Children's Assessment Of Participation And Enjoyment Research Articles

Home-based Telehealth Movement-to-Music Increases Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot RCT

<h3>Research Objectives</h3> Aim 1 was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing Leisure-time Physical Activity (LTPA) and activity participation compared with a waitlist control group in adolescents with cerebral palsy (CP). Aim 2 was to qualitatively evaluate factors that influenced engagement and develop a theory that would inform the development of a more targeted M2M telehealth program. <h3>Design</h3> Randomized controlled trial piloting a 4-week M2M program. Participants were recruited randomized into one of two groups: a) M2M or b) waitlist control, which maintained their daily activities before receiving M2M. <h3>Setting</h3> Recruited from the Children's Hospital of Alabama. <h3>Participants</h3> Recruitment of 58 adolescents (10-19 years of age) with cerebral palsy (GMFCS I-V) occurred from September 2020 to September 2021. <h3>Interventions</h3> M2M incorporated music-oriented routines to improve cardiovascular capacity, muscular strength and endurance, range of motion, and general physical function.M2M videos were organized into weekly playlists. Participants were instructed to complete their playlist 3x/week. <h3>Main Outcome Measures</h3> Changes in activity and LTPA participation were measured pre to post intervention via the Children's Assessment of Participation and Enjoyment (CAPE) total domain scores and active physical recreation domain scores (CAPE-APR), respectively. Changes in scores were compared between groups using analysis of covariance (ANCOVA). A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. <h3>Results</h3> ANCOVA revealed statistically significant between group differences in pre to post change score for CAPE-Intensity (F (1, 47)=5.63, p = 0.022, effect size=0.11) (a.k.a. volume of activity) and CAPE-APR-Intensity (F (1, 47)=8.76, p = 0.0048, effect size=0.17; a.k.a. volume of LTPA). Estimated marginal means revealed that changes were small, in favor of the intervention group. We developed a theory based on 6 factors that affected engagement. <h3>Conclusions</h3> The project established the preliminary efficacy of a scalable telehealth M2M program for increasing LTPA behavior among adolescents with CP and provides a theory for making additional CP-specific modifications before implementation in a larger trial. <h3>Author(s) Disclosures</h3> None to declare.

Validation of Image Descriptions for the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children: A Delphi Study

Introduction: The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) are useful measures to assess how children with visual impairments are meeting the nine areas of the expanded core curriculum (ECC). Each item of the CAPE and PAC includes an activity with an accompanied image to illustrate it. However, the measures do not provide standardized image descriptions for each item, which limits its validity and reliability for this population. Thus, the purpose of this Delphi study was to validate and standardize image descriptions for the CAPE and PAC so they can be used more effectively with children with visual impairments. Methods: The expert panel consisted of 11 professionals with extensive knowledge and experience with individuals with visual impairments and six dyads of parents and their child with a visual impairment. Each panel member assessed the accuracy of wording for 57 image descriptions on a 4-point Likert scale and provided feedback on items rated below 3. Results: Consensus on all image descriptions was reached after two rounds. Discussion: The results of this study help to increase the validity and reliability of the CAPE and PAC for children with visual impairments. Implications for Practitioners: The CAPE and PAC can be used more effectively by practitioners and researchers to assess the areas of the ECC for children with visual impairments.

Quality of Life, Participation, and Individualized Support in a Community-Based Yoga Class: A Case Series.

To assess quality of life and participation in children with disabilities following a community-based yoga class, to examine the feasibility of implementing a community-based program with individualized support, and to make recommendations for the development of future programs. Four children participated in a 10-week yoga class, with doctor of physical therapy students providing individualized physical and behavioral support. Children improved in components of the Children's Assessment of Participation and Enjoyment (CAPE) following the program; however, changes in quality of life on the Pediatric Quality of Life Inventory (PedsQL) were inconsistent. Parents provided feedback regarding the family's experience and reported that the children improved behavior, communication, and relationships following the yoga class. A community-based yoga class for children with disabilities using individualized support is feasible and can improve participation and enjoyment in recreational activities.

