Child engagement in daily life: a measure of participation for young children with cerebral palsy

Child and adolescent participation measurement tools and their translations: A systematic review

BACKGROUND

Numerous participation measurement tools targeting children and youth have been developed. Despite the translation of these tools into specific languages and cultures, the reliability and validity of the translated versions remain uncertain. To address this gap in knowledge, this study aims to identify tools for assessing the participation of children aged 5-18 years and to appraise the psychometric properties of their translated versions.

METHODS

Four electronic databases were searched for peer-reviewed studies published in English. Preferred Reporting Items for Systematic Reviews guidelines was followed. Study titles and abstracts were screened by four independent reviewers. Data were extracted for both original and translated versions of eligible tools. Instrument quality assessments were performed using the Outcome Measures Rating Form Guidelines. Any discrepancies were resolved by consensus.

RESULTS

Out of the 31 measurement tools examined, 18 tools had at least one translated version available, and among those original measurement tools, a total of 58 translated versions were identified. The most widely translated tool was the Physical Activity Questionnaire for Children (12 languages), and the most frequently translated language was Chinese (7 tools). Most translated versions verified internal consistency and content validity. Only three translated versions were verified inter-rater reliability, and seven translated versions were tested criterion validity with the gold standard tools assessing participation of children (e.g., accelerometer, Pediatric Evaluation of Disability Inventory and four 24-h recalls). None of the translated versions were tested for intra-rater reliability and responsiveness.

CONCLUSIONS

These findings can support the selection of psychometrically sound tools for children with disabilities, given their culture and language, and tool quality.

Motor training for young children with cerebral palsy: A single-blind randomized controlled trial

AIM

To compare the effect of iMOVE (Intensive Mobility training with Variability and Error) therapy with dose-matched conventional therapy on gross motor development and secondary outcomes in young children with cerebral palsy.

METHOD

This single-blind, randomized controlled trial included repeated assessments of gross motor function (using the Gross Motor Function Measure) and secondary outcomes during a 12- to 24-week intervention phase and at three follow-up points after treatment. Treatment was delivered three times per week in both groups. Forty-two children aged 12 to 36 months were stratified by age and motor function to ensure equivalence between groups at baseline.

RESULTS

Thirty-six children completed treatment and follow-up phases. Treatment fidelity was high and adherence was equivalent between groups (77.3% conventional therapy, 76.2% iMOVE). There were no group differences on the primary (gross motor function after 12 weeks p = 0.18; after 24 weeks p = 0.94) or any secondary (postural control p = 0.88, caregiver satisfaction p = 0.52, child engagement p = 0.98) measure after treatment or at the follow-up points. However, one-third of total participants exceeded predicted change after 12 weeks and 77% exceeded predicted change after 24 weeks of treatment.

INTERPRETATION

Our observations indicate a potential dose-response effect of rehabilitation therapy. We further demonstrated that individual therapeutic ingredients can be manipulated. When delivered consistently, both iMOVE and conventional therapy interventions might both be more effective than standard care.

WHAT THIS PAPER ADDS

Those receiving iMOVE therapy demonstrated more independent practice time, error, and child-initiation than those receiving the dose-matched control. iMOVE therapy was not superior to the control (conventional physical) therapy. Most participants exceeded predicted change after 24 weeks of treatment.

Translation, reliability and validity of the Greek version of the Child Engagement in Daily Life in children with cerebral palsy

BACKGROUND

Participation in family, recreational activities and self-care is an integral part of health. It is also a main outcome of rehabilitation services for children and adolescents with disabilities. However, there are currently no available tools in Greek to assess participation in young children.

METHODS

The Child Engagement in Daily Life (CEDL) was cross-culturally translated into Greek using forward-backward translation, review by expert committee, pretest application and final review. Parents with children who have been diagnosed with cerebral palsy (CP) and were 18 months to 5 years old were recruited. Internal consistency was evaluated using the Cronbach alpha and test-retest reliability in 2 weeks using intra-class correlation coefficient (ICC) and Bland-Altman plot for the agreement of each domain score. Measurement error was assessed utilising the standard error of measurement (SEM) and the smallest detectable change (SDC) and interpretability was assessed using the floor and ceiling effects. Validity was evaluated using the 'known groups' method, that is, assessing parents of children with typical development (TD).

