Capacity to Participation in Cerebral Palsy: Evidence of an Indirect Path Via Performance

Abstract

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.

Walking activity patterns in youth with cerebral palsy and youth developing typically

“…New literature has documented that the relationship of what a child is “able” to perform in a clinic setting and their participation in life is significantly mediated by what they physically “actually” do each day in ambulatory children with CP [21]. These results suggest that participation in day-to-day life maybe positively influenced by interventions focusing on improving what they actually do every day regardless of capacity to perform.…”

Characteristics associated with physical activity capacity and performance in children and adolescents with an acquired brain injury

“…Capacity refers to an individual's ability to execute a task or action in a standardized environment [2]. Performance describes the individual's execution of a task or action in the natural environment [2]. Knowledge of the factors that influence physical activity capacity and performance may allow therapists to develop more effective physiotherapy interventions for children with an ABI.…”

“…Activity outcomes can be divided into capacity and performance qualifiers. Capacity refers to an individual's ability to execute a task or action in a standardized environment [2]. Performance describes the individual's execution of a task or action in the natural environment [2].…”

Relationship between habitual physical activity, gross motor function, community mobility and quality of life in 4-5 year old children with cerebral palsy

“…The results of this systematic review confirmed that HPA was directly associated with motor capacity in children with CP aged 2-17 years. A metaanalysis could not be performed in this study because the HPA measurements across studies included both subjective 15,[68][69][70] and objective measures. 14,[30][31][32][33][34] The objective HPA measurements were the StepWatch® 14, 30-33 and the ActiGraph®.…”

“…15,69,70 Additionally, three studies recruited children with CP from 2 years of age, but only ambulant children (GMFCS I-III) were observed. 32,33,68 No study investigated HPA using objective measurements in all functional abilities of children with CP. In addition, data on HPA in non-ambulant children with CP is not available.…”