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Cooper C, Linden M, Kerr C. Social participation in adults with cerebral palsy: a systematic review of the evidence-base. Disabil Rehabil 2024; 46:2720-2733. [PMID: 37497638 DOI: 10.1080/09638288.2023.2236026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To identify and synthesise the current evidence on social participation in adults with cerebral palsy (CP). METHODS Four databases (PubMed, CINAHL Plus, PsycINFO, Web of Science) were systematically searched between December 2021 and February 2022. Pre-specified eligibility criteria were applied to all identified studies resulting in the inclusion of 16 articles. Data extraction was performed using a standardised tool and quality appraisal was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach was taken for data analysis. RESULTS The 16 included studies were rated as high (n = 11) and medium quality (n = 5). Numbers of participants included in the studies ranged from 7 to 335. Definitions of social participation were discussed. Common themes were identified: the impact of home and work environments on social participation, the importance of age-appropriate support and interventions, and the impact of limited autonomy on social participation. CONCLUSIONS Adults with CP experience limited social participation due to lack of appropriate support in childhood, issues across the lifespan including physical limitations when ageing, and factors such as societal expectations and inaccessible environments which limit opportunities for autonomy. Social participation may be improved by supporting families to provide opportunities in childhood, providing timely interventions, and by enhancing autonomy.
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Affiliation(s)
- Claire Cooper
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Mark Linden
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Kerr
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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2
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Ding JY, Cleary SL, Morgan PE. Participation experiences of young people with cerebral palsy in key life situations: A qualitative study. Dev Med Child Neurol 2024. [PMID: 38616349 DOI: 10.1111/dmcn.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/24/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
AIMS To explore the participation experiences of adolescents and young adults with cerebral palsy (CP) in key life situations of young adulthood and investigate the impact of a government-funded, disability insurance scheme on participation and health service access. METHOD We conducted a qualitative descriptive study using semi-structured interviews. Sixteen young people with CP (aged 16-30 years; mean age = 24 years 4 months) participated. Interviews were audio-recorded and transcribed verbatim before thematic analysis. RESULTS An overarching theme of 'branching out into adulthood' was identified. Participants described early adulthood as a time of change, choice, and challenge. The sub-themes were: (1) making sense of my CP as an adult; (2) people's attitudes towards disability and the impacts on me; (3) roadblocks and workarounds; and (4) participation at the time of the COVID-19 pandemic. Participants reported complex views on the new disability insurance scheme. While access to services and support increased, participants experienced significant difficulty negotiating appropriate funding, resulting in frustration and reduced confidence in the scheme. INTERPRETATION Young people with CP experience complexity as they participate during young adulthood. Alongside exploring how their identity is intertwined with having CP, they face significant barriers to participation when navigating relationships, accessing services, and being involved in the community.
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Affiliation(s)
- Jacqueline Y Ding
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stacey L Cleary
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Prue E Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
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3
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Guyard A, Fauconnier J, Muehlan H, Cytera C, Markwart H, Himmelmann K, Schmidt S, Duffaut C, Arnaud C, Thyen U. Differences in participation between young adults with cerebral palsy and their peers: A cross-sectional multicentre European study. Disabil Health J 2024; 17:101554. [PMID: 38129262 DOI: 10.1016/j.dhjo.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Children and adolescents with disabilities are known to participate less in most areas of life than their non-disabled peers. OBJECTIVES (1) To estimate differences in participation between young adults with cerebral palsy (CP) and their non-disabled peers; (2) to test the mediating role of financial difficulties and student status; (3) to test the moderating role of personal factors on participation difference; and (4) to test the moderating role of impairment. METHODS A cross-sectional study was conducted in young adults [19-28 years] with CP (n = 228) and non-disabled peers (n = 2861) in France, Germany and Sweden. Participation was assessed using the Questionnaire of Young People's Participation adapted for young adults (QYPP-YA). Differences in five domains of participation were estimated using structural equation modeling with WLSMV method and bias-corrected bootstrap confidence intervals. RESULTS Young adults with CP showed lower participation than others in all domains, with the largest difference in the "intimate relationships" domain (β = 1.71 bcCI95[1.46; 1.95]). Student status mediated the difference in "intimate relationships", "interpersonal relationships" and "independence". Women showed greater differences than men on "independence". Impairments moderated difference in participation. The less severely impaired young adults showed no difference with their non-CP peers in "interpersonal relationships", "social life" and "independence", but made autonomous everyday decisions more often than their peers. CONCLUSIONS Young adults with CP do not have the same opportunities to attain the participation level of non-CP people of the same age. Continuance of education could help to reduce participation difference in "interpersonal relationships" and "independence".
