BACKGROUND

Individuals with intellectual disabilities have decreased leisure participation, affecting their health and well-being. Existing measures of leisure participation are primarily based on self- or proxy reports. This study describes the initial validity and reliability of Leisure Participation Observation (LPO), developed for individuals with ID.

METHOD

Two judge panels (N = 10 each) completed a table of specifications for content validity. Reliability of the LPO was established on 38 individuals with moderate ID 25-45 years old.

RESULTS

This study established the content validity of the LPO. Additionally, weighted kappa showed moderate-high statistically significant inter-rater reliability (.667-.859, p < .01) and low-moderate, significant test-retest reliability, based on intraclass correlations (.226-.474, p < .05). Finally, results yielded moderate-high internal consistency (α = .74).

CONCLUSIONS

The LPO shows promise as an observation tool for assessing leisure participation in the moderate ID population that may serve as the basis for developing intervention programmes.

Psychometric properties of the Turkish version of Participation and Environment Measure for Children and Youth

BACKGROUND

Participation in daily activities provides many opportunities for children with and without disabilities to improve cognitive, physical and communication abilities; to develop social relationships and to promote adaptive behaviours. The aim of this study is to examine the psychometric properties of the Participation Environment Measure for Children and Youth (PEM-CY) in Turkish children and youth with and without a disability.

METHODS

A total of 410 parents of children with (n = 232) and without (n = 178) disabilities, aged 5-17 years, were included in this study. Cronbach's alpha (α) and intraclass correlation coefficients (ICCs) were evaluated for internal consistency and test-retest reliability, respectively. Discriminant validity was determined by comparing the differences in participation and environment scores for disability groups and age intervals with the two-way analysis of variance (ANOVA) followed by post-hoc analyses when results were statistically significant.

RESULTS

Internal consistency (0.67-0.80) and test-retest reliability (0.67-0.93, p < 0.0001) ranged from moderate to very strong for different summary scores. Discriminant validity of the Turkish version of PEM-CY was supported by significant differences between children with and without disabilities on participation and environment scales (p < 0.05). We identified some significant age differences, but they did not follow consistently.

CONCLUSIONS

The Turkish version of the PEM-CY is a valid and reliable tool to determine the participation and environmental factors in the home, at school and in community settings in Turkish children and youth aged 5-17 years, with and without disabilities.

The Participation of Children with Intellectual Disabilities: Including the Voices of Children and Their Caregivers in India and South Africa

There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child’s or the caregiver’s perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children’s participation. This paper reports on both perceptions—those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children’s Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child–caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children’s participation.

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.

A Strength-Based Intervention to Increase Participation in Leisure Activities in Children with Neuropsychiatric Disabilities: A Pilot Study

The aim is to evaluate the feasibility of an intervention model with a client-centered goal-directed approach with the aim to enhance the child's participation in leisure activities, self-efficacy, and activity performance. A pilot intervention using a client-centered goal-directed approach and a single-subject design was performed. Two Swedish boys with neuropsychiatric diagnosis aged 12 and 14 years old were included, and 3 leisure activity goals were identified. The intervention was carried out over 8 weeks and took place in the adolescent's everyday environment and at the pediatric rehabilitation center. The goal attainment of participation goals (GAS), the perceived performance ability according to the Canadian Occupational Performance Measure (COPM), the self-efficacy, and the participants' satisfaction were used to study the effect. The participants succeeded in attaining their leisure goals as specified by the GAS by achieving +2 on one goal and +1 on the other two goals. They estimated higher performance ability and self-efficacy in their goal performance. Participants, parents, and therapists were overall satisfied and found the intervention to be applicable and helpful in optimizing leisure participation. The intervention model with a client-centered goal-directed approach in which participants define their own leisure activity goals appears to be effective in increasing participation in leisure activities.

Developmental Language Disorder: Applications for Advocacy, Research, and Clinical Service

Purpose

The CATALISE group (Bishop, Snowling, Thompson, Greenhalgh, & CATALISE Consortium, 2016; Bishop, Snowling, Thompson, Greenhalgh, & CATALISE-2 Consortium, 2017) recommended that the termdevelopmental language disorder(DLD) be used to refer to neurodevelopmental language deficit. In this tutorial, we explain the appropriate application of the term and present advantages in adhering to the CATALISE recommendations.

