Determinants of participation in family and recreational activities of young children with cerebral palsy

Neglect of Psychological Care for Children with Cerebral Palsy and Their Families and Its Impact on Their Occupational Engagement in Saudi Arabia

Background and Objectives: Many children with (CP) and their families in Saudi Arabia struggle emotionally. Unfortunately, there have not been many studies conducted on how to help them with these challenges. This research aims to bring attention to this gap and to explore how a lack of proper mental health care might affect these children's ability to participate in everyday activities. Materials and Methods: In this cross-sectional descriptive study, a survey was conducted between August and October 2023. A total of 300 parents of CP children from Saudi Arabia participated in the study. The impact of psychological care negligence on the occupational engagement of CP children and their families was assessed by designing a valid questionnaire. Results: A total of 300 parents of children with CP participated in this study. The majority of the sample, 71% of parents, said that their children did not receive any psychological care, and 59.7% of the participants said that their children did not even receive a referral to a psychologist. However, 60.3% of parents of children noticed a significant decline in the occupational performance of their children, and 65.7% predicted an improvement in their children's performance with future psychological care. Conclusions: It is clear that there is a lack of awareness about the importance of mental health care for children with CP in Saudi Arabia. This lack of care hinders these children and their families' occupational engagement and social participation.

Adaptive behavior and mastery motivation in children with physical disabilities

BACKGROUND

Adaptive behavior consists of conceptual, social, and practical skills and describes the ability of individuals to manage environmental demands, interact with others, and engage in activities to meet ones needs. Mastery motivation is an intrinsic characteristic that enables persistence when attempting to master a skill. Children with physical disabilities often demonstrate less effective adaptive behaviors and lower mastery motivation than their peers without disabilities, which may subsequently impact development and participation in daily activities. Therefore, it may be beneficial for pediatric rehabilitation practitioners to focus intentionally on facilitating effective adaptive behaviors in children with physical disabilities as they aim to support child development and function.

OBJECTIVE

This perspective paper highlights the importance of adaptive behavior for children with physical disabilities, discusses methods of assessment, and illustrates intervention principles and strategies to support the development of appropriate adaptive behaviors across childhood. Key intervention principles include: 1) engage children and address motivation; 2) collaborate with others; 3) support real-life meaningful experiences; 4) scaffold the just-right challenge; and 5) guide children in discovering solutions.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future

BACKGROUND

The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words.

METHODS

Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future').

RESULTS

The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y.

CONCLUSIONS

Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

Asymmetry in sensory-motor function between the lower limbs in children with hemiplegic cerebral palsy: An observational study

The objective of this study was to examine the difference in sensory-motor impairments (i.e., balance, contracture, coordination, strength, spasticity, and sensation) between legs in children with hemiplegic cerebral palsy. An observational study measured both lower limbs of children with hemiplegic cerebral palsy over one session. Six sensory-motor impairments (balance, coordination, strength, spasticity, contracture, and proprioception) were measured. The between-leg differences were analyzed using the paired t-tests and presented as the mean differences (95% confidence interval (CI)). Twenty-four participants aged 10.3 years (standard deviation: 1.3) participated. The affected leg was less than the less-affected leg in terms of the strength of dorsiflexors (mean difference (MD) -2.8 Nm, 95% CI -4.2 to -1.4), plantarflexors (MD -2.6 Nm, 95% CI -4.1 to -1.0), knee extensors (MD -5.3 Nm, 95% CI -10.2 to -0.5) as well as range of ankle dorsiflexion (MD -8 deg, 95% CI -13 to -3), and balance (median difference -11.1, 95% CI -11.6 to -10.6). There was a trend toward a difference in terms of the strength of hip abductors (MD -2.6 Nm, 95% CI -5.3 to 0.1) and coordination (MD -0.20 taps/s, 95% CI -0.42 to 0.01). The legs were similar in terms of the strength of hip extensors (MD 0.3 Nm, 95% CI -4.7 to 5.3), proprioception (MD 1 deg, 95% CI 0 to 2), and spasticity (median difference 0, 95% CI 0 to 0). Examination of the difference in sensory-motor impairments between legs in children with hemiplegic cerebral palsy has given us some insights into the deficits in both legs. Not only was balance, strength, and coordination decreased compared with the less-affected leg but also the less-affected leg was markedly decreased compared with typically developing children. Therefore, an intervention aimed at increasing muscle strength and coordination in both legs might have a positive effect, particularly on more challenging physical activities. This may, in turn, lead to successful participation in mainstream sport and recreation.