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Affiliation(s)
- Audrey Guyard
- UMR 5525 CNRS / TIMC-IMAG Team MESP, Grenoble Alpes University, Pavillon Taillefer CHU Grenoble CS10217, F-38043, Grenoble, Cedex 9, France.
| | - Jérôme Fauconnier
- UMR 5525 CNRS / TIMC-IMAG Team MESP, Grenoble Alpes University, Pavillon Taillefer CHU Grenoble CS10217, F-38043, Grenoble, Cedex 9, France
| | - Holger Muehlan
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Chirine Cytera
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany; Hospital for Child and Adolescent Medicine, University of Lübeck, DE-23538, Lübeck, Germany
| | - Henriette Markwart
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Kate Himmelmann
- Institute of Clinical Sciences, University of Gothenburg, Medicinaregatan 3A Plan 500, 413 90, Göteborg, Sweden
| | - Silke Schmidt
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Hôpital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, F-31059, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Hôpital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, F-31059, Toulouse, France; Clinical Epidemiology Unit, University Hospital, F-31059, Toulouse, France
| | - Ute Thyen
- Hospital for Child and Adolescent Medicine, University of Lübeck, DE-23538, Lübeck, Germany
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4
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Ding JY, Cleary SL, Morgan PE. Health literacy in adolescents and young adults with cerebral palsy: a mixed methods systematic review. Disabil Rehabil 2024:1-13. [PMID: 38314775 DOI: 10.1080/09638288.2024.2311879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To identify evidence of health literacy in young people with cerebral palsy (13-38 years), describe current strategies they use to access and build their health knowledge, and explore associations between health literacy and quality of life (QoL). METHODS Four electronic databases were systematically searched (2001 to June 2023) to identify studies describing components of health literacy in this population. Two reviewers screened for eligibility, then extracted data and assessed methodological quality of included studies. Data were synthesised using a convergent integrated analysis framework and summarised with a narrative synthesis. RESULTS Eleven studies were included (N = 363). Evidence of health literacy was demonstrated through a range of strategies young people employed to identify their specific information needs, develop health literacy skills, and learn experientially. The preferred method for building health knowledge was obtaining information from trusted sources. Information gaps were identified in topics such as ageing with cerebral palsy, sexuality and navigating intimate relationships. There were minimal data on health literacy and QoL. CONCLUSIONS Young people with cerebral palsy want tailored and credible health information to increase participation in making informed health-related decisions. Building capacity and development of self-efficacy may assist with the identification of emerging health literacy needs.
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Affiliation(s)
- Jacqueline Y Ding
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Australia
| | - Stacey L Cleary
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Prue E Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
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Pérez-Curiel P, Vicente E, Morán ML, Gómez LE. The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1587. [PMID: 36674341 PMCID: PMC9864803 DOI: 10.3390/ijerph20021587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 05/31/2023]
Abstract
Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.
