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Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed Methods Study to Generate Evidence for Developing an Intervention
Abstract
Participation in physical play/leisure ('PPP') is an important therapy goal of children with motor impairments. Evidence for PPP interventions for these children is scarce. The first step is to identify modifiable, clinically meaningful predictors of PPP for targeting by interventions.
To identify body function and structure, activity, environment, and personal factors related to PPP in children with motor impairments and modifiable by therapists.
A mixed methods, intervention-development study using the WHO framework International Classification of Functioning, Health and Disability.
Participants: children (6-8yrs) with motor impairments, mobilizing independently with/without equipment, and seen by physical or occupational therapists in six regions in the United Kingdom; and their parents. Self-reported PPP was assessed by Children's Assessment of Participation and Enjoyment (CAPE). Modifiable-factor data were collected by therapists' observations, parent questionnaires, and child-friendly interviews. CAPE, therapist, and parent data were analysed using descriptive statistics and linear regression. Interview data were analysed for emerging themes.
Children's (n=195) PPP [mean 18 times/week (IQR=11-25)] was mainly 'recreational' (e.g., pretend play, playing with pets) rather than 'active physical' (e.g. riding a bike/scooter). Parents (n=152) reported positive beliefs about children's PPP but varying levels of family PPP. Therapists reported 23 unique impairments (e.g., muscle tone), 16 activity limitations (e.g., walking), and 3 personal factors (e.g., child's PPP confidence). Children interviewed (n=17) reported strong preference for active play, but indicated that adults regulated their PPP. Family PPP and impairment in the child's movement-related body structures explained 18% of variation in PPP. Family PPP explained most variation.
Results converge with wider literature about the child's social context as a PPP intervention target. Results question therapists' observations in explaining PPP.
© 2015 American Physical Therapy Association.
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... Gasparoto e Alpino 7 pesquisaram as condições de acessibilidade e participação de um grupo de crianças com dificuldade de locomoção usuárias de equipamento de tecnologia assistiva no ambiente domiciliar. Por meio de check-list para mensurar a acessibilida-de nos domicílios, previamente testado mas não validado, com uma amostra pequena composta por apenas cinco crianças do sexo feminino (ida-de entre quatro e 12 anos), foi detectada carência de mobiliário e/ou recursos adaptados, apesar da frequente indicação; bem como predomínio 9 Neurologia Pediátrica Paralisia Cerebral e Acidente Vascular Encefálico Hammel et al. 10 Neurologia Lesão medular, Traumatismo Crânio-Encefálico e Acidente Vascular Encefálico Kolehmainen et al. 11 Neurologia Pediátrica Paralisia Cerebral e outros diagnósticos não especificados Rouquette et al. 12 Reumatologia Osteoartrite de joelhosnão submetidos aartroplastia Zhang et al. 13 Neurologia Acidente Vascular Encefálico Rantakokko et al. 14 Gerontologia Idosos comunitários Bostan et al. 15 Ortopedia e Reumatologia Dor crônica difusa, Lombalgia, Osteoartrite, Osteoporose, Artrite Reumatóide Chang et al. 16 Neurologia Acidente Vascular Encefálico Rauch et al. 17 Neurologia Lesão Medular den Ouden et al. 18 Gerontologia Condições de saúde variadas (cardiovasculares, neurológicas, metabólicas, respiratórias, ortopédicas e neoplásicas) Sveen et al. 19 Neurologia Traumatismo Crânio-Encefálico Virués-Ortega et al. 20 Gerontologia Idosos comunitários Randström et al. 21 Neurologia, Ortopedia e Reumatologia Acidente Vascular Encefálico e condições ortopédicas (predomínio de fraturas e artroplastias de quadril). ...
... AVE), pôde-se identificar que os pais de crianças com déficits cognitivos percebem de forma mais significativa a necessidade de apoio de profissionais e serviços especializados em relação àquelas com déficit motor. Kolehmainen et al.11 estudaram a relação do ambiente e a participação no brincar de 195 crianças com deficiências motoras (com PC, em sua maioria, e algumas sem diagnóstico firmado), de seis a oito anos, com locomoção independente assistida ou não por equipamentos. A participação no brincar, mensurada por questionário validado, apresentou correlação significativa com os seguintes fatores ambientais: ter amigos para brincar; família imediata (comportamento dos pais no brincar sem as crianças e comportamento de toda família no brincar). ...
... Ciência & Saúde Coletiva, 22(11):3645-3652, 2017 ...
Resumo Indivíduos com incapacidades físicas podem, em interação com facilitadores e barreiras, modificar a sua participação em sociedade. O ambiente, no panorama da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), apresenta-se com relevante papel na saúde e na expressão da funcionalidade. Dessa forma, o objetivo deste estudo foi investigar a influência de fatores ambientais sobre a incapacidade física, pautado no referencial teórico da CIF. Foi realizada uma revisão sistemática da literatura, norteada por recomendações dos documentos Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE). Os estudos selecionados puderam reforçar os preceitos teóricos da CIF. O ambiente físico e social, de modo geral, pôde ter sua interferência atribuída a diferentes condições clínicas, especialmente em neurologia, tanto em estudos quantitativos quanto qualitativos. Limitações metodológicas foram observadas e podem ser entraves à consolidação de alguns direcionamentos, o que deve incentivar novas pesquisas sobre o tema com métodos criteriosos, instrumentos validados e amostras cuidadosamente selecionadas.
... Furthermore, evidence suggests that while occupational therapy interventions are recommended to utilize a broad range of pathways to change (e.g. Person-Environment-Occupation), in practice therapists [12] or researchers [8] rarely do this. Interventions tend to focus on children's biomedical impairments and basic movement skills, and rarely consider environmental factors or the child's psychological factors (e.g. ...
... Interventions tend to focus on children's biomedical impairments and basic movement skills, and rarely consider environmental factors or the child's psychological factors (e.g. confidence, motivation) [8,12]. ...
... For example, beliefs about capabilities have shown to influence what people do and how they engage in life situations [14], with applicability to rehabilitation [15]. The results from this study therefore support the proposals that considering participation as a therapeutic outcome may be congruent with considering participation as human behaviour [15][16][17], and that therapists should explicitly consider human behavioural factors when designing therapy interventions [12]. The results further expand the existing literature by identifying and illustrating specific ways in which behaviour change techniques and change processes may be present in children's therapy. ...
Background: There is limited evidence about the effectiveness of occupational therapy interventions for participation outcomes in children with coordination difficulties. Developing theory about the interventions, i.e. their ingredients and change processes, is the first step to advance the evidence base.
Aim: To develop theory about the key ingredients of occupational therapy interventions for children with coordination difficulties and the processes through which change in participation might happen.
Material and methods: Grounded theory methodology, as described by Kathy Charmaz, was used to develop the theory. Children and parents participated in semi-structured interviews to share their experiences of occupational therapy and processes of change. Data collection and analysis were completed concurrently using constant comparison methods.
Results: Five key ingredients of interventions were described: performing activities and tasks; achieving; carer support; helping and supporting the child; and labelling. Ingredients related to participation by changing children’s mastery experience, increasing capability beliefs and sense of control. Parents’ knowledge, skills, positive emotions, sense of empowerment and capability beliefs also related to children’s participation.
Conclusion and significance: The results identify intervention ingredients and change pathways within occupational therapy to increase participation. It is unclear how explicitly and often therapists consider and make use of these ingredients and pathway.
... Prior to the pandemic, video calls were not commonly used for interviewing, although some studies used this method to good effect. 11,12 The video call included a period of time prior to the start of the interview to build rapport with the child. We used photographs, drawings, and similar items that bring the child comfort (e.g. ...
... We used photographs, drawings, and similar items that bring the child comfort (e.g. toys/books), suggested through previous research, 12 to open a dialogue and put the child at ease to enhance conversation. ...
Aims
Perthes’ disease is an idiopathic avascular necrosis of the developing femoral head, often causing deformity that impairs physical function. Current treatments aim to optimize the joint reaction force across the hip by enhancing congruency between the acetabulum and femoral head. Despite a century of research, there is no consensus regarding the optimal treatment. The aim of this study was to describe the experiences of children, their families, and clinicians when considering the treatment of Perthes’ disease.