Activity Participation in the Pediatric Skeletal Dysplasia Population

<h3>Research Objectives</h3> To investigate activities children with skeletal dysplasia participate.To identify activities with the greatest and lowest participation rates among children with skeletal dysplasia .To investigate participation patterns among children with skeletal dysplasia. <h3>Design</h3> Children with skeletal dysplasia were asked to complete the Children's Assessment of Participation and Enjoyment (CAPE) survey during visits July 2014-June 2019. Demographic information and use of assistive devices was collected retrospectively. <h3>Setting</h3> City-based ambulatory orthopedic hospital. <h3>Participants</h3> Sixty-six children (38 females, 28 males) average age 11.5+/-4.21 years participated. Twenty-three (35%) were at least 13 years old, 43 (65%) were younger than 13. Thirty-two had average stature for age, 34 had short stature. There were 21 different skeletal dysplasia diagnoses among the participants. Fifteen children (23%) used assistive devices. Thirty-six children identified as white, 10 as black, 9 as Hispanic, 9 as Asian, 2 as other. <h3>Interventions</h3> CAPE was validated in Ontario, Canada for children (ages 6-21) with or without disabilities. <h3>Main Outcome Measures</h3> CAPE measures children participation of 55 informal and formal activities of five activity types: recreational, active-physical, social, skill-based, and self-improvement. <h3>Results</h3> Children participated in an average of 27.6+/-9.21 activities (overall diversity scores) out of 55 individual activities. CAPE diversity responses for each domain were used to compare the degree of activity involvement. Intensity and enjoyment were calculated. Chi-square analyses were conducted to analyze responses by each individual item. Paired t-tests were used to compare variation across population demographics. All statistical analysis was conducted using SPSS 22 for Windows. <h3>Conclusions</h3> Children with skeletal dysplasia participate in a wide variety of activities. Greatest participation was in social activities, lowest in physical activities. Use of assistive devices did not affect participation; there were no participation differences between genders. No study has previously evaluated the participation activities in this population. <h3>Author(s) Disclosures</h3> Dr. Cathleen Raggio received consulting fees from Alexion Pharmaceuticals, Ascendis and Biomarin. She was on speaker's bureau for Alexion Pharmaceuticals and Medical Advisory Board for Osteogenesis Imperfecta Foundation. Erin Carter on Medical Advisory Board for Little People of America, Inc.

Predictors of Leisure Participation in 6 to 14-Year-Old Children with Cerebral Palsy: Structural Equation Modeling.

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). 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. 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). 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.

Cross-Cultural Validation of Children's Assessment of Participation and Enjoyment Portuguese Version.

Background: Participation is a major pediatric rehabilitation goal according to The International Classification of Functioning, Disability and Health Children and Youth version (ICF-CY). ICF-based leisure participation measures for Portuguese-speaking children with cerebral palsy are currently not available. The aim of this study is to assess validity and reliability of the Portuguese (European) version of the Children's Assessment of Participation and Enjoyment (CAPE). Methods: CAPE Portuguese version was applied to 170 children with cerebral palsy (n = 69) and typical development (n = 101) aged between 8 and 18 years (mean = 12.5 years; SD = 2.91). Construct validity was assessed by using the know-groups method and the correlation between participation and quality of life. Reliability was determined by internal consistency and test-retest.Results: CAPE discriminates between participation scores of children with cerebral palsy and typical development. A positive correlation was found between participation frequency and physical well-being. Internal consistency was not entirely satisfactory but comparable with that from the original CAPE study. Test-retest reliability was considered good.Conclusions: CAPE Portuguese (European) version showed satisfactory validity and test-retest reliability to assess leisure participation in children with cerebral palsy and typical development aged between 8 and 18 years.

Structured home-based exercise program to improve ADL and participation among children with cerebral palsy

Motor function, activities of daily living (ADL) and participation are of primary concerns of parents or caregivers with cerebral palsy (CP) children. This structured home-based exercise program (SHEP) was developed to offer a practical exercise program, which includes all components of exercise for both upper and lower limbs to improve the above functions. Eleven children participated in this study [7 males and 4 females, mean age 10y 3mo, standard deviation (SD) 3y] with Gross Motor Function Classification System (GMFCS) I–III. The multiple baseline study design was used to measure SHEP effects on ADL with Pediatric Evaluation in Disability Inventory - Computer Adaptive Test (PEDI-CAT), children's participation with Children's Assessment of Participation and Enjoyment (CAPE) questionnaire and motor function (GMFM-66). An exercise logbook was given and OMNI-RPE scale was taught to caregiver and children to monitor exercise intensity. Outcome assessments were done at pre-intervention, intervention and post-intervention phases. The intervention with SHEP phase was done for eight weeks. Two assessments were done at one month and three months post-intervention. Comparison between means of each phases were analyzed using Repeated Measure (RM) Anova and Paired t -test when appropriate. SHEP improves ADL, PEDI-CAT ( P = 0.028, d = 0.5) and participation at Where-domain, CAPE questionnaire ( P = 0.047, d = 0.8) as well as motor function, GMFM-66 ( P = 0.04, d = 0.14) during the intervention period. SHEP is a practical and quick exercise intervention, which can be done at home to achieve short-term goal in improving motor function, activities of daily living and participation.