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Affiliation(s)
- Patricia Pérez-Curiel
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - Eva Vicente
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - M. Lucía Morán
- Department of Education, University of Cantabria, Av./de los Castros, 52, 39005 Santander, Spain
| | - Laura E. Gómez
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
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6
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Brandão MB, Bueno KMP, Silvério APM, Antunes FIT, Feitosa AM, Figueiredo PRP, Mancini MC. "Listen to us!" A qualitative study of adolescents with disabilities to help plan a transition service. Child Care Health Dev 2022; 48:833-841. [PMID: 35229345 DOI: 10.1111/cch.12992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The development and implementation of transition services for adolescents with disabilities should incorporate perceptions of their needs and interests. The aim of the study was to understand the concerns of adolescents with physical disabilities during adolescence and their expectations regarding adulthood to help plan a transition programme in Brazil. METHODS This is a qualitative study, using a phenomenological approach. Eight adolescents with physical disabilities (seven with cerebral palsy, one with muscular dystrophy), aged between 15 and 17 years, participated in two focus groups. Prior to the conduction of the groups, clinicians selected topics related to adolescence and the transition to adulthood, based on their professional experience and available literature. During the focus groups, illustrative images of each topic were presented to the participants. Each adolescent was asked to select five topics that he/she considered important to be discussed in a future transition programme. The participants justified their individual choices and, in groups, reached a consensus on the groups' priorities. This strategy was chosen to motivate the discussion among the participants and to explore their concerns regarding adolescence and transition to adulthood. The focus groups were audio recorded and transcribed for content analysis. RESULTS Three themes emerged from the content analysis: (1) "Adolescents and their social relationships," (2) "Identity formation: self-awareness and development of autonomy," and (3) "What about adulthood?" CONCLUSION The themes revealed conflicts between the adolescents' desire to achieve independence and autonomy and the awareness of their limitations. The interpretation of the results helped structuring the actions of the Adolescence in Focus Programme, with two main actions: promotion of the adolescent's functional performance in daily living activities and assistance with their identity formation and preparation for adulthood.
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Affiliation(s)
- Marina B Brandão
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kátia M P Bueno
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda I T Antunes
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline M Feitosa
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Priscilla R P Figueiredo
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Belo Horizonte, Brazil
| | - Marisa C Mancini
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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8
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Jordan A, Carter B, Forgeron P, Fournier K, Sanders K. Romantic Relationships in Young People with Long-Term Health Conditions: A Scoping Review. J Pediatr Psychol 2021; 46:264-279. [PMID: 33306805 DOI: 10.1093/jpepsy/jsaa106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Forming and maintaining romantic relationships is an important developmental task in adolescence and young adulthood. This scoping review seeks to explore how young people with long-term physical health conditions understand and experience romantic relationships. METHODS Using Arksey and O'Malley's scoping review framework, a systematic search of five databases was conducted (PsychINFO, Cinahl, MEDLINE, Embase, and Web of Science). Studies were eligible for inclusion in the review if they were published in peer-reviewed journals, used primary data collection methods, and adopted quantitative, qualitative, or mixed-methods approaches to study romantic relationships in 11-25 year olds with long-term physical health conditions. Using a data extraction form, data pertaining to demographic characteristics of young people with long-term physical health conditions and relationship engagement were extracted from eligible papers. RESULTS Searches returned 4645 papers after duplicate removal, with a two-stage screening process resulting in 111 full-text papers being reviewed. Thirty-three eligible papers were included across a range of long-term physical health conditions. Findings identified that living with a long-term physical health condition impacted young people's perceptions and experiences of romantic relationships across the relationship lifespan, from envisaging future relationships, to forming relationships, and sustaining relationships. Issues around body confidence and self-esteem were identified as challenging in terms of perceptions and experiences of romantic relationships. CONCLUSIONS Findings demonstrate that young people wish to engage with romantic relationships, yet many report particular challenges associated with forming and sustaining relationships due to the constraints of their condition and treatment. Future research should consider nonheterosexual relationships.