RESULTS

One hundred and seven children with CP (mean age 43.63 ± 13.5 months), Gross Motor Function Classification System (GMFCS) levels I-V and 97 children with TD (mean age 43.63 ± 14.4 months) were included. Significant differences (p < 0.01) between children with CP and children with TD were recorded for all CEDL domains. Mean ± standard deviation of the CEDL domains 'frequency of participation', 'enjoyment of participation' and 'self-care' were 58.8 ± 14.5, 3.9 ± 0.9 and 49.7 ± 23.5, respectively for children with CP and 62.3 ± 9.1, 4.4 ± 0.9 and 74.2 ± 15 for children with TD. Internal consistency of all domains was high; Cronbach alpha for 'frequency of participation' was 0.83, for 'enjoyment of participation' was 0.76 and for 'self-care' was 0.92. Test-retest reliability (ICC) was excellent for the 'self-care' (0.95) and good for 'frequency of participation' and 'enjoyment of participation' domains (0.90 and 0.88, respectively) while Bland-Altman analysis revealed no systematic differences or bias between the two measurements. SEM was 0.8, 0.05 and 1.6 for frequency of participation, enjoyment and self-care with SDC of 2.4, 0.16 and 4.5, respectively. No relevant floor and ceiling effects were observed.

CONCLUSION

The Greek CEDL has good reliability, validity and interpretability. It can be used to evaluate participation in Greek young children with CP. Future studies should investigate the validity of this tool in longer periods and its responsiveness to intervention.

Child engagement in daily life measure V2: validation of psychometric properties for children with cerebral palsy

PURPOSE

Measurement development is a reiterative process requiring refinements and revalidation. The purpose of this study was to examine structural validity and reliability of the Child Engagement in Daily Life Measure (Version 2) for parents of children with cerebral palsy (CP) across a broader age span.

METHODS

Participants were 1054 parents of children with CP 1.5-11 years of age. Parents completed the Child Engagement in Daily Life measure that consists of the Participation in Family and Recreational Activities domain (11 items) and the Performance of Self-care Activities domain (18 items) as part of two longitudinal studies related to outcomes for children with CP.

RESULTS

Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty for both frequency of participation in family and recreational activities and performance of self-care activities. Test-retest reliability was good to excellent: ICC = 0.78 for frequency of participation, ICC = 0.68 for enjoyment of participation, and ICC = 0.97 for self-care.

CONCLUSIONS

Evidence supports reliability and validity of the Child Engagement in Daily Life Measure (Version 2) for parent-report of their children's participation in family and recreational activities and performance of self-care activities for children with CP 1.5-12 years of age.IMPLICATIONS FOR REHABILITATIONParticipation in family and recreational activities and performance of self-care activities of children with cerebral palsy can be assessed using the concise parent-report Child Engagement in Daily Life Measure V2.Knowledge of the continuum of difficulty of the frequency of participation in family and recreational activities and performance of self-care activities can assist practitioners in progressing service plans.Practitioners are encouraged to use the measure to guide discussions with parents and children on areas to focus services to support participation in family and recreational activities and performance of self-care activities.

Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance

OBJECTIVES

To determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be feasible.

DESIGN

A single group feasibility study.

SETTING

An Australian paediatric community therapy provider.

PARTICIPANTS

Forty children were recruited. Inclusion criteria were age 2-5 years with a non-progressive neurodisability, Gross Motor Function Classification System (GMFCS) levels III-V or equivalent, and goals relating to mobility, communication and upper limb function. Exclusion criteria included orthopaedic surgery in the past 6 months, unstable hip subluxation, uncontrolled seizure disorder or treadmill training in the past month.

INTERVENTION

A goal-directed programme of three 2-hour sessions per week for 4 weeks (24 hours total). This consisted of treadmill and overground walking, communication practice, and upper limb tasks tailored by an interdisciplinary team.

PRIMARY AND SECONDARY OUTCOME MEASURES

Limited-efficacy measures from preintervention (T1) to postintervention (T2) and 4-week follow-up (T3) included the Goal Attainment Scaling (GAS), Canadian Occupational Performance Measure (COPM), Gross Motor Function Measure (GMFM-66) and 10-Metre Walk Test (10MWT). Acceptability, demand, implementation and practicality were also explored.

RESULTS

There were improvements at T2 compared with T1 for all limited-efficacy measures. The GAS improved at T2 (mean difference (MD) 27.7, 95% CI 25.8 to 29.5) as well as COPM performance (MD 3.2, 95% CI 2.8 to 3.6) and satisfaction (MD 3.3, 95% CI 2.8 to 3.8). The GMFM-66 (MD 2.3, 95% CI 1.0 to 3.5) and 10MWT (median difference -2.3, 95% CI -28.8 to 0.0) improved at T2. Almost all improvements were maintained at T3. Other feasibility components were also demonstrated. There were no adverse events.

