Physical Activity Levels of Adolescents and Adults With Cerebral Palsy in Urban South Africa

Cerebral palsy in African paediatric populations: A scoping review

AIM

To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21-year period.

METHOD

The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021.

RESULTS

A total of 1811 articles underwent review against explicit criteria; 93 articles were selected for inclusion in the scoping review. The reported prevalence of CP ranged from 0.8 to 10 per 1000 children. Almost half had perinatal risk factors, but up to 26% had no identifiable risk factor. At least one-third of children with CP had one or more comorbidities, most commonly epilepsy, intellectual disability, and malnutrition. African children with CP demonstrated excess premature mortality approximately 25 times that of the general population, predominantly from infections. Hospital-based and younger populations had larger proportions of children with severe impairments. African children with CP had inadequate access to care and education, yet showed functional improvements compared to controls for all evaluated interventions.

INTERPRETATION

The prevalence of CP in Africa remains uncertain. African children with CP have different risk profiles, greater premature mortality, and more severe functional impairments and comorbidities compared to the Global North. Several barriers prevent access to optimal care. Larger African studies on validated and effective interventions are needed.

Exploring the unmet needs of adults with cerebral palsy living in urban South Africa

PURPOSE

The investigators aimed to understand the unmet needs of adults with cerebral palsy (CP) living in urban South Africa and to ascertain similarities or differences to typically developing (TD) adults in the same community.

MATERIALS AND METHODS

Participants were interviewed with an adapted version of the Southampton Needs Assessment Questionnaire (SNAQ). Non-parametric statistical analysis was utilised for quantitative data and qualitative data were analysed using free coding to identify themes.

RESULTS

Thirty adults with CP (median age 34.8 years; GMFCS levels I/II/III/IV/V: n = 6/6/5/7/6; socio-economic status (SES) low/average/high: n = 8/17/5) were matched for gender, age, and SES. Adults with CP reported a higher unemployment rate and lower level of satisfaction with access to health services than TD peers. Core themes identified by the participants with CP that made community participation more difficult were physical capacity, poor access to accommodation, transport and health services, lack of socialising opportunities, poor universal design, and lack of financial independence.

CONCLUSIONS

Adults with CP reported experiencing many challenges in their communities. Improved access to health care services and transport, and the universal design of housing and community buildings to accommodate individuals with a disability should be made a priority.Implications for rehabilitationAdults with cerebral palsy (CP) reported that their disability had an impact on their social life, home life, and work life.Accessibility issues have been identified as a major factor affecting adults with CP in a variety of areas, including access to and use of health services, housing, transportation, and community buildings.Adults with CP reported the need for support during the transition to adulthood, especially with developing life skills that will promote living independently in the community as adults with disabilities.

Does exercise affect quality of life and participation of adolescents and adults with cerebral palsy: a systematic review

PURPOSE

Investigate the effect of exercise for adults with cerebral palsy (CP) on quality of life, participation (attendance and involvement in life situations), functional mobility, pain, fatigue, mood, and self-efficacy.

METHODS

A systematic review was completed. Twelve databases were searched from inception to August 2022 for studies including participants (≥16 years) with cerebral palsy, and that evaluated an exercise intervention. Two reviewers independently assessed eligibility, risk of bias, and extracted data.

RESULTS

Seventeen studies (total n = 532) were included: 12 randomised control trials, four non-randomised trials, and one single case experimental design. Interventions studied were predominantly strength, aerobic or treadmill training, dance, and swimming. No study assessed participation, pain or mood. Of two studies that assessed quality of life, one reported a positive effect on an aspect of mental health immediately after the programme finished. All studies assessed functional mobility, but only one reported a positive effect. One study assessed self-efficacy and found no effect, and another assessed fatigue and reported conflicting results.

CONCLUSIONS

The effect of exercise for adults with CP, on outcomes that adults report as important to them - quality of life, participation, pain, mood, and fatigue - are unknown.IMPLICATIONS FOR REHABILITATIONTo address outcomes important to adults with cerebral palsy (CP), it is important to understand how exercise affects participation and quality of life.All modes of exercise reviewed appear safe for adults with CP and choice should be based on the client's preferences, access to services, and convenience.Addressing any needed accommodations in the environment and context is likely more important than exercise prescription parameters when tailoring exercise to meet the needs of adults with CP and sustain participation.

Attitudes and Behaviors of Physical Activity in Children with Cerebral Palsy: Findings from PLAY Questionnaire

To investigate the domains of physical activity in children with cerebral palsy (CP) and to compare these findings to typically developed (TD) children. Methods: A cross-sectional study design. Responses of the four domains in Play Lifestyle and Activity in Youth (PLAY) questionnaire were descriptively analyzed and compared between children with CP (GMFCS I-II) and TD children. Results: Fifty-three children with CP (N = 53, 36 males and 17 females, age of 8.4 ± 1.7 years) and 58 TD children (N = 58, 34 males and 24 females, age of 7.6 ± 1.4 years) participated in this study. In analyses of daily behavior, reported participation in weekly (adaptive) physical education (PE) and sports were more frequent in children with CP (0.6 ± 0.5 days per week) compared to TD children (0.4 ± 0.6 days per week, p = 0.040). Outside play time including free play, organized (adaptive) sports and recess were higher in children with CP (2.7 ± 0.8 days per week) than TD children (2.4 ± 0.7 days per week, p = 0.022). About motivation/attitudes, a higher proportion of TD children feel sad if they are not able to play sports during the day (74.1%) compared to children with CP (48.7%, p < 0.001). Conclusion: Physical activity level was comparable between children with CP and age-matched TD children, while TD children showed higher scores in knowledge and understanding, motivation/attitudes, and physical competence.