Methods
A qualitative study gathered information from children and their families affected by Perthes’ disease, along with treating clinicians. Interviews followed a coding framework, with the interview schedule informed by behavioural theory and patient and public involvement. Transcripts were analyzed using the framework method.
Results
A total of 24 interviews took place, with 12 child/family dyads and 12 clinicians from UK NHS centres. Interviews identified widespread variation of routine care. Children/their families recounted positive experiences when included in the decision-making process for treatment. There is a strong desire from clinicians and children/families for consistent guidance from everyone involved in care, which should be based on clinical consensus.
Conclusion
This is the first study to describe how children/families and clinicians experienced receiving or providing treatment in Perthes’ disease. The results indicate the need for robust evidence to support treatment decisions. Children and families valued feeling involved in the clinical decision-making process. Clinicians acknowledged the central importance of providing patient-centred care, particularly in the absence of robust evidence to guide the optimal treatment decisions. This study will inform a future Delphi project to develop clinical consensus guidelines for the treatment of Perthes’ disease.
Cite this article: Bone Jt Open 2023;4(10):735–741.
... Therefore, integrating a therapy regime with a leisure experience cannot just characterise the therapy experience with the enjoyment of an activity, but can also allow the individual to integrate the regime into his/her everyday life, using different situations (such as shopping) to maintain parts of his/her health and/or capabilities (such as the movement in the joints) (Kunstler and Daly 2010). Additionally, this ties into Kolehmainen et al. (2015) and Wiles et al. (2008) observations that suggest that the sole engagement with physiotherapy exercises makes the physiological experience static and unattractive for the individual. But, being able to transfer a physiotherapy regime away from the clinic into a real life setting enables individuals to integrate their therapy requirements into their everyday activities, making the therapy experience feel more dynamic (Kolehmainen et al. 2015;Wiles et al. 2008). ...
... Additionally, this ties into Kolehmainen et al. (2015) and Wiles et al. (2008) observations that suggest that the sole engagement with physiotherapy exercises makes the physiological experience static and unattractive for the individual. But, being able to transfer a physiotherapy regime away from the clinic into a real life setting enables individuals to integrate their therapy requirements into their everyday activities, making the therapy experience feel more dynamic (Kolehmainen et al. 2015;Wiles et al. 2008). ...
Disability and the importance of making leisure accessible and inclusive for people with disabilities has been an issue within leisure studies over the years. However, evidence suggests that researchers and society still needs to develop an understanding of the different aspects of disabled individuals’ lives, in particular their leisure experiences. Therefore, this research aimed to critically explore and assess disabled individuals’ social worlds and leisure experiences. The research methodology adopted a constructivist-interpretivist approach involving interviews to gather data from individuals about their disabilities, lives and leisure experiences. Five participants were interviewed (2 males and 3 females, who were aged between 18 and 57). They all had different physical disabilities. Two major themes were identified, “Living and experiencing a disability” and “The leisure experience”.
The first theme related to living and experiencing a disability. It was seen that each disability is different and that having a disability does not affect the personal characteristics of the individual, but does require the individual to manage and experience the implications of his/her medical condition(s). The second theme was about the participants’ leisure experiences where it was found that leisure is a personal activity which could be meaningful, enjoyable and could be beneficial to disabled individuals. However, it was also found that if the participants experience any access problems, or negative attitudes from others within society, this meaningful, enjoyable and beneficial experience could get interrupted. This interruption means that the leisure experience becomes less personal and has less of a positive impact upon the participants’ lives.
Overall, it was found that different medical condition(s) can affect different individuals on different levels. It was also found that individuals with disabilities need to be seen as individuals. In addition, the leisure experience of individuals with a disability is not just about access and inclusion, but also about the individual experiencing leisure and having the ability to feel the positive effects of leisure. Consequently, the thesis contributes to knowledge of the social realities of the disabled individual’s life and how his/her disability affects his/her world. The thesis also contributes an understanding of the disabled individual’s leisure experiences and how leisure is a meaningful element of his/her time.
... The Children Play Preferences Survey is a 23-item selfreport checklist that measures the frequency of participation in play and leisure activities compiled for this study based on Kolehmainen's et al. (2015) and Case-Smith and Miller-Kuhaneck's (2008) studies. It includes a variety of activities indoor and outdoor, social, and solitary play activities (i.e., sports, playing an instrument, board games, role play, drawing, and coloring) measured on an ordinal scale from 1 (rarely engaged) to 4 (always; 1 time per day or more). ...
Maternal practices and their exposure to traumatic events might impede children’s psychological adjustment; however, family relations, play, and leisure engagement may mitigate it. Previous research that has focused on the mechanisms influencing children’s psychological adjustment has not included contextual factors such as family relations and children’s engagement in play. In a sample of mothers with and without a history of trauma, this study aimed to examine the impact of maternal practices on children’s psychological adjustment and to test their indirect effect through family relations and child engagement in play and leisure activities. A cross-sectional study comprised a sample of 99 mother-child dyads with children aged 6 to 12 years old, predominantly Caucasian, and mothers with college-level education. Self-report measures assessed parental acceptance-rejection, the impact of maternal exposure to traumatic events, family relations, child psychological adjustment, and play. Children of mothers who reported exposure to traumatic events had significantly more psychosocial difficulties. A moderated mediated model tested whether family relations and child play engagement effects varied based on maternal exposure to traumatic events. The model was significant and both direct and indirect effects were supported. Maternal rejection predicted children’s psychological maladjustment and this relation was mediated by children’s engagement in play for mothers with a trauma history. These findings point to the importance of play and leisure activities within and outside the family context during the middle childhood period.
... Children with severe motor impairments (CwSMI) such as cerebral palsy (C.P.), acquired brain injury, or muscular diseases may specially experience difficulties with autonomous object manipulation [14]. This can result in decreased (or even a complete lack of) opportunities to interact with their environment during the early stages of their development [15], and as a consequence, their engagement in activities of daily living, including free play and academic activities [16,17], may become weakened. For example, a child with mild C.P. may not have enough hand dexterity, and therefore be unable to manipulate toys as desired, while another more severely impaired child may be further unable to express or communicate his or her interest in a toy [9]. ...
Purpose:
To describe the extent, type, and quality of studies involving robots for augmentative manipulation during play by children with severe motor impairments (CwSMI), and to explore how they influenced children's cognitive skills and engagement.
Methods:
Web of Science, Scopus, PubMed & EBSCO were systematically searched for articles published until March 2021, that reported cognitive skills and/or engagement outcomes from interventions involving the use of robots in play activities, where participants included CwSMI, and full-text was available. Data extracted comprised characteristics of participants, study design, purpose of the study, outcomes assessed, collection methods, and intervention carried out (robot-environment interaction and robot used).
Results:
Eight mobile robots and five robotic arms were reported in the 17 included and reviewed articles. Most of them informed a positive impact on CwSMI's cognitive skills and/or engagement. However, the studies scored poorly on a five-criteria quality assessment, and only one single-case design proved strong evidence of treatment. None of the analysed interventions was an evidence-based practice.
Conclusion:
The use of manipulative robots during play activities may have a positive impact on the CwSMI's cognitive skills and engagement in activities. However, further studies with higher internal and external validity are needed to support stronger evidence.Implications for rehabilitationThe use of robots for augmentative manipulation during play activities may have a positive influence on the cognitive functions and the engagement in activities of children with severe motor impairments.Through manipulative robots, this population could be able to show the abilities that are hidden due to their motor impairments, and subsequently, receive educational and physical training more aligned with their real capacities and potential.
... A strength of the current review was the mixed-method approach utilised. Mixedmethod studies are widely used to develop PA interventions [93][94][95] and can help in understanding the mechanisms of action behind intervention effects [96]. In particular, integrating the quantitative and qualitative findings (the 1 + 1 = 3 approach [97]) rather than interpreting them separately is recognised as a way of enhancing the value of mixedmethods research [98]. ...
Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some—but largely mixed—evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables’ long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.