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Affiliation(s)
- Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK.,Centre for Pain Research, University of Bath, Bath, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Kate Sanders
- Department of Psychology, University of Bath, Bath, UK
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Gray SH, Byrne R, Christensen S, Williams D, Wylie M, Fowler E, Gaebler-Spira D, Marciniak C, Glader L. Women with cerebral palsy: A qualitative study about their experiences with sexual and reproductive health education and services. J Pediatr Rehabil Med 2021; 14:285-293. [PMID: 34092661 PMCID: PMC8673520 DOI: 10.3233/prm-210020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the recalled experiences of women with CP regarding sexual health education and services they received. METHODS Semi-structured interviews and focus groups were conducted at four academic tertiary hospitals with 33 adult women with CP. Templates were used to ask about four key content domains: appointment planning (including planning for a gynecologic exam), accessibility of services, experiences with providers, and recommendations for improvement. Sessions were transcribed verbatim and analyzed to generate a coding dictionary. Blinded coding was carried out for each transcript, with duplicate coding used to confirm identified themes. Iterative analysis was used to identify and consolidate coding and key themes. RESULTS Similar barriers were discussed at the four sites, including lack of accessible exam tables, hospital staff unfamiliar with physical disabilities, and assumptions that women with CP are not sexually active. Many described the sexual education they received as brief, omitted, or mistimed. Self-advocacy was crucial, and recommended strategies ranged from pre-gynecologic exam medication to visit checklists. CONCLUSION Reproductive health education for young women with CP is frequently inadequate. Medical professionals lack relevant knowledge and awareness; medical facilities lack necessary infrastructure. Recommendations for improvements are made.
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Affiliation(s)
- Susan Hayden Gray
- University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.,University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - David Williams
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Eileen Fowler
- Tarjan Center at UCLA, Center for Cerebral Palsy at UCLA, Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Laurie Glader
- Division of Complex Care, Comprehensive Cerebral Palsy Program, Nationwide Children's Hospital. The Ohio State University, Columbus, OH, USA.,University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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10
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Pfister A, Georgi-Tscherry P, Berger F, Studer M. Participation of adults with cognitive, physical, or psychiatric impairments in family of origin and intimate relationships: a grounded theory study. BMC Public Health 2020; 20:642. [PMID: 32380993 PMCID: PMC7206802 DOI: 10.1186/s12889-020-08770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND How adults with disabilities perceive participation has received little attention. Our purpose was to formulate a grounded theory on participation, based on the subjective experience of adults with cognitive, physical, or psychiatric impairment(s), and to identify barriers, facilitators, and support needs concerning participation in different areas of life. We aimed to explore whether the United Nations' Convention on the Rights of Persons with Disabilities (CRPD), ratified by Switzerland in 2014, and its principles are being met. Here we report on the main category and focus on the participation areas 'family of origin' and 'intimate relationships.' METHODS In a qualitative, grounded theory study, we conducted problem-centered interviews with 23 adults with cognitive, physical, or psychiatric impairments (30-53 years; 11 men, 12 women), with different housing (on their own, assisted living, with parents) and work situations (primary vs. secondary labor market) in nine German-speaking Swiss cantons. RESULTS Participation can be understood as a continuum that extends on a horizontal level (from participation is restricted to participation takes place) and a vertical level (separative setting vs. inclusive setting). In separative as well as in inclusive settings, diverse levels of participation are possible. Many participants were stuck in an 'in-between' area between separative and inclusion-oriented settings. In the family of origin, there was a thin line between fulfilling relations that enhance participation and conflictual relations and overprotective parenting that limit participation. In intimate relationships, opportunities for participation were limited overall. Many interviewees were single. Social environment and family of origin (e.g., parents) can enable and facilitate intimate relationships and sexual contacts but can also be an important barrier. CONCLUSIONS Participation can be understood as a continuum. Participation restrictions exist in separative as well as in inclusive-oriented settings, also in the areas of family of origin and intimate relationships. Participation barriers must be torn down in separative as well as in inclusion-oriented settings. Trajectories to inclusive settings should be facilitated. Families with children with impairment(s) should be supported from early on to create the best possible participation possibilities for the (adult) person with impairment(s) and to support the family of origin itself.
