Are you doing what you want to do? Leisure preferences of adolescents with cerebral palsy

Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design

BACKGROUND

Worldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP.

METHODS

Children established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children's Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers.

RESULTS

Fifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children's mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands.

CONCLUSION

Bootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation. Trial registration Trial registration number: NCT05403567.

More than just having fun! Understanding the experience of involvement in physical activity of adolescents living with cerebral palsy

Purpose: To explore the experiences of involvement of adolescents living with cerebral palsy, and their parents, while participating in physical activity. Understanding involvement in physical activity may be used to guide future participation.Methods: Eight adolescents (mean age 13 years 11 months, SD 1 year 6 months) with cerebral palsy participated in a New Zealand-based high-level mobility programme (HLMP) focused on running skills, twice per week for 12 weeks. The adolescents and 12 parents were interviewed before, after the 12 weeks and 9-months following the HLMP. Guided by interpretative description, 38 interviews were coded, analysed, and interpreted.Results: Four themes were: "Turning up is not enough" ("There's no point being there if you're not involved"); "In it all the way", "Changes on a dime", and "What works for me." Perceptions of involvement varied between adolescents and parents. Being "very involved" related to high levels of focus, concentration, effort; but not always enjoyment.Conclusions: Focusing on enjoyment as the key experience of involvement understates the complexity and dynamic nature of involvement. "Being involved" is not always easy and may not mean the absence of discomfort or effort. Optimising the individuals' involvement continuum during physical activity may be essential to promote lifelong participation.IMPLICATIONS FOR REHABILITATIONAdolescents living with cerebral palsy and their parents have differing perspective of involvement and utilise different strategies to encourage being and staying active.Teaching adolescents living with cerebral palsy about their involvement continuum and optimal level of involvement for each activity, context and environment could promote sustained participation.To ensure adolescents are "being involved" in physical activity, opportunities for engagement, motivation and persistence are important; enjoyment is a possible, but not essential attribute of involvement.Encouraging involvement in physical activity can be a source of family conflict from a young age therefore clinicians have a role as an essential supporter, motivator and educator.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Predicting high quality of participation in adaptive snow-sports for individuals with disabilities: An exploratory study

OBJECTIVES

This exploratory study aimed to examine the individual, program and environmental (social and physical) characteristics which predict high quality of participation in adaptive snowsports for each dimension of the Quality of Participation in Parasport Framework (QPPF): autonomy, belongingness, mastery, challenge, engagement and meaning.

METHODS

A survey was completed by 133 individuals with disabilities or their representatives on each dimension of the QPPF in adaptive snowsports and on the factors impacting the quality of participation. Descriptive statistics were used to describe the study participants, and a multivariate logistic regression model was constructed for each dimension of the QPPF to evaluate the relative contribution of individual, snowsport-related, program and environmental factors to each dimension.

RESULTS

Individuals with disabilities in this study reported high quality of participation on all dimensions of the QPPF. The individual characteristics only predicted the QPPF dimension of challenge. However, the program and environmental characteristics such as equipment, number of instructors and barriers were robust predictors of quality of participation.

CONCLUSION

Overall, participants experienced high quality participation. Supporting the adaptive snowsports programs while reducing the barriers faced by people with disabilities should be a continued effort to promote quality of participation.

The Journey to Sustainable Participation in Physical Activity for Adolescents Living with Cerebral Palsy

PURPOSE

To understand adolescents' and their parents' perspectives on 'being active', this study explored the experience of participation in physical activity (PA), the role of long-term participation in PA, and the importance of remaining active for life.

METHODS

Eight ambulant adolescents with CP (aged 11-16 years, seven male) participated in a high-level mobility programme twice per week for 12 weeks. Guided using interpretive description, adolescents and 12 of their parents were interviewed before, after and nine months following the programme. Thirty-eight interviews were coded, analysed, and interpreted, informed by audit information, reflective journaling, and team discussions.

RESULTS

Adolescents and their parents highly value being active now and into adulthood. Sustainable participation in PA requires adolescents and families to navigate complex environments (interpersonal, organisational, community, and policy). Core themes were: 'Just Doing it', 'Getting the Mix Right' (right people, right place, right time), 'Balancing the Continua' and 'Navigating the Systems'. The continua involved balancing intra-personal attributes: 'I will try anything' through to 'I will do it if I want to' and 'It's OK to be different' through to 'It sucks being disabled'.

CONCLUSIONS

The journey to sustainable participation was complex and dynamic. Experiences of successful journeys are needed to help adolescents with CP "stay on track" to sustainable participation.

Participation patterns of children with cerebral palsy: A caregiver's perspective

Background

Participation in activities of daily living (ADL), education, leisure and play in children living with cerebral palsy (CP) may be affected by various factors, as outlined in the International Classification of Functioning, Disability and Health Framework (ICF). The aim of this study was to describe the participation patterns of a group of these children.