Conclusion

Both specific language impairment and DLD refer to a neurodevelopmental condition that impairs spoken language, is long-standing and, is not associated with any known causal condition. The applications of the termsspecific language impairmentandDLDdiffer in breadth and the extent to which identification depends upon functional impact. Use of the termDLDwould link advocacy efforts in the United States to those in other English-speaking countries. The criteria for identifying DLD presented in the CATALISE consensus offer opportunities for scientific progress while aligning well with practice in U.S. public schools.

Sensory Integration and Perceptual-Motor Profiles in School-Aged Children with Autistic Spectrum Disorder

PURPOSE

This study aimed to investigate the sensory integration and perceptual-motor performances in elementary school children (5-12 years) with autistic spectrum disorder (ASD) in Taiwan. The impacts of comprehensive body functions on activity participations in ASD were also investigated to provide evidence for clinical applications and further study.

METHODS

One hundred and seventeen children with ASD (42 females; aged 5-13 years, average age 8 years 3 months) were recruited. All participants were assessed with standardized measures of body functions and activity participations. The body function measures included Bruininks-Oseretsky of Motor Proficiency - Second Edition, Sensory Profile, Test of Sensory Integration Functions, and Test of Visual Perception Skills - Third Edition. The activity participation measures included the Chinese versions of both Vineland Adaptive Behavior Scale and School Function Assessment.

RESULTS

School-aged children with ASD had different levels of impairments on body function measures. Most participant scores fell within the impairment range on 13 to 15 items out of the total 19 sensory and perceptual-motor measure subtests, with worst performance on coordination-related motor task and most sensory integrative dimensions. The results indicated a significant main effect for age and sex on some body functions and activity participations. Correlation analyses indicated strong associations between body function and activity participation across settings in ASD.

CONCLUSION

Our findings characterized the developmental continuum of body functions of school-aged children with ASD and showed their associations with adaptation and participation. While emphasizing the development of functional skills to facilitate age-appropriate activity participation in multiple scenarios, interventions aiming to improve body functions are indispensable.

Outcome Assessment and Function in Cerebral Palsy

Care and research in childhood cerebral palsy (CP) continue to evolve. As our understanding of CP grows more nuanced, so grows our need to describe function, activities, challenges, adaptations of children with CP. In CP, robust means of measuring outcomes are vital to understanding utility of treatments. Research must accurately measure meaningful constructs of children with CP as a reliable ruler to establish if interventions produce useful effects. This article addresses the challenges of outcome measurement in CP, current status of outcome measurement in CP, and issues of understanding change in childhood CP.

The International Spinal Cord Injury Pediatric Activity and Participation Basic Data Set

Study design

International focus groups.

Objectives

The objective of this project was to develop the International Spinal Cord Injury (SCI) Pediatric Activity and Participation (A&P) Basic Data Set.

Methods

A focus group of experts in pediatric and adult SCI, and contributors of the existing adult International SCI Adult A&P Basic Data Set convened to develop an initial draft of the data set, which was iteratively refined over a 12 month period based on relevant literature and existing outcome measures that evaluate pediatric activity and participation. The draft was reviewed and approved by the larger project working group and then distributed to the International Spinal Cord Society (ISCoS), American Spinal Injury Association (ASIA), and relevant expert groups for review. Feedback received was considered before the final data set was approved.

Results

The International SCI Pediatric A&P Basic Data Set is comprised of 13 variables: administration date, mobility, dressing, feeding, toileting, communication, family outings, spending time with friends, being out with friends, participating in team or club activity, paid work, dating, and physical activity. It is intended for children between 6 and 17 years of age, who have been discharged from initial rehabilitation/hospitalization for a minimum of 3 months.

Conclusion

The International SCI Pediatric A&P Basic Data Set was developed to standardize the recording of a minimal amount of information about activities and participation in children with SCI. Further work on reliability and cultural validation is needed.