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Affiliation(s)
- Andreas Pfister
- Lucerne University of Applied Sciences and Arts, School of Social Work, Institute of Social Management, Social Policy and Prevention, Werftestrasse 1, Postfach 2945, CH-6002 Lucerne, Switzerland
| | - Pia Georgi-Tscherry
- Lucerne University of Applied Sciences and Arts, School of Social Work, Institute of Social Pedagogy and Education, Werftestrasse 1, Postfach 2945, CH-6002 Lucerne, Switzerland
| | - Fabian Berger
- Careum School of Health, Careum Research, Pestalozzistrasse 3, CH-8032 Zurich, Switzerland
| | - Michaela Studer
- University of Applied Sciences in Special Needs Education, Schaffhauserstrasse 239, Postfach 5850, CH-8050 Zurich, Switzerland
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11
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Jahnsen R, Ramstad K, Myklebust G, Elkjaer S, Pripp AH, Klevberg GL. Independence of young people with cerebral palsy during transition to adulthood: a population-based 3 year follow-up study. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundThis study describes developmental and service transitions during a 3-year period among young people with cerebral palsy (CP) as measured by the Rotterdam Transition Profile (RTP) and evaluates the test-retest reliability of the RTP. The RTP is a questionnaire developed to classify phases of transition across nine participation domains.MethodsA three-step design was applied: Step I consisted of a translation and test-retest reliability study of the RTP, Step II was a comparison of independence between youth with and without CP and Step III was a follow-up survey of youth with CP describing changes of independence after a 3-year transition period. A sample of 103 typically developing youth were recruited for Steps I and II, and a population-based sample of 76 (response rate = 59%) youth with CP (males = 40) from South-Eastern Norway aged 16–17 years were recruited for Steps II and III. The subtypes of CP were classified as spastic unilateral (n = 30), spastic bilateral (n = 37), dyskinetic (n = 8) and ataxic (n = 1) CP. The levels of gross motor function followed the categories of the Gross Motor Function Classification System (GMFCS) as level I (n = 30), level II (n = 17), level III (n = 6), level IV (n = 8) and level V (n = 15).ResultsTwenty-six participants had epilepsy and 13 had gastrostomy. Forty-four of the youth with CP (response rate = 58%) responded to the 3-year follow-up survey in Step III. The test-retest study of the RTP showed excellent reliability (Kw 0.76–0.93). At baseline (Step II), the reference group was significantly more independent than the youth with CP in all the participation domains. At the 3-year follow-up (Step III), the levels of independence had increased significantly for all the participation domains in the youth with CP except for transportation and leisure. Despite increased independence during the transition period regarding health services, only 25% independently formulated their own care needs or applied for services and assistance at 19–20 years of age. Youth who responded to the RTP by a caregiver proxy more often had a diagnosis of epilepsy and/or gastrostomy and higher GMFCS levels. These individuals were significantly less independent than those who self-reported, both at baseline and at follow-up.ConclusionsIn conclusion, the excellent test-retest results support the use of the RTP as a tool for classifying phases of transition among youth with CP. The youth with CP were significantly less independent than their typically developing peers at baseline, yet increased their independence during a 3-year period. Those who self-reported to the RTP were generally more independent than those who proxy-reported, which supports the need to distinguish between the service needs of subgroups during the transition phase.
