Children and youth with cerebral palsy (CP) experience difficulties in their ability to move, problem solve, socialize, and communicate, associated with limitations in activities in all environments. They are at risk for lower participation in social and leisure activities critical in fostering friendships, developing interests, and promoting well-being. Little is known about involvement in leisure activities and their determinants. This systematic review aims to describe participation in leisure activities by children with CP and identify personal and environmental factors that influence participation. The following databases were reviewed--CINAHL, Medline, Cochrane, Web of Science, OT-seeker, and REHABDATA--using the keywords participation, cerebral palsy, leisure, and recreation. The literature to date suggests that children with physical disabilities are less involved in leisure activities than their peers; activities are more passive, home based, and lack variety. Several factors influence participation in leisure activities, including age, gender, activity limitations, family preferences and coping, motivation, and environmental resources and supports.

There is a great interest in rehabilitation to engage stakeholders in the research process. However, further evidence is needed to identify effective strategies for meaningful stakeholder engagement that leads to more useful research that positively impacts practice. Implications for Rehabilitation Using several strategies to engage various stakeholders throughout the research process is thought to increase the quality of the research and the rehabilitation process by developing proposals and programs responding better to their needs. Engagement strategies need to be better reported and evaluated in the literature. Engagement facilitate uptake of research findings by increasing stakeholders' awareness of the evidence, the resources available and their own ability to act upon a situation. Factors influencing opportunities for stakeholder engagement need to be better understood.

The use of thematic analysis enabled the synthesis of findings from quantitative, qualitative, and mixed methods study designs. Participating in both naturally occurring, spontaneous forms of leisure activities and participating in more structured types of leisure and therapeutic programs that focus on leisure contribute to improving the QoL of children with neurodevelopmental disabilities. A key aspect to consider is the child's ability to participate in his/her preferred leisure activities. Environmental adaptations may be required to ensure that the leisure opportunities meet the children's capabilities and contribute positively to their QoL.

Health care providers should take into consideration what adolescents with CP value the most. The identification of attributes that can be modified such as accessibility to and competence in, and preference for different activities may help professionals to advocate for greater participation in these activities and tailor individual therapeutic strategies accordingly, increasing the likelihood of enhancing the quality of life of this population.

Aim To describe the pattern of use of rehabilitation services in children and adolescents with cerebral palsy (CP), and to identify factors associated with use. Methods In this study, parents of 91 school-age children and 167 adolescents with CP completed a questionnaire regarding educational and rehabilitation resources received within the last 6 months. Rehabilitation services included occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology and special education. Demographic characteristics were documented and developmental and functional status was assessed. Relationships between service utilization and sociodemographic factors, functioning and school setting were determined. Results Over half of children (53.2%) and adolescents (57.5%) were in regular schools; however, 41% of these required special education resources. The remainder (42.5-46.8%) was in special schools. The majority of children (84.6%) were receiving at least one rehabilitation service although this decreased (68.1%) in adolescence. PT and OT were most common and services were provided predominantly in the school setting. Services were primarily weekly direct interventions at school age, with weekly interventions or consultations most common for adolescents. Younger age was associated with service receipt at school age only. Children with greater motor limitations, lower IQ and greater activity limitations were more likely to receive OT, PT, SLP or special education. Children in segregated schools were significantly more likely to receive rehabilitation services, when compared with children in regular schools. Conclusions The majority of children and youth received one or more services. Individuals with greater motor or cognitive challenges were more likely to receive a range of school-based services from rehabilitation specialists. When compared with children of school age, adolescents were less likely to receive services and when provided, services were more likely to be consultative. Services may need to be more optimally organized through childhood to enhance benefits to children with CP across activity limitation profiles.

AIM The objective was to describe leisure activity preferences of children with cerebral palsy (CP) and their relationship to participation. Factors associated with greater interest in leisure activities were identified.METHOD Fifty-five school-aged children (36 males, 19 females; mean age 9y 11mo; range 6y 1mo-12y 11mo) with CP (Gross Motor Function Classification System [GMFCS]) level I 62%, level II 22%, level III-IV 16%; 33.3% hemiplegia, 29.6% diplegia, 25.9% quadriplegia, 11.2% other) who could complete the Preferences for Activities of Children (PAC) were recruited.RESULTS Social and recreational activities were most preferred, and self-improvement activities were least preferred. Younger age, higher motivation, and IQ predicted interest in active-physical activities (r 2 =0.39). Negative reaction to failure was associated with less preference for social activities (r 2 =0.16), whereas increased prosocial behaviours were related to greater preference for recreational (r 2 =0.13) and self-improvement activities; the latter is also predicted by older age (r 2 =0.24). Interest in skill-based activities was greater in females and in children who were highly motivated, younger, and had greater motor limitations (r 2 =0.51). The findings suggest that personal factors and functional abilities influence leisure activity preferences. High preference for certain activities was not always associated with involvement in these activities.INTERPRETATION Determination of preferences is inherent to child-centred practice and should, therefore, be part of the evaluation process. Rehabilitation strategies can minimize barriers to leisure participation, such as fear of failure, low motivation, or environmental obstacles.Cerebral palsy (CP) is a disorder of movement and posture causing activity limitations arising from a lesion or abnormality of the immature brain.1,2 Rehabilitation is primarily directed at minimizing motor impairments and maximizing functional independence. Recently, there has been greater emphasis on promoting participation; however, while remediation and adaptive strategies to diminish limitations in mobility and self-care are well established, targeted interventions to promote participation in leisure activities are less well developed.Participation is defined by the World Health Organization as taking part or being involved in life situations. Specifically, everyday activities within particular domains are grouped into life habits, such as mobility, communication, or self-care. Evaluation tools typically include a range of these activities, which are then combined to represent participation in these related activities. Participation is a concept that is receiving considerable attention, particularly with the adoption and usage of the International Classification of Functioning, Disability, and Health. 3 The level of participation in life roles is probably modified by health condition, functional limitations, and personal and environmental factors. 4 Leisure is regarded as the time designated for free...

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