Association Between Participation in Life Situations of Children With Cerebral Palsy and Their Physical, Social, and Attitudinal Environment: A Cross-Sectional Multicenter European Study

Abstract

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...

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