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Affiliation(s)
- Reidun Jahnsen
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjersti Ramstad
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Gerd Myklebust
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Sonja Elkjaer
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Gunvor Lilleholt Klevberg
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
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12
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van Gorp M, E Roebroeck M, van Eck M, M Voorman J, Twisk JWR, J Dallmeijer A, van Wely L. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study. Disabil Rehabil 2019; 42:3162-3171. [PMID: 31060408 DOI: 10.1080/09638288.2019.1585971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine childhood predictors of participation in domestic life and interpersonal relationships of young adults with cerebral palsy (CP).Materials and methods: This 13-year follow-up of an existing cohort (baseline age 9-13 years) included 67 young adults with CP (age 21-27 years). The Vineland adaptive behavior scales (VABS) and Life Habits questionnaire were used to assess attendance and difficulty in participation in domestic life and interpersonal relationships. Baseline factors were categorised according to the international classification of functioning, disability, and health. Stepwise multiple linear regression analyses determined significant predictors (p < 0.05).Results: Lower manual ability, intellectual disability (ID), epilepsy and lower motor capacity predicted decreased future participation in domestic life, and/or interpersonal relationships (explained variance R2 = 67-87%), whereas no association was found with environmental and personal factors. Extending models with baseline fine motor skills, communication, and interpersonal relationships increased R2 to 79-90%.Conclusions: Childhood factors account for 79-90% of the variation in young adult participation in domestic life and interpersonal relationships of individuals with CP. Children with limited motor capacity, low manual ability, ID, or epilepsy are at risk for restrictions in participation in young adulthood. Addressing fine motor, communication, and social skills in paediatric rehabilitation might promote young adult participation.Implications for rehabilitationChildhood risk factors for limited participation in domestic life and interpersonal relationships as a young adult with CP are ID, epilepsy, low manual ability, low motor capacity, and low activity & participation levels.In line with current practice, this study confirms the importance of addressing gross and fine motor skills in children with CP for their future participation in domestic life.In addition, results suggest that addressing communication and social skills during paediatric rehabilitation may optimise future participation in interpersonal relationships.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jeanine M Voorman
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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13
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Abstract
Cerebral palsy is a rare condition following injury of the developing brain and including nonprogressive neurological disorders, spasticity, intellectual impairment and others. Boys with cerebral palsy have a high incidence of undescended testis. Although the motives for treatment (infertility, cancer prevention, psychological aspects, testicular torsion) are not different in boys without neurological impairment, the decision-making process in boys with cerebral palsy is very difficult. Besides medical and surgical arguments the discussion involves challenging ethical issues.
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14
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Predicting sexual problems in young adults with an anorectal malformation or Hirschsprung disease. J Pediatr Surg 2018; 53:1555-1559. [PMID: 29454526 DOI: 10.1016/j.jpedsurg.2018.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to examine the prevalence of sexual dysfunction and distress and to assess whether sexual functioning could be predicted by psychosocial factors in childhood and adolescence in patients with an anorectal malformation or Hirschsprung disease. MATERIAL AND METHODS In 1998 patients completed a psychosocial questionnaire: The Self-Perception profile. To assess the prevalence of sexual distress and sexual functioning in adulthood (2015) the Female Sexual Function Index (FSFI), The Female Sexual Distress Scale (FSDS) and the International Index of Erectile Functioning (IIEF) were used. RESULTS In total 74 patients returned the questionnaires (26.2%). 36.8% of women reported sexual dysfunction and 45% experienced sexual distress. In our male sample 8.8% reported mild to moderate erectile dysfunction. In females perceived self-competence in adolescence was associated with sexual distress (p<.01). In male adolescents associations were found between perceived self-competence in romantic relations (p<.01) and in close friendships (p<.05) and sexual desire in adulthood. CONCLUSION Pediatric surgeons should be more aware of sexual problems patients may face at older age as a result of their congenital disease and treatment. More standardized care and follow-up are needed. Prognosis study-Level II.
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15
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Zhang-Jiang S, Gorter JW. The use of the Rotterdam Transition Profile: 10 years in review. JOURNAL OF TRANSITION MEDICINE 2018. [DOI: 10.1515/jtm-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe aim of this literature review was to describe the use and utility of the Rotterdam Transition Profile (RTP), as we near the tenth year since its publication in 2008. It is a tool to summarize a youth’s transition process to adulthood by classifying various domains of participation and health care into developmental stages. This review provided a comprehensive synthesis of available knowledge on the RTP by summarizing published and grey literature. Using search terms related to transition, social participation, and questionnaire, a systematic search was conducted for literature up to November 2017 in MEDLINE and Embase databases, and was supplemented with a hand-search using Google Scholar and a general internet search using Google Search. Inclusion criteria were specified to determine the papers selected for review, yielding fifty-five materials for detailed review. Combined analysis of published and grey literature identified nine papers that used some form of the RTP as a measure, 18 materials that cited the RTP or its domains but did not employ it as a measure, and twenty-eight materials that cited the original RTP development and validation paper for information not directly related to the RTP. The literature demonstrated that the RTP seems to be a useful tool to describe and monitor the transition process of adolescents and young adults, in both research and clinical settings. While it has been used with youth of 14–31 years of age across genders and health conditions, more evidence is needed to demonstrate its psychometric properties beyond construct validity in young adults with cerebral palsy.
