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Lisa Chiarello, PT, PhD, PCS Drexel University & Shriners Hospital for Children, Philadelphia, PA, USA

Drexel University

Physical Therapy and Rehabilitation Sciences Philadelphia, PA, USA

Why is participation in recreation & leisure important for young children?

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85 young children with cerebral palsy, mean age 4 years (range 2 to < 6 years of age) Parents participated in a structured interview (Canadian Occupational Performance Measure) –! 313 priorities identified –! 70% of the priorities in daily activity –! 8% in productivity –! 22% in leisure

Daily Activities Self-care Mobility Communication Other Productivity Household School Community Other Leisure Socialization Community entertainment Quiet recreation Physical recreation Other 42% 17% 4% 7% 1% 5% 1% 1% 6% 1% 4% 11% 0% Image from: Livestrong.com .

Challenges in Measuring Participation .

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Functional skills Caregiver Assistance Modifications (Ostensjo. 2003) . p. & Vollestad. 606. Carlberg.

motivation . 2003) !! !! Social-emotional status Interest.79 (Ostensjo. et al. 2007) (Forsyth et Motor ability –! PEDI mobility & social function r=.. Body Function & Structure. and Personal Attributes !! !! !! !! What influences participation in young children with CP? Age: Explained 6% of variance (Ostensjo. Activity. et al. 2003) Gender Health status: Significant predictor of participation al. 2003) –! GMFCS explained 48% of variance (Ostensjo.. et al.... et al. 2003) !! Intellectual and communication ability –! Learning problems explained 9% of variance (Ostensjo.ASPECTS of the CHILD: Health.

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and gross motor function on intensity of participation 3) Identify child. family. and service determinants of participation .1) Describe participation of young children with cerebral palsy 2) Determine effects of gender. age.

leisure & recreation Environmental: Family relationships Family interests Services Personal: Age Motivation Adaptability . 2001) Body Functions & Structures: Activities: Motor abilities Participation: Play.The Components of the ICF Model Health Condition: Cerebral Palsy (WHO.

1 to 5.5 years (SD=.Participants !! 85 young children with cerebral palsy –! Age: 3.3) –! 57% greater than high school education .9 years.8) –! 50 boys. 35 girls –! 71% white !! Parents completed the Assessment of Preschool Children’s Participation –! 88% mothers –! Mean age 34 years (SD=9. mean = 4.

Primary Outcome !! Amount of participation: The Assessment of Preschool Children’s Participation Child factors !! Gross motor function: Gross Motor Function Classification System (GMFCS) !! Physical activities: Pediatric Outcomes Data Collection Instrument (PODCI) –! Upper Extremity and Physical Function –! Transfers and Basic Mobility –! Sports/ Physical Functioning !! Age !! Adaptive behavior: Coping Inventory Measures .

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“going to a party” .!! !! !! !! 45 items Participate: Yes or No and How often Overall diversity and intensity score Types of Activity Scores –! Play: e.g.g. “riding a bicycle” –! Social: e.g.g. “helping around the house” –! Physical: e. “doing pretend play” –! Skill development: e.

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)!-. transported outdoors! Level V Self mobility severely limited! .&)-(/0+1&! walking aid! Walks with a walking aid! "#$%&!'()*+.Gross Motor Function Classification System (GMFCS) (Palisano et al.)!#!'#$%(12!#(3! Level III Walks short distances with a "#$%&!'()*!#!'#$%(12!#(3! walking aid! Level IV Self mobility is limited within a room. 2008) Children 2 to 4 years Level I Level II Children 4 to 6 years Moves by walking without a "#$%&!'()*+.

e. 1998) !! !! !! Health and physical functioning: 6 domains Completed by parents How easy or hard for you to: –! Upper Extremity / Physical Function (8 items).g. & Goldberg. e. “get on or off a toilet or chair” –! Sports/ Physical Function (12 items).g.Pediatric Outcomes Data Collection Instrument (PODCI) (Daltroy. “write with a pencil” –! Transfers and Basic Mobility (11 items) . Liang.e. i. Fossel. “run a short distance” .

Coping Inventory (Zeitlin. 5= the behavior is effective most of time . 1985) !! !! !! Adaptive behaviors: behaviors to meet personal needs and to respond to and interact with the physical and social environment 48 items Self and Environment –! Productive: degree that behaviors achieve what a child wants !! “Child applies what he or she has learned to a new situation” –! Active: degree of initiation and persistence !! “Child stays with a task until it is completed” –! Flexible: degree of adaptability !! “Child can shift plans or change behavior to achieve a goal” !! 5-point Likert scale: 1= the behavior is not effective.

2002) . “Learning about new & different things is very important in our family” –! Active-recreational orientation: e.g. “Activities in our family are pretty carefully planned” –! Intellectual-cultural orientation: e.g.g. “Everyone in our family has a hobby or two” Family Environment Scale (FES) (Moos & Moos. “Family members really help & support one another” –! Conflict: e. personal growth.g.g. “We fight a lot in our family” –! Organization: e.!! !! !! !! 90 items True / False Relationships. and system maintenance 10 subscales –! Cohesion: e.

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4 and 5 years) and GMFCS Level groups (I. family. II/III and IV/V) !! Mann-Whitney U test –! Gender differences –! Post-hoc multiple comparison tests for effect of age and GMFCS levels !! Stepwise multiple regression analysis –! Identify child. and service determinants .Statistical Analysis !! Kruskal-Wallis test –! The effects of age (3.

Results: What does participation look like? !! Children participated in an average of 26 (60%) of the 45 activities [children without disabilities: 74%] –! Individual children doing between 2 (4%) and 39 (87%) of the activities –! Types !! 74% of play activities !! 58% of social activities –! 5-6 year old children doing > # than children 3-4 years of age !! 56% of skill development activities of active physical activities –! Children in GMFCS level I doing > # than children GMFCS level IV/V !! 52% .

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Move and PLAY study Patterns for Participation .

IV.02 Children level I > participation than levels III. & V Children level V < participation & enjoyment than all other levels .Results: Effect of Gross Motor Function on Intensity of Participation * * p = .

Results: Effect of Gender and Age on Intensity of Participation .

429 children 18 months – 5 years of age !! Older children (often) had higher frequency of participation than youngest children (once in awhile) !! .

63 . and service factors were not related to intensity of participation .36 .Results: Relationships of Child.39 Child age. family factors.42 . Family. and Service Factors with Participation Factor GMFCS level Adaptive Behavior Index Upper Extremity and Physical Function Transfers and Basic Mobility Sports/ Physical Functioning Correlation Coefficient -.45 .

Results: Determinants of Intensity of Participation Consistent findings for child factors: Adaptive behavior and gross motor function explained 39% of the variance in frequency of participation .

Implications for Practice Build on child’s interests and preferences •! Assess and focus on family priorities •! PTs have an important role in identifying child priorities and promoting desired participation in leisure and recreational activities .

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Case Example: Outcomes Sara Age GMFCS level Preschool CAPE Diversity Intensity 21 2.5 6 IV Andrew 6 IV 30 3.2 .

2 59 49 53 58 53 2 Less than HS $15.Case Example: Child and Family Factors Sara Transfers / Basic Mobility UE Function Sports / Physical Function Adaptive Behavior Cohesion Conflict Organization Intellectual Cultural Orientation Active Recreation Orientation # children in household Parent Education Family Income 21 38 24 2.999 .000-29.7 38 70 53 41 59 3 Bachelor’s degree $15.000-29.999 Andrew 36 38 11 3.

What can we do to support Sara and Andrew ? !! Can we influence children’s adaptive behavior? .

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Key References .