Mental health, physical activity, and sports among children with cerebral palsy

BACKGROUND

People with cerebral palsy (CP) may be at an increased risk for mental health disorders due to co-occurring physical and communication limitations associated with the condition. Participation in physical activity (PA) and sports may provide opportunities to increase socialization and improve physical function. The purpose of this study was to examine associations between participation in daily PA and sports and mental health among children with CP.

METHOD

Participants included children with CP (n = 458) and typically developing children (TDC) (n = 40 091) 6-17 years whose parents participated in the 2016-2020 National Survey of Children's Health. Mental health disorders included anxiety, depression, behavioural disorders and attention-deficit/hyperactivity disorder (ADHD).

RESULTS

Compared with TDC, children with CP had a higher prevalence of mental health disorders (75.5% vs. 54.2%) and were more likely to receive mental health care (21.5% vs. 14.6%). Controlling for sociodemographic variables, children with CP were more likely to experience anxiety [odds ratio (OR) 2.6; 95% confidence interval (CI) = 2.1-3.3), depression (OR 1.8; 95% CI 1.3-2.4), behavioural disorders (OR 4.8; 95% CI 3.8-6.0) and ADHD (OR 2.1; 95% CI 1.6-2.6). The likelihood of these conditions decreased when children participated in sports for anxiety (OR 2.2; 95% CI 1.8-2.8), depression (OR = 1.4; 95% CI 1.0-2.0), behavioural disorders (OR 4.1; 95% CI 3.2-5.1) and ADHD (OR 1.9; 95% CI 1.5-2.5). The likelihood for anxiety (OR 2.3; 95% CI 1.8-2.8), depression (OR 1.4; 95% CI 1.0-1.9), behavioural disorders (OR 4.4; 95% CI 3.5-5.5) and ADHD (OR 1.9; 95% CI 1.5-2.4) also decreased with participation in daily PA.

CONCLUSIONS

There is an overwhelming disparity in the number of children with CP who have a mental health disorder and those who receive mental health care. Increasing access to participation in sports and PA may be beneficial.

Association of Chronic Pain With Participation in Motor Skill Activities in Children With Cerebral Palsy

This cross-sectional study examines the association between pain and activities requiring motor skill performance among a nationally representative sample of US children with cerebral palsy.

The Relationship Between Physical Activity and School Success Among Children With and Without Special Health Care Needs

BACKGROUND

School-environments are thought to be strong influences of behavioral choices. There is limited research available on the role of physical activity (PA) and school success among children with special health care needs (CSHCN). The purpose of this study was to explore differences in PA among CSHCN and non-CSHCN and how the school success index is related to PA in both groups.

METHODS

Data were taken from new version of the National Survey of Children's Health (NSCH), which consolidated questions from the previous NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Chi-square and logistic regression analyses were employed to examine group differences.

RESULTS

There were significant differences among both subgroups, although most school-aged children did not meet recommended PA guidelines. Chi-squared analyses indicated; school engagement and the parent's perception of child safety at school were associated with the likelihood of meeting PA guidelines. Logistic regression analyses showed that the odds of meeting PA guidelines were associated with the school success index.

CONCLUSIONS

Comprehensive school health programs should focus on PA both subgroups. School health educators should continue to advocate for safe and structured extracurricular activities to improve the child and adolescent's engagement and overall well-being.

Preferential deficit of fat-free soft tissue in the appendicular region of children with cerebral palsy and proposed statistical models to capture the deficit

BACKGROUND

Cerebral palsy (CP) is a neurological disorder characterized by a profound skeletal muscle deficit. However, whether there is a regional-specific skeletal muscle deficit in children with CP is unknown. The purpose of this study was to determine whether fat-free soft tissue mass (FFST), a commonly used surrogate for skeletal muscle mass, is more compromised in the limbs than in the trunk in children with CP. A second purpose was to determine whether physical characteristics can be used to accurately estimate appendicular FFST (AFFST) in children with CP.

METHODS

Forty-two children with CP (4-13 y) and 42 typically developing children matched to children with CP for sex, age and race were studied. Whole body FFST (FFST_whole), FFST in the upper limbs (FFST_upper), FFST in the lower limbs (FFST_lower), the ratio of AFFST to height (AFFST/ht), the ratio of AFFST to height² (AFFST/ht²) and non-appendicular FFST were estimated from dual-energy X-ray absorptiometry. Statistical models were developed to estimate AFFST, AFFST/ht and AFFST/ht² in both groups of children, and the leave-one-out method was used to validate the models.

RESULTS

Children with CP had 21% lower FFST_whole, 30% lower AFFST, 34% lower FFST_lower, 14% lower non-appendicular FFST, 23% lower AFFST/ht, 19% lower AFFST/ht² and 9% lower AFFST/FFST_whole (all p < 0.05). Statistical models developed using data from typically developing children overestimated AFFST, AFFST/ht and AFFST/ht² by 35%, 30% and 21% (all p < 0.05), respectively, in children with CP. Separate models developed using data from children with CP yielded better accuracy, with the estimated results highly correlated (r² = 0.78, 0.66 and 0.50, respectively; all p < 0.001) and not different from calculated AFFST, AFFST/ht and AFFST/ht² (all p > 0.99). However, when the difference in estimated values and measured values of AFFST, AFFST/ht and AFFST/ht² were plotted against measured values, there was an inverse relationship (r = -0.38, -0.47 and -0.61, respectively, all p < 0.05).

