Personal assistance, adaptations and participation in students with cerebral palsy mainstreamed in elementary schools

The aims of this study were to examine differences in level of participation of students with CP in full inclusion (FI group) as compared to self-contained classes (SC group), differences in the task supports provided for these two groups, the interrelationships between assistance and adaptation provided and the differential impact of physical task supports vs. cognitive/behavioural task supports on participation.

148 elementary school students were divided into two groups: 100 fully included (FI) students with CP, and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles.

Statistically significant differences (p < 0.0001) were found between the two groups on all scales (physical and cognitive/behavioural assistance and adaptations). Supports provided to the SC group were significantly greater than to the FI group and physical task supports provided to both groups were significantly greater than cognitive/behavioural supports. Pearson correlations and Smallest Space Analyses (SSA) revealed significant (p < 0.01) moderate to strong correlations (0.57 > r < 0.77) between all four task supports, and between provided task supports and participation (0.66 > r < 0.82).

This study's focus enhances our understanding of the impact of task supports to the various factors contributing to the dimensions of the ICF, as well as their interrelationship with participation. Devises and cognitive and behavioural adaptations are required in a wider manner in addition or alternative to physical assistance by adults if we are to increase the chance of students with severe CP to become participatory for academic and social tasks required in school.