CONCLUSIONS

An intensive interdisciplinary programme is feasible in improving goal and motor outcomes for preschool children with neurodisabilities (GMFCS III-V or equivalent). A randomised controlled trial is warranted to establish efficacy.

TRIAL REGISTRATION NUMBER

ACTRN12619000064101.

Engagement of Preschool-Aged Children in Daily Routines

Child engagement refers to the time spent interacting with physical and social environments according to age, abilities, and a situation. The aim of this study is to assess the functioning of children in early childhood routines using engagement assessment instruments relative to the presence of developmental disabilities, age, gender, and parental characteristics within the contexts of preschool and family routines. The sample comprised 150 children aged 3-5 (AS = 4.02, D = 0.78), including typically developing children (N = 49) and children with developmental disabilities (N = 101). To assess the children's engagement in preschool classrooms, we used the Classroom Measure of Engagement, Independence, and Social Relationships (ClaMEISR), and the Child Engagement in Daily Life Measure was used to assess the children's engagement in family routines. The results obtained indicate a significantly higher rate of engagement in routines and activities among girls and older children. Parental characteristics associated with children's engagement included employment and marital status. Children with developmental disabilities, compared to their typically developing peers, had lower levels of engagement in social relationships and functional independence in daily routines. The results indicate that both instruments have a high internal consistency and are thus suitable for future use in the Republic of Serbia.

Active mobility, active participation: a systematic review of modified ride-on car use by children with disabilities

BACKGROUND

Modified ride-on cars (MROC) are a low-cost option to provide self-directed mobility to children with mobility limitations, in lieu of or as a precursor to other powered mobility devices.

OBJECTIVES

We appraised evidence to (1) describe and categorize MROC study characteristics, (2) synthesize existing knowledge of children's use of MROCs and (3) frame outcomes within the International Classification of Functioning, Disability and Health (ICF) framework.

METHODS

Articles were identified through four electronic databases: Medline, CINAHL, PsycNET, and Web of Science. We included all published, peer-reviewed studies involving MROC use. Relevant data were extracted, and articles were appraised using the American Academy of Cerebral Palsy and Developmental Medicine criteria for group and single-subject designs.

RESULTS

23 studies met inclusion criteria of 204 titles identified from 1980 to 2021. Study designs included case studies, case series, group designs, and qualitative research, but only three studies were rated evidence level III or higher. Children with a range of disabilities used MROCs across multiple settings, including the home, hospital, and community, though use and adherence varied widely. Positive impacts were reported on a range of outcomes related to the ICF framework, with an emphasis on activity and participation.

CONCLUSIONS

MROC studies have primarily addressed activity and participation, with most studies suggesting increased functional mobility and social interactions due to MROC use. More robust research designs with larger samples are needed in order to develop evidence-based strategies for MROC use.IMPLICATIONS FOR REHABILITATIONPhysical and occupational therapists may consider using MROCs as a therapeutic tool or accessible play opportunity as part of a multi-modal approach to increase children's mobility, family engagement, and participation in community life.Personal (e.g., child's enjoyment) and environmental factors (e.g., caregiver attitudes and stress) must be considered when developing plans of MROC use.

Exploring participation in family and recreational activities among children with cerebral palsy during early childhood: how does it relate to motor function and parental empowerment?

PURPOSE

To explore participation in real-life activities during early childhood, compare children's participation based on motor function and investigate relationships between participation and parental empowerment.

METHODS

Data derived from the Cerebral Palsy Follow-up Program (CPOP) in Norway and the research registry Habilitation Trajectories, Interventions, and Services for Young Children with CP (CPHAB). Fifty-six children (12-56 months, GMFCS levels I-IV, MACS levels I-V) and their families were included. Frequency and enjoyment of participation were assessed by the Child Engagement in Daily Life Questionnaire and parental empowerment in family and service situations by the Family Empowerment Scale at least twice during the preschool years. Differences between groups based on motor function were explored by the Kruskal-Wallis tests. A linear mixed model was conducted to explore relationships between child participation and parental empowerment.

RESULTS

Similarities and differences in participation between children at different motor function levels varied between the activities explored. Fluctuations in frequency and stable enjoyment scores over time were most common. A statistically significant relationship was revealed between child participation and parental empowerment in family situations, but not in service situations.

CONCLUSIONS

Child participation appears as context-dependent and complexly influenced by both motor function and parental empowerment. This supports a focus on transactional processes when exploring and promoting child participation.Implications for RehabilitationFamily and recreational activities represent real-life contexts providing opportunities for interactions and experiences supporting development and learning.Children with CP appreciate a wide range of activities in the home and community, which emphasizes the importance of providing opportunities for such participation in order to fulfill their desires and interests.Child participation appears as complexly influenced by the unique activity setting, motor function and characteristics of the family environment, requiring attention to transactional processes when aiming to explore and promote participation.