In the Driver's Seat: A Randomized, Crossover Clinical Trial Protocol Comparing Home and Community Use of the Permobil Explorer Mini and a Modified Ride-On Car by Children With Cerebral Palsy

OBJECTIVE

The aims of this study are 2-fold: (1) to evaluate a powered mobility intervention to promote developmental, activity, and participation outcomes of young children aged 12 to 36 months who have cerebral palsy; and (2) to compare the use patterns (frequency, duration, environment) of 2 different powered mobility options.

METHODS

This study is a multisite, mixed-methods, doubly counterbalanced, randomized, crossover clinical trial, where intervention A is the Permobil Explorer Mini and intervention B is a modified ride-on toy car. The study will take place in rural and urban home and community settings surrounding 3 sites (Washington, Oregon, and Michigan). There will be 24 child-caregiver dyads in the study (8 dyads per site). Primary outcome measures include the Bayley Scale of Infant and Toddler Development, the Youth and Children's Participation and Environment Measure, the Assessment for Learning Power mobility use, automated device use tracking logs, caregiver semistructured interviews, and the Acceptability, Feasibility, and Intervention Appropriateness Measures. Secondary measures include the Child Engagement in Daily Life and caregiver diaries.

IMPACT

The use of powered mobility devices for young children with cerebral palsy has gained traction, with evidence that the use of powered mobility at young ages complements (rather than detracts from) other interventions focused on more traditional mobility skills such as crawling and walking. However, research is limited, and often comprised of low-level evidence. Given the clearance of the first powered mobility device for infants, the Permobil Explorer Mini, and the recent popularity of modified ride-on toy cars as an alternative for powered mobility for young children with disabilities, this study will contribute to rigorous examination of the developmental outcomes, use patterns, and caregiver perceptions of these novel devices.

Exploring demographic, medical, and developmental determinants of adaptive behaviour in children with hemiplegic cerebral palsy

Hemiplegic cerebral palsy (CP), the most common subtype, is characterized by high levels of mobility. Despite this, children with hemiplegic CP can face challenges functioning in and adapting to situations of everyday life. The purpose of this cross-sectional study (Hemi-NET database) was to identify factors associated with adaptive behaviour in 59 children with hemiplegic CP (ages 4-18; GMFCS I-IV). Using multivariate regression analyses, the relationship between demographic, medical, and developmental factors and adaptive behaviour (measured by the Adaptive Skills Composite score of the BASC-2) was explored. Results indicate that 34% of children had impaired adaptive skills. An autism diagnosis and lower communication functioning were significantly associated with poorer adaptive skills (R² = 0.42, F(4, 43) = 7.87, p < 0.001), while factors such as IQ scores and GMFCS level were not. The results contribute to the growing literature that suggests that clinicians and researchers need to look beyond motor functioning when working with individuals with CP.

Understanding Acceptability, Barriers, and Facilitators to Clinical Implementation of the on Track Developmental Monitoring System for Children with Cerebral Palsy: A Qualitative Study

AIMS

On Track Developmental Monitoring System (DMS) is a novel series of tools to assist in shared-decision making, guide rehabilitation intervention based on functional ability levels, and promote episodic care service models. Further understanding of the acceptability, feasibility, and appropriateness of On Track DMS in clinical settings is critical. The purpose of this study was to understand clinician perspectives of the acceptability of On Track DMS and to identify potential implementation barriers and facilitators within pediatric physical therapist practice.

METHODS

Three, day-long training workshops were conducted with 32 pediatric physical therapists across the US. Focus groups with 21 workshop participants were conducted following training. Results were audio recorded, transcribed verbatim, and coded into themes.

RESULTS

Three themes emerged from the data: (1) Valuing the On Track Approach to Intervention; (2) Setting-Specific Needs and Challenges to Implementation; and (3) Training Material/Tool Strengths and Limitations.

CONCLUSIONS

On Track DMS appears to have initial value and acceptability for pediatric physical therapists across practice settings. Perceived benefits include facilitation of data-driven practice and therapist/family collaboration to improve health outcomes for children with CP. Using this data to understand and assess barriers and facilitators to knowledge use are first steps in successfully implementing On Track DMS.

Participation patterns and predictors of participation in preschool children with developmental disability

Introduction

The research was aimed to evaluate patterns and clinical and environmental predictors of participation in preschool children with developmental disability.

Method

Cross-sectional design was employed. Caregivers ( n = 98) of children aged 9–70 months (mean = 48, SD = 1.5) with developmental disability completed a health questionnaire and the Lithuanian Young Children’s Participation and Environment Measure (YC-PEM). Descriptive statistics and multiple linear regressions were performed to identify patterns and predictors of participation at home, daycare/preschool, and the community.

Results

Participation restrictions, based on frequency and variety of activities, were mostly observed in the community setting. Both clinical and environmental factors explained at least two dimensions of participation across all settings. Of the clinical factors, the predictors of participation were found to be the severity but not the number of impairments of body structures and functions and/or activity limitations.

