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Evaluate changes in two-wheel cycling skills and biking participation goals for children with neurodevelopmental disorders (ND) receiving a home visit and email following iCan Bike camp. Participants: 11 children with ND, 9–16 years, and one of their parents. A cycling skills checklist, two-wheel riding Goal Attainment Scaling (GAS), and biking participation GAS were completed before camp (T1), at support visit after camp (T2), and three months following camp (T3). Parents completed biking practice logs. Participants received a support visit to provide instruction, coaching, and address questions, and an email to check progress. Significant changes were made in two-wheel riding GAS T1 to T2 (p = 0.01), biking participation GAS T2 to T3 (p = 0.02), and cycling skills T1 to T2 (p = 0.01) and T2 to T3 (p = 0.02). Practice frequency was related to cycling skills (0.72, p = 0.01) and biking participation (0.86, p < 0.001); cycling skills were related to biking participation (0.81, p = 0.003). Children improved cycling skills and biking participation following camp, support visit, and email check-in. Children who practiced more had greater cycling skills and biking participation. Encouraging weekly bicycling and providing support may promote cycling skills and participation following camp. [ABSTRACT FROM AUTHOR]

Aim: To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID‐19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. Method: An interrupted time‐series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8‐week self‐chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed‐effects models were used. Results: The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0–3.2] and 3.2 points [95% CI: 2.4–3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. Interpretation: Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body‐function level. What this paper adds: Environmental‐based interventions can improve participation even during adverse times such as the COVID‐19 pandemic.Significant improvement with large effect sizes occurred in both activity performance and satisfaction.Intervention was effective for all; those without mental health problems benefited more.Improvements in body‐function outcomes were partially observed, especially in motor‐related outcomes.Body functions may improve through participation even if not targeted by the intervention. [ABSTRACT FROM AUTHOR]

Translate, investigate reliability, and construct validity of the Brazilian Early Activity Scale for Endurance (EASE). Translation followed the international guidelines. Test–retest reliability was tested by 100 parents of children with cerebral palsy (CP): 18 months–5 years and 6–11 years. To determine construct validity, 94 parents of typically children completed the EASE. Statistical analysis included Bland–Altman, Intraclass Correlation Coefficient (ICC), Internal Consistency, and Floor and Ceiling Effect. The majority of the sample consisted of children with CP in GMFCS (IV–V). EASE showed good test–retest reliability for younger (ICC = 0.8) and excellent test–retest reliability for older children with CP (ICC = 0.9), and good internal consistency of 0.7 and 0.8 for the young and older group, respectively. Bland–Altman showed the bias close to zero, with no ceiling or floor effect. Regarding construct validity, younger children showed lower scores when compared to the older children. Endurance differed significantly between children with CP who were walking and those who were not walking and also for age groups. Children with CP showed lower endurance compared to typically participants in the same age group. Brazilian EASE is reliable and valid to estimate endurance in children with CP. Results provide evidence of construct validity. Endurance to physical activity is an important construct to be evaluated and that directly interferes with the health and quality of life of children with Cerebral Palsy (CP). The Brazilian-Portuguese version of the 4-item Early Activity Scale for Endurance (EASE) is a valid and reliable scale to assess endurance to physical activity in children with CP. [ABSTRACT FROM AUTHOR]

Aims: To evaluate a collaborative participation-based therapy approach for two preschool students with multiple disabilities from the experience of Individualized Education Program (IEP) teams, highlighting the perspective of the physical therapist. Methods: The phases of collaborative participation-based therapy were implemented: (a) collaborative relationships were developed and supported within the IEP teams, (b) collaborative meaningful physical recreation goals were developed for participation at school, (c) strengths and needs assessments using the "Collaborative Process for Action Plans to Achieve Participation Goals" were conducted with IEP teams, (d) participation-based interventions were provided, and (e) goal achievement and processes were evaluated. The use of technology for collaboration was encouraged. The physical therapist kept intervention logs and wrote reflective journal entries. Interventions adhered to COVID-19 regulations. Goal achievement was measured using Goal Attainment Scaling. IEP team members completed questionnaires on their experiences. Results: One student met their goal expectation, and one student exceeded their goal expectation. The students were engaged, and IEP team members' experiences were positive. Conclusions: The use of participation-based therapy is meaningful, feasible, and acceptable to IEP teams. Team collaboration and flexibility were instrumental to successful implementation. Strategies to promote effective communication and the use of technology would support a participation-based therapy approach. [ABSTRACT FROM AUTHOR]