Cross-cultural adaptation of the Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children measures

PURPOSE

To cross-culturally adapt the Self-Care Domain of Child Engagement in Daily Life and the Ease of Caregiving for Children to Arabic language and Saudi culture and to examine the reliability of the Arabic version of both measures.

METHODS

A modified cross-cultural adaptation procedure was employed. A total 36 children with cerebral palsy (aged 1.5-11 years) and their parents participated in the pilot and final testing steps. A committee of 7 stakeholders evaluated cross-cultural equivalence of both measures. Cronbach's alpha, intra-class correlation coefficient, and minimal detectable change were used to establish internal consistency, test-retest reliability, and distribution-based index, respectively.

RESULTS

Minor linguistic, not cultural, adaptations were made in the Arabic version of both measures. Conceptual, item, semantic, and operational types of equivalences were supported. The Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children demonstrated high internal consistency (0.97 and 0.91, respectively), excellent test-retest reliability (0.99 and 0.96, respectively), and appropriate minimal detectable change values (0.29, 0.43, respectively).

CONCLUSIONS

The Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children are reliable and culturally appropriate for use with parents of children with cerebral palsy in Saudi Arabia.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Longitudinal Trajectories and Reference Percentiles for Participation in Family and Recreational Activities of Children with Cerebral Palsy

AIM

To create longitudinal trajectories and reference percentiles for frequency of participation in family and recreational activities for children with cerebral palsy (CP) by Gross Motor Function Classification System (GMFCS) level.

METHODS

708 children with CP 18-months to 12-years of age and their families participated in two to five assessments using the GMFCS and Child Engagement in Daily Life Measure. Data were analyzed using mixed-effects models and quantile regression.

RESULTS

Longitudinal trajectories depict the relatively stable level of frequency of participation with considerable individual variability. Average change in the frequency of participation scores of children from 2-12 years of age by GMFCS level varied from 3.7 (GMFCS level I) to - 9.0 points (GMFCS level V). A system to interpret the magnitude of change in percentiles over time is presented.

CONCLUSIONS

Longitudinal trajectories and reference percentiles can inform therapists and families for collaboratively designing services and monitoring performance to support children's participation in family and recreational activities.

Participation Measures for Infants and Toddlers Aged Birth to 23 Months: A Systematic Review

AIMS

Participation is a key health outcome; however little is known specifically about how to measure participation of infants and toddlers. The aim of this review was to identify and examine the psychometric properties of participation measures for infants and toddlers aged birth to 23 months according to family of Participation-Related Constructs (fPRC).

METHODS

Four electronic databases were searched to identify (i) measures available in English, (ii) that quantify at least one participation concept of 'attendance' and/or 'involvement' according to the fPRC, (iii) with psychometric data for infants or toddlers aged from birth to 23 months published in a full text, peer reviewed journal. Psychometric quality was examined using the COSMIN checklist.

RESULTS

Four measures met the inclusion criteria: Child Engagement in Daily Life (CEDL) measure, Daily Activities of Infants Scale (DAIS), Test of Playfulness (ToP), and Young Children's Participation and Environment Measure (YC-PEM). All measured 'attendance' and three also measured 'involvement'. Measures showed unknown to moderate validity and unknown to moderate reliability, with the CEDL reporting the strongest psychometric properties.

CONCLUSION

There are few measures that evaluate infant and toddler participation. Further research is needed to develop psychometrically sound participation measures that evaluate 'attendance' and 'involvement' for this population.

Participation patterns and determinants of participation of young children with cerebral palsy

INTRODUCTION

Understanding participation patterns of young children with cerebral palsy (CP) will enable occupational therapists to tailor family- and child-centred services. This study compares participation patterns and participation barriers of young children with CP with those of typically developing (TD) children. In addition, effect of age and gender on participation were examined as well as child-related determinants of participation for young children with CP.

METHODS

Participants were a convenience sample of 110 young children with CP and 150 TD children, aged 36-72 months. Children with CP represented different levels of the Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The Arabic Preschool Activity Card Sort was used to measure participation level as well as barriers of participation. T-tests, ANOVA, and exploratory regressions were employed. Significance was set at p < .05.

RESULTS

Young children with CP showed significant decreased overall and domain-specific participation compared to TD children (p < .001). Perceived barriers of participation were mostly related to child-factors for young children with CP compared to greater variability in barriers in TD children. Gender had no significant effect on participation regardless of diagnosis; however, pattern of the effect of age was different among the two groups. MACS was found to be the only significant predictor of participation for children with CP (p = .001).