Conclusions

This study emphasizes the role of the environment and activity limitations in explaining participation of preschool children with developmental disability. Findings can re-direct practitioners’ attention towards context-based assessments and interventions to promote health through participation.

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

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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 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.

Advancing the Evidence Base of Pediatric Physical Therapy: "Sincerely, From the Heart"

PURPOSE

To share reflections on themes that have become important to me as a developing pediatric physical therapy researcher contributing to knowledge generation in our field.

KEY POINTS

The themes are: select strong mentors, assemble a research team with diverse perspectives and strengths, be family-centered, be rigorous in approaches to study design to match the research question, mentor the next generation, and engage in knowledge translation and exchange.

CONCLUSIONS

I encourage everyone to reflect on who has been or could be your mentors or mentees, and on how you can be a part of an effective, family-centered research team, by encouraging a breadth of research designs to answer the many research questions that remain and by assisting in the implementation of knowledge to practice.

CLINICAL RELEVANCE

Outcomes for children and families receiving pediatric physical therapy services are enhanced through the use of evidence-based knowledge.

Physical, occupational, and speech therapy for children with cerebral palsy

AIM

To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).

METHOD

We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.

RESULTS

Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.

INTERPRETATION

Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.

WHAT THIS PAPER ADDS

Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.

Child and family factors that predict participation attendance in daily activities of toddlers with global developmental delay

PURPOSES

Enhancing children's daily participation is the optimal goal of early childhood intervention. This study aimed to identify child and family predictors of participation for toddlers with global developmental delay.

METHODS

Fifty-nine toddlers with global developmental delay (aged 24-43 months) and their mothers participated in a 6-month longitudinal study. Predictors for participation were child factors [age, gender, delay severity, mastery motivation (perceived persistence and task persistence), and withdrawal behavior], and family factors (socioeconomic status, family income, maternal education, stress, and maternal teaching behavior). Dependent variables were participation diversity and intensity of four activity types measured 6-month later using the Assessment of Preschool Children's Participation (Chinese version). Correlation and hierarchical regression statistical methods were used.

RESULTS

Older children with higher persistence had higher overall participation. Different factors predicted different participation dimensions and different activity types. Older age, higher perceived persistence, and being less withdrawn predicted higher diversity and intensity for play participation. For skill development participation, older age, less severity, higher mastery motivation, and better maternal teaching behaviors predicted higher diversity; and age, mastery motivation and maternal teaching predicted intensity.

CONCLUSIONS

Different factors predict participation attendance differently. Supporting parents to enhance toddlers' mastery motivation may optimize children's participation in daily activities.Implications for rehabilitationBased on the child and their caregiver preferences, applicability and/or engagement for different activity types, interventionists could collaborate further with caregivers to find strategies to increase children's participation attendance in daily life.Interventionists could consult with caregivers: (a) to observe the persistence and positive affect (mastery motivation) of children during different activities, (b) to figure out the possible barriers to participation in those activities, and (c) to demonstrate appropriate caregiver-child interactions.Interventionists are encouraged to support children's mastery motivation and quality of maternal teaching behaviors to enhance participation in daily activities.

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.

Determinants of playfulness of young children with cerebral palsy

PURPOSE

To identify child, family, and service determinants of playfulness of young children with cerebral palsy.

METHODS

Participants were 429 children, 18-60 months. Children were divided into two groups, Gross Motor Function Classification System levels I-II and III-V. Therapists collected data on body functions and gross motor function; parents provided information about children's health conditions and adaptive behavior, family life, and services. One year after the beginning of the study, therapists assessed children's playfulness. Data were analyzed using structural equation modeling.

RESULTS

Higher gross motor function was associated with higher playfulness for both groups. Greater impact of health conditions on daily life was associated with lower playfulness for children in levels I-II. More effective adaptive behavior was associated with higher playfulness, and higher parent perception of therapists' family-centeredness was associated with lower playfulness for children in levels III-V.

CONCLUSION

Supporting gross motor function, health, and adaptive behavior may foster playfulness.

Participation profiles in domestic life and peer relations as experienced by adolescents with and without impairments and long-term health conditions

PURPOSE

To investigate how individual and environmental factors relate to self-reported participation profiles in adolescents with and without impairments or long-term health conditions.

METHODS

A person-oriented approach (hierarchical cluster analysis) was used to identify cluster groups of individuals sharing participation patterns in the outcome variables frequency perceived importance in domestic life and peer relations. Cluster groups were compared using one-way analysis of variance (ANOVA).