Objectives

This study aimed to describe participation patterns in ADL, education, leisure and play activities of children living with CP in Modimolle.

Method

An exploratory-descriptive qualitative (EDQ) study design was used. A researcher-constructed bio-demographic data sheet and a semi-structured interview schedule were used to collect data from the primary caregivers of children (5-17 years) living with CP in Modimolle. Interviews were transcribed verbatim, translated from Sepedi to English and analysed using the content analysis approach and NVivo software.

Results

The findings of this study indicated that children living with CP in Modimolle require set-up and assistance to participate in various ADL such as self-care, family and community activities. They also participate in formal and informal educational programmes as well as active and passive leisure and play activities. However, at the moment, they have limited opportunities to participate because of resource constraints and inaccessible infrastructure.

Conclusion

Although children with CP in Modimolle perform some ADL, and participate in educational, leisure and play activities, they are not fully integrated into their community. Legislative support and policy implementation are required to improve participation and integration of children living with CP. Further studies on community-specific integrative strategies to enhance participation among children living with disabilities are recommended.

Contribution

This paper provides valuable information on the participation patterns of children with CP living in a rural area of South Africa. The findings can assist with development and implementation of community-specific, integrative health and social care strategies to enhance participation among children living with disabilities.

A qualitative exploration of motivations and barriers for community leisure organisations' engagement with the Jooay™ mobile app

PURPOSE

Participation in leisure activities is key to the physical and mental health of children and adolescents with disabilities. The Jooay™ mobile app aims to link children and adolescents with disability to participation opportunities in their community. This study explored the perspectives of community leisure organisations and their motivations and perceived barriers to be listed as a leisure service on Jooay™.

MATERIALS AND METHODS

Twenty representatives of community leisure organisations in metropolitan Perth, Western Australia were interviewed. Vroom's Expectancy Theory was used to shape the semi-structured interview guides. Data were analysed with thematic analysis using an inductive open coding approach.

RESULTS

Four key themes pertaining to motivations and barriers to registration with Jooay™ were developed: Building reputation; Collaboration; Ability to deliver accessible leisure services; and Usability of Jooay™. Multiple motivating factors for registering on Jooay™ were identified including positive financial implications, meeting corporate social responsibilities, building collaborative stakeholder partnerships, and building organisational confidence and awareness of disability through supportive partnerships. Environmental and organisational barriers to inclusion were highlighted.

CONCLUSION

Findings will inform future promotion of the features and benefits of Jooay™ to engage community leisure organisations. This may increase the number of accessible leisure services listed within the app, providing a greater selection of community leisure activities in which children and adolescents with disability can participate.IMPLICATIONS FOR REHABILITATIONCommunity leisure organisations would be motivated to engage with the Jooay^TM app, provided the right supports are in place for them.Additional benefits of registering on Jooay^TM may include positive financial implications, meeting corporate social responsibilities, building collaborative stakeholder partnerships, and building disability confidence and awareness through supportive partnerships.Ongoing education and support is needed for community leisure organisations regarding; disability awareness, competency, and capacity to deliver leisure services in inclusive and equitable ways. This will enable them to increase their accessibility for children with disabilities, particularly for non-disability-specific leisure organisations.Information about leisure services on the Jooay™ app builds capacity in the community to identify diverse access needs of children and young people with disabilities and the most effective strategies to address them.

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.

Technology and Communication Considerations for Engaging Youth Receiving Supplemental Security Income (SSI) Benefits: Vocational Rehabilitation Counselor Perspectives

Technology has been shown to enhance daily activities, increase participation in individualized planning and supports, and accommodate the transition needs of students with disabilities. This study examined the benefits and challenges regarding technology use when providing transition services for youth and families receiving Supplemental Security Income (SSI) benefits. Specifically, it explored the nuances of employing technology to encourage engagement in Wisconsin Promoting the Readiness of Minors in Supplemental Security Income (WI PROMISE) services and foster communication between counselors and participants. This qualitative study used a constant comparative method for analyzing data collected through two focus groups of WI PROMISE counselors. Counselors identified technology as essential to maintaining contact with WI PROMISE participants as well as extant barriers including inconsistent access to the internet, financial expense, and insufficient training and support. Recommendations for using technology to communicate with transition-age youth and their families will be discussed.

Predictive role of individual factors in the leisure preferences of children and adolescents with cerebral palsy: a cross-sectional study in Iran

Background/Aims

The participation of children and adolescents with cerebral palsy in leisure activities is associated with their preferences. A better understanding of their leisure preferences and the factors that influence them can help therapists to promote young patients' participation in leisure activities. The aim of this study was to describe the role of individual factors in the prediction of leisure preferences of children and adolescents with cerebral palsy in Iran.