... Disabled C&YP need to have the same opportunities for fun and friendship as everyone else (Brokenbrow et al., 2016;Disabled Children's Partnership, 2017). At present this is not the case for PDC&YP as nationally and internationally, they have decreased participation in community activities and are at significantly higher risk of being socially isolated (Carroll et al., 2018;Carter et al., 2014;Disabled Children's Partnership, 2017;Ghanbari et al., 2016;Kolehmainen et al., 2015;Pyer, 2016). Current evidence regarding participation in out-ofschool activities weighed heavily toward C&YP with cognitive and learning disabilities; however, physical disability was specifically chosen due to the lack of research with this particular cohort in the UK (K Knight et al., 2014). ...
Physically disabled children and young people (PDC&YP) face many challenges when participating in out-of-school activities. PDC&YP should have the same choices and opportunities as other C&YP: to forge friendships locally and to access out-of-school activities. However, PDC&YP have fewer opportunities than their non-disabled peers due to challenges such as access, support, and suitable provision. This multi-method qualitative study examined the factors affecting participation of PDC&YP in out-of-school activities. The perspectives of PDC&YP and parents were sought using a range of data collection tools. These included interviews, focus groups, and creative focus groups with 13 PDC&YP and 19 parents. Play-based creative focus groups were specifically designed for PDC&YP aged 7 to 17 years. The study demonstrated that PDC&YP enjoy specialist disabled activities to meet others ‘like them’ but want more local opportunities to do this. Some PDC&YP and parents felt they were not disabled enough for ‘disabled’ activities but not able enough for mainstream. PDC&YP requiring personal care were a ‘hidden’ group who are at risk of missing out on experiences that they are entitled to. The study concludes by presenting the need to improve provision through disability awareness training and a co-ordinated partnership approach to be employed by the local authority to raise the profile of disability and ‘bridge the gap’ between service users and service providers. The social needs of children require the same focus and attention to aid their wellbeing and to enhance out-of-school lives.
... It is widely agreed that children's services need to be participation focused, that is, to focus on children's involvement in life situations as a core outcome (Allard et al., 2014;Department of Health, 2012World Health Organization, 2001). The past two decades have seen a drive to develop concepts, tools, evidence, and interventions related to participation outcomes (e.g., Adair et al., 2018;Arakelyan, Maciver, Rush, O'Hare, & Forsyth, 2019;Imms et al., 2016;Imms et al., 2017;Kolehmainen et al., 2015;Reedman, Boyd, & Sakzewski, 2017). However, anecdotal evidence and research reports suggest that front-line services find implementation of participation-focused practices challenging (Anaby et al., 2017). ...
Background:
It is widely agreed that children's services should use participation-focused practice but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers.
Method:
Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (i) targets participation outcomes; (ii) involves child/parent in setting participation outcomes; and (iii) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n=25 clinicians) in a large UK healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n=122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning.
Results:
A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included: clinicians' skills in participation-focused behaviours [Medians 3.00-5.00 (IQRs 2.25-6.00)]; social processes [4.00 (3.00-5.00)]; and behavioural regulation [4.00-5.00 (3.00-6.00)].
Conclusions:
MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.
... Children and adolescents with low motor competence (MC) display decreased fitness and lower physical activity (PA) levels affecting their health and well-being as adults. [1][2][3][4][5] Interestingly, MC generally improves throughout development, this is not always true with some young people, particularly girls, observing a decline in MC. 6 The development of MC is not straightforward and can be explained by a number of psychosocial, biological and environmental factors. Furthermore, while MC development in young children is affected by biological maturation, practice and opportunity are more influential during adolescence. ...
Introduction
Motor competence (MC) is an important factor in the development of health and fitness in adolescence.
Aims
This cross-sectional study aims to explore the distribution of MC across school students aged 13–14 years old and the extent of the relationship of MC to measures of health and fitness across genders.
Methods
A total of 718 participants were tested from three different schools in the UK, 311 girls and 407 boys (aged 13–14 years), pairwise deletion for correlation variables reduced this to 555 (245 girls, 310 boys). Assessments consisted of body mass index, aerobic capacity, anaerobic power, and upper limb and lower limb MC. The distribution of MC and the strength of the relationships between MC and health/fitness measures were explored.
Results
Girls performed lower for MC and health/fitness measures compared with boys. Both measures of MC showed a normal distribution and a significant linear relationship of MC to all health and fitness measures for boys, girls and combined genders. A stronger relationship was reported for upper limb MC and aerobic capacity when compared with lower limb MC and aerobic capacity in boys (t=−2.21, degrees of freedom=307, P=0.03, 95% CI −0.253 to –0.011).
Conclusion
Normally distributed measures of upper and lower limb MC are linearly related to health and fitness measures in adolescents in a UK sample.
Trial registration number
NCT02517333.
... In studies of children with physical disability, a wide range of child, family, and environmental factors, such as the child's motivation and health status, family resources, and features of the physical and social environment, have been identified as facilitators or barriers that influence children's participation in leisure, recreation, and play. 8,20,21 Similarly, for children who use LEP, it is important to understand the child, family, and/or environment factors that influence participation in active play and the barriers to play, as in other areas of daily life function. While there may be similarities to children in other diagnostic groups or with other orthopedic, past and current medical conditions, children who use LEP have important unique differences, including the use of prostheses. ...
Background
Through play, children develop motor, cognitive, social, and other life skills. Play barriers can impede physical and psychosocial benefits.
Objectives
We describe participation in active play, fundamental movement skills, play environment characteristics, and potential play barriers for school-aged children (6–12 years) who use lower extremity prostheses.
Study design
Cross-sectional questionnaire study.
Methods
A questionnaire was developed and administered online to parents of children 6–12 years who use lower extremity prostheses. Questions focused on children’s valued play activities, participation in active play, fundamental movement skills, body positions for play, and characteristics of play environments.
Results
Parents (n = 26) reported their children who use lower extremity prostheses participated in a range of activities including active play (e.g. playgrounds, swimming). Fundamental movement skill limitations were identified (e.g. walking long distances, running fast, hopping on one foot, and skipping). Mobility limitations with floor positions, movement transitions, and uneven or sloped surfaces were reported. Active play with equipment such as roller skating, climbing structures, and bicycling presented challenges.
Conclusion
Parents of children who use lower extremity prostheses reported participation restrictions associated with mobility limitations, activity type, and built environment characteristics (e.g. surfaces and equipment). Challenges made it difficult for children who use lower extremity prostheses to keep up with peers in schools and communities.
Clinical relevance
Understanding potential barriers to participation in active play of children who use lower extremity prostheses may contribute to enhanced prosthetic design, rehabilitation strategies, universal design of play and built environments, and improved outcome measures ultimately enabling these children to participate fully in active play in diverse contexts.
... Only a small number of studies have included this cohort as part of their sample (e.g., Anaby et al., 2014;Kanagasabai, Mulligan, Hale, & Mirfin-Veitch, 2017;Kolehmainen et al., 2015). The authors of two systematic reviews (see Anaby et al., 2013;Bult, Verschuren, Jongmans, Lindeman, & Ketelaar, 2011) found that the most elaborate studies of participation have been with children with a physical disability, in particular, cerebral palsy. ...
Children with developmental disabilities participate in more solitary, sedentary, and home-based leisure activities than active physical pursuits or community-based activities. Clinical experience suggests that children with less well-recognized developmental difficulties also have compromised leisure experiences; however, this has not been fully investigated. This study engaged 20 school-age children with developmental difficulties in a community-based circus program, designed in collaboration with occupational therapists. The program included activities such as trampolining, trapeze, and acrobatics. Semi-structured interviews with children and parents explored children's leisure experiences both at circus and more broadly. Qualitative content analysis revealed that friendships, having fun, and being physically active were highly valued aspects of leisure. The coaching style and “just right” level of challenge within programs were identified as central to children's engagement and sense of competence. Participating in a supported leisure program such as circus appeared to promote children's engagement in community leisure, at least in the short term.
