SummaryBackground Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that infl uence it, and how it compares with QoL of the general population.

This study shows that the factors associated with disagreement are different according to the direction of disagreement. In particular, parental well-being and child pain should be taken into account in the interpretation of parent proxy reports, especially when no child self-report of quality of life is available. In the latter cases, it may be advisable to obtain additional proxy reports (from caregivers, teachers, or clinicians) to obtain complementary information on the child's quality of life.

Objectives To evaluate how involvement in life situations (participation) in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation.Design Cross sectional study. Trained interviewers visited parents of children with cerebral palsy; multilevel multivariable regression related participation to impairments, pain, and sociodemographic characteristics.Setting Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.Participants 1174 children aged 8-12 with cerebral palsy randomly selected from the population registers, 743 (63%) joined in the study; the further region recruited 75 children.Main outcome measure Children’s participation assessed by the Life-H questionnaire covering 10 main areas of daily life. Scoring ignored adaptations or assistance required for participation.Results Children with pain and those with more severely impaired walking, fine motor skills, communication, and intellectual abilities had lower participation across most domains. Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains, but the sociodemographic factors examined were not. Impairment and pain accounted for up to a sixth of the variation in participation. Participation on all domains varied substantially between regions: children in east Denmark had consistently higher participation than children in other regions. For most participation domains, about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals.Conclusions Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect. Pain should be carefully assessed. Some European countries facilitate participation better than others, implying some countries could make better provision. Legislation and regulation should be directed to ensuring this happens.

A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.

The parent-reported quality of life for children with cerebral palsy is associated strongly with impairment. However, depending on the areas of life, the most severely impaired children (in terms of motor functioning or intellectual ability) do not always have the poorest quality of life.

No abstract

The prevalence of dyskinetic cerebral palsy appears to have increased in children with a normal birth weight. They have frequently experienced perinatal adverse events. Most children have a severe motor impairment and several accompanying impairments.

Objective-To evaluate how participation of children with cerebral palsy (CP) varied with their environment. Design-Home visits to children. Administration of Assessment of Life Habits and EuropeanChild Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child's impairments and pain. Setting-European regions with population-based registries of children with CP.Participants-Children (n=1174) aged 8 to 12 years were randomly selected from 8 populationbased registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study. Interventions-Not applicable.Main Outcome Measure-Participation in life situations.Results-For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities -mealtimes, health hygiene, personal care, and home life-was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School © 2012 by the American Congress of Rehabilitation Medicine Reprint requests to Allan Colver, MD, Sir James Spence Building, Newcastle University, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, UK, allan.colver@ncl.ac.uk.. Presented to the European Academy of Childhood Disability, May 16-19, 2012, Istanbul, Turkey. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Two United Nations (UN) conventions emphasize the importance of participation: Article 23 of the UN Convention on the Rights of the Child 3 states that "a mentally or physically disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child's active participation in the community"; Article 9 of the UN Convention on the Rights of Persons with Disabilities 4 asserts the obligation of states "to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, transportation, information and communications." Europe PMC Funders GroupIf resources are to be directed to implementing these UN resolutions, governments need evidence from large quantitative studies of children about whether environmental adjustments do promote participation of disabled children. There is little such evidence, a recent systematic review 5 finding only 4 small quantitative studies on the relationship of children's participation to their environment.The Study of PARti...