Measurement development is a reiterative process requiring refinements and revalidation. The purpose of this study was to examine structural validity and reliability of the Child Engagement in Daily Life Measure (Version 2) for parents of children with cerebral palsy (CP) across a broader age span. Participants were 1054 parents of children with CP 1.5–11 years of age. Parents completed the Child Engagement in Daily Life measure that consists of the Participation in Family and Recreational Activities domain (11 items) and the Performance of Self-care Activities domain (18 items) as part of two longitudinal studies related to outcomes for children with CP. Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty for both frequency of participation in family and recreational activities and performance of self-care activities. Test–retest reliability was good to excellent: ICC = 0.78 for frequency of participation, ICC = 0.68 for enjoyment of participation, and ICC = 0.97 for self-care. Evidence supports reliability and validity of the Child Engagement in Daily Life Measure (Version 2) for parent-report of their children's participation in family and recreational activities and performance of self-care activities for children with CP 1.5–12 years of age. Participation in family and recreational activities and performance of self-care activities of children with cerebral palsy can be assessed using the concise parent-report Child Engagement in Daily Life Measure V2. Knowledge of the continuum of difficulty of the frequency of participation in family and recreational activities and performance of self-care activities can assist practitioners in progressing service plans. Practitioners are encouraged to use the measure to guide discussions with parents and children on areas to focus services to support participation in family and recreational activities and performance of self-care activities. [ABSTRACT FROM AUTHOR]

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Aim: To identify and provide a descriptive overview of the development of children, adolescents, and young adults with cerebral palsy (CP) in longitudinal studies; and map areas of focus according to the components of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). Method: Longitudinal studies of the development of children, adolescents, and/or young adults with CP were included in this scoping review. A search for eligible studies was conducted in the databases MEDLINE, PubMed, LILACS, EMBASE, Cochrane, CINAHL, and Scopus, and was restricted to the years 2002 to 2022. All outcome measures of the studies were classified into ICF components. Results: In the 56 studies included, there were 19 438 participants, involving mainly children, followed by adolescents, and lastly young adults. All components of the ICF were investigated and many studies reported outcomes in more than one component. Activity was the most investigated (67.9%; n = 38 studies), followed by body functions and structures (42.9%; n = 24 studies). Participation (14.2%; n = 8 studies) and environmental factors (3.6%; n = 2 studies) were the least studied. None of the studies investigated personal factors as an outcome. Interpretation: This scoping review provides an overview of studies on the development of children, adolescents, and young adults with CP, using the ICF framework, identifying current areas of focus and gaps in the research. Future studies should target participation, contextual factors, and the transition into adulthood. What this paper adds: The International Classification of Functioning, Disability, and Health can be used to map a range of outcomes through developmental studies.The main outcomes investigated in children with cerebral palsy were activity, and body functions and structures.Little has been explored in participation and contextual factors outcomes over time.The main classification used to stratify the participants was the Gross Motor Function Classification System. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe physical therapy (PT) and occupational therapy (OT) services for a cohort of 399 children with cerebral palsy (CP), 2-6 years old, residing in the United States and Canada. Parents completed a services questionnaire by telephone interview. Therapists classified children's Gross Motor Function Classification System (GMFCS) level. Mean minutes per month of PT and OT were greater for children receiving services in both an educational and clinic setting. Mean minutes per month of PT and OT were greater for children in levels IV-V than children in level I and greater for children in the United States than children in Canada. Parents reported that interventions focused a moderate to great extent on primary impairments, secondary impairments, activity, and structured play activities, a moderate extent on environmental modifications and equipment; and a moderate to small extent on self-care routines. The results support the importance of coordination of PT and OT services. (Contains 7 tables.)