... With the young people, J. McA. and C. D. facilitated discussions about experiences and opinions of the different participation outcome categories by using visual characters and prompts, scenarios and vignettes. These have been previously shown to enable young people, including young people with communication limitations, to direct the agenda, engage with concepts and voice opinions (Fargas-Malet et al. 2010;Morris et al. 2014;Kolehmainen et al. 2015). With the adults, N. K. and J. M. provided visual summaries of the participation outcome categories and related key words from existing qualitative evidence . ...
There is an urgent, agreed need to improve participation outcomes and interventions for children and young people with neurodisability. We worked together with service users and providers to design research into participation outcomes and interventions in neurodisability. We built on existing evidence about participation outcomes and interventions and the WHO International Classification of Functioning, Disability and Health. We: (1) specified seven participation outcome categories for measurement; (2) prioritized these for improvement: self-care, friends and social, and physical activity ranked the highest; (3) identified 11 potential intervention categories for targeting the top priority, self-care, through eight hypothesized change mechanisms and agreed for the interventions to be delivered as a ‘Menu of Interventions’ for personalized self-care support; and (4) designed a before-and-after mixed methods feasibility study to evaluate the Menu with children and young people (0–12 years) and their parents and therapists.
... Treatment of high tone in children with neuromotor disorders depends on the type of impairment. 1 It is known that abnormalities of muscle tone can influence daily activities and movement variability and affect joint mobility, growth, posture, and biomechanical alignment. 2 Assessments that can assess hypertonia and distinguish between hypertonia types such as spasticity or dystonia would be valuable to improve our understanding of the mechanisms leading to deformities and to plan rehabilitative or surgical interventions. 3 Sanger et al 4 defined 3 types of hypertonia: spasticity, dystonia, and rigidity. ...
The Hypertonia Assessment Tool is a 7-item instrument that discriminates spasticity, dystonia, and rigidity on 3 levels: item scores, subtype, and hypertonia diagnosis for each extremity. We quantified the inter- and intrarater reliability using Kappa statistics, Gwet’s first-order agreement coefficient (both with 95% confidence interval), and percentage agreement for all levels. For validity, we compared the Hypertonia Assessment Tool subtype with the clinical diagnosis provided by the physicians. Two physiotherapists tested 45 children with neuromotor disorders. The interrater reliability (n = 45) of the Hypertonia Assessment Tool subtype was moderate to substantial whereas the intrarater reliability (n = 42) was almost perfect. The Hypertonia Assessment Tool showed good agreement in detecting spasticity. On the contrary, there was a higher presence of dystonia of 24% to 25% tested with the Hypertonia Assessment Tool compared to the clinical diagnosis. Even some individual items showed lower agreement between raters; the Hypertonia Assessment Tool subtypes and diagnosis were reliable. Validity of the Hypertonia Assessment Tool to test spasticity is confirmed, whereas, for dystonia and rigidity, further studies are needed.
The purpose of this scoping review was to examine how mixed methods research (MMR) has been applied in adapted physical activity (APA) research about children and adolescents age 5–18 years with a disability. Six electronic databases were searched to retrieve relevant studies published between 2003 and 2020. Sixty-four studies were identified and analyzed. The findings were organized into five categories of interest: publication information, study objectives, mixed methods research design, participants’ information, and data integration. Challenges related to the design and publication of MMR in APA were uncovered, and suggestions for improvement are provided. This study adds to the knowledge of MMR design, and it provides an understanding of the underlying processes and methodological strategies that have guided this approach in APA research. This article will encourage APA researchers to engage in MMR while also aligning future studies with contemporary MMR literature and publication standards.
Background:
Children and youth with severe motor and communication impairment (SMCI) have difficulty providing self-expression through typical speech, writing with a paper and pencil, or using a standard keyboard. Their emotional expressions can be missed by peers and novel caregivers.
Purpose:
To describe the indicators and components of emotional experiences for children/youth with SMCI.
Methods:
Primary guardians of nine children/youth with SMCI were involved in photo/video data collection and follow-up qualitative interviews. Twenty-one familiar people (e.g., friends, family members, and/or care team) participated in semi-structured qualitative interviews.
Results:
A conceptual understanding of emotional well-being specific to the population has been developed consisting of nine themes, encompassed by four domains i) Core Attributes, ii) Personal Experiences, iii) Surroundings, iv) Expression and Reception.
Conclusions:
Emotional experiences of children/youth with SMCI are diversely expressed. Primary guardian and familiar person insight can be amplified to positively impact care and participation.
The existing literature on the interplay between entrepreneurship, knowledge-based economy and urban economic prosperity has often portrayed a predictable relationship between entrepreneurship and economic growth, yet the arguments are mainly broad-brush. It appears that most studies fail to pay adequate attention to the dynamic forces of positive externalities and mechanisms through which they affect the sources of economic growth in cities. This paper adopts a scoping review approach to determine the scope, coverage, knowledge gap and context of the existing literature on the topic. The paper further uses thematic analysis to identify, analyse and report the patterns in the reviewed literature. The paper finds that the literature relating to the entrepreneurship–growth nexus determinants is sporadic and less structured. The paper concludes that the multidimensionality of this complicated relationship requires a more systematic understanding of the dynamic interaction between factors such as innovation, urbanisation and technology. Additionally, this scoping review finds that while migration and industry clusters are growing phenomena in both developed and developing countries, their effects on entrepreneurial activities and growth have yet to receive sufficient attention. Finally, the paper finds a paucity of comparative studies on the multi-level interactions of entrepreneurial activities at the industry–city–country level.
Objective:
The aim of this study was to test a model of child, family and environment and identify factors affecting the intensity of leisure participation by children with cerebral palsy (CP).
Materials & methods:
In this cross-sectional study, 232 children with cerebral palsy (141 boys and 91 girls), aged 6 to 14 years old and their parents were selected from four schools of children with special needs and five rehabilitation centers through the convenience sampling method in Shiraz, Iran. To evaluate the intensity of leisure participation, we used the Persian version of Children's Assessment of Participation and Enjoyment (CAPE) completed by the participants. Demographic form, Craig Hospital Inventory of Environmental Factors (CHIEF), Strengths and Difficulties Questionnaire (SDQ), Family Environmental Scale (FES), SPARCLE cognitive level and parents' version of Gross Motor Function Classification System, Manual Ability Classification System and Communication Function Classification System were sent to the parents with some necessary explanations. Structural equation modeling was used to test the model hypothesis. SPSS version 18 and AMOS version 16 were used for data analysis.
Results:
Comparative fit indexes indicated a moderate to good model fit. The presented model explained 44% of the variance in the intensity of participation. Constructs such as Family Activity Orientation with standardized total effect of 0.31 and path coefficients of P< .05 showed the most significant direct effect on participation, followed by higher gross motor function (-.26), higher manual ability (-.19), communication function (-.17), higher cognitive level (-.16), more siblings in the family (.15) and less emotional-behavioral problems (-.15). Family structures and relationships (.17) and unsupportive environment constructs (-.14) demonstrated an indirect but significant effect (P< .05). The relationship of family education level and income with participation was not significant (P>.05).
Conclusion:
The intensity of CP children's participation is influenced by child, family and environmental factors. Parents' knowledge of recreational activities and their preference to participate in leisure and recreational activities provide children more opportunities to participate. Higher gross motor function, manual ability, and communication function also play an important role in their participation. Family structure means family cohesion, roles organization, and conflicts between family members and encountering physical, attitudinal and structural barriers at home and community indirectly impact children's participation pattern. To enhance children's participation, we suggest therapists to support children's behaviors, family relationships and involvement in community activities and optimize physical function of children with limitations in self-mobility.
Background
In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.
Methods
A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.
Results and implications
We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
The quantity and quality of studies in child and adolescent physical activity and sedentary behaviour have rapidly increased, but research directions are often pursued in a reactive and uncoordinated manner.
To arrive at an international consensus on research priorities in the area of child and adolescent physical activity and sedentary behaviour.
Two independent panels, each consisting of 12 experts, undertook three rounds of a Delphi methodology. The Delphi methodology required experts to anonymously answer questions put forward by the researchers with feedback provided between each round.
The primary outcome of the study was a ranked set of 29 research priorities that aimed to be applicable for the next 10 years. The top three ranked priorities were: developing effective and sustainable interventions to increase children’s physical activity long-term; policy and/or environmental change and their influence on children’s physical activity and sedentary behaviour; and prospective, longitudinal studies of the independent effects of physical activity and sedentary behaviour on health.