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Affiliation(s)
- Sofía Zhang-Jiang
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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16
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Czapla K, Otrębski W. Differences in Sexual Behavior of Teenagers and Young Adults with Cerebral Palsy: The Role of Sexual Needs and Sexual Esteem. SEXUALITY AND DISABILITY 2017; 36:33-46. [PMID: 29568142 PMCID: PMC5847148 DOI: 10.1007/s11195-017-9512-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Sexuality is an inherent attribute of all human beings regardless of their race, religion and the level of physical fitness. The way it is perceived and manifested is determined by a number of biopsychosocial factors. In some people, including persons with cerebral palsy, the factors and their influence are rooted in the psychophysical condition of the human body. The aim of this study was to answer the question about how the levels of sexual esteem and sexual needs differentiate the sexual behaviors of young people with cerebral palsy. The study being presented was conducted with 62 young persons with cerebral palsy (half women and half men), who were selected using purposive sampling. They were aged 15-25 years and were individuals without cognitive difficulties. The research tool used was the Cerebral Palsy Individual's Sexual Behavior Questionnaire developed by the authors. The findings of the study showed that half of the participants engaged in various sexual behaviors from the list that was presented to them. The frequencies of these engagements depended on the levels of their sexual esteem and sexual needs. Persons characterized by high levels of sexual esteem and sexual needs (much fewer than those with the low levels of both characteristics) engaged in sexual behaviors significantly more frequently. The most frequent among them was direct engagement in sexual activity (petting and sexual intercourse; p ≤ .001) and then exposure to sexually explicit magazines or films (p ≤ .05).
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Affiliation(s)
- Klaudia Czapla
- The John Paul II Catholic University of Lublin, Al. Racławickie 14, 20-950 Lublin, Poland
| | - Wojciech Otrębski
- The John Paul II Catholic University of Lublin, Al. Racławickie 14, 20-950 Lublin, Poland
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17
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Bonfils KA, Firmin RL, Salyers MP, Wright ER. Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity. Psychiatr Rehabil J 2015; 38:249-55. [PMID: 25664756 PMCID: PMC4530100 DOI: 10.1037/prj0000117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. METHOD A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. RESULTS Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning.
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Affiliation(s)
- Kelsey A. Bonfils
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Ruth L. Firmin
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Michelle P. Salyers
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
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Abstract
<b>Background</b><br />
Sexuality is an important part of human existence, irrespective of race, religion or level of physical fitness. It can, however, be treated and exhibited by individuals in very different ways. The place of sexuality in a person’s life, and in the way it is materialised, is determined by a number of biopsychosocial factors. For some, the presence of these factors and their influence is not a matter of choice. They may arise as a consequence of the psychophysical condition of their organism. People with motor disabilities undoubtedly belong to this group.<br />
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<b>Participants and procedure</b><br />
The study was carried out in Poland on a group of 61 people with roughly equal proportions of men and women. Subject selection was non-random; every subject was diagnosed with cerebral palsy (CP) and was aged between <br />
15 and 25. All of the subjects had normal levels of intelligence. Two methods were used in the study: Sexual Self-esteem Scale and Sexual Needs Scale.<br />
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<b>Results</b><br />
The results in terms of sexual self-esteem and sexual needs allowed two different subgroups of subjects to be distinguished (H – with high scores; L – with low scores). The analysis of significance levels of the differences in terms of sexual self-esteem and sexual needs between subgroups H and L confirmed the clear distinction between each of the subgroups’ clinical pictures (p < .001) in 20 out of 21 of the analysed aspects. Falling in love was the only matter that did not differentiate the subgroups.<br />
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<b>Conclusions</b><br />
There is a clear polarization of the results. Only 1/3 of the respondents had high sexual self-esteem and sexual needs. The remaining 2/3 reported having a rather low sexual self-esteem and low levels of needs with regards to their own sexuality. It needs to be stressed that CP-affected youth, similarly to their peers, may need support in discovering their sexuality and satisfying their sexual needs (2/3 of the respondents). The specifics of the range of support should take into account the aspects highlighted by the literature as associated with the causes of disability and contexts of psychosocial functioning of individuals with CP.
