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Capacity to participation in cerebral palsy: evidence of an indirect path via performance.

ABSTRACT: OBJECTIVE:To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance. DESIGN:Secondary analysis of a prospective cross-sectional study sample. SETTING:Regional pediatric specialty care hospital. PARTICIPANTS:Children (N=128; 59% boys; age range, 2-9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Activity capacity was measured with the Gross Motor Function Measure-66, performance was measured with the Activities Scale for Kids, and participation was measured with the Assessment of Life Habits. Children's Assessment of Participation and Enjoyment and the Assessment of Preschool Children's Participation assessed diversity participation. Regression equations and Sobel z test were used to examine the mediated effect via performance. RESULTS:Physical activity performance mediates 74.9% (?=.83, P<.001) of the effect of activity capacity on total participation levels and 52.8% (?=.47, P=.001) of the effect of capacity on diversity participation. CONCLUSIONS:The relation between what an ambulatory child with cerebral palsy is able to perform in a clinical setting and their participation in life is significantly mediated by what they actually do motorically in day-to-day life. Results suggest that interventions focusing on improving what they actually do every day, regardless of their capacity to perform (what they can do when tested), may positively influence participation.

SUBMITTER: Bjornson KF

PROVIDER: S-EPMC4060892 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Capacity to participation in cerebral palsy: evidence of an indirect path via performance.

Bjornson Kristie F KF Zhou Chuan C Stevenson Richard R Christakis Dimitri A DA

Archives of physical medicine and rehabilitation 20130705 12

<h4>Objective</h4>To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance.<h4>Design</h4>Secondary analysis of a prospective cross-sectional study sample.<h4>Setting</h4>Regional pediatric specialty care hospital.<h4>Participants</h4>Children (N=128; 59% boys; age range, 2-9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity.<h4>Interventions ...[more]

PMID: 23835350

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Project description:ObjectiveTo examine the relation between walking performance and participation in mobility-related habits of daily life in children with cerebral palsy (CP). To date, walking outcomes in CP have been capacity-based (what a child does in structured setting). Physical activity performance (what a child really does in daily life) has been documented to affect the relation of capacity-based gross motor measures and participation.DesignCross-sectional prospective cohort study.SettingRegional pediatric specialty care centers.ParticipantsA cohort of ambulatory children with CP (N=128; age, 2 to 9y; 41% girls; 49% having hemiplegia) participated.InterventionsNot applicable.Main outcome measuresWalking performance was quantified from a 5-day sample of accelerometry data. Stride activity was summarized through the outcomes of the average number of total strides per day (independent of intensity) and the average number of total strides per day at >30 strides/min (marker of intensity). Mobility-based participation was assessed by using the Assessment of Life Habits for Children questionnaire categories of personal care, housing, mobility, and recreation. Regression models were developed controlling for sex, age, cognition, communication, pain, and body composition.ResultsThe average number of total strides per day was positively associated with the personal care, housing, mobility, and recreation Assessment of Life Habits for Children questionnaire categories (β=.34-.41, P<.001). The average number of total strides per day at >30 strides/min was associated with all categories (β=.54-.60, P<.001).ConclusionsAccelerometry-based walking activity performance is significantly associated with levels of participation in mobility-based life habits for ambulatory children with CP. Evaluation of other factors and the direction of the relation within the International Classification of Functioning, Disability and Health is warranted to inform rehabilitation strategies.

Project description:BackgroundAssessment of arm-hand use is very important in children with cerebral palsy (CP) who encounter arm-hand problems. To determine validity and reliability of new instruments to assess actual performance, a set of standardized test situations including activities of daily living (ADL) is required. This study gives information with which such a set for upper extremity skill research may be fine-tuned, relative to a specific research question. Aim of this study is to a) identify upper extremity related ADL children with CP want to improve on, b) determine the 10 most preferred goals of children with CP, and c) identify movement components of all goals identified.MethodThe Canadian Occupational Performance Measure was used to identify upper extremity-related ADL preferences (goals) of 53 children with CP encountering arm-hand problems (mean age 9 ± 4.5 year). Goals were ranked based on importance attributed to each goal and the number of times a goal was mentioned, resulting in a gross list with goals. Additionally, two studies were performed, i.e. study A to determine the 10 most preferred goals for 3 age groups (2.5-5 years; 6-11 years, 12-19 years), based on the total preference score, and study B to identify movement components, like reaching and grasping, of all goals identified for both the leading and the assisting arm-hand.ResultsSeventy-two goals were identified. The 10 most preferred goals differed with age, changing from dressing and leisure-related goals in the youngest children to goals regarding personal care and eating for children aged 6-11 years. The oldest children preferred goals regarding eating, personal care and computer use. The movement components 'positioning', 'reach', 'grasp', and 'hold' were present in most tasks. 'Manipulating' was more important for the leading arm-hand, whereas 'fixating' was more important for the assisting arm-hand.ConclusionThis study gave insight into the preferences regarding ADL children with CP would like to improve on, and the movement components characterizing these activities. This information can be used to create a set of standardized test situations, which can be used to assess the validity and reliability of new measurement instruments to gauge actual arm-hand skilled performance.

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Capacity to participation in cerebral palsy: evidence of an indirect path via performance.

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Capacity to participation in cerebral palsy: evidence of an indirect path via performance.

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