These research priorities can help to guide decisions on future research directions.
To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance.
Secondary analysis of a prospective cross-sectional study sample.
Regional pediatric specialty care hospital.
Participants included 128 children with cerebral palsy (CP) with 59% male, ages 2-9 years, Gross Motor Function Classification System levels I-III, 49% had hemiplegia and 72% with spasticity.
Not Applicable.
Activity capacity was measured with the Gross Motor Function Measure-66 (GMFM-66) and performance with the Activities Scale for Kids (ASKp). Participation was measured with the Assessment of Life Habits (Life-H). Children's Assessment of Participation and Enjoyment (CAPE) and the Assessment of Preschool Children's Participation (APCP) assessed diversity participation. Regression equations and Sobel's z test were employed to examine the mediated effect via performance.
Physical activity performance mediates 74.9% (β=.83, p<0.001) of the effect of activity capacity on total participation levels and 52.8% (β-.47, p=0.001) of the effect of capacity on diversity participation.
The relationship between what an ambulatory child with CP is 'able' to perform in a clinic setting and their participation in life is significantly mediated by what they 'actually' do motorically in day to day life. Results suggest that interventions focusing on improving what they actually do every day regardless of capacity to perform (what they can do when tested) may positively influence participation.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
The primary goal of occupational therapy intervention for children with disabilities is enabling participation in the daily activities of childhood. The World Health Organization conceptualizes chronic health conditions and disability as two distinct aspects of health, with the primary concern on the level of health condition being with diagnosis rather than function. Participation, within the International Classification of Functioning, Disability and Health (ICF), is characterized by the interactions between a child, its family, and other personal and environmental factors. Few studies have examined the relationships between diagnosis, function, and participation in children with disabilities. Using the results of a study of the participation of 427 children with physical disabilities in activities outside mandated school, the authors examined the relative influence of diagnostic category on participation. When adjusted for age, sex, and physical function, diagnostic category does not significantly affect the intensity and diversity of participation. The results of this study confirm and highlight the limitations in using diagnostic information in children's rehabilitation in the absence of other information. Participation is a complex phenomenon so it is important to understand more clearly how personal, environmental, and family factors influence the child's involvement in everyday activities. There is a need to move beyond diagnosis to focus on other personal and environmental factors as major predictors of participation.
Objective:
To evaluate how participation of children with cerebral palsy (CP) varied with their environment.
Design:
Home visits to children. Administration of Assessment of Life Habits and European Child Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child's impairments and pain.
Setting:
European regions with population-based registries of children with CP.
Participants:
Children (n=1174) aged 8 to 12 years were randomly selected from 8 population-based registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study.
Interventions:
Not applicable.
Main outcome measure:
Participation in life situations.
Results:
For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities-mealtimes, health hygiene, personal care, and home life-was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School participation was associated with attitudes of teachers and therapists. Environment explained between 14% and 52% of the variation in participation.
Conclusions:
The findings confirmed the social model of disability. The physical, social, and attitudinal environment of disabled children influences their participation in everyday activities and social roles.
This paper argues that ethical problems in research involving direct contact with children can be overcome by using a participatory approach. A study of children's participation in decisions when they are looked after is described in terms of how a view of the ‘social child’ (James, 1995) shaped the approach to establishing contact with children, the choice of topics and methods of communication which were used, and the way in which children were given opportunities to interpret the data for themselves. The paper concludes with the suggestion that a participatory approach can also assist with reliability and validity.
Objective:
Most contemporary theories of physical activity include an intention construct as the proximal determinant of behavior. Support of this premise has been found through correlational research. The purpose of this paper was to appraise the experimental evidence for the intention-behavior relationship through meta-analysis.
Methods:
Studies were eligible if they included: (1) random assignment of participants to intervention/no intervention groups; (2) an intervention that produced a significant difference in intention between groups; and (3) a measure of behavior was taken after the intention measure. Literature searches were concluded in December 2010 among five key search engines.
Results:
This search yielded a total of 1,033 potentially relevant records; of these, 11 passed the eligibility criteria. Random effects meta-analysis procedures with correction for sampling bias were employed in the analysis. The sample-weighted average effect size derived from these studies was d+ = .45 (95% CI .30 to .60) for intention, yet d+ = .15 (95% CI .06 to .23) for behavior.
Conclusions:
These results demonstrate a weak relationship between intention and behavior that may be below meaningful/practical value. We suggest that prior evidence was probably biased by the limits of correlation coefficients in passive designs. It is recommended that contemporary research apply models featuring intention-behavior mediators or action control variables in order to account for this intention-behavior gap.
Children with motor impairments (e.g. difficulties with motor control, muscle tone or balance) experience significant difficulties in participating in physical play and leisure. Current interventions are often poorly defined, lack explicit hypotheses about why or how they might work, and have insufficient evidence about effectiveness. This project will identify (i) the 'key ingredients' of an effective intervention to increase participation in physical play and leisure in children with motor impairments; and (ii) how these ingredients can be combined in a feasible and acceptable intervention.
The project draws on the WHO International Classification of Functioning, Disability and Health and the UK Medical Research Council guidance for developing 'complex interventions'. There will be five steps: 1) identifying biomedical, personal and environmental factors proposed to predict children's participation in physical play and leisure; 2) developing an explicit model of the key predictors; 3) selecting intervention strategies to target the predictors, and specifying the pathways to change; 4) operationalising the strategies in a feasible and acceptable intervention; and 5) modelling the intervention processes and outcomes within single cases.
The primary output from this project will be a detailed protocol for an intervention. The intervention, if subsequently found to be effective, will support children with motor difficulties to attain life-long well-being and participation in society. The project will also be an exemplar of methodology for a systematic development of non-drug interventions for children.
To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP).
Prospective cohort study.
Children's hospitals (N=7).
Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS).
Not applicable.
Youth completed the Children's Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire.
Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P ≤ .05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant.
Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.
To develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes.
MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised.
Of 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies.
This comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.
Parents can influence their children's physical activity participation and screen time.This study examined the relative significance of perceived parental barriers and self-efficacy in relation to children's physical activity participation and screen time viewing. The associations between these factors and the behaviours were analysed.
Cross-sectional population survey in New South Wales, Australia of parents of pre-school (N = 764), younger (Kindergarten, Grades 2 and 4; N = 1557) and older children (Grades 6, 8 and 10; N = 1665). Parents reported barriers and self-efficacy to influence their child's physical activity and screen time behaviours in a range of circumstances. Differences were examined by child's sex and age group, household income, maternal education and location of residence. The duration of physical activity and screen viewing was measured by parental report for pre-school and younger children and self-report for older children. Associations between parental factors and children's organised, non-organised and total activity and screen time were analysed.
Cost, lack of opportunities for participation and transport problems were the barriers most often reported, particularly by low income parents and those in rural areas. The number of barriers was inversely related to children's time spent in organised activity, but not their non-organised activity. Higher parental self-efficacy was positively associated with organised physical activity in the younger and older children's groups and the non-organised activity of older children. School-age children (younger and older groups) were less likely to meet physical activity guidelines when parents reported ≥4 barriers (OR 3.76, 95% CI 1.25-11.34 and OR 3.72, 95% CI 1.71-8.11 respectively). Low parental self-efficacy was also associated with the likelihood of children exceeding screen time guidelines for each age group (pre-school OR 0.62, 95% CI 0.43-0.87; young children OR 0.56, 95% CI 0.39-0.80; and older children OR 0.57, 95% CI 0.43-0.74).
Parental barriers are associated with the time that children spend in both active and sedentary pursuits. These findings highlight family, economic and environmental factors that should be addressed in programs to promote child physical activity and tackle sedentary behaviour.
Long waiting times and large caseloads are a challenge to children's therapy services internationally. Research in hospital-based healthcare indicates that waiting times are a function of throughput, and that length of care episode is related to clinicians' caseload management behaviour (i.e. actions at assessment, treatment, post-treatment, and discharge). There have been few attempts to study this in community health services. The present study investigated whether community occupational therapists' behaviour predicts children's length of time (LoT) on caseloads.