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Tan SS, Wiegerink DJHG, Vos RC, Smits DW, Voorman JM, Twisk JWR, Ketelaar M, Roebroeck ME. Developmental trajectories of social participation in individuals with cerebral palsy: a multicentre longitudinal study. Dev Med Child Neurol 2014; 56:370-7. [PMID: 24359158 DOI: 10.1111/dmcn.12343] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy (CP) aged 1 to 24 years. METHOD As part of the Pediatric Rehabilitation Research in the Netherlands (PERRIN+), 424 individuals with CP (261 males, 163 females; mean age [SD] 9y 6mo [6y 2mo]; Gross Motor Function Classification [GMFCS] levels I-V [50% level I]; 87% with spastic CP; 26% with intellectual disability) were longitudinally followed for up to 4 years between 2002 and 2007. Social participation was assessed with the Vineland Adaptive Behavior Scales survey. Effects of age, GMFCS level and intellectual disability were analysed using multilevel modelling. RESULTS The developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability. INTERPRETATION Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age.
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Affiliation(s)
- Siok Swan Tan
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Shikako-Thomas K, Shevell M, Schmitz N, Lach L, Law M, Poulin C, Majnemer A. Determinants of participation in leisure activities among adolescents with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2621-2634. [PMID: 23751302 DOI: 10.1016/j.ridd.2013.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 06/02/2023]
Abstract
Studies have identified restrictions in engagement in leisure activities for adolescents with disabilities. Participation is a complex construct and likely influenced by a variety of factors. These potential determinants have not yet been sufficiently explored in the population of adolescents with cerebral palsy (CP). The objective of this study is to estimate the potential influence of adolescent characteristics and environmental factors as determinants of participation in leisure activities for adolescents with CP. A cross-sectional design was used. Participants were adolescents (12-19 years old) with cerebral palsy. Participants were assessed with the Vineland Adaptive Behavior Scale - II, Gross Motor Function Measure, Gross Motor Function Classification System, Manual Ability Classification System and completed the Self-Perception Profile for Adolescents, Dimensions of Mastery Questionnaire, Strengths and Difficulties Questionnaire, Family Environment Scale, the European Child Environment Questionnaire and the Preferences for Activities of Children. The main outcome measure was the Children's Assessment of Participation and Enjoyment. 187 adolescents (age M=15.4; SD=2.2) completed the study. Multivariate models of participation in leisure revealed associations with factors related to the adolescents' functional characteristics and attitudes, the family environment, socioeconomic status, and contextual factors such as school type, and collectively explained from 28% (diversity of skill-based activities) up to 48% (intensity and diversity of self-improvement activities) of the variance in intensity and diversity in five leisure participation domains (diversity: r(2)=.33 recreational; r(2)=.39 active-physical; r(2)=.33 social activities). Adolescent's mastery motivation, self-perception and behavior were individually associated with participation in different activity domains, but did not strongly predict participation within multivariate models, while preferences for activities were strong predictors of participation in all domains, except for skill-based activities. Engagement in different types of leisure activities is important for adolescents' development and well-being. Health care professionals should consider adolescents' and families' characteristics to promote participation in leisure activities.
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