This article reports on the findings of a qualitative study about the experiences and perceptions of adolescents with cerebral palsy (CP) in relation to social participation. A phenomenological approach was used to interview 10 adolescents with CP, 17 to 20 years of age, selected using purposeful sampling. An iterative process of data collection and analysis resulted in four themes about social participation. The themes of "experience, barriers, and supports", and "tradeoffs" supported the current view of participation as a dynamic interaction between person and environment. The fourth theme of "making choices" described the unique challenges facing adolescents with CP in terms of deciding what was most important and meaningful to them now and in their future. Health care professionals can support adolescents as they develop the capacity to make their own decisions during the transition to adult living by ensuring that assessments and interventions address social participation. (Contains 2 tables and 1 figure.)

Participation in home, school, and community activities is a primary outcome of early intervention services for children with disabilities and their families. The objectives of this study were to (a) describe participation of preschool-age children with cerebral palsy (CP); (b) determine effects of sex, age, and gross motor function on intensity of participation; and (c) identify child, family, and service determinants of intensity of participation. A convenience sample of 85 preschool-age children with CP and their parents participated. Parents completed self-report measures on children's participation, adaptive behavior, physical function, family functioning, and services. Children's Gross Motor Function Classification System levels (Palisano, Rosenbaum, Bartlett, & Livingston, 2008) were determined by assessors. A multiple linear regression analysis was conducted to determine the variance in intensity of participation explained by the determinants. Children with limited self-mobility had a lower intensity of participation than children with independent upright mobility. Adaptive behavior, transfers and basic mobility function, and upper extremity and physical function explained 46% of the variance of intensity of participation. (Contains 8 tables.)

A multivariate model of determinants of change in gross-motor ability and engagement in self-care and play provides physical and occupational therapists a framework for decisions on interventions and supports for young children with cerebral palsy and their families. Aspects of the child, family ecology, and rehabilitation and community services may influence children's activity and participation. Aspects of the child include primary and secondary impairments, associated and comorbid health conditions, and adaptive behaviors. Literature support for the model is reviewed. A clinical scenario illustrates the use of the model as a framework for practice. The model encourages therapists to broaden the focus of rehabilitation services for young children with CP to include not only development of motor abilities but also comprehensive interventions and supports to enhance participation in daily activities and routines. Therapists are encouraged to consider how child, family, and service factors interact when planning interventions and evaluating outcomes. (Contains 1 figure.)

Aim: To test a model of child, family, and service determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy (CP). Method: Participants were 288 children with CP, age range 6 to 12 years (mean 9y 8mo, SD 2y), and their parents from seven children's hospitals. The sample comprised 166 (57.6%) males and 122 (42.4%) females, and between 40 (13.9%) and 74 (25.7%) children in each of the five levels of the Gross Motor Function Classification System. Children completed the Children's Assessment of Participation and Enjoyment by interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, and two questionnaires. Structural equation modeling was used to test the model. Results: Fit statistics indicated a good model fit. The model explains 32% of the variance in intensity of participation. Path coefficients (p less than or equal to 0.05) indicate that higher gross motor function, higher enjoyment, more effective adaptive behavior, younger age, and higher family activity orientation are associated with higher intensity of participation. The path between services and participation was not significant. Interpretation: Intensity of participation of children with CP is influenced by multiple child and family determinants. Children's gross motor function and behavior in life situations are important for participation; knowledge of activities the child and family enjoy has implications for opportunities for participation. Professionals are encouraged to address priorities for leisure and recreation identified by children with CP and their families.