Retrospective survey of case notes of children recently discharged from occupational therapy services. Using cluster random sampling, case notes were drawn from therapy records in six NHSScotland Health Boards. Data about therapists' behaviours of assessing, treating, reviewing and discharging, together with child characteristics, were used to construct regression models of factors related to LoT.
Twenty-six therapists [median(IQR) time in paediatrics 8(6-13) years] and 154 of their cases [mean(SD) age 7(3) years; median(IQR) LoT 10(3-21)] were included. A multi-level model, adjusting for clustering, for therapists' actions of communicating assessment outcomes to parents, providing treatment, and placing the child on review, and for a diagnosis of cerebral palsy, explained 44% of variation in LoT.
Occupational therapists' caseload management behaviours are associated with children's LoT on caseloads. Further research is required to investigate the direction of relationships between therapists' behaviours and LoT; and the relationships between contextual factors, therapists' caseload management behaviours and LoT. Further exploration of therapists' beliefs about caseload management could also be useful in identifying possible factors contributing to variation between therapists.
Children's unstructured outdoor free-play (or active free-play) has the potential to make an important contribution to children's overall physical activity levels. Limited research has, however, examined physical activity in this domain. This study examined associations between individual, social and physical environmental factors and the frequency with which children play in particular outdoor locations outside school hours. This study also investigated whether the frequency of playing in outdoor locations was associated with children's overall physical activity levels.
Participants including 8-9 year old children and their parents (n = 187) were recruited from a selection of primary schools of varying socioeconomic status across metropolitan Melbourne, Australia. Parents completed a survey and children's overall physical activity levels were measured by accelerometry. Regression models examined the odds of children playing in various outdoor settings according to particular correlates.
Inverse associations were found between preference for activities not involving physical activity, and the likelihood of children playing in the yard at home on the weekend (OR = 0.65; CI = 0.45,0.95). Positive correlates of children playing in their own street included: parental perceptions that it was safe for their child to play in their street (weekdays [OR = 6.46; CI = 2.84,14.71], weekend days [OR = 6.01; CI = 2.68,13.47]); children having many friends in their neighbourhood (OR = 2.63; CI = 1.21,5.76); and living in a cul-de-sac (weekdays [OR = 3.99; CI = 1.65,9.66], weekend days [OR = 3.49; CI = 1.49,8.16]). Positive correlates of more frequent play in the park/playground on weekdays included family going to the park together on a weekly basis on weekdays (OR = 6.8; CI = 3.4,13.6); and on weekend days (OR = 7.36; CI = 3.6,15.0). No differences in mean mins/day of moderate-vigorous physical activity were found between children in the highest and lowest tertiles for frequency of playing in particular outdoor locations.
The presence of friends, safety issues and aspects of the built environment were reported by parents to be associated with children's active free-play in outdoor locations. Future research needs to further examine associations with time spent in active free-play and objectively-measured overall physical activity levels. It is also important to investigate strategies for developing a supportive social and physical environment that provides opportunities for children to engage in active free-play.
Three-quarters of 3-6 year-old children in the U.S. spend time in childcare; many spend most of their waking hours in these settings. Daily physical activity offers numerous health benefits, but activity levels vary widely across centers. This study was undertaken to explore reasons why physical activity levels may vary. The purpose of this paper is to summarize an unexpected finding that child-care providers cited was a key barrier to children's physical activity.
Nine focus groups with 49 child-care providers (55% black) from 34 centers (including inner-city, suburban, Head Start and Montessori) were conducted in Cincinnati, OH. Three independent raters analyzed verbatim transcripts for themes. Several techniques were used to increase credibility of findings, including interviews with 13 caregivers.
Two major themes about clothing were: 1) children's clothing was a barrier to children's physical activity in child-care, and 2) clothing choices were a significant source of conflict between parents and child-care providers. Inappropriate clothing items included: no coat/hat/gloves in the wintertime, flip flops or sandals, dress/expensive clothes, jewelry, and clothes that were either too loose or too tight. Child-care providers explained that unless there were enough extra coats at the center, a single child without a coat could prevent the entire class from going outside. Caregivers suggested several reasons why parents may dress their child inappropriately, including forgetfulness, a rushed morning routine, limited income to buy clothes, a child's preference for a favorite item, and parents not understanding the importance of outdoor play. Several child-care providers favored specific policies prohibiting inappropriate clothing, as many reported limited success with verbal or written reminders to bring appropriate clothing.
Inappropriate clothing may be an important barrier to children's physical activity in child-care settings, particularly if the clothing of a few children preclude physical activity for the remaining children. Center directors and policy makers should consider devising clear and specific policies for the types of clothing that will be permitted in these settings so that children's active play opportunities are not curtailed. To enhance compliance, parents may need education about the importance and benefits of active play for children's development.
Physical activity declines as children approach puberty. Research has focussed on psychosocial, environmental, and demographic determinants. This paper explores how family and socioeconomic factors are related to children's physical activity.
Seventeen focus groups were conducted with 113, 10-11 year old children from 11 primary schools in Bristol, UK. Focus groups examined: 1) the way parents encourage their children to be physically active; 2) the extent to which physical activity is engaged in as a family; and 3) the types of non-family based physical activities Year 6 children commonly participate in.
Participants from all socioeconomic (SES) groups reported that parents encouraged them to be physically active. However approaches differed. Children from middle/high SES schools were assisted through actions such as logistical and financial support, co-participation and modelling. Parents of children from low SES schools mainly restricted their input to verbal encouragement and demands. Participation in family-based activities was reported to be higher in children from middle/high SES schools than children from low SES schools. All SES groups reported time to be a limiting factor in family-based activity participation. Cost was reported as a significant barrier by children from low SES schools. Children from middle/high SES schools reported engaging in more sports clubs and organised activities than children from low SES schools, who reported participating in more unstructured activities or 'free play' with friends.
The family is important for encouraging children to be physically active, but families from different socioeconomic backgrounds support their children in different ways. This research suggests that the design of physical activity interventions, which might include working with families, requires tailoring to groups from different socio-economic backgrounds.
There is evidence of a clustering of healthy dietary patterns and physical activity among young people and also of unhealthy behaviours. The identification of influences on children's health behaviors, particularly clustered health behaviors, at the time at which they develop is imperative for the design of interventions. This study examines associations between parental modelling and support and children's physical activity (PA) and consumption of fruit and vegetables (FV), and combinations of these behaviours.
In 2002/3 parents of 775 Australian children aged 10-12 years reported how frequently their child ate a variety of fruits and vegetables in the last week. Children wore accelerometers for eight days during waking hours. Parental modelling and parental support (financial and transport) were self-reported. Binary logistic and multinomial logistic regression analyses examined the likelihood of achieving >/= 2 hours of PA per day (high PA) and of consuming >/= 5 portions of FV per day (high FV) and combinations of these behaviors (e.g. high PA/low FV), according to parental modelling and support.
Items of parental modelling and support were differentially associated with child behaviours. For example, girls whose parents reported high PA modelling had higher odds of consuming >/= 5 portions of FV/day (OR = 1.95, 95% CI = 1.32-2.87, p < 0.001). Boys whose parents reported high financial support for snacks/fast foods had higher odds of having 'high PA/low FV' (OR = 2.0, 95% CI = 1.1-3.7).
Parental modelling of and support for physical activity and fruit and vegetable consumption were differentially associated with these behaviours in children across behavioural domains and with combinations of these behaviours. Promoting parents' own healthy eating and physical activity behaviours as well encouraging parental modelling and support of these behaviours in their children may be important strategies to test in future research.
Physical activity independent of adult supervision is an important component of youth physical activity. This study examined parental attitudes to independent activity, factors that limit licence to be independently active and parental strategies to facilitate independent activity.
In-depth phone interviews were conducted with 24 parents (4 males) of 10-11-year-old children recruited from six primary schools in Bristol.
Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children's ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision.
Strategies are needed to build children's licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.
