Capacity to participation in cerebral palsy: evidence of an indirect path via performance
Kristie F Bjornson1, Chuan Zhou1, Richard Stevenson2
1Seattle Children's Research Institute, University of Washington, Seattle, WA.
Insights
Physical activity performance significantly mediates the link between capacity and participation in children with cerebral palsy. Interventions should focus on daily activities to improve real-world participation.
Area of Science:
- Pediatric rehabilitation
- Motor control and learning
- Child development
Background:
- Children with cerebral palsy (CP) often face challenges in participation.
- Understanding the factors influencing participation is crucial for effective interventions.
Purpose of the Study:
- To investigate if activity performance mediates the relationship between physical activity capacity and participation in children with CP.
- To explore the role of daily motor activities in bridging capacity and participation.
Main Methods:
- Secondary analysis of a prospective cross-sectional study.
- Participants: 128 children (aged 2-9 years) with CP (GMFCS levels I-III).
- Measures: Gross Motor Function Measure-66 (capacity), Activities Scale for Kids (performance), Assessment of Life Habits, Children's Assessment of Participation and Enjoyment, Assessment of Preschool Children's Participation (participation).
Main Results:
- Activity performance mediated 74.9% of the effect of capacity on total participation.
- Activity performance mediated 52.8% of the effect of capacity on diversity of participation.
- Statistical significance was established using regression equations and the Sobel z test (P<.001).
Conclusions:
- Daily motor activity performance significantly mediates the relationship between an ambulatory child with CP's capacity and their life participation.
- Interventions targeting daily functional activities, rather than just capacity, may enhance participation.
- Focusing on 'what children actually do' is key to improving participation outcomes.
Objective:
To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance.
Design:
Secondary analysis of a prospective cross-sectional study sample.
Setting:
Regional pediatric specialty care hospital.
Participants:
Children (N=128; 59% boys; age range, 2-9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity.
Interventions:
Not applicable.
Main Outcome Measures:
Activity capacity was measured with the Gross Motor Function Measure-66, performance was measured with the Activities Scale for Kids, and participation was measured with the Assessment of Life Habits. Children's Assessment of Participation and Enjoyment and the Assessment of Preschool Children's Participation assessed diversity participation. Regression equations and Sobel z test were used to examine the mediated effect via performance.
Results:
Physical activity performance mediates 74.9% (β=.83, P<.001) of the effect of activity capacity on total participation levels and 52.8% (β=.47, P=.001) of the effect of capacity on diversity participation.
Conclusions:
The relation between what an ambulatory child with cerebral palsy is able to perform in a clinical setting and their participation in life is significantly mediated by what they actually do motorically in day-to-day life. Results suggest that interventions focusing on improving what they actually do every day, regardless of their capacity to perform (what they can do when tested), may positively influence participation.