CONCLUSION

Occupational therapists should focus on enhancing participation for young children with CP and consider participation barriers when designing their interventions. Several factors need to be considered when aiming to enhance participation of children with CP. The use of the MACS could contribute to better intervention planning.

Self-Rated Depressive Symptoms in Children and Youth with and without Cerebral Palsy: A Pilot Study

Children with cerebral palsy (CP) often exhibit mental health problems, such as depressive symptoms. The purpose of this study was to describe the self-rated depressive symptoms in children with and without CP and to investigate the associated predictors. Participants included 24 children with CP and 33 typically developing (TD) children. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Severity of self-rated depressive symptoms was higher in children with CP than that in TD children. Particularly, decline in activities and enjoyment was identified as a contributor to the increased severity of depressive symptoms. Hierarchical multiple regression analysis revealed that the greater severity of depressive symptoms in children with CP was mediated by hyperactivity/inattention and peer problems. Our study suggests that it is imperative to provide opportunities to participate in social activities from an early age.

Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties

AIM

To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection.

METHOD

Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed.

RESULTS

Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations.

INTERPRETATION

Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines.

WHAT THIS PAPER ADDS

Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.

The occupational repertoires of children with mobility difficulties: The child’s perspective

Introduction

Children with mobility difficulties are thought to share similar participation repertoires due to the impact of their physical impairments. However, with these children, as with all others, individual differences and contexts should mediate occupational repertoires and experiences, resulting in participation differences, at least in part. This study aimed to explore the occupational repertoires of children with mobility difficulties and their view of their occupational participation.

Methods

Five children with mobility difficulties were assessed using the paediatric activity card sort, to establish their occupational repertoires. Semi-structured interviews were used to understand the children’s occupational participation.

Findings

Our findings suggest that children with mobility issues are more likely to participate in quiet occupations, but not exclusively. The children defined participation in their own way.

Conclusion

The knowledge about how children with mobility difficulties understand participation in occupation can help occupational therapists to establish goals with their clients and personalise interventions.

Quality of survival assessment in European childhood brain tumour trials, for children below the age of 5 years

The highest incidence rate of childhood brain tumours is in children below the age of five years, who are particularly vulnerable to the effects of treatments. The assessment of quality of survival (QoS) in multiple domains is essential to compare the outcomes for different tumour types and treatment regimens. The aim of this position statement is to present the domains of health and functioning to be assessed in children from birth to five years, to advance the collection of a common QoS data set in European brain tumour trials. The QoS group of the European Society of Paediatric Oncology (SIOP-E) Brain Tumour group conducted consensus discussions over a period of six years to establish domains of QoS that should be prioritised in clinical trials involving children under 5 years. The domains of health and functioning that were agreed to affect QoS included: medical outcomes (e.g. vision, hearing, mobility, endocrine), emotion, behaviour, adaptive behaviour, and cognitive functioning. As for children aged five years and older, a 'core plus' approach is suggested in which core assessments are recommended for all clinical trials. The core component for children from birth to three years includes indirect assessment which, in this age-group, requires proxy assessment by a parent, of cognitive, emotional and behaviour variables and both direct and indirect endocrine measures. For children from four years of age direct cognitive assessment is also recommended as 'core'. The 'plus' components enable the addition of assessments which can be selected by individual countries and/or by, age-, treatment-, tumour type- and tumour location-specific trials.

Psychometric Evaluation of the ACHIEVE Assessment

Objective: There has been a significant change within clinical practice in childhood disability from "treating" at the level of body function to ecological approaches that address the child's involvement in everyday life. Clinical assessment, and robust tools to support this, are of key importance. The aim of this study was to assess the psychometric properties of the ACHIEVE Assessment in a clinical dataset. The ACHIEVE assessment is a parent and teacher report of participation in home, school and community settings, important contributory factors for participation, and environmental factors. Design: ACHIEVE scores of children were collected from parents and teachers. The Rasch Rating Scale Model produced model estimates with WINSTEPS software. Setting: Clinical rehabilitation settings in Scotland (United Kingdom). Subjects: 401 parents and 335 teachers of 402 children participated resulting in a final sample of 736 responses. Children (78% male) were 4-17 years old (mean 7.91 years SD 2.61). Children had a range of disabilities including Developmental Coordination Disorder, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder. Results: The study includes a large clinical sample of children with disabilities. The results demonstrate that the ACHIEVE Assessment can provide unidimensional measurements of children's participation and important contributory factors for participation. Differential item functioning analysis indicated majority of items were comparable between parent and teacher report. Conclusions: The results confirm evidence of appropriate psychometric properties of the ACHIEVE Assessment. ACHIEVE is a comprehensive tool that enables identification of patterns and issues around participation for clinical and research purposes.