Aim: Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP. Method: Five hundred participants (277 males, 223 females) were grouped by age and Gross Motor Function Classification System (GMFCS) level. There were 291 children aged 6 to 12 years and 209 young people aged 13 to 21 years. There were 128 participants in GMFCS level I, 220 in levels II/III, and 152 in levels IV/V. Participants completed the Children's Assessment of Participation and Enjoyment to measure number of activities (diversity) and how often they were performed (intensity) in the past 4 months. Results: Children had higher overall participation diversity and intensity than young people (p less than 0.001). Children and young people in GMFCS level I had the highest overall participation, followed by children and young people in levels II/III and IV/V. Children had higher participation in recreational (p less than 0.001) but not formal (such as team sports or clubs) or physical activities. Children (p less than 0.01) and young people (p less than 0.001) in level I had the highest participation in physical activities; diversity and intensity were generally low. Interpretation: The findings provide evidence of the effect of age and gross motor function on participation of children and young people with CP. Low participation in physical activities may have implications for fitness and health, especially for children and young people in GMFCS levels IV and V.

Aim: Our aim was to describe how the probability of walking, wheeled mobility, and assisted mobility changes with environmental setting and age in children and adolescents with cerebral palsy (CP). Method: The parents of a population-based sample of 642 children and adolescents (360 males, 282 females; age range 16mo-21y) reported their children's mobility at home, school, and outdoors at 6- or 12-month intervals a mean of 5.2 times. Generalized mixed-effects analyses were used to model the probabilities. Results: By age 3 years, children with motor function classified as level I according to the Gross Motor Function Classification System (GMFCS) walked in all three settings. Children/adolescents classified as level V used assisted mobility, with a small number using wheeled mobility. In the case of children classified as GMFCS level II, the probability of walking varied with the environmental setting, which, at age 18, is outdoors 90% of the time. Among children classified as GMFCS level III, the probability of walking was highest at age 9 at school (68%), and at age 18 was approximately 50% in all three settings. Among children/adolescents rated as GMFCS level IV, the probability of wheeled mobility increased with age and, at age 18, 57% of mobility took place outdoors. Interpretation: The results provide evidence that age and environmental setting influence method of mobility of children/adolescents with CP. The method that is preferred in one setting may not be preferred in another setting or at another age. (Contains 4 figures.)

Research on intensity of therapy services is limited and perspectives often vary considerably among families, therapists, administrators, policy makers, and health insurers. In this commentary, the authors share their perspectives on intensity of physical therapy and/or occupational therapy services for children with developmental conditions. Five considerations are discussed: episode of therapy, readiness for activity and participation, method of service delivery, the distinction between intensity of therapy and practice of activity in natural environments, and the link between skill level and method of service delivery. We conclude that for children with developmental considerations, method of service delivery and intensity of therapy may differ for each episode of therapy based on contextual factors including child and family priorities and goals. In most situations, more than one method of service delivery can and should occur simultaneously. (Contains 1 table.)

The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts were analyzed for key concepts and themes. Credibility was established through triangulation of researchers and member checking. Participants viewed mobility as important for "self-sufficiency". Youth who walked and also used wheeled mobility spoke of "making choices". "Safety" and "efficiency" were important considerations when making choices. Some participants had mobility "preferences" at home that may not be safe, practical, or socially appropriate at school or in the community. Youth spoke of constantly "adapting to situations" that often reflected a lack of control over the environment. Youth indicated the need for "constantly planning ahead" to go places and do things. Most participants were dependent on others for transportation and expressed "dissatisfaction with public transportation". Safe and efficient mobility to enable participation in daily activities appears to be the primary concern of youth with cerebral palsy. (Contains 1 figure and 4 tables.)