Participation changes in various activities for school children with cerebral palsy of different motor severities

Cerebral palsy (CP) not only affects movement and posture, but also is accompanied with cognition, speech, or social problems. These problems further cause limitation in participation in life activities in children with CP. This study aims to investigate the changes in participation outcomes in various activities for children with CP of different motor severities. Sixty-five parents of schoolchildren with CP (6–18 years) were enrolled and classified into two groups based on the Gross Motor Function Classification System (GMFCS) levels: mild (GMFCS levels I–III, n = 41) and severe group (GMFCS level IV–V, n = 24). Participation outcome was assessed by the Children's Assessment of Participation and Enjoyment (CAPE) at baseline and 6-month follow-up. CAPE measures participation diversity and intensity in five activities (recreational, active physical, social, skill-based, and self-improvement), ANCOVA was used to compare the participation changes in various domains between two groups. At baseline and follow-up, mild groups had better participation diversity and intensity in all activities except the intensity in social activities at follow-up than severe groups ( P < 0.05). ANCOVA results showed mild groups had better changes in the participation diversities for total and all activities except the social and skill-based activities than severe groups ( P < 0.05). Furthermore, mild groups had better changes in the participation intensities for total, active physical, and self-improvement activities, than severe groups ( P < 0.05). The GMFCS levels were associated with participation changes in the diversities and intensities for various activities in children with CP. Mild groups had better changes in the participation diversities and intensities for some activities than severe groups. These findings may allow clinicians early predict the changes in the participation outcomes for these children based on simple GMFCS levels.

Participation changes in various activities for school children with cerebral palsy of different motor severities

Cerebral palsy (CP) not only affects movement and posture, but also is accompanied with cognition, speech, or social problems. These problems further cause limitation in participation in life activities in children with CP. This study aims to investigate the changes in participation outcomes in various activities for children with CP of different motor severities. Sixty-five parents of schoolchildren with CP (6–18 years) were enrolled and classified into two groups based on the Gross Motor Function Classification System (GMFCS) levels: mild (GMFCS levels I-III, n = 41) and severe group (GMFCS level IV-V, n = 24). Participation outcome was assessed by the children's assessment of participation and enjoyment (CAPE) at baseline and 6-month follow-up. CAPE measures participation diversity and intensity in five activities (recreational, active physical, social, skill-based, and self-improvement), ANCOVA was used to compare the participation changes in various domains between two groups. At baseline and follow-up, mild groups had better participation diversity and intensity in all activities except the intensity in social activities at follow-up than severe groups ( P < 0.05). ANCOVA results showed mild groups had better changes in the participation diversities for total and all activities except the social and skill-based activities than severe groups ( P < 0.05). Furthermore, mild groups had better changes in the participation intensities for total, active physical, and self-improvement activities, than severe groups ( P < 0.05). The GMFCS levels were associated with participation changes in the diversities and intensities for various activities in children with CP. Mild groups had better changes in the participation diversities and intensities for some activities than severe groups. These findings may allow clinicians early predict the changes in the participation outcomes for these children based on simple GMFCS levels.

Variety of activity participation influences leg bone mineral content of pre-pubertal children with developmental coordination disorder