Self-Care Trajectories and Reference Percentiles for Children with Cerebral Palsy

Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP).Methods: Participants were 708 children with CP, 18 months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents' completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles.Results: The trajectories for children in levels I, II, and III are characterized by an average maximum score between 79.6 (level I) and 62.8 (level III) and an average attainment of 90% of the maximum score between 7 and 9 years of age. The trajectories for children in level IV and V show minimal change over time. Extreme variation in performance among children of the same age and GMFCS level complicate interpretation of percentile change of individual children.Conclusion: The findings are useful for monitoring self-care of children with CP and evaluating change for children in GMFCS levels I-III.

What Makes Participation Meaningful? Using Photo-Elicitation to Interview Children with Disabilities

AIMS

The purpose of this study was to describe meaningful participation in everyday life from the perspectives of children with disabilities.

METHODS

Nine children (5-10 years, mean age 7.2 years, 5 boys, 4 girls) with disabilities participated in individual photo-elicitation interviews. The interview data was transcribed verbatim and analyzed with inductive content analysis.

RESULTS

The children's meaningful participation mainly comprised free leisure activities that fostered enjoyment, capability, autonomy and social involvement with family and friends. The children's emotions and physical sensations, opportunities to influence, knowledge about the activity and the participation context, presumptions and previous experiences of the activity and the environment played a vital role in their decisions to participate.

CONCLUSION

The meaningful participation facilitated enjoyment and self-determination for the children. Identifying personal and environmental factors supporting or restricting participation from the child's perspective emerges as important in order to provide opportunities for the child's meaningful participation in everyday life. The photo-elicitation interviews demonstrated the potential to act as a tool to identify and explore the children's views about participation in a real-life context.

Cross-cultural adaptation, validity, and reliability of the Turkish version of Assistance to Participate Scale

BACKGROUND

The Assistance to Participate Scale is a questionnaire to evaluate activity participation of children with developmental disabilities. The purpose of this study was to determine the validity and reliability of the Turkish version of the Assistance to Participate Scale.

METHODS

Ninety-eight mothers' children with developmental disabilities were included in this study. The Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory were applied to all subjects. To evaluate reliability, Cronbach's alpha coefficient, minimal detectable change (MDC) with standard error of measurement (SEM), and intraclass correlation coefficient (ICC) for test-retest were used. The relationship between Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory was investigated, and exploratory and confirmatory factor analysis were used for construct validity.

RESULTS

Cronbach's alpha value of the scale was found.93, demonstrating that this value has excellent internal consistency. Test-retest reliability was found 0.99 (ICC 95% CI [0.995, 0.998]; SEM:0.57, MDC:1.58). For construct validity, the correlations between Assistance to Participate Scale, Pediatric Quality of Life Inventory, and Pediatric Evaluation of Disability Inventory total scores and items were significant (p < .001). Factor analysis showed that the questionnaire had unidimensional and the explained variance was 0.84%.

CONCLUSIONS

The Turkish version of the Assistance to Participate Scale is valid and reliable scale for children with developmental disabilities.

Total and regional body fat status among children and young people with cerebral palsy: A scoping review

The purpose of our scoping review was to determine if children and young people with cerebral palsy (CP) have elevated total or regional body fat compared to children and young people without CP. Databases (Ovid MEDLINE, Embase Ovid, CINHAL and Scopus) were systematically searched from 1 January 1993 to 7 December 2018 in order to identify articles that compared weight status, total body fat or regional body fat (eg, abdominal) between children and young people (0-21 years) with and without CP. Extracted data included country, subject characteristics, group sample sizes and matching strategies, methods/measures for weight status/fat depot, fat depot(s) assessed and key findings. Twenty-two studies were included. Of these, 19 studies examined total body fat; the most common method was use of anthropometrics and the more common measures were body mass index and skin-fold thickness. Twelve studies examined at least one regional fat depot; the most common method was use of anthropometrics and the most common measure was skin-fold thickness. Findings were inconsistent across studies. Further, among 10 studies that examined total and regional body fat depots, 8 found differences across fat depots within the same children and young people (eg, no difference in total body fat but higher abdominal fat). This review provides a summary of inconsistent findings from published studies on body fat comparisons between children and young people with vs without CP, highlights limitations for evaluating body fat for children with CP and discusses future research directions.

Mental health disorders, participation, and bullying in children with cerebral palsy

AIM

To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP).

