Determinants of leisure and recreational participation in children with cerebral palsy

Determinants of leisure and recreational participation in children with cerebral palsy
RJ PALISANOSCD1, 2, LACHIARELLO1, 2, MN ORLINPHD1, 2, J MAGGS1, D OEFFINGER3,
M POLANSKY4, G GORTON5, A BAGLEY6

1Physical therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA
2Sriners Hospitals for children, Philadelphia, PA;
3Shriners Hospital for children, Lexington, KY;
4 School of public Health, Drexel University, Philadelphia, PA,
5Shriners Hospitals for Children, Spingfield, MA;
6Shriners Hospitals for Children Northern California, Sacramento, CA, USA

Background/Objectives: An important outcome of rehabilitation services for children with cerebral palsy is successful participation. Though participation children from friendship, gain knowledge , learn skills, express creativity, and determine and purpose in life .the aim of this study was to test a conceptual model of child, family, and service factors as determinants of participation in leisure and recreational activities for children with cerebral palsy (CP).
Design: prospective cohort study.
Participants and Setting: A sample of convenience of 297 children with CP, 6-12 years of age, and their parents from six shriners Hospital for children and the kluge children’s rehabilitation Center.
Material/Methods: children’s ASSESSMENT OF PARTICIPATION AND Enjoyment (CAPE) by interview. Parents completed the Family Environment Scale, the Coping Inventory, the measure of processes of Care and questionnaires on the family, child, and services. Structural equation modeling was used to test conceptual model.
Results: The factor loadings for indicators of latent variables varied from 0.56 to 0.76 supporting the measurement model. Fit statistics indicated a good fit between the observed covariance matrix and the covariance predicted by the structural model. The structural model explains 32%of the variance in intensity of participation of children with CP. The standardize regression weight were significant for the direct paths between Child Gross Motor Function Level-0.27), Child Enjoyment of Participation (0.26) Child Adaptive Behavior (0.23) Child Age (-0.14), Family activity Orientation (.27) and Intensity of Participation. Higher gross motor function, enjoyment of participation, more effective adaptive behavior ,younger age higher family-activity orientation were associated with higher intensity of participation . Child speech and communication (-0.48) and family Structure and relationships (0.30) explained 32% of the variance in Child adaptive Behavior. The less speech and communication affects daily activities and the higher family structure and relationship, the more effective adaptive behavior. The direct path between Services and Intensity of Participation was not significant.
Conclusions/ Significance: Participation in leisure and recreational activities by children with Cp is influenced by multiple child and family factors. The model supports the importance of children’s behavior in life situation s, activity adaptation s, and physical accommodations to enable participation Knowledge of activities the child enjoys and family activity orientation are important for identifying opportunities for participation. The proposed path between services and participation was not supported and may reflect the indicators measured. Alternatively services may not have specifically addressed family and child needs for participation. The unexplained variance indicates that the model should include additional determinants.

 
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