Methods

A cross-sectional study design was used. A total of 152 children and adolescents with cerebral palsy were selected to complete the Preferences for Activities of Children questionnaire. Simple and multiple linear regression analyses were performed to assess the role of individual factors in the prediction of preferences for leisure activities.

Results

Individual factors played a significant role in the prediction of leisure preferences. Their influence on the preferences for recreational, physical and self-improvement domains (r2=0.215; 0.154; 0.127, respectively) were greater than for social and skill-based domains (r2=0.045; 0.052, respectively).

Conclusions

Preferences for physical activities need to be augmented while a high preference for social and recreational activities could be used to promote participation in leisure activities. Therapists and other healthcare professionals should consider individual factors relating to leisure preferences when devising therapeutic plans that aim to promote participation in leisure activities.

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study

Importance/Background

Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures.

Aim

This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home.

Methods

Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8–18 years old) completed the 4-week home-based intervention in France and Canada.

Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software).

Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect size estimates and variance were determined for Body Function outcome measures: active wrist extension, grip strength and Box and Blocks Test; and for Activities and Participation measures: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM) and Self-Reported Experiences of Activity Settings (SEAS).

Results

Recruitment response (31%) and assessment completion (84%) rates were good and 74% of participants reached self-identified practice goals. As 17% of technical issues required external support to resolve, the intervention was graded as feasible with modifications. No adverse events were reported.

Moderate effects were observed in Body Function measures (active wrist extension: SMD = 1.82, 95%CI = 0.85–2.78; Grip Strength: SMD = 0.63, 95%CI = 0.65–1.91; Box and Blocks: Hedge’s g = 0.58, 95%CI = -0.11–1.27) and small-moderate effects in Activities and Participation measures (AHA: Hedge’s g = 0.29, 95%CI = -0.39–0.97, COPM: r = 0.60, 95%CI = 0.13–0.82, SEAS: r = 0.24, 95%CI = -0.25–0.61).

Conclusion

A definitive RCT to investigate the effectiveness of this novel intervention is warranted. Combining SFC-style coaching with high-quality biofeedback may positively engage youth in home rehabilitation to complement traditional therapy.

Trial registration

ClinicalTrials.gov, U.S. National Library of Medicine: NCT03677193.

Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives

PURPOSE

To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings.

METHODS

A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis.

RESULTS

Features of the technology and the intervention influence feelings of autonomy (e.g., personalization), competence (e.g., calibration), and relatedness (e.g., social play, virtual therapist/coach). There may be multiple and differently valued goals in interactive computer play-based interventions (e.g., game- and therapy-focused) that, if disconnected or unmet, negatively impact engagement. Multiplayer interactions, real-time feedback and progress tracking provide information that influences self-regulation and engagement over time.

CONCLUSIONS

Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy. Implications for rehabilitation The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies. Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization) and the intervention (e.g., interactions with therapists, social play). Increased effort should be directed towards ensuring that interactive computer play-based interventions and technologies reward and reinforce efforts towards therapy goals.

Promoting the Human Rights of Children With Neurologic Conditions

Children with neurologic conditions benefit from international conventions, and national treaties, policies and regulations that safeguard their human rights. These regulations also exist to serve as guidance in the creation of comprehensive systems of care, inclusive environments, accessible societies and communities that allow these children to thrive and to achieve the best of their capacities. This narrative review of issues related to human rights and advocacy in pediatric neurologic disabilities will provide an overview of the human rights conventions that relate to children with disabilities, and the most current approaches implicating health care providers in rights promotion for these individuals and their families. We also suggest venues for professionals to advocate for their patients, and suggest strategies to consider rights-based approaches as a mean to provide holistic care in a social neurology framework.

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

BACKGROUND

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

AIMS

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

METHODS AND PROCEDURES

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

OUTCOMES AND RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

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

Accessibility to information and communications technology for the social participation of youths with disabilities: a two-way street

The current study examined by mixed method the effectiveness of an accessibility to Information and Communications Technology (ICT) program that provided computers, assistive technology, tutors, and internet connection to 65 youths with severe disabilities (aged 13.22 ± 3.4 years) in their homes. The quantitative evaluation included assessment of computer task performance, computer skills, and participation in social ICT leisure activities before and after the program. Findings revealed low baseline and significant progress on most outcome measures 6 months after the program, mostly among those youths who had tutors. Additional in-depth interviews were conducted 1 year later with 10 participants to explore their ICT use and its impact on their social participation. The analysis revealed a significant contribution of the ICT use, while critical thinking about its risks and some disappointment with the social needs that ICT does not address. Our findings raise awareness of 'two-way streets' policies and programs to ensure e-inclusion.