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To identify and synthesise the current evidence on social participation in adults with cerebral palsy (CP). Four databases (PubMed, CINAHL Plus, PsycINFO, Web of Science) were systematically searched between December 2021 and February 2022. Pre-specified eligibility criteria were applied to all identified studies resulting in the inclusion of 16 articles. Data extraction was performed using a standardised tool and quality appraisal was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach was taken for data analysis. The 16 included studies were rated as high (n = 11) and medium quality (n = 5). Numbers of participants included in the studies ranged from 7 to 335. Definitions of social participation were discussed. Common themes were identified: the impact of home and work environments on social participation, the importance of age-appropriate support and interventions, and the impact of limited autonomy on social participation. Adults with CP experience limited social participation due to lack of appropriate support in childhood, issues across the lifespan including physical limitations when ageing, and factors such as societal expectations and inaccessible environments which limit opportunities for autonomy. Social participation may be improved by supporting families to provide opportunities in childhood, providing timely interventions, and by enhancing autonomy. Considering the support needs of the wider family, in order to build a supportive family environment in childhood, could improve social participation opportunities for individuals with cerebral palsy (CP) in adulthood. Social participation in adulthood may be improved by encouraging independence and autonomy in childhood and adolescence. Taking a lifespan approach to services for individuals with CP could improve social participation and better prepare them for the challenges of adulthood. [ABSTRACT FROM AUTHOR]

Aim: To explore the factors that influence the process of transitioning from child to adult services in Ireland among young people with cerebral palsy, their parents, and service providers. Method: This study followed a qualitative descriptive approach. Semi‐structured interviews were conducted with 54 participants, including young people with cerebral palsy aged 16 to 22 years (n = 13), their parents (n = 14), and service providers (n = 27). Data were analysed using the Framework Method. Findings were categorized using an ecological model across four levels: individual, microsystem, mesosystem, and exosystem. Results: Limited awareness, preparation, and access to information hindered successful transition. Microsystem factors such as family knowledge, readiness, resilience, and health professional expertise influenced transition experience. Mesosystem factors encompassed provider–family interaction, interprofessional partnerships, and interagency collaboration between child and adult services. Exosystem factors included inadequate availability and distribution of adult services, limited referral options, coordination challenges, absence of transition policies, staffing issues, and funding allocation challenges. Interpretation: Transition is influenced by diverse factors at multiple ecological levels, including interactions within families, between health professionals, and larger systemic factors. Given the complexity of transition, a comprehensive multi‐level response is required, taking into account the interactions among individuals, services, and systems. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe how and why adults with CP living in the UK and Ireland accessed and used physiotherapy services; to describe the type of physiotherapy accessed and satisfaction with physiotherapy services and to examine the associations between relevant factors. A cross-sectional semi-structured online survey was employed. Participants were adults with CP aged 18 and above living in the UK and Ireland; able to complete an online questionnaire in English independently or with technical or physical assistance. Data were collected from April 2019 to February 2020. Participants (n = 162) were aged 18–74 years. The majority were female (75%) and lived in the UK (83%). Ninety percent of participants reported a need for physiotherapy but only 35% received physiotherapy services. The most common reason for visiting physiotherapy was mobility decline (62%). Satisfaction with the availability and quality of physiotherapy services were 21% and 27%, respectively. Adults with scoliosis and mobility decline were less likely to report that they received the physiotherapy they needed. Adults with CP did not receive the physiotherapy services that they perceived they needed. There is a need to develop physiotherapy services in collaboration with people living with CP. Adults with cerebral palsy (CP) needed physiotherapy services, but were not receiving the physiotherapy services that they perceive they needed. Adults were not satisfied with the availability or quality of physiotherapy services received. Adults with scoliosis and mobility decline were less likely to report that they received the physiotherapy they needed. There is a need to develop physiotherapy services from a life-span perspective for adults living with CP. [ABSTRACT FROM AUTHOR]