CONCLUSION

Children with CP have a remarkable deficit in FFST that is more pronounced in the appendicular than in the non-appendicular region and more pronounced in the lower than in the upper limbs. Preliminary models developed using data from children with CP can provide reasonable estimates of AFFST and indexes of AFFST relative to height, but further development of the models may be needed.

Community-Based Upper Extremity Power Training for Youth with Cerebral Palsy: A Pilot Study

Aim: To examine the effects of an upper-extremity, community-based, and power-training intervention.Methods: Twelve participants with cerebral palsy (CP) [8 males, 4 females; mean age 14 years 6 months (SD 5 years 4 months), range 7-24] were randomly assigned to a rest-training (RT; n = 6) or training-rest (n = 6) group in this randomized, cross-over design. Training took place in participants' home or school, three times per week for 6 weeks. We examined changes in upper extremity average power output (Pavg) in watts (W) and changes in function via the Pediatric Outcomes Data Collection Instrument (PODCI).Results: Each participant completed at least 15 of the 18 total training sessions (91.2% adherence). Pavg increased 92.2% on average among participants (p < .05). There was a significant three-way interaction among treatment, sequence, and period with the data stratified by (Bimanual Fine Motor Function [BFMF]) level on the pain subscale of the PODCI (p = 0.0118). All participants decreased pain after training with the exception of individuals with lower functioning (BFMF II-V) in the RT group.Conclusion: A community-based upper extremity power-training intervention was feasible and effective at improving power among young people with CP and has the potential to improve pain.

Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities

BACKGROUND

Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas.

METHODS

We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes.

RESULTS

There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context.

CONCLUSIONS

Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Predictors of Coordinated and Comprehensive Care Within a Medical Home for Children With Special Healthcare (CHSCN) Needs

The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.

Comparing impact on the family and insurance coverage in children with cerebral palsy and children with another special healthcare need

BACKGROUND

Families and caregivers of children with special healthcare needs (CSHCN) often experience financial difficulties, have unmet physical and mental health needs, and are at increased risk of marital problems due to the stress caused by carrying for their child. Within the larger population of CHSCN, young people with cerebral palsy (CP) have more unmet needs due to the complexity and potential severity of the disability. The purpose of this study was to identify factors associated with differences in insurance coverage and impact on the family of children with CP and other CHSCN.

METHODS

The data were taken from the National Survey of Children with Special Health Care Needs, which was designed to examine state- and national-level estimates of CSHCN. Three variables examined differences in insurance coverage between those children diagnosed with CP versus all other CSHCN: insurance coverage for the previous year, current insurance coverage, and adequacy of insurance coverage. Four variables representing different indicators of family impact were used to assess differences between children with CP versus all other CSHCN: out-of-pocket expenses for healthcare, family financial burden, hours per week that family members spent caring for the child, and impact on family work life.

RESULTS

The results of this study showed significant differences between households with a child with CP and a child with another health special need in terms of insurance coverage, indicating a tendency of children with CP to be insured the entire year. As for the impact on the family in households with children with CP versus other CSHCN, there were significant differences in all four variables that were analysed.

CONCLUSIONS

There is limited evidence highlighting differences between the impact of caring for a child with CP and caring for other CSHCN. Caring for a child with CP has a significant impact on the family, despite insurance coverage.

VERB™ Summer Scorecard: increasing tween girls' vigorous physical activity

OBJECTIVE

We assessed changes in the frequency of self-reported physical activity (PA) among tween girls exposed and not exposed to the VERB™ Summer Scorecard (VSS) intervention in Lexington, Kentucky, during 2004, 2006, and 2007.

METHODS

Girls who reported 0-1 day per week of PA were classified as having little or no PA. Girls who reported 2-3 days of PA were classified as low PA performers; 4-5 days of PA were labeled as moderate performers; and 6-7 days of PA were identified as high performers. Logit regression analysis of survey data from girls identified trends in PA frequency across time.

RESULTS

In 2004, participant girls were more likely than girls unfamiliar with VSS (reference group girls) to report high frequency of PA (OR = 1.44, CI = 1.18, 1.70). In 2006, participants were statistically less likely than reference group girls to report low frequency of PA (OR = 1.75, CI = 1.33, 2.21). In 2007, VSS participants were consistently more likely to report moderate frequency (OR = 1.56, CI = 1.35, 1.77) and high frequency of PA (OR = 1.44, CI = 1.24, 1.64) than reference group girls.

CONCLUSION

An innovative, community-driven intervention demonstrated promise for increasing PA among tween girls. VSS may have transportability to other communities to help reverse the secular trend of declining PA for this population segment.