RESULTS

A nine-cluster solution was chosen. All clusters included adolescents with impairment and long-term health conditions. Perceived importance of peer relations was more important than frequent attendance in domestic-life activities. Frequency of participation in dialogues and family interaction patterns seemed to affect the participation profiles more than factors related to body functions.

CONCLUSION

Type of impairment or long-term health condition is a weaker determinant of membership in clusters depicting frequency and perceived importance in domestic life or peer relations than dialogue and family environment.

School-based physical therapy services and student functional performance at school

AIM

We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy.

METHOD

Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes.

RESULTS

Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R² ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized β=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized β=-0.14 to -0.22).

INTERPRETATION

Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions.

WHAT THIS PAPER ADDS

No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.

Technology-based functional assessment in early childhood intervention: a pilot study

Background

Electronic patient-reported outcomes (e-PROs) may provide valid and feasible options for obtaining family input on their child’s functioning for care planning and outcome monitoring, but they have not been adopted into early intervention (EI). The purpose of this pilot study was to evaluate the feasibility of implementing technology-based functional assessment into EI practice and to examine child, family, service, and environmental correlates of caregiver-reported child functioning in the home.

Methods

In a cross-sectional design, eight individual EI providers participated in a 90-min technology-based functional assessment training to recruit participants and a 60-min semi-structured focus group post data collection. Participants completed the Young Children’s Participation and Environment Measure (YC-PEM) home section online and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) via iPad. Participants’ EI service use data were obtained from administrative records.

Results

A total of 37 caregivers of children between 6 and 35 months old (mean age = 19.4, SD = 7.7) enrolled, a rate of 44% (37/84) in 2.5 months. Providers suggested expanding staff training, gathering data during scheduled evaluations, and providing caregivers and providers with access to assessment summaries. Caregivers wanted their child’s participation to change in 56% of home activities. Lower caregiver education and higher EI intensity were related to less child involvement in home activities.

Conclusions

Implementing technology-based functional assessment is feasible with modifications, and these data can be useful for highlighting child, family, and EI service correlates of caregiver-reported child functioning that merit further study. Feasibility results informed protocol modifications related to EI provider training, timing of data collection, and management of EI service use data extraction, as preparation for a subsequent scale-up study that is underway.

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.

The effect of child, family and environmental factors on the participation of young children with disabilities

BACKGROUND

While participation is essential to a child's health and well-being, little is known about participation patterns of young children with disabilities.

OBJECTIVE

This study described the participation of children with disabilities under age 6, and examined the extent to which the child's factors (i.e., age, complexity of child's condition), family factors (i.e., general family functioning, income) and environmental factors (i.e., environmental helpfulness) affect participation dimensions (frequency, involvement, desire for change) in three different settings: home, daycare/preschool and community.

METHODS

Cross-sectional design was employed. Parents (n = 90) of children aged 1.4-6 years old (mean = 4.15, SD = 1.03) with disabilities completed the French Young Children's Participation and Environment Measure (YC-PEM) and Family Assessment Device. Descriptive statistics and multiple linear regressions were performed to describe participation patterns and identify the significant explanatory factors in each setting.

RESULTS

Participation restriction, based on frequency of activities, was primarily observed in the community setting. Environmental helpfulness (resources, supports) consistently explained participation levels for at least one of the dimensions across all settings, whereas contribution of the child's factors was less evident. Family functioning had a significant effect when examining participation involvement in the community and desire for change in the home setting and, in combination with environmental helpfulness, explained 18% and 21% of the variance respectively.

CONCLUSION

This study emphasizes the role of the environment in supporting participation of young children with disabilities. Findings can re-direct practitioners' attention towards modifying the environment as a primary target of intervention aimed at promoting health through participation.

Environmental impact on young children's participation in home-based activities

AIM

To test the effect of child, family, and environmental factors on young children's participation in home-based activities.

METHOD

Caregivers of young children were recruited using convenience and snowball sampling. Participants were 395 caregivers of children (222 males, 173 females) aged from 1 month to 5 years and 11 months. Demographic items and the home section of the Young Children's Participation and Environment Measure were administered online, followed by completion of the daily activities, mobility, and social/cognitive domains of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test by telephone interview.

RESULTS

A structural equation model fitted the data well (comparative fit index=0.91) and explained 31.2% of the variance in perceived environmental support and 42.5% of the variance in home involvement. Functional limitations and performance had an indirect effect on young children's participation through their effect on perceived environmental support. Specifically, fewer functional limitations and higher task performance were associated with greater environmental support, which in turn predicted higher levels of home involvement.

INTERPRETATION

Results suggest the importance of a young child's functional abilities and task performance on caregiver perceptions of environmental support at home, and the impact of environmental support on a child's participation in home-based activities during the early childhood period. Results warrant replication with more diverse samples to evaluate model generalizability.