Children and youth with cerebral palsy (CP) experience difficulties in their ability to move, problem solve, socialize, and communicate, associated with limitations in activities in all environments. They are at risk for lower participation in social and leisure activities critical in fostering friendships, developing interests, and promoting well-being. Little is known about involvement in leisure activities and their determinants. This systematic review aims to describe participation in leisure activities by children with CP and identify personal and environmental factors that influence participation. The following databases were reviewed--CINAHL, Medline, Cochrane, Web of Science, OT-seeker, and REHABDATA--using the keywords participation, cerebral palsy, leisure, and recreation. The literature to date suggests that children with physical disabilities are less involved in leisure activities than their peers; activities are more passive, home based, and lack variety. Several factors influence participation in leisure activities, including age, gender, activity limitations, family preferences and coping, motivation, and environmental resources and supports.
Participation in leisure has known health benefits. Children and young people (CYP) with physical disabilities demonstrate reduced participation in leisure. To facilitate their meaningful participation, one must understand what leisure means to CYP. The aim of this study was to systematically synthesize evidence from qualitative studies on the meaning of leisure for CYP with physical disabilities.
CINAHL, MEDLINE, AMED, EMBASE, PsycINFO, and ERIC were searched periodically from January 2012 until May 2013. Qualitative studies reporting the views of CYP (0-18y) with physical disabilities on leisure participation were included. The analysis involved thematic syntheses, double coding, and established quality appraisal procedures.
Twelve studies met inclusion criteria, addressing the leisure experiences of 146 CYP with disabilities. Four themes core to the meaning of leisure for these CYP were (1) 'fun': the enjoyment and pleasure experienced from leisure; (2) 'freedom' of choice and from constraints; (3) 'fulfilment': discovering, developing, and displaying potential; and (4) 'friendship': social connectedness and belonging.
The identified themes resonate with the psychological needs outlined by self-determination theory: fun relates to satisfaction and intrinsic motivation; freedom relates to 'autonomy'; fulfilment relates to a belief in 'competence'; and friendship resonates with 'relatedness'. Social context had an impact on all of these themes, indicating that this is an important target for leisure participation interventions.
© 2015 Mac Keith Press.
For full text, please go to: http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12788/abstract
1.1. Bandura presents the concept of efficacy expectations ambiguously; at times they are discussed as if they include action-outcome expectations, at other times they are contrasted as distinct from these.2.2. It is helpful to keep action-outcome expectations and efficacy expectations conceptually distinct. Failure to do so does not allow consideration of the possibility that psychological treatments for phobias operate by modifying action-outcome expectations, without altering efficacy expectations.3.3. There is no firm experimental evidence to support Bandura's contention that “psychological procedures, whatever their form, serve as means of creating and strengthening expectations of personal efficacy”, or to decide between alternative expectation accounts of the action of psychological treatments.
The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).
This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health.
Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).
Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
Perceived control is postulated as a possible moderator of the relationship between impairment and disability. This hypothesis was experimentally investigated in patients with chronic pain attending a clinical psychology department in a hospital. Patients were randomly allocated to experimentally increased (N = 25) or decreased (N = 25) perceptions of control and the effects on disability examined. Perceived control was manipulated using sections of the normal clinical interview which enhanced beliefs in control (asking about times when control had been high) or reduced them (asking about times when control had been low). Results showed that the cognitive manipulations had been effective in modifying cognitions and had resulted in the predicted effects on disability as assessed by a lifting task. The possible emotional mediation of the cognitive manipulation is considered but cannot be reconciled by these data. The results do, however, strengthen the findings from correlational studies suggesting that the simple WHO model of disability needs to be modified to include cognitive and/or emotional moderators.
In recent years evaluators of educational and social programs have expanded their methodological repertoire with designs that include the use of both qualitative and quantitative methods. Such practice, however, needs to be grounded in a theory that can meaningfully guide the design and implementation of mixed-method evaluations. In this study, a mixed-method conceptual framework was developed from the theoretical literature and then refined through an analysis of 57 empirical mixed-method evaluations. Five purposes for mixed-method evaluations are identified in this conceptual framework: triangulation, complementarity, development, initiation, and expansion. For each of the five purposes, a recommended design is also presented in terms of seven relevant design characteristics. These design elements encompass issues about methods, the phenomena under investigation, paradigmatic framework, and criteria for implementation. In the empirical review, common misuse of the term triangulation was apparent in evaluations that stated such a purpose but did not employ an appropriate design. In addition, relatively few evaluations in this review integrated the different method types at the level of data analysis. Strategies for integrated data analysis are among the issues identified as priorities for further mixed-method work.
The quality of life (QOL) of children with developmental coordination disorder (DCD) is largely unknown, but evidence suggests that multiple QOL domains are affected by the disorder. While DCD is primarily considered a motor disorder, multiple studies have reported psychological and social concerns in children with this condition. Our primary aim was to present the current state of the evidence regarding the physical, psychological, and social QOL domains that can be affected in children with DCD. Systematic review of articles from seven databases through November 2010 (MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, CDSR, DARE) was conducted. Search terms included developmental coordination disorder, dyspraxia, quality of life, life satisfaction, well-being, activities of daily living, and participation. Two independent reviewers screened titles, abstracts, and full-text articles. Studies meeting the following criteria were selected: (1) sample comprised solely of individuals with coordination difficulties consistent with DCD; (2) outcome measures related to physical, psychological, or socials domains of QOL; and (3) articles published in English. Data were extracted by one author and verified by a second. Outcomes were categorized according to physical, psychological and social domains of QOL and study quality was rated by case definitions of DCD based on diagnostic criteria as per the Diagnostic and Statistical Manual - 4th edition. Forty-one articles were included. Most studies reported significantly poorer results in physical, psychological and social functioning in children with DCD compared with peers. Despite the impact of DCD on multiple domains, only one study used a QOL measure as an outcome. Although DCD impacts several QOL domains, the QOL of children with this disorder remains largely unknown. The next critical step is for clinicians and researchers to use QOL measures to gather information on how DCD may affect the QOL of children with this disorder.
To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics.
Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated. Ambulatory activity was measured during 1 week with a StepWatch activity monitor as steps per day, and time spent at medium and high step rates. Multiple linear regression analyses were performed following a backward selection procedure until only independent variables with p<0.05 remained in the model. Ambulatory activity outcome parameters served as dependent variables, and disease, personal, and environmental characteristics as independent variables. Ambulatory activity was corrected for body height.
Children took more steps during school days (5169 steps, SD 1641) than during weekend days (4158 steps, SD 2048; p<0.001). Higher GMFCS level, bilateral CP, and higher age were associated with lower ambulatory activity on school days (R(2) ranged from 43-53%), whereas bilateral CP, higher age, and no sport club participation were associated with lower ambulatory activity in the weekend (R(2) ranged from 21-42%). Correcting for body height decreased the association with age.
Interventions should focus at increasing physical activity at the weekend for children with bilateral spastic CP.
The aim of the current study was to test the hypothesis that children with probable Developmental Coordination Disorder have an increased risk of reduced moderate to vigorous physical activity (MVPA), using data from a large population based study. Prospectively collected data from 4331 children (boys=2065, girls=2266) who had completed motor coordination testing at 7 years and accelerometry at 12 years were analysed from the Avon Longitudinal Study of Parents and Children (ALSPAC). Probable DCD (p-DCD) was defined, using criteria based on the DSM IV classification, as those children below the 15th centile of the ALSPAC Coordination Test at seven years who had a functional impairment in activities of daily living or handwriting, excluding children with a known neurological diagnosis or IQ<70. Secondary exposure variables consisted of subtests from the ALSPAC Coordination test (manual dexterity, ball skills and balance). Objective measurement of the average daily minutes of MVPA was recorded as ≥3600 counts per minute (cpm) using actigraph accelerometry. Boys with p-DCD were less physically active than boys without DCD (mean difference in MVPA 4.36 cpm, t=2.69; p=0.007). For boys, targeting skill (bean bag toss) was related to increased MVPA, after adjustment for confounding factors including neonatal, family and environmental factors as well as Body Mass Index at age seven and 12 years (β=0.76, t=3.37, p<0.001, CI 0.32-1.20). There was no difference in level of MVPA in girls with and without p-DCD (mean difference 1.35 min, t=0.97, p=0.31), which may reflect the low levels of MVPA of girls in this cohort. Our findings suggest that the presence of movement difficulties, particularly poor targeting (bean bag toss/ball skills), at a young age is a potential risk factor for reduced MVPA in boys.