METHOD

This cross-sectional study included 6- to 17-year-olds with (n=111; 40.4% 6-11y, 59.6% 12-17y) and without (n=29 909; 50.2% 6-11y, 49.8% 12-17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention-deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships.

RESULTS

After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9-8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4-11.3), and multimorbidity (OR 2.8; 95% CI 1.1-7.0), but not depression (OR 1.4; 95% CI 0.6-3.8) or attention-deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6-4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased.

INTERPRETATION

The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors.

WHAT THIS PAPER ADDS

Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population.

Physical activity in non-ambulatory toddlers with cerebral palsy

BACKGROUND

Children with cerebral palsy are less likely to be physically active than their peers, however there is limited evidence regarding self-initiated physical activity in toddlers who are not able, or who may never be able, to walk.

AIMS

The aim of this study was to measure self-initiated physical activity and its relationship to gross motor function and participation in non-ambulatory toddlers with cerebral palsy.

METHODS AND PROCEDURES

Participants were between the ages of 1-3 years. Physical activity during independent floor-play at home was recorded using a wearable tri-axial accelerometer worn on the child's thigh. The Gross Motor Function Measure-66 and the Child Engagement in Daily Life, a parent-reported questionnaire of participation, were administered.

OUTCOMES AND RESULTS

Data were analyzed from the twenty participants who recorded at least 90 min of floor-play (mean: 229 min), resulting in 4598 total floor-play minutes. The relationship between physical activity and gross motor function was not statistically significant (r = 0.20; p = 0.39), nor were the relationships between physical activity and participation (r = 0.05-0.09; p = 0.71-0.84).

CONCLUSIONS AND IMPLICATIONS

The results suggest physical activity during floor-play is not related to gross motor function or participation in non-ambulatory toddlers with cerebral palsy. Clinicians and researchers should independently measure physical activity, gross motor function, and participation.

Measures used to quantify participation in childhood disability and their alignment with the family of participation-related constructs: a systematic review

AIM

We aimed to identify measures used to assess the participation of disabled children and to map the measures' content to the family of participation-related constructs (fPRC) to inform future research and practice.

METHOD

Six databases were searched to identify measures used to assess participation in health, psychology, and education research. Included studies involved children aged 0 to 18 years with a permanent impairment or developmental disability and reported use of a quantitative measure of participation. A second search sought relevant literature about each identified measure (including published manuals) to allow a comprehensive understanding of the measure. Measurement constructs of frequently reported measures were then mapped to the fPRC.

RESULTS

From an initial yield of 32 767 articles, 578 reported one or more of 118 participation measures. Of these, 51 measures were reported in more than one article (our criterion) and were therefore eligible for mapping to the fPRC. Twenty-one measures quantified aspects of participation attendance, 10 quantified aspects of involvement as discrete scales, and four quantified attendance and involvement in a manner that could not be separated.

INTERPRETATION

Improved understanding of participation and its related constructs is developing rapidly; thoughtful selection of measures in research is critical to further our knowledge base.

WHAT THIS PAPER ADDS

The fPRC can support our rapidly evolving and expanding understanding of participation. Instruments selected to measure participation do not always align with emerging concepts. Matching research aims to a chosen measure's content will improve understanding of participation. Opportunities exist to develop validated participation measures, especially self-reported measures of involvement.

iMOVE: Intensive Mobility training with Variability and Error compared to conventional rehabilitation for young children with cerebral palsy: the protocol for a single blind randomized controlled trial

BACKGROUND

Cerebral palsy (CP) is the most common cause of physical disability in children. The best opportunity to maximize lifelong independence is early in motor development when there is the most potential for neuroplastic change, but how best to optimize motor ability during this narrow window remains unknown. We have systematically developed and pilot-tested a novel intervention that incorporates overlapping principles of neurorehabilitation and infant motor learning in a context that promotes upright mobility skill and postural control development. The treatment, called iMOVE therapy, was designed to allow young children with CP to self-initiate motor learning experiences similar to their typically developing peers. This manuscript describes the protocol for a subsequent clinical trial to test the efficacy of iMOVE therapy compared to conventional therapy on gross motor development and other secondary outcomes in young children with CP.

METHODS

The study is a single-blind randomized controlled trial. Forty-two participants with CP or suspected CP between the ages of 1-3 years will be randomized to receive either the iMOVE or conventional therapy group. Distinguishing characteristics of each group are detailed. Repeated measures of gross motor function will be collected throughout the 12-24 week intervention phase and at three follow-up points over one year post therapy. Secondary outcomes include measures of postural control, physical activity, participation and caregiver satisfaction.