While passive range of motion (PROM) is commonly used to inform decisions on therapeutic management, knowledge of PROM of children with spastic cerebral palsy (CP) is limited. A population-based sample of 178 children with spastic CP (110 male; unilateral, n = 94; bilateral, n = 84; age range 4-17 years) and 68 typically developing children (24 male; age range 4-17 years) were recruited to the study. All children were able to walk a minimum of 10 m over a straight flat course, with or without assistive devices. Gross Motor Function Classification System (GMFCS) levels of participants with CP were: Level I = 55, Level II = 88, Level III = 21, and Level IV = 14. Ankle dorsiflexion, knee extension, popliteal angle, hip abduction, hip internal rotation, and hip external rotation were measured using a goniometer. The results indicate that the children with CP had significantly reduced PROM compared to the children with typical development. Children with CP demonstrated reduced length in the hamstrings, hip adductor, iliopsoas and gastrocnemius-soleus musculature, and contracture at the knee joint. Among children with CP, there were significant reductions in range with increasing functional limitation (higher GMFCS level) and variations based on unilateral or bilateral involvement. This was particularly the case for the hamstrings and hip adductor musculature, where PROM varied considerably across GMFCS Levels I to IV. (Contains 5 tables and 1 figure.)

The aim of the study was to establish if a relationship exists between the energy efficiency of gait, and measures of activity limitation, participation restriction, and health status in a representative sample of children with cerebral palsy (CP). Secondary aims were to investigate potential differences between clinical subtypes and gross motor classification, and to explore other relationships between the measures under investigation. A longitudinal study of a representative sample of 184 children with ambulant CP was conducted (112 males, 72 females; 94 had unilateral spastic CP, 84 had bilateral spastic CP, and six had non-spastic forms; age range 4-17y; Gross Motor Function Classification System Level I, n=57; Level II, n=91; Level III, n=22; and Level IV, n=14); energy efficiency (oxygen cost) during gait, activity limitation, participation restriction, and health status were recorded. Energy efficiency during gait was shown to correlate significantly with activity limitations; no relationship between energy efficiency during gait was found with either participation restriction or health status. With the exception of psychosocial health, all other measures showed significant differences by clinical subtype and gross motor classification. The energy efficiency of walking is not reflective of participation restriction or health status. Thus, therapies leading to improved energy efficiency may not necessarily lead to improved participation or general health.

Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years (n=184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had clinical diagnoses of unilateral (n=94) and bilateral (n=84) spastic CP, ataxia (n=4), dyskinesia (n=1), and hypotonia (n=1), and could walk independently with or without the use of an aid (GMFCS Levels I-IV). Research physiotherapist (n=184) and parent/guardian data (n=178) were collected in a research environment. Data from the child's community physiotherapist (n=143) were obtained by postal questionnaire. Results, using the kappa statistic with linear weighting (K[subscript 1w]), showed good agreement between the parent/guardian and research physiotherapist (K[subscript 1w]=0.75) with more moderate levels of agreement between the clinical physiotherapist and researcher (K[subscript 1w]=0.64) and the clinical physiotherapist and parent/guardian (K[subscript 1w]=0.57). Agreement was consistently better for older children (greater than 2y). This study has shown that agreement with parent report increases with therapists' experience of the GMFCS and knowledge of the child at the time of grading. Substantial agreement between a computed GMFCS and an experienced therapist (K[subscript 1w]=0.74) also demonstrates the potential for extrapolation of GMFCS rating from an existing CP registry, providing the latter has sufficient data on locomotor ability.

To understand how healthcare professionals' perceptions of supports and barriers to routine clinical assessment, for children aged 3–18 years with cerebral palsy, evolved in the presence of a knowledge translation intervention. A prospective longitudinal mixed-methods study was completed. The intervention comprised knowledge brokers, an e-evidence library, locally provided education and embedding routine clinical assessment in practice. Healthcare professionals from five disability services completed the Supports and Barriers Questionnaire and focus groups at baseline, 6, 12 and 24 months. Quantitative data were analysed descriptively and qualitative data using longitudinal framework analysis. Questionnaire ratings indicated participants felt supported in implementing routine assessment over time. Subtle differences emerged from the longitudinal framework analysis. Participants shifted from 'adopting' to 'embedding' and 'maintaining' routine assessment. Integration of assessment was impacted by a new national disability funding model. Participants highlighted the need to maintain skills and for unambiguous, sustained communication between the organisation, clients, and stakeholders. If, how and why families engaged with routine assessment developed over time. After an initial focus on pragmatic implementation issues, over time healthcare professionals began to reflect more on the complexities of children and families' engagement with assessment and the impact on the therapist-child-family relationship. Trial registration: This trial was not a controlled healthcare intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015. Healthcare professionals can be supported over time to embed routine clinical assessment using multifaceted knowledge translation interventions. It takes time and ongoing support for healthcare professionals to embed, maintain and begin to adapt the routine clinical assessment to fit with policy, organisational context and the needs and wishes of children and families. Understanding and tailoring knowledge translation approaches to the policy context are essential. Even in the context of major policy shifts, it is possible to harness the commitment of organisations and professionals to improve their services in line with evidence-based approaches. [ABSTRACT FROM AUTHOR]