Limited participation in activities in children with developmental coordination disorder (DCD) may have a negative impact on bone mineral accrual. This study aimed to compare bone mineralization and activity participation patterns of pre-pubertal children with DCD and those with typical development, and to determine the relationship between activity participation patterns and bone mineralization in children with DCD. Fifty-two children with DCD (mean age = 7.5 years) and 61 children with typical development (mean age = 7.2 years) participated in the study voluntarily. Appendicular and total body bone mineral content (BMC) and bone mineral density (BMD) were assessed by a whole-body dual-energy X-ray absorptiometry scan. Activity participation patterns were assessed using the Children's assessment of participation and enjoyment (CAPE). Children with DCD had lower appendicular and total body BMCs and BMDs than children with typical development ( P < 0.05). Additionally, they had lower CAPE total activity and physical activity diversity and intensity scores ( P < 0.05). After accounting for the effects of bone age, sex, lean mass and fat mass, the total activity diversity score remained independently associated with leg BMC in children with DCD, explaining 5.5% of the variance ( P < 0.001). However, the physical activity diversity score was no longer associated with leg BMC ( P = 0.084). Diversity (variety) and intensity of activity participation and bone mineralization were lower in pre-pubertal children with DCD. Decreased total activity participation variety was a contributing factor to lower BMC in the legs of children with DCD.

Characteristics Influencing Diversity of Participation of Children in Activities Outside School.

A cross-sectional survey was conducted to determine which personal and environmental characteristics influenced diversity of participation in activities outside school for typically developing children and adolescents. Four hundred twenty-two (215 boys) typically developing Australian children (mean = 11.0 yr) completed the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activity of Children to describe their participation on five activity types: Recreational, Active Physical, Social, Self-Improvement, and Skill-Based. Linear regression analyses were conducted. Predictors of participation diversity were age and preference for Recreational (aR² = .44); preference for Active Physical (aR²= .19); gender, school type, and preference for Social (aR² = .19); preference for Skill-Based (aR² = .25); and gender, school style, socioeconomic score, and preference for Self-Improvement (aR² = .24). Preference plays a key role in determining the diversity of participation in activities outside school.

Diversity of activity participation determines bone mineral content in the lower limbs of pre-pubertal children with developmental coordination disorder.

Limited activity participation in children with developmental coordination disorder (DCD) may have a negative impact on bone mineral accrual. The objectives of this study were to compare bone mineralization and activity participation patterns of pre-pubertal children with DCD and those with typical development, and to determine the association between activity participation patterns and bone mineralization in children with DCD. Fifty-two children with DCD (mean age = 7.51years) and 61 children with typical development (mean age = 7.22years) participated in the study. Appendicular and total body (less head) bone mineral content (BMC) and bone mineral density (BMD) were evaluated by a whole-body dual-energy X-ray absorptiometry scan. Activity participation patterns were assessed using the Children's Assessment of Participation and Enjoyment (CAPE) questionnaire. Children with DCD had lower appendicular and total body BMCs and BMDs than children with typical development overall (p < 0.05). They also had lower CAPE total activity and physical activity diversity scores (p < 0.05). After accounting for the effects of age, sex, height, lean mass, and fat mass, the total activity diversity score remained independently associated with leg BMC in children with DCD, explaining 5.1% of the variance (p = 0.030). However, the physical activity diversity score was no longer associated with leg BMC (p = 0.090). Diversity of activity participation and bone mineralization were lower in pre-pubertal children with DCD. Decreased total activity participation diversity was a contributing factor to lower BMC in the legs of children with DCD.

Cultural adaptation and construct validation of the Arabic version of children’s assessment of participation and enjoyment and preferences for activities of children measures

Purpose: To establish the construct validity and internal consistency of the Arabic Children Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) and to determine the effects of age, gender, and disability status on diversity and intensity of participation.Methods: The World Health Organization guidelines for translation of measures were applied to translate the CAPE and PAC, 75 children with cerebral palsy (mean age = 10.7 ± 2.9 years) and 75 children with typical development (mean age = 10.8 ± 2.7 years) completed the translated measures. The construct validity of the translated measures was demonstrated by principle component analyses in addition to the known-groups method by examining the effects of age, gender, and presence of disability on diversity and intensity scores. The internal consistencies of the extracted components were examined by Cronbach’s alpha.Results: Four components emerged: (1) physical activities; (2) home-based activities; (3) self-improvement activities; and (4) social activities. Cronbach’s alpha varied from 0.61 (social activities) to 0.83 (physical activities). Age, gender, and disability were significant determinants of types of activities.Conclusions: The Arabic CAPE and PAC are culturally valid in measuring participation of children with or without disabilities in Jordan. The child’s age, gender, and disability should be considered to provide participation-based plans of care that are considerate for children and their families.Implications for rehabilitationThe Arabic CAPE and PAC are culturally valid measures for participation of children with or without disabilities in Jordan.The Arabic CAPE and PAC measures can guide participation-based plans of care that are meaningful and considerate for children and their families.Child age and gender should be considered to provide appropriate activities and to facilitate participation of children with and without disabilities.Families and service providers in Jordon are encouraged to provide children opportunities to participate in desired physical, self-improvement, and social activities.