Sponsorship

This study was funded by the Rick Hansen Institute, Research Award #G2015-27 (Mulcahey, PI).

The convergent validity of the Children's Leisure Assessment Scale (CLASS) and Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC)

Background: Children's play and leisure participation is often assessed by occupational therapists. As such, it is essential that therapists utilize play and leisure scales that are valid, reliable and responsive.Aim: To examine the convergent validity between the Children's Leisure Assessment Scale (CLASS) and Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC).Methods: Forty healthy Australian children (60% female; mean age 9.2 ± 2.01 years) completed the CLASS and CAPE/PAC. Spearman's rho correlations with bootstrapping were completed.Results: A number of the CLASS and CAPE/PAC subscales were significantly correlated. The CAPE's overall scale scores and CLASS's instrumental indoor activities, outdoor activities and games and sport activities subscales were significantly correlated (p > 0.05). The CAPE's Social domain showed several significant correlations with the CLASS's instrumental indoor activities, outdoor activities and self-enrichment activities domains (p < 0.05). Statistically significant relationships were found between the CLASS's outdoor activity preference and the PAC's recreational, physical, formal, informal and overall performance scores (r = 0.466-0.773, p < 0.05).Conclusions and Significance: Preliminary evidence in support of the convergent validity between the CAPE/PAC and CLASS was obtained. Limitations include a small sample size and convenience sampling. Further investigation of the psychometric properties of the CAPE/PAC and CLASS are recommended.

Child participation in health care (ChiPaC)-Development and psychometric evaluation of a self-report instrument for children's participation in health care

AIMS AND OBJECTIVES

To develop and evaluate the psychometric properties of a self-report instrument measuring 6- to 12-year-old children's own experiences of participation in health care.

BACKGROUND

Validated measures to evaluate children's participation in health care can play a critical role in strategic work towards supporting children's participation at an individual level and in working towards quality improvements at an organisational level. There are, however, no available instruments to achieve this.

METHODS

An instrument development design was used, together with the TRIPOD checklist. Item construction was based on research about children's perspectives on participation in health care and Shier's model for participation. The face and content validity was evaluated by 14 healthy children, 9 paediatric nurses and 8 children with different diseases. The construct validity, internal consistency and stability reliability were evaluated based on data from 138 children visiting a paediatric clinic.

RESULTS

The testing of the face and content validity resulted in an instrument with child-friendly language, additional instructions and visual attractive presentation. The principle component analysis resulted in the four-factor solution: "To be included," "To trust professionals," "To take control," and "To understand information." Internal consistency and intraclass correlation coefficients were acceptable.

CONCLUSION

We conclude that the child participation in health care (ChiPaC) instrument has adequate reliability and validity when used to evaluate children's participation in health care. The involvement of children in the development of ChiPaC resulted in a brief, colourful and user-friendly instrument for use in paediatric health care.

RELEVANCE TO CLINICAL PRACTICE

This new questionnaire, ChiPaC, is adapted for children between 6-12 years measuring participation in health care from a child perspective. ChiPaC can be used in the practical work of supporting individual children's participation in health care as well as in the strategical work towards quality improvements on an organisational level.

Neurodevelopmental Treatment (Bobath) for Children With Cerebral Palsy: A Systematic Review

AIM

To assess the effects of neurodevelopmental treatment for children with cerebral palsy.

METHODS

We conducted a systematic review following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. Through a comprehensive literature search we considered all randomized clinical trials that compared neurodevelopmental treatment with conventional physical therapy for children with cerebral palsy. We used the Cochrane Risk of Bias Table to assess the risk of bias of the included randomized clinical trial, and the GRADE approach to evaluate the certainty of the body of the evidence.

RESULTS

We found 3 randomized clinical trials (2 published and 1 ongoing) comprising 66 children. Published randomized clinical trials presented methodological and reporting limitations and only 1 provided data for outcomes of interest. No difference between neurodevelopmental treatment and conventional physical therapy was found for gross motor function (mean difference 1.40; 95% confidence interval -5.47 to 8.27, low certainty evidence).

