A Life Course Perspective on Growing Older With Cerebral Palsy

The everydayness of falling: consequences and management for adults with cerebral palsy across the life course

PURPOSE

To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed.

MATERIALS AND METHODS

We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically.

RESULTS

Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity.

CONCLUSIONS

Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.

The Transition to Adulthood From the Perspectives of Young People With Cerebral Palsy and Their Caregivers: A Systematic Literature Review

BACKGROUND

The transition to adulthood can be a complex time in the lives of young people with cerebral palsy (CP). There is a lack of research examining this period from the perspectives of young people and their caregivers.

OBJECTIVE/AIMS

The review sought to identify challenging experiences during the transition to adulthood from the perspectives of young people with CP and their caregivers and to examine factors that acted as barriers and enablers to positive transition outcomes.

METHODS

A systematic literature review of peer-reviewed, empirical studies was completed. Thirteen articles were extracted and analysed using a narrative synthesis approach.

RESULTS

The findings identified challenges for the young people in the areas of independent living, sexuality and relationships, navigating health and social care systems, feeling different from their peers and increasing autonomy. Barriers contributing to negative experiences included overprotective parents and a lack of resources. Greater motor ability, supportive parents and knowledgeable healthcare practitioners enabled positive transition outcomes.

CONCLUSIONS

The transition to adulthood presents multiple challenges as perceived by young people with CP and their caregivers. Both parties require greater support to address these challenges during this time. Further research is required to develop interventions that can support this transition experience.

Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy

PURPOSE

To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention.

MATERIALS AND METHODS

An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context.

RESULTS

Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living.

CONCLUSIONS

The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.

The state of employment in the United States among young adults with cerebral palsy

Young adults with Cerebral Palsy (CP) have lower employment rates compared to young adults in general, as they may be confronted with physical, sensory, and cognitive impairments, coupled with personal and societal barriers as they mature. These challenges are clear, but the solutions are less so. Understanding the factors that impact employment is vital. This study aimed to identify and examine variables related to employment for this population through the lens of the International Classification of Functioning, Disability, and Health (ICF) model. The Rehabilitation Services Administration (RSA-911) federal dataset was used to examine the relationship between functioning and disability within the context of personal and environmental factors as predictors of employment among young adults with CP. Following a descriptive cross-sectional design using a secondary analysis of this national dataset, binomial logistic regression was used to predict employment outcomes. Data representing those with CP who participated in vocational rehabilitation (VR) services and were between 18 and 30 years of age at the time of exit were extracted from the 2019 RSA-911 dataset (n = 2465). Just under one-third (30.4 %, n = 750) emerged as employed, while 69.6 % (n = 1715) were unemployed at exit from their VR programs in 2019. Significant predictors for employment were participation in career and other support services, having basic skills and literacy, and being of non-Hispanic/Latino ethnicity. These findings concur with the persistent low employment rates for adults with CP and reinforce the need to understand the factors that increase employability. Healthcare professionals are urged to incorporate participation in self-management activities for all transition-aged youth that will not only improve health outcomes but promote future independence and increase awareness of vocational services for this population.

Social participation in adults with cerebral palsy: a systematic review of the evidence-base

PURPOSE

To identify and synthesise the current evidence on social participation in adults with cerebral palsy (CP).

METHODS

Four databases (PubMed, CINAHL Plus, PsycINFO, Web of Science) were systematically searched between December 2021 and February 2022. Pre-specified eligibility criteria were applied to all identified studies resulting in the inclusion of 16 articles. Data extraction was performed using a standardised tool and quality appraisal was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach was taken for data analysis.

RESULTS

The 16 included studies were rated as high (n = 11) and medium quality (n = 5). Numbers of participants included in the studies ranged from 7 to 335. Definitions of social participation were discussed. Common themes were identified: the impact of home and work environments on social participation, the importance of age-appropriate support and interventions, and the impact of limited autonomy on social participation.

CONCLUSIONS

Adults with CP experience limited social participation due to lack of appropriate support in childhood, issues across the lifespan including physical limitations when ageing, and factors such as societal expectations and inaccessible environments which limit opportunities for autonomy. Social participation may be improved by supporting families to provide opportunities in childhood, providing timely interventions, and by enhancing autonomy.