Comparing parent and child reports of health-related quality of life and their relationship with leisure participation in children and adolescents with Cerebral Palsy

The aim of this study was to examine the level of agreement between reports of health-related quality of life (HR-QoL) obtained from children and adolescents with cerebral palsy (CP) and their parents. We also examined the relationships between child and parent perception of the different domains of HR-QoL and participation dimensions. Sixty-nine children and adolescents with CP and their parents separately completed parallel forms of the KIDSCREEN questionnaire. The Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE) was completed by the child/adolescent. Concordance between the children's and the parents' HR-QoL scores was analyzed via Pearson and intraclass correlations. Differences in means were tested using paired Student's t-tests. Chi-square tests were using to assess the incidence of personal variables in the agreement and disagreement of children-parents’ responses. The relationships between HR-QoL and leisure participation was confirmed with Pearson's correlation coefficients. Correlations between child and parent HR-QoL scores were small in 7 domains, medium in 2 and large in the Social Support & Peers domain.Children reported significantly better HR-QoL than their parents did. Participation was positively associated with specific domains of HR-QoL, but only weakly, and there were discrepancies between parent and child reports of HR-QoL. These findings provide interesting information about the importance of hearing the voices of children and adolescents with CP to promote HR-QoL and leisure participation.

Having Fun and Staying Active! Children with Disabilities and Participation in Physical Activity: A Follow-Up Study

ABSTRACTAim: This study investigated change in the participation profile of physical activity over 15 months after a three-week intensive rehabilitation that used physical activity as the main intervention. Methods: The Children's Assessment of Participation and Enjoyment (CAPE) was used in a longitudinal prospective study (pre- and post-design) with three measurements over 15 months. Eighty children with physical disabilities (6–17 years old; mean score 11.1; SD 2.4), some with additional cognitive challenges, completed all three measurements. Results: Participation diversity and intensity of all 55 leisure activities declined significantly over the 15-month period. The largest decline was for children aged between 10 and 13 years. Among physical activities, there was a stable level of participation of the total group, and sub-groups. Boys preferred “active physical activities” to a greater extent, while girls preferred “skill-based activities.” Both genders expressed a higher level of enjoyment in their preferred activities according to the Preferences for Activities of Children. Conclusions: This intervention may have the potential to maintain the level of physical activity among children and youths with disabilities, yet further controlled studies are needed. Gender differences should be taken into consideration to facilitate stable participation in physical activities with a high level of enjoyment.

The Participation Patterns of Youth with Down Syndrome.

The purpose of this paper was to investigate the participation patterns of children with Down syndrome (DS) using the construct of participation as defined by the International Classification of Functioning Disability and Health (ICF). Sixty-two children with DS were recruited between the ages of 9 and 17 years. All participants were given an interview-administered version of the Children's Assessment of Participation and Enjoyment (CAPE) to measure participation (1). Children with DS participated the most often, based on frequency, in recreational activities (p < 0.001); social activity types represented the greatest extension into the community based on with whom the children participated with (p < 0.05); finally, physical and social activities represented the greatest extension into the community geographically (p < 0.001). In addition, children with DS are significantly more active in activities that are informal in nature. Children with DS participate in a number of activities; however, the extent of their participation within these activities differs depending on the participation pattern examined. Implications for educational and community-based programs are discussed.

Reliability of the German version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC).

The introduction of the International Classification of Functioning, Disabilities and Health of the World Health Organization in 2001 made social participation a major rehabilitation outcome and the ultimate goal of rehabilitation services. There is no available instrument to measure the youth participation in leisure activities apart from asking the youth themselves. The goal of this study was to present a German version of the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC). The CAPE/PAC questionnaire was translated into German, a cultural adaptation process was designed and a reliability study was conducted. One hundred and fifty-two youths with and without disabilities, with a mean age of 15.2 years (standard deviation 1.7), participated in the study. The participants completed CAPE and PAC twice within 4 weeks. Reliability was examined by intraclass correlation coefficients, standard error of measurement, smallest detectable change and Cronbach's alpha. The absolute values of participation differ between the typically developed youth group and those with impairments; the reliability of the CAPE/PAC is comparable in both groups. Intraclass correlation coefficients ranged from 0.43 to 0.74 for the CAPE and from 0.71 to 0.83 for the PAC in all participants. The alpha values for internal consistency ranged from 0.42 to 0.82 for the CAPE and from 0.65 to 0.92 for the PAC. The German version of the PAC showed satisfactory reliability; however, reliability was not satisfactory for all scores of the CAPE, but comparable with versions in other languages. The need for newly developed participation measurements requires further discussion.