CONCLUSION

This review found that the effects of neurodevelopmental treatment for children with cerebral palsy are still uncertain. Further studies are required to assess the efficacy and safety of neurodevelopmental treatment for this purpose and until there, current evidence do not support its routinely use in practice. Number of protocol registration in PROSPERO database: CRD42017082817 (available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=82817 ).

Physical activity and aerobic fitness in children after liver transplantation

To determine physical activity (PA), aerobic fitness, muscle strength, health-related quality of life (HRQOL), fatigue, and participation in children after liver transplantation. Children, 6-12 years, at least one year after liver transplantation, participated in this cross-sectional study. Measurements: Time spent in moderate to vigorous PA (MVPA) was measured using an accelerometer, and aerobic fitness (VO_{2 peak} ) was measured by cardiopulmonary exercise testing. Muscle strength was measured by hand-held dynamometry. Fatigue was measured using the multidimensional fatigue scale, and HRQOL with the Pediatric Quality of life Core scales and leisure activities was measured using the Children's Assessment of Participation and Enjoyment. Outcomes (medians and interquartile range (IQR)) were compared to norm values. Twenty-six children participated in this study (14 boys, age 9.7 years, IQR 7.7;11.4). Children spent 0.8 hours/d (IQR 0.6;1.1) on MVPA. One child met the recommendation of at least 1 hour of MVPA every day of the week. Aerobic fitness was similar to norms (VO_{2 peak} 1.4 _L/min , IQR 1.1;1.7, Z-score -0.3). Z-scores of muscle strength ranged between -1.4 and -0.4 and HRQOL and fatigue between -2.3 and -0.4. Participation was similar to published norms (Z-scores between -0.6 and 0.6). Young children after liver transplantation have similar MVPA patterns and aerobic fitness compared to published norms. Despite lower HRQOL, more fatigue, and less muscle strength, these children have similar participation in daily activities. Although children do well, it remains important to stimulate PA in children after liver transplantation in the context of long-term management.

Intervention strategies in residential immersive life skills programs for youth with disabilities: a study of active ingredients and program fidelity

Objective: To examine intervention strategy use in residential immersive life skills (RILS) programs. Methods: The Service Provider Strategies-Checklist was used to record the strategies used in 100 activity settings across two summers at three RILS program sites. Activity settings were categorized by activity type and session format. Relative occurrence of the strategies was examined using percentages. Results: Socially mediated strategies (listening, engaging youth) and teaching/learning techniques (verbal cues, verbal instruction) were used in over 75% of the settings. Strategy use was highly contextualized, with different strategy patterns observed for different types of activity settings. Conclusion: The findings suggest that RILS programs be characterized by their use of socially mediated strategies and teaching/learning techniques, with socially mediated and non-intrusive strategies appearing to be program hallmarks. Strategy use was aligned with the types of sessions offered, providing evidence of program fidelity and indicating that RILS programs are complex in their formats, activities, and strategy use.

A Randomised Controlled Feasibility Trial of Immersive Virtual Reality Treatment with Cognitive Behaviour Therapy for Specific Phobias in Young People with Autism Spectrum Disorder

We examined the feasibility and acceptability of using an immersive virtual reality environment (VRE) alongside cognitive behaviour therapy (CBT) for young people with autism experiencing specific phobia. Thirty-two participants were randomised to treatment or control. Treatment involved one session introducing CBT techniques and four VRE sessions, delivered by local clinical therapists. Change in target behaviour was independently rated. Two weeks after treatment, four treatment participants (25%) and no control participants were responders; at 6 months after treatment, six (38%) treatment and no control participants were responders. At 6 months post-treatment, symptoms had worsened for one treatment and five control (untreated) participants. Brief VRE exposure with CBT is feasible and acceptable to deliver through child clinical services and is effective for some participants.

