Factors affecting social participation of Iranian children with cerebral palsy

Participation restriction of children with cerebral palsy living in Thailand and influential factors: A cross-sectional study

OBJECTIVE

To explore participation in daily activities of children with cerebral palsy(CP) in Thailand and influential factors.

METHODS

A convenience sample of family-caregivers of 80 children with CP, 6-18 year-old, completed self-administered questionnaires (i.e., frequency of participation, Gross Motor Function Classification System-Family Report) during clinic visits at a university hospital.

RESULTS

Family-caregivers reported that more than one-third of the children never participated in outdoor activities. The gap in the frequency of participation between groups with high versus low motor function was very high. Better gross motor and communication were strong predictors of participation. Caregiver's education and family income were associated with participation in art/cultural, leisure and tourist activities.

CONCLUSIONS

Family-caregiver-report suggests that Thai-children with CP, especially those with severe impairments, have limited participation in daily activities. Increasing mobility and communication may promote the participation. Comprehensive intervention is needed to narrow the participation gap found between high and low functioning children.

Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy

OBJECTIVE

To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP.

METHODS

Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports.

RESULTS

Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70.

CONCLUSIONS

Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.

The implementation of systematic monitoring of cognition in children with cerebral palsy in Sweden and Norway

PURPOSE

Children with cerebral palsy (CP) are at risk of cognitive impairments and need to be cognitively assessed to allow for individualized interventions, if applicable. Therefore, a systematic protocol for the follow-up of cognition in children with CP, CPCog, with assessments offered at five/six and 12/13 years of age, was developed. This report presents and discusses assessment practices in Sweden and Norway following the introduction of CPCog and a quality improvement project in Norway aimed at increasing the number of children offered cognitive assessments.

MATERIALS AND METHODS

A questionnaire investigating assessment practices was sent to pediatric habilitation centers in Sweden and Norway. In Norway, the habilitation centers also participated in a quality improvement project aimed at increasing adherence to the CPCog protocol.

RESULTS

Of the respondents, 64-70% report that they assess cognition in children with all degrees of motor impairment, and 70-80% assess at the ages recommended in CPCog. Following the quality improvement project in Norway, the percentage of children assessed increased from 34 to 62%.

CONCLUSIONS

The findings illustrate that the provision of information is not sufficient to change practice. Implementation of new re/habilitation procedures is aided by targeting health care practices individually.Implications for rehabilitationChildren with cerebral palsy (CP) have increased risk of cognitive impairments that require intervention.Assessments of cognition should be offered to all children with CP because the nature of cognitive impairments may vary.Introducing a follow-up protocol of how and when to perform cognitive assessments is a step towards ensuring equal access to the services for all children with CP.A quality improvement project might be a viable method for implementing a protocol into everyday clinical practice.

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.

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.

Social participation: the perspectives of adolescents with cerebral palsy and their mothers

BACKGROUND

Social participation is a complex construct, thus different factors may facilitate or restrict engagement. Adolescents with Cerebral Palsy (CP) and their mothers often experience barriers in social participation. Therefore, they are frequently facing challenges in order to engage in meaningful activities, in different contexts.

OBJECTIVE

We aimed at exploring the perspectives of mothers and adolescents with CP on their social participation.

METHOD

This is a cross-sectional and exploratory study, with a qualitative design. Seven adolescents with CP, aged from 11 to17 years old and their mothers, participated in a semi-structured interview, in São Paulo, Brazil. Data from interviews were analyzed with the Collective Subject Discourse (CSD) technique.

RESULTS

Mothers believed that their parenting practices contribute to the social participation of their children. Mothers revealed concerns about how to support the autonomy of their children and how to help them to establish meaningful and mature relationships. Adolescents with CP reported to engage in a range of social activities, with friends in different contexts, such as restaurants, cinema, concerts, parks and school. They also reported to appreciate social participation and to look for strategies in order to engage.

CONCLUSIONS

This work can contribute to the understanding of social participation of adolescents with CP, under the perspective of these people and their mothers by allowing them to express their thoughts and voice their fears and limitations. Healthcare providers should adopt a lifespan approach to disabilities and recognize the unique challenges of adolescence in the life of both child and parents.

Participation in leisure-time activities and the role of individual factors in children and adolescents with cerebral palsy

Background/Aims

This study evaluated the role of individual factors of children and adolescents with cerebral palsy in the prediction of leisure participation.

Methods

A cross-sectional study design was used. A group of children and adolescents with cerebral palsy were selected to complete the Children's Assessment of Participation and Enjoyment. Participants' cognitive levels were assessed based on the Study of Participation of Children with Cerebral Palsy Living in Europe estimated cognitive levels.

Findings

The models could best predict up to 31.8% of the variance in the participation rates, 28.4% of the variance in the frequency scores and 33.5% of the variance in the enjoyment scores of leisure domains. The type of cerebral palsy was one of the most significant predictive factors of leisure participation (β ranged from −0.177 to −0.525 for quadriplegia).

Conclusions

Therapists and rehabilitation specialists may consider individual factors to predict a proportion of leisure participation subscales before planning for interventions aimed at promoting the leisure participation of children and adolescents with cerebral palsy.

Assessment priorities in cerebral palsy using ICF core set by Iranian occupational therapists

BACKGROUND.

International Classification of Functioning, Disability and Health (ICF) core set for cerebral palsy allows for the description of the levels of functioning in cerebral palsy. It is not exactly clear which of these levels is more important for evaluation from the perspective of occupational therapists in Iran. By identifying these priorities, we can establish a better plan for intervention.

PURPOSE.

This study defines assessment priorities in children with cerebral palsy (<6 years).

METHOD.

Sixty-two Iranian occupational therapists studied the priorities of assessment based on the Iranian ICF core set. The therapists were asked to rate the code categories from 1 to 3. The results are presented as mean values.

FINDINGS.

Occupational therapists first focus on body functions assessment, then activities/participation, and ultimately, environmental factors.

IMPLICATIONS.

Occupational therapists in Iran have a bottom-up approach toward clients with cerebral palsy. It may be necessary to revise the educational curriculum, prepare a training course, and provide more supervision for practising occupational therapists.