DISCUSSION

This clinical trial will add to a small, but growing, body of literature on early interventions to optimize the development of motor control in young children with CP. The information learned will inform clinical practice of early treatment strategies and may contribute to improving the trajectory of motor development and reducing lifelong physical disability in individuals with CP.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02340026 . Registered January 16, 2015.

A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations

To increase the efficiency and effectiveness of clinical research studies, cerebral palsy (CP) specific Common Data Elements (CDEs) were developed through a partnership between the National Institute of Neurological Disorders and Stroke (NINDS) and the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). International experts reviewed existing NINDS CDEs and tools used in studies of children and young people with CP. CDEs were compiled, subjected to internal review, and posted online for external public comment in September 2016. Guided by the International Classification of Functioning, Disability and Health framework, CDEs were categorized into six domains: (1) participant characteristics; (2) health, growth, and genetics; (3) neuroimaging; (4) neuromotor skills and functional assessments; (5) neurocognitive, social, and emotional assessments; and (6) engagement and quality of life. Version 1.0 of the NINDS/AACPDM CDEs for CP is publicly available on the NINDS CDE and AACPDM websites. Global use of CDEs for CP will standardize data collection, improve data quality, and facilitate comparisons across studies. Ongoing collaboration with international colleagues, industry, and people with CP and their families will provide meaningful feedback and updates as additional evidence is obtained. These CDEs are recommended for NINDS-funded research for CP.

WHAT THIS PAPER ADDS

This is the first comprehensive Common Data Elements (CDEs) for children and young people with CP for clinical research. The CDEs for children and young people with CP include common definitions, the standardization of case report forms, and measures. The CDE guides the standardization for data collection and outcome evaluation in all types of studies with children and young people with CP. The CDE ultimately improves data quality and data sharing.

Scoping Review: Social Determinants of Young Children's Participation in the United States

Optimal child development is supported by services, policies, a social determinants of health (SDOH) frame, and meaningful participation (as defined by the International Classification of Functioning, Disability, and Health-Children and Youth [ICF-CY]). This scoping review describes the social determinants that may affect the participation of young children aged 0 to 3 years with developmental disabilities (DD) in the United States. Scoping review of studies including U.S. children with DD aged 0 to 3 years, from 2000 to 2016, were used. 5/979 studies met inclusion criteria. Two researchers independently coded studies to align them with both ICF-CY and SDOH. Studies found determinants of participation stemming from the child (e.g., individual) and multiple contexts: immediate, community, and policy. The emergent literature continues to primarily focus on child determinants but suggests participation of young children with DD is affected by social determinants stemming from the community and policy contexts. The literature underrepresents children from racial/ethnic minority backgrounds.

Understanding participation of children with cerebral palsy in family and recreational activities

AIMS

The primary aim of this study was to determine the effect of age, sex, gross motor, manual ability, and communication functions on the frequency and enjoyment of children's participation in family and recreational activities. The secondary aim was to determine the relationships between motor and communication functions and participation.

METHODS

Participants were 694 children, 1.5-12 years old, with cerebral palsy (CP) and their parents across the US and Canada. Parents rated children's frequency and enjoyment of participation using the Child Engagement in Daily Life measure. Parents and therapists identified children's level of function using Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS).

RESULTS

Differences in frequency and enjoyment of participation were found based on children's GMFCS, MACS, and CFCS levels but not age or sex. Children with higher gross motor, manual, and communication functions had higher frequency and enjoyment of participation, compared to children with lower functions. Frequency of participation was associated with GMFCS and CFCS levels whereas enjoyment of participation was only associated with CFCS level.

IMPLICATIONS

Knowledge of child's gross motor, manual ability, and communication functions of children with CP is important when setting goals and planning interventions for participation.

Excellence in Promoting Participation: Striving for the 10 Cs-Client-Centered Care, Consideration of Complexity, Collaboration, Coaching, Capacity Building, Contextualization, Creativity, Community, Curricular Changes, and Curiosity

Participation of children with physical disabilities is critical to optimizing their life roles and lived experiences. This perspective explores the complex and multidimensional construct of participation and presents recommendations for practice, education, and research to transform pediatric physical therapy service delivery. Two models are reviewed of participation-based service delivery grounded in client-centered care and the principles of coaching to engage clients in their rehabilitation. The roles and responsibilities of the physical therapist and the importance of team collaboration are emphasized. Considerations are presented for ecological measurements and interventions to support client participation goals for children of all ages in home and community settings. Practitioners, educators, and researchers are encouraged to be advocates and change agents to ensure that services support meaningful participation for children in real-life contexts.