Measurement of Children's Real-Time Physical Activity Enjoyment Using a New Visual Analog Scale

Background: This study validated the How(e) Happy Scale (HHS) for measuring children's real-time physical activity (PA) enjoyment across PA type, intensity, sex, and weight status and compared state versus trait enjoyment. Methods: Children's (N = 31; 9.7 [1.7] y) PA intensity was measured during sport, play, and locomotive PA. Following each activity, children rated their perceived state (HHS) of enjoyment across 4 constructs (social engagement). Questionnaires measured trait PA enjoyment prior to play. Rasch Rating Scale analysis assessed model-data fit and probability distribution of HHS responses. Analyses of variance compared state versus trait PA enjoyment across main effects, and correlations assessed relationships between measured PA intensity versus state and trait PA enjoyment. Results: Trait PA enjoyment was neither different across sex and weight status nor correlated with PA intensity (r = -.16 to .22). By contrast, HHS responses differed across sex, weight status, and PA type and intensity and correlated with PA type (r = -.56 to -.28) and intensity (r = -.29 to -.32). HHS responses were ordered along the probability curve and showed good infit (0.76-1.22) and outfit (0.71-1.28) statistics and good person (r = .62) and item (r = .88) reliability. Conclusion: HHS is valid for detecting differences in real-time enjoyment across PA type and intensity in all children.

Content development, accessibility and feasibility of a self-report tool for use in programmes serving youth with cognitive disabilities: The Participatory Experience Survey

INTRODUCTION

Participation in community-based recreation and leisure activities may afford valuable opportunities to young people with cognitive disabilities (CD) to develop important self-determination skills needed for success in adulthood. To evaluate whether these programmes are achieving their intended impact, it is important to have a tool that captures the perspective of the participants using an accessible method. This article describes the content development and evaluation of accessibility and feasibility of the Participatory Experience Survey (PES).

METHOD

Participant observation and focus group sessions were conducted in conjunction with a summer youth programme hosted by a special education advocacy organisation. Photos were used to guide identification of factors influencing both negative and positive experiences. Findings informed question content. Three groups of stakeholders, parents of youth with CD (Group 1), service providers (Group 2), and experts in cognitive disability and/or programme planning (Group 3) reviewed the PES to provide feedback on the relevance and accessibility of the measure. After stakeholder feedback was incorporated, cognitive interviewing was conducted with young people with CD to assess instrument accessibility and appropriateness for use in context.

RESULTS

Youth described their participation in three categories: personal, social and environmental. Stakeholder Groups 1 and 2 identified 15 questions as needing revisions. Seven additional questions were added based on suggestions from stakeholder Group 3. Cognitive interviewing led to revision of 13 questions and removal of 16 questions due to issues related to vocabulary, item meaning, response bias, repetitiveness and length.

CONCLUSION

The PES has the potential to offer programmes a means to more fully include young people with disabilities in programme evaluations, leading to better-structured, more supportive programmes. Additional validity and feasibility work is needed to confirm these initial findings.

CyFiT telehealth: protocol for a randomised controlled trial of an online outpatient physiotherapy service for children with cystic fibrosis

BACKGROUND

Telehealth and telemonitoring is an emerging area of study in people with cystic fibrosis (CF), with the potential of increasing access to care, and minimising infection control risks to patients without compromising their health outcomes. To date, limited evidence is available to support the use of telehealth in paediatric population with CF in a clinical setting. This study aims to investigate the utility of a multimodal telehealth-based outpatient physiotherapy service and assess its effect on quality of life, functional exercise capacity, hospital admission and intravenous antibiotic requirements, lung function, processes of care, participation in activities of daily living, and health economics associated with operating an innovative service.

METHOD

This single centre, prospective, parallel, randomised, controlled, non-inferiority trial aims to recruit 110 children with CF between the ages 8 to 18 years of age. Participants will be randomised to the Usual Outpatient Physiotherapy Service group (Usual OPS) or the telehealth intervention group (CyFiT OPS). Quality of life, participation in activity of daily living, functional exercise capacity and patient perception of care will be examined every six months using the Cystic Fibrosis Questionnaire-Revised (CFQ-R), Children's Assessment of Participation and Enjoyment (CAPE), Preferences for Activities of Children (PAC) questionnaire, Modified Shuttle Test-25 (MST25), and Measure of Process of Care (MPOC-20) questionnaire. Physiological measurements collected during routine clinical visits such as spirometry, body weight and height, information will be retrospectively retrieved via a chart review at the end of the study.