This review provides an overview of the literature on the conceptualisation of the Personal Factors (PF) component of the International Classification of Functioning, Disability and Health (ICF).
A systematic literature review was carried out. Electronic searches were performed in Pubmed, Embase, PsycINFO, CINAHL and SSCI. Qualitative content analysis of statements about PF was conducted using inductive coding.
The searches yielded 353 citations, 79 papers were eligible for analyses. Five hundred thirty-eight statements about PF were extracted, condensed and coded. Beside conceptual statements, 238 examples of potential PF as well as five attempts at classifying PF were found in the literature. PF were considered in relation to clinical service provision, assessment and intervention, in research and social security contexts. PF were seen to be related to various aspects of health, functioning, disability and the environment.
The analysis of the literature shows that PF is seen as relevant to the application of the ICF in various settings. The review revealed a need for standardisation of PF. The literature points to the potential of PF in enhancing the understanding of functioning, disability and health, in facilitating interventions and services for people with disabilities, and strengthening the perspective of individuals in the ICF.
Supporting children's participation in health-enhancing physical activities is an important occupational goal for therapists. Fundamental movement skills (FMS) are thought to underpin and enable many activity options. This study had two goals: first, to examine the relationship between fundamental movement skills (FMS) and physical activity, and second, to use this and existing evidence to inform strategies whereby children's motivation for and engagement in physical activity can be supported.
A cross-sectional investigation of 124 children, aged 6-12 years, was undertaken. FMS were assessed using the Movement Assessment Battery for Children (M-ABC) and physical activity by pedometer step counts.
A weak but significant association was found between weekend physical activity and balance skills for girls. Correlations between physical activity and ball skills or manual dexterity were not significant for either gender, however, having age appropriate ball skills did result in greater but not significant levels of physical activity for all children when grouped together.
Findings from this study question the magnitude of the relationship between children's FMS and physical activity as measured by pedometers. If the goal of health enhancement through physical activity engagement is to be realised, it is proposed that community, occupation-based approaches may offer more potential than skills-based interventions at increasing activity participation. The concept of Engaging and Coaching for Health (EACH)-Child is introduced to this end. Occupational therapists are encouraged to work collaboratively with school and community organisations to assist children to find the physical activities that best accommodate their interests, abilities and offer opportunities for lifelong engagement.
This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after inclusion and exclusion criteria were applied. The investigated physiotherapy interventions included strength and functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT). A category of treatment dosage was also included. Strength training was the most studied intervention with significant improvements found in the strength of selected muscle groups using dynamometry, with fewer studies showing significant improvement in function. Functional training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Nonsignificant trends of improvement on the Gross Motor Function Measure (GMFM) and gait velocity were found for WBSTT by a few studies with low levels of evidence (case series). Of three studies that evaluated NDT, one high-level evidence study, i.e., randomized controlled trial (RCT) found significant improvements on the GMFM. All studies reviewing treatment dosage had high levels of evidence (RCTs), yet found no significant differences for different intensities of treatment. These results indicate that the levels of evidence for physiotherapy interventions, particularly strengthening and to a lesser extent functional training, in school-aged children with CP has improved; however, further high-level evidence is needed for other interventions.
To examine parents' perceptions on how cost, time, travel and the variety of organised sporting activities influence their decisions to allow their child to participate in organised sport; and recent expenditure on sport-related items for their child.
Computerised assisted telephone interviews survey of 402 parents of children aged 5-17 years old living in New South Wales, Australia.
Overall, 63% of children participated in organised sporting activities. Multivariate analysis shows that for parents of 5-12-year old children, the decision to allow their child to participate in organised sports was strongly influenced by time (P < 0.00). The financial costs associated with a child's participation in organised sports influenced families with lower incomes (p = 0.01) and with girls (p=0.04), while for rural families the option of a wider variety of local sporting activities influenced decisions about their child's participation in organised sport (p=0.05). Footwear/uniforms were the main sporting related expense. Sydney parents were more likely to report sport related expenditures for their child (P < 0.01).
Sporting costs, variety and time commitments influenced parents' decisions about their child's participation in organised sport. These factors indicate the need for initiatives to promote access to organised sports through reducing costs and increasing variety, particularly for families with lower incomes and are living in rural and regional areas.
Libro de metodología cualitativo para investigación en las ciencias sociales. La utilización de la computadora, el uso de datos y la recolección de los mismos. Se describen detalladamente numerosos métodos de datos y análisis.
To identify barriers to parents' support of their children's physical activity (PA) and to develop a survey to assess such barriers.
Eighty-two parents (40 white; 36 African-American; 6 other) of elementary school-aged children participated in small-group interviews. Parents reported barriers to supporting their children's PA and suggested possible solutions. This information was used to develop the Barriers to Activity Support Scale (BASS), which was completed by 75 of the 82 parents along with a survey that assessed the parents' support for their children's PA.
Parents reported community-based, interpersonal, and intrapersonal barriers to supporting their children's PA. Top barriers included the importance of children's school performance, a lack of facilities, and concerns about safety. Parents who reported greater barriers reported lower support for their children's PA.
Results provide preliminary evidence for the reliability and validity of the BASS and highlight the need to address barriers during the development of family-based PA programs.
Briefly review the current state of theorizing about volitional behaviour change and identification of challenges and possible solutions for future theory development.
Review of the literature and theoretical analysis.
Reasoned action theories have made limited contributions to the science of behaviour change as they do not propose means of changing cognitions or account for existing effective behaviour change techniques. Changing beliefs does not guarantee behaviour change. The implementation intentions (IMPs) approach to planning has advanced theorizing but the applications to health behaviours often divert substantially from the IMPs paradigm with regard to interventions, effects, mediators and moderators. Better construct definitions and differentiations are needed to make further progress in integrating theory and understanding behaviour change.
Further progress in theorizing can be achieved by (a) disentangling planning constructs to study their independent and joint effects on behaviour, (b) progressing research on moderators and mediators of planning effects outside the laboratory and (c) integrating planning processes within learning theory and self-regulation theory.
To review research that examined the participation in activities of children who have cerebral palsy, in order to understand their extent of participation and the factors that influenced participation.
A comprehensive search of seven databases retrieved 2,111 papers, 40 of which met criteria and were relevant for critique. As this paper intended to examine participation broadly, an ecological framework was used to organise the relevant papers into those studies that considered personal, environmental and occupational factors related to participation.
Children with cerebral palsy participated in a diverse array of activities across a range of occupational contexts. Their participation was not always a positive experience. Factors most commonly identified as barriers to participation were social attitudes and the physical environment. This review identified only emergent understandings of the naturally occurring changes in the participation of children with cerebral palsy that come with increasing age and, concurrently, with increasing social and environmental demands.
Future research designs must accommodate the complexity of participation to further our knowledge and improve our ability to target therapeutic interventions at community, family and child levels.
The objective of this study was to characterize participation in leisure activities in children with cerebral palsy (CP) and identify determinants of greater involvement. Ninety-five children of school age (9y 7mo [SD 2y 1mo]) with CP were recruited, and participation was evaluated with the Children's Assessment of Participation and Enjoyment in a subset (67/95; 42 males, 25 females) who could actively participate in completion of the assessment. Most had mild motor dysfunction (Gross Motor Function Classification System: 59% level I, 23% level II, 18% levels III-V) and had a spastic subtype of CP (23 hemiplegia, 17 diplegia, 16 quadriplegia, 11 other). Biomedical, child, family and environmental predictor variables were considered in the analysis. Results demonstrated that these children were actively involved in a wide range of leisure activities and experienced a high level of enjoyment. However, involvement was lower in skill-based and active physical activities as well as community-based activities. Mastery motivation and involvement in rehabilitation services enhanced involvement (intensity and diversity) in particular leisure activities, whereas cognitive and behavioral difficulties, activity limitations, and parental stress were obstacles to participation.
The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.