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Background and objectives Whilst the evidence base supports the physical health benefits, less is known about the emotional wellbeing effects from participation in recreational activities for children and young people with cerebral palsy. Especially for those who need assistance to walk, are non-ambulant or have difficulty with communication and learning. In Wales, although investment in adapting sporting activities has increased, wider participation in recreational activities remains limited for this group. This lack of choice for meaningful participation for children and young people with cerebral palsy, can lead to less participation in adulthood. This is thought to reduce their health related quality of life. The objectives were to explore how children and young people with cerebral palsy and their carers viewed, experienced and chose their level of participation in recreational activities and how they think this impacts upon their emotional wellbeing. Study Design Comparative case study design- Those who participated a lot and those whose participation was limited. Study participants and setting 7 children and young people were recruited via schools, charities and community groups (age range 9-16 years, Levels III-V Gross motor Function Classification System: 4 at IV, 2 at III, 1 at V; Communication Function Classification System: 4 at IV, 2 at III, 1 at V; 4 boys, 3 girls; 4 who participated a lot and 3 whose participation was limited). Materials and methods A qualitative approach was devised. Each case study was comprised of 2 semi-structured interviews 12 weeks apart, a diary written in between, plus some observations at one of their usual activities during this time. Visual images were taken during the observations as well as field notes written. Some parents took images to add to the diary. Two of the participants were interviewed via their communication aids which gave insight into their experiences and choices. However to ascertain their views it had to be reported by proxy via the parents, as it was not possible to probe further with their limited vocabulary. The 5 who were not able to communicate directly were observed and the parents were interviewed. The data was managed with NVIVO and analysed according to Braun and Clark’s six stages of thematic analysis. Results The 7 cases generated 212,843 words, 220 images, from 18 hours of interviews, 7 diaries and 15 hours of observation across both data sets. Themes were identified that reflected both Intrinsic factors with their Idiosyncratic ways to communicate well-being and Extrinsic factors including People’s Attitudes towards Disabled Children. Those in the participatory group had a vast range of experiences that supported a positive emotional well-being state. These activities included surfing, skiing, bike riding, Race Running, swimming, horse riding, uniformed clubs, trampolining and some craft activities. These were attributed to innovative designs. Those who participated less encountered barriers from pervasive ‘Can’t do’ attitudes and environments or equipment that had not been adapted for their needs. Only 1 child had evidence of the Leuven Scale for emotional well-being and involvement for non-verbal children, being used in school. Conclusion/Significance The case study method enabled rich data to be collected to represent their views, experiences and choices. More needs to be developed to reliably capture this group of children and young people’s emotional well-being.

Key points • This chapter will describe two research projects carried out with disabled children and young people in the United Kingdom (UK) about what it means to the emotional wellbeing of disabled children and young people to join in meaningful recreational activities. • It begins with the links between health, recreation and childhood regarding disabled children. • The perspectives and stories by disabled children and young people presented illustrate the agency and fun enjoyed in recreation as well as relationships with others that includes issues of inclusion. • Recreation is different to therapy and treatments in terms of functional goals, but this chapter suggests that some important goals of therapy and health can be met by recreation and importantly, the objectives of fun are added. • Policy implications include the case for equality of opportunity for disabled children to play and participate in all activities, and to voice their experiences and ideas for future recreational activities. • This chapter shows that a simple cost saving objective for NHS and Social Services needs caution as holistic care and participation requires investment if it is to be successful and have any real impact for disabled children.

Children and youth with Cerebral Palsy (CP) have limited opportunities for participation. These qualitative results are part of a mixed methods study exploring the effects of participation in physical activities including adapted cycling.\ud Objectives:\ud The first aim was to explore physical activity participation of children and youth with CP. The second aim was to introduce information about adapted cycling and explore if they would participate in the future.\ud Methods:\ud Mosaic methods were adapted and this involved the use of puppetry, pictures and drawing and they also kept a written diary.\ud Results:\ud 18 participants were recruited aged 2–13, 11 male, 7 female resulting in 17 interviews and 15 diaries. The participants had a range of communication abilities, 10 spoke verbally, 3 were nonverbal, 2 used Makaton signing and 3 had dysarthria. The data were managed in NVIVO and analysed with coding using a template approach. The themes which emerged revealed some barriers and encouragers of physical activity participation represented by a ‘Wheel of Participation’. The interview and diary data enabled their voices to be heard as their ‘Mosaic’ was built up through this iterative analytic process. 11 of the 18 children actually tried adapted cycling following the provision of written information.\ud Conclusion:\ud This change behaviour was positive and further research should explore habitual participation in physical activities such as adapted cycling. By hearing their perspectives about participation in physical activities and cycling, the experiences described suggest there are now some enjoyable opportunities for participation for children and youth with CP.

This chapter will describe the challenges of designing rigorous research studies with disabled children and young people. The issues of gaining consent /assent are explored as well as seeking ways to represent children’s views who do not have spoken language. Ethical issues that impact on the rigour of research studies with children and young people with disabilities will be outlined. Examples of research done with children who have cerebral palsy will be used. This will illustrate decisions not to include children where coercion was felt to take advantage of their vulnerability and assent could not be assumed. Carrying out research with children without the parent’s present was not considered good practice; a discussion around the age for consent will be outlined. Finding ways to manage data protection, lone working and child protection were areas requiring strategies for safe practice. Transferable skills are identified from physiotherapy practise to research, including skills in communicating with children and young people with disabilities and team working. There is a need to recognise that boundaries change when working in different environments. The change of role for the researcher to an ‘enquirer’ of the topic rather than a ‘service provider’ requires some adaption. New skills need to be developed in completing applications for National Research Ethical Service and NHS Trust Research and Development requiring patience and perseverance and infinitely more time than one can imagine.

Purpose Children and young people with Cerebral Palsy have limited opportunities for participation and there has been limited research to explore this concept. Adapted dynamic cycling (ADC) is one activity that can enable them to participate in the community. The aim of this paper is to report the views and experiences of children and young people with CP and their families regarding their participation in (ADC). Methods This was part of a mixed methods study of which the qualitative findings are reported here. Iterative creative methods were developed which involved semi structured interviews and diaries about the ADC experience. Results The themes that emerged were the staff and the environment at the cycling hire project, the facilitators and barriers to ADC, the technical set up of the bike and the impact on the child and family in terms of developments over time, future aspirations, learning cycling skills, social participation and health benefits. Conclusions The data showed that children’s experiences of ADC were fun and enjoyable. This fun exercise should be incorporated into a physiotherapy programme as part of the child or young person with CP’s rehabilitation. Policy makers and parents may find the information useful to increase the child’s participation.

The use of observation, child conferencing, interviews, and the child’s own photographs can contribute to a mosaic about their early years nursery experiences. The pre-school children gave the observer a tour of their nursery and made maps of the different rooms, meaning the mosaic encompassed what was important to them from their perspective; parental views were added to this. Paige-Smith and Rix (2011) adapted the mosaic approach by using photographs to listen to children with Down’s syndrome. They describe in detail how the pictures were used as the basis for the interview discussion with children and their parents. The researchers gave an example of how the child made choices within a physiotherapy session, but they suggest the child disengaged