The Comparison of Participation in School-Aged Cerebral Palsy Children and Normal Peers: A Preliminary Study.

BackgroundParticipation in daily activities during childhood is an important aspect for health and social development.ObjectivesThis study was designed to investigate the participation of children with cerebral palsy aged 8 to 14 years, and their normal peers.Patients and MethodsIn this cross-sectional study, 30 children with cerebral palsy, and 30 normal children were selected via the non-probability convenience sampling. Their participation was evaluated with children’s assessment of participation and enjoyment (CAPE) through interviews.ResultsSignificant differences were found between the means of the two groups regarding the diversity, intensity, overall participation (P = 0.000) and all types of the activities except the recreational activities. The children with cerebral palsy took part in the skill-based activities and overall activities individually compared to the normal peers. The children with cerebral palsy, in comparison with their normal peers, often performed most of the activities inside the house. The main effect of gender and the interaction between gender and groups were not statistically significant in any of the variables of the CAPE test.ConclusionsPhysical disability can influence the children’s daily activities and socialization. Understanding the participation of physically disabled children can help health care professionals in designing and introducing appropriate treatment according to their needs.

The extent, context and experience of participation in out-of-school activities among children with disability

BackgroundA growing literature describes the participation of children with disability, but less is known about the effect of disability type, severity and environmental factors on participation. AimTo investigate the extent, context, experience and preferences for participation in out-of-school activities among children with disability in Victoria, Australia. Methods and proceduresTwo-hundred and eighty-six children (177 boys, 109 girls; mean age 11.5 years) with physical (n=77), intellectual (n=67), multiple (n=93), and other disabilities (n=49) took part. Data were collected using the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) questionnaires. Outcomes and resultsChildren with disability participated in 28 out of 55 activities (SD 6 activities), 2–3 times per month, on average. Preference was the most important predictor of participation diversity for all activity types. Disability type was a predictor of participation diversity in active-physical activities only. Severity was a predictor of participation diversity overall, and of participation in formal and informal activities. Age, severity and preference accounted for almost 50% of the variance of diversity of recreational activities. Conclusions and implicationsThese results underscore the importance of taking a child's activity preferences into account when implementing interventions to increase participation in out-of-school activities.

Stability of leisure participation from school-age to adolescence in individuals with cerebral palsy

With increasing age, youth with disabilities are at risk for decreased participation in leisure activities, a key component for physical and mental health. This prospective study describes changes in leisure participation and leisure preferences from school-age to adolescence in children with cerebral palsy (CP). Participants were recruited at school-age (6–12 years) for a study on participation and reassessed for a second study on adolescents (12–19 years) if >12 years. Thirty-eight children (24 males) with CP who could actively participate in the completion of the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) comprised the sample. Average time between assessments was 5.0±1.3 years. Most children were ambulatory (32/38 Gross Motor Function Classification System I–II). In addition to the CAPE and PAC, children were evaluated using the Gross Motor Function Measure-66 and parents completed a socio-demographic questionnaire. Paired t-tests revealed a significant decline in leisure participation diversity and intensity (CAPE) for recreation (p<.0001), skill-based (p<.0001) and self-improvement (p<.05) activities, whereas social participation remained stable (p>.05). Diversity of active-physical activities increased modestly (p=.06) although intensity of participation in this activity domain decreased (p=.003). There was also a decline in enjoyment of leisure activities. Preferences for these leisure activities remained unchanged between school-age and adolescence, except for recreational activities. Gender, maternal education, family income and gross motor ability were not related to differences in CAPE/PAC scores with increasing age. Findings suggest that over time, children with CP's participation in leisure activities diminishes, which is of concern to their functioning and well-being. Parents may be more involved in early childhood in facilitating participation whereas in adolescence, youth may be faced with more environmental barriers and a greater awareness of challenges to participation. Adolescents demonstrated a persisting desire to do these activities, challenging rehabilitation specialists to prioritize strategies to promote greater participation as children transition to adolescence.