Aim: To assess if young people with cerebral palsy experience and health professionals provide practices that may improve transition from child to adult health services. Method: Seventy‐five young people (31 females, 44 males; mean age 18 years 5 months [standard deviation 2 years 2 months]) and/or parents and 108 health professionals completed a questionnaire describing their experience or the provision of nine transition practices. Results: The percentage of young people reporting each practice was: appropriate parent involvement (90%); promotion of health self‐efficacy (37%); named worker who supports the transition process (36%); self‐management support for physical health (36%); self‐management support for mental health (17%); information about the transition process (24%); meeting the adult team (16%); and life skills training (16%). Post‐discharge, 10% of young people reported that their general practitioner (GP) received a discharge letter. The percentage of health professionals reporting each practice was: promotion of health self‐efficacy (73.2%); self‐management support (73.2%); information (69%); consulting the parent and young person about parent involvement (63% and 66%); discharge letter to a GP (55%); life skills training (36%); named worker (35%); meeting the adult team (30%); and senior manager (20%). Interpretation: Many young people did not experience practices that may improve the experience and outcomes of transition. Young people should be involved in the development and delivery of transition to ensure it meets their needs. What this paper adds: Many young people with cerebral palsy (CP) do not receive support that may improve the experience of transition.Appropriate protocols and training for health professionals may improve the provision of transition and reduce inconsistency in care between and within organizations.Young people and their families should be involved in service design, delivery, and evaluation related to the transition to ensure it meets their needs. [ABSTRACT FROM AUTHOR]

Examines the extent to which Scottish children, parents, and teachers exhibit within- and between-group consensus, both in their perceptions and relative judgments of different forms of child prosocial and antisocial behaviors, and their responses to such behaviors. Significant between-group differences are discussed in the context of teaching social behavior. (DSK)

OBJECTIVE. The purpose of this analysis was to assess recruitment bias in a population-based study of locomotor ability in children with cerebral palsy. METHOD. A population-based case register was used as a sampling frame and was considered a highly ascertained record of children with the condition. A twin track approach to recruitment for the Locomotor Study was adopted through: (1) a specialist orthopedic service and (2) a community pediatric network on behalf of the case register. The subjects included children with cerebral palsy aged 4 to 16 years in 2003, able to walk [greater than or equal to] 10 m, and a resident in Northern Ireland, as well as their parents. RESULTS. The Orthopaedic Service identified clinically distinct children with cerebral palsy in terms of type, severity, age, and geographic residence. More families responded to an invitation, and more were ultimately recruited into the study via the Orthopaedic Service compared with a case register using community pediatric contacts. Overall, 37.8% of the eligible cerebral palsy population participated in the Locomotor Study, but there was no evidence of any systematic biases in demographic or key clinical characteristics when compared with nonparticipants. One follow-up reminder led to an increase in recruitment of 10%. CONCLUSIONS. Care must be taken in the recruitment of children with cerebral palsy through clinic-based populations, although these routes may prove more successful in follow-up. Provided they are comprehensive, case registers have a valuable contribution to make to clinical research by providing a sampling frame including information on baseline characteristics of an affected population. Key Words recruitment, cerebral palsy, case register, bias Abbreviations NICPR--Northern Ireland Cerebral Palsy Register GMFCS--Gross Motor Function Classification System IQ--intelligence quotient POS--Pediatric orthopedic service CI--confidence interval, CEREBRAL PALSY IS a leading cause of significant physical disability in childhood (1) and refers to a collection of conditions primarily affecting motor function and posture caused by damage to [...]