Date Presented 3/30/2017
This study examined the degree to which child, family, and environmental factors influence participation in young children with cerebral palsy. Findings suggest that when substantial family and environmental supports are present, participation is largely explained by gross motor impairment and age.
Primary Author and Speaker: Claire Morress
Contributing Authors: Max Ito, Sandra Winkler, Jilda Vargus Adams
PURPOSE: Participation is a primary outcome for children with cerebral palsy (CP) and thus is an important focus of pediatric occupational therapy. It is essential that clinicians understand the factors that facilitate or constrain participation in order to select effective interventions, yet few studies of young children exist (Khetani, Graham, & Alvord, 2013). The purpose of this study was to examine the participation patterns of children ages 2–6 yr with CP and determine the degree to which child, family, and environmental factors influence participation in this population.
DESIGN: This study used a descriptive, cross-sectional design. Children ages 2–6 years with CP classified at Gross Motor Functional Classification System (GMFCS) Levels I–V and their caregivers were recruited from outpatient clinics across a large tertiary care pediatric hospital in the Midwest. Fifty one child–caregiver dyads were enrolled and completed the study. Children represented all GMFCS levels, with most classified at GMFCS Levels IV and V (n = 34, 67%). They ranged in age from 24 to 70 mo (M = 42.25, SD = 13.80).
DESIGN: This study used a descriptive, cross-sectional design. Children ages 2–6 years with CP classified at Gross Motor Functional Classification System (GMFCS) Levels I–V and their caregivers were recruited from outpatient clinics across a large tertiary care pediatric hospital in the Midwest. Fifty one child–caregiver dyads were enrolled and completed the study. Children represented all GMFCS levels, with most classified at GMFCS Levels IV and V (n = 34, 67%). They ranged in age from 24 to 70 mo (M = 42.25, SD = 13.80).
RESULTS: Most families reported receiving substantial supports in the form of respite services (76%); occupational, physical, and speech therapies (100%); and adapted equipment such as seating (73%). Families perceived the environment as a small problem (M CASE score = 52.55, SD = 10.91) and reported moderate levels of family burden associated with their child’s illness (M IOF score = 50.96, SD = 11.38). Children were restricted in all areas of participation, scoring on average 3.68 (SD = 1.92) out of 10 possible points on the LIFE–H questionnaire. They were least restricted in interpersonal relationships (M = 7.51, SD = 1.62) and most restricted in the areas of mobility (M = 2.40, SD = 2.34) and personal care (M = 2.70, SD = 1.88). The full regression model was significant, F(3, 45) = 19.38, p < .001, and accounted for 68.3% of the variance in participation in social roles and daily activities (R
2 = .683). Intrinsic child factors (GMFCS level, age, and associated conditions) accounted for 65% of the total model (p < .001), while extrinsic factors (environmental and family factors) accounted for 3.3% of the total variance (p = .108) after controlling for GMFCS, associated conditions, and age.
CONCLUSION: The findings suggest that for children with substantial environmental and family supports, participation restrictions may be strongly associated with gross motor impairments and age. Thus, interventions focusing on child factors such as motor control and task practice may maximize participation in similar populations.
IMPACT STATEMENT: Clinicians can choose a variety of effective child or context-focused interventions for children with CP (Novak et al., 2013). This study provides initial evidence to support clinicians’ clinical reasoning when selecting interventions for children with substantial family and environmental supports.
References
Khetani, M., Graham, J., & Alvord, C. (2013). Community participation patterns among preschool-aged children who have received Part C early intervention services. Child: Care, Health and Development, 39, 490–499. https://doi.org/10.1111/cch.12045
Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., . . . Goldsmith, S. (2013). State of the evidence: Systematic review of interventions for children with cerebral palsy. Developmental Medicine and Child Neurology, 55, 885–910. https://doi.org/10.1111/dmcn.12246