DISCUSSION

We anticipate that this multi-modal telehealth service will deliver a comparable service to traditional face-to-face models. An alternative to existing outpatient physiotherapy services may potentially increase patient options for access to care and patient-orientated outcomes such as quality of life. If deemed appropriate, the new model of care can be integrated into clinical practice immediately.

TRIAL REGISTRATION

This trial is registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617001035314 ) last updated 17th July 2018.

Mindfulness-Based Yoga for Youth With Persistent Concussion: A Pilot Study

OBJECTIVE. We explored the potential impact of mindfulness-based yoga (MBY) for youth with persistent concussion by examining occupation-based and neurophysiological outcomes.

METHOD. In this case series design study, 6 youths ages 13–17 yr with concussion symptoms for &gt;4 wk participated in an 8-wk MBY intervention, 1×/wk for 45 min. Participation, self-efficacy, and heart rate variability (24 hr) were collected before, after, and 3 mo after the intervention. Heart rate variability was also measured during each session.

RESULTS. Trends of increased self-efficacy in academic, social, and emotional domains were found after MBY and maintained at 3-mo follow-up. Trends of increasing heart rate variability were also found pre- to postintervention and within the eight MBY sessions.

CONCLUSION. Preliminary results reveal positive trends after a novel, safe intervention for youth with persistent concussion symptoms and the value of exploring both occupation-based and neurophysiological measures. Future research with a larger sample and control group is warranted.

Cross-Cultural Validation of Children's Assessment of Participation and Enjoyment Portuguese Version

Background: Participation is a major pediatric rehabilitation goal according to The International Classification of Functioning, Disability and Health Children and Youth version (ICF-CY). ICF-based leisure participation measures for Portuguese-speaking children with cerebral palsy are currently not available. The aim of this study is to assess validity and reliability of the Portuguese (European) version of the Children's Assessment of Participation and Enjoyment (CAPE). Methods: CAPE Portuguese version was applied to 170 children with cerebral palsy (n = 69) and typical development (n = 101) aged between 8 and 18 years (mean = 12.5 years; SD = 2.91). Construct validity was assessed by using the know-groups method and the correlation between participation and quality of life. Reliability was determined by internal consistency and test-retest. Results: CAPE discriminates between participation scores of children with cerebral palsy and typical development. A positive correlation was found between participation frequency and physical well-being. Internal consistency was not entirely satisfactory but comparable with that from the original CAPE study. Test-retest reliability was considered good. Conclusions: CAPE Portuguese (European) version showed satisfactory validity and test-retest reliability to assess leisure participation in children with cerebral palsy and typical development aged between 8 and 18 years.

Program opportunities of residential immersive life skills programs for youth with disabilities

PURPOSE

Residential immersive life skills programs provide youth with the skills and outlooks needed to adopt new roles in life. Observed program opportunities and service providers' perceptions of opportunities were examined to determine program fidelity. Service providers' views of how the programs work were also examined.

METHOD

107 activity settings were observed across two summers at three programs, with opportunities assessed using the Measure of Environmental Qualities of Activity Settings (MEQAS-48). Activity settings were classified by session format (instructional versus experiential) and activity type (active physical, skill-based, self-improvement). Qualitative interviews were held with seven service providers.

RESULTS

Service providers indicated the importance of life-preparatory learning opportunities for social interaction, choice, and skill development, which aligned with high observed MEQAS-48 opportunities for social interaction, choice in experiential session formats, and personal growth. Providers individualized program delivery to provide youth with personally meaningful and challenging experiences. Providers also discussed emergent, transformational outcomes, including enhanced awareness of strengths, enhanced confidence in skills, identity development, and greater awareness of future life possibilities.

CONCLUSIONS

The study provided evidence of program fidelity, along with robust evidence for program opportunities as an active ingredient that may be transferable to the design and delivery of other transition-support programs.