participation leisure recreational activities children cerebral palsy
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Lisa Chiarello, PT, PhD, PCS
Drexel University &
Shriners Hospital for Children,Philadelphia, PA, USA
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Physical Therapy
and
Rehabilitation
Sciences
Philadelphia, PA, USA
Drexel University
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Why is participation in
recreation & leisure importantfor young children?
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Daily ActivitiesSelf-care 42%Mobility 17%Communication 4%Other 7%
ProductivityHousehold 1%School 5%Community 1%Other 1%
Leisure
Socialization 6%Community entertainment 1%Quiet recreation 4%Physical recreation 11%Other 0% Image from: Livestrong.com
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Challenges in Measuring
Participation
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Functional skills Caregiver
AssistanceModifications
(Ostensjo, Carlberg, & Vollestad, p. 606, 2003)
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What influences participation inyoung children with CP?
ASPECTS of the CHILD: Health, Body Function & Structure,Activity, and Personal Attributes
! Age: Explained 6% of variance(Ostensjo, et al., 2003)! Gender! Health status: Significant predictor of participation (Forsyth et
al., 2007)
! Motor ability PEDI mobility & social function r=.79 (Ostensjo, et al., 2003) GMFCS explained 48% of variance (Ostensjo, et al., 2003)
!Intellectual and communication ability Learning problems explained 9% of variance (Ostensjo, et al., 2003)
! Social-emotional status! Interest, motivation
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1)Describe participation of young childrenwith cerebral palsy
2)Determine effects of gender, age, andgross motor function on intensity ofparticipation
3)Identify child, family, and service
determinants of participation
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Body Functions& Structures:
Environmental:Family relationshipsFamily interests
Services
Personal:Age
Motivation
Adaptability
Health Condition:Cerebral Palsy
(WHO, 2001)
The Components of the ICF Model
Activities:Motor abilities
Participation:Play, leisure& recreation
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Participants! 85 young children with cerebral palsy
Age: 3.1 to 5.9 years, mean = 4.5 years (SD=.8) 50 boys, 35 girls 71% white
! Parents completed the Assessment of PreschoolChildrens Participation
88% mothers Mean age 34 years (SD=9.3) 57% greater than high school education
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MeasuresPrimary Outcome
! Amount of participation: The Assessment of PreschoolChildrens ParticipationChild factors
! Gross motor function: Gross Motor FunctionClassification System (GMFCS)
! Physical activities: Pediatric Outcomes Data CollectionInstrument (PODCI)
Upper Extremity and Physical Function Transfers and Basic Mobility Sports/ Physical Functioning
! Age! Adaptive behavior: Coping Inventory
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! 45 items! Participate: Yes or No and How often! Overall diversity and intensity score! Types of Activity Scores
Play: e.g. doing pretend play Skill development: e.g. helping around the
house
Physical: e.g. riding a bicycle Social: e.g. going to a party
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Gross Motor FunctionClassification System (GMFCS)(Palisano et al, 2008)
Children 2 to 4 years Children 4 to 6 years
Level I Moves by walking without awalking aid
"#$%& '()*+,) -.&)-(/0+1&
Level II Walks with a walking aid "#$%& '()*+,) # '#$%(12 #(3Level III Walks short distances with a
walking aid
"#$%& '()* # '#$%(12 #(3
Level IV Self mobility is limited within a room, transported outdoorsLevel V Self mobility severely limited
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Pediatric Outcomes Data
Collection Instrument(PODCI) (Daltroy, Liang, Fossel, & Goldberg, 1998)! Health and physical functioning: 6 domains! Completed by parents! How easy or hard for you to:
Upper Extremity / Physical Function (8items), e.g. write with a pencil
Transfers and Basic Mobility (11 items) , e.g.get on or off a toilet or chair
Sports/ Physical Function (12 items), i.e. runa short distance
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Coping Inventory(Zeitlin, 1985)
! Adaptive behaviors: behaviors to meet personal needs andto respond to and interact with the physical and socialenvironment
! 48 items! Self and Environment
Productive: degree that behaviors achieve what a child wants!Child applies what he or she has learned to a new situation
Active: degree of initiation and persistence!Child stays with a task until it is completed
Flexible: degree of adaptability!Child can shift plans or change behavior to achieve a goal
! 5-point Likert scale: 1= the behavior is not effective;5= the behavior is effective most of time
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Family Environment Scale
(FES) (Moos & Moos, 2002)! 90 items! True / False! Relationships, personal growth, and system maintenance!
10 subscales Cohesion: e.g. Family members really help & support
one another
Conflict: e.g. We fight a lot in our family Organization: e.g. Activities in our family are pretty
carefully planned
Intellectual-cultural orientation: e.g. Learning about new& different things is very important in our family
Active-recreational orientation: e.g. Everyone in ourfamily has a hobby or two
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Statistical Analysis
! Kruskal-Wallis test The effects of age (3, 4 and 5 years) and GMFCS
Level groups (I, II/III and IV/V)
! Mann-Whitney U test Gender differences Post-hoc multiple comparison tests for effect of
age and GMFCS levels
! Stepwise multiple regression analysis Identify child, family, and service determinants
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Results: What does
participation look like?! Children participated in an average of 26 (60%) of the
45 activities [children without disabilities: 74%]
Individual children doing between 2 (4%) and 39(87%) of the activities
Types! 74% of play activities! 58% of social activities
5-6 year old children doing > # than children 3-4 yearsof age
! 56% of skill development activities Children in GMFCS level I doing > # than children
GMFCS level IV/V
! 52% of active physical activities
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Move and PLAY study
Patterns for Participation
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Results: Effect of Gross Motor Functionon Intensity of Participation
*
* p = .02Children level I > participation than levels III, IV, & V
Children level V < participation & enjoyment than all other
levels
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Results: Effect of Gender and Age on
Intensity of Participation
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! 429 children 18 months 5 years of age! Older children (often) had higher
frequency of participation than youngest
children (once in awhile)
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Results: Relationships of Child,Family, and Service Factors with
Participation
Factor Correlation Coefficient
GMFCS level -.36
Adaptive Behavior Index .63
Upper Extremity and Physical Function .45
Transfers and Basic Mobility .42
Sports/ Physical Functioning .39
Child age, family factors, and service factors were not
related to intensity of participation
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Results: Determinants of
Intensity of Participation
Consistent findings for child factors: Adaptive
behaviorand gross motor function explained
39% of the variance in frequency of participation
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Implications for Practice
Build on childs interests and
preferences
Assess and focus on familypriorities
PTs have an important role inidentifying child priorities and
promoting desired participation
in leisure and recreational
activities
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Case Example: Outcomes
Sara AndrewAge 6 6GMFCS level IV IVPreschool CAPE
Diversity 21 30Intensity 2.5 3.2
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Case Example: Child and Family FactorsSara Andrew
Transfers / Basic Mobility 21 36
UE Function 38 38
Sports / Physical Function 24 11
Adaptive Behavior 2.2 3.7
Cohesion 59 38
Conflict 49 70
Organization 53 53
Intellectual Cultural Orientation 58 41
Active Recreation Orientation 53 59
# children in household 2 3
Parent Education Less than HS Bachelors degree
Family Income $15,000-29,999 $15,000-29,999
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What can we do to support
Sara and Andrew ?! Can we influence childrens adaptive
behavior?
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Key References
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