participation leisure recreational activities children cerebral palsy

8/12/2019 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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participation leisure recreational activities children cerebral palsy

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