The Gross Motor Function Classification System (GMFCS) for cerebral palsy has been widely used internationally for clinical, research, and administrative purposes. This paper recounts the ideas and work behind the creation of the GMFCS, reports on the lessons learned, and identifies some philosophical challenges inherent in trying to develop an ordered, valid, and consistent system to describe function in children and adolescents with developmental differences. It is hoped that these ideas will be useful to others who choose to expand the field with additional systems in other areas of childhood neurodisability.

This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p less than 0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p less than 0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r[superscript 2]). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations.

The process of identification of children with delays or disorders in motor development includes developmental screening, examination, and reexamination. Throughout this process, various types of measures are used, including discriminative and evaluative measures. Discriminative and evaluative measures of motor development and function that are commonly used for preschool-aged children include the Bayley Scales of Infant Development II, Peabody Developmental Motor Scales, 2nd edition, Toddler and Infant Motor Evaluation, Pediatric Evaluation of Disability Inventory, and Gross Motor Function Measure. Selecting an appropriate measure is a crucial part of the examination process and should be geared toward the purpose of testing and characteristics of the child. Evidence of reliability and validity are important considerations for selection of a measure. (Contains 2 tables.)

Children with cerebral palsy frequently receive therapeutic intervention to remediate standing balance deficits. Evaluation of the impairments associated with poor balance could facilitate more effective treatment programs. This study evaluated the relationship between lower extremity force production, range of motion and standing balance in thirty-five children between the ages of 6 and 14 years of age with spastic cerebral palsy. Standing balance was evaluated using the Pediatric Clinical Test of Sensory Interaction (P-CTSIB). Hand-held dynamometry was used to assess force production and goniometry was used to assess range of motion. The results indicated that force production and range of motion are highly related to standing balance. Blocked, hierarchical multiple regression analysis revealed that force production explained 41% of the variance in P-CTSIB scores in this sample, while range of motion explained an additional 13%. Therefore, the total variance explained by these variables was 54%. Results of this study suggest that impairment level testing may allow the development of more effective individualized intervention programs to remediate balance deficits. Clinical suggestions are provided. (Contains 1 figure, 5 tables, and 1 note.)

Purpose: The purpose of this study was to examine the test-retest and inter-rater reliability of a measure of muscle extensibility developed by Tardieu, de la Tour, Bret, and Tardieu (1982) in fullterm and preterm newborns. Method: Twenty-one fullterm infants and twenty preterm infants were examined by two physical therapists. Each physical therapist measured A[subscript O] (shortened position of the muscle belly and lengthened tendon) and A[subscript Max] (maximum muscle belly and tendon length) of the gastrocnemius/soleus muscle twice in succession. Reliability was assessed using intraclass correlation coefficients (2,2) and (3,2). Results: Inter-rater reliability between the two examiners ranged from 0.86 to 0.97 and test-retest reliability on the two measures ranged from 0.91 to 0.98. Conclusions: The results suggest that this measure of muscle extensibility is reliable in the gastrocnemius/soleus muscle with fullterm and preterm newborns. Further research is needed to investigate if differences in muscle extensibility are present between fullterm and preterm infants and the relationship between muscle extensibility and active movement. (Contains 2 figures and 3 tables.)

This study examined changes in mobility methods of children with cerebral palsy (CP) over time and across environmental settings. Sixty-two children with CP, ages 6-14 years and classified as levels II-IV on the Gross Motor Function Classification System, were randomly selected from a larger data base and followed for three to four years. On each of several assessments, parents completed a questionnaire on their child's usual mobility methods in the home, school, and outdoors/community settings. During the first assessment interval, mobility methods increased to methods requiring more gross motor control. During the second assessment interval, mobility methods were unchanged or decreased to methods requiring less gross motor control. Changes within the child and within the environment are hypothesized to occur and to impact changes in mobility methods. Screening at regular intervals is recommended to monitor changes in mobility. Interventions to enhance mobility may be indicated during periods of change in the child or exposure to new environments. (Contains 2 figures and 5 tables.)

Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended. [ABSTRACT FROM AUTHOR]