Environmental settings and families' socioeconomic status influence mobility and the use of mobility devices by children with cerebral palsy

Cury, Valéria C. R.; Figueiredo, Priscilla R. P.; Mancini, Marisa Cotta

doi:10.1590/s0004-282x2013005000003

Cited by 13 publications

(9 citation statements)

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“…Two retrospective population‐based studies in the USA have explored the possible relationship between race and risk of CP and found that the risk of CP was higher among black children than white children; a similar association was found for risk of severe CP, as determined by the GMFCS level. A recent study in Brazil showed that SES influences functional mobility and the use of assistive mobility devices in children with CP …”

Section: Discussionmentioning

confidence: 99%

“…At an individual level, maternal SES is recognized as a robust predictor of child health . Studies to date suggest that children with CP, born to disadvantaged families, have more severe phenotypes as defined by spastic quadriparesis, poor mobility, and cognitive impairment . We hypothesize that, beyond individual‐level SES factors, socio‐economic indicators related to families' areas of residence may also affect CP outcomes, with areas associated with chronic exposure to socio‐economic stressors (e.g.…”

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confidence: 99%

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Variation in cerebral palsy profile by socio‐economic status

Oskoui

Messerlian

Blair

et al. 2015

Develop Med Child Neuro

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DAGDirected acyclic graph MACS Manual Ability Classification System REPACQ Registre de la Paralyse C er ebrale de Qu ebec SES Socio-economic status AIM Socio-economic differences in maternal and child health are well recognized, but the role of individual-level and area-level determinants in cerebral palsy (CP) phenotypes is debated. We set out to examine (1) the association between area-level and individual-level measures of socio-economic deprivation and CP phenotype among children, including subtype, severity, and comorbidities; and (2) the direct effect of area-level deprivation not mediated through individual-level deprivation.METHOD Regional data from a provincial CP register were analyzed. The outcome of interest was CP phenotype. The area-level exposure was measured using the Pampalon Deprivation Index. Individual-level socio-economic status (SES) was determined using maternal education. We conducted multiple regression models, stratified by preterm birth, controlling for key covariates, and a mediation analysis of area-level deprivation on the association between individual SES and CP phenotype.RESULTS A socio-economic gradient in mobility was seen in our cohort, above and beyond differences in maternal and perinatal factors. The added direct effect of area-level deprivation was seen only in children whose mothers were educated to a higher level, suggesting no additional contribution of area-level deprivation in children of mothers with a lower level of education.INTERPRETATION Contextual socio-economic factors can impact the severity of CP. These findings indicate important areas for potential community-level or area-level public health intervention (i.e. neighborhood reinvestment, preventive measures), and suggest that neighborhood-level research in maternal and perinatal health should continue to be pursued.Cerebral palsy (CP) is one of the most common motor disabilities in childhood, affecting approximately 2 per 1000 children, creating an important health burden for affected children, their families, and their communities. 1 Biological risk factors for CP include placental abnormalities, major and minor birth defects, and preterm delivery. 2 Beyond these, few studies have examined the social determinants of CP. A recent systematic review 3 found an association between area-level and, to a lesser degree, individual-level socio-economic status (SES) and risk of CP. Socio-economic differences in maternal and child health are well recognized, 4 but their role in CP remains debated. It is unclear if the distribution of CP cases and case severity is associated with environmental exposures.We hypothesize that there exist both individual-level and area-level socio-economic determinants of CP severity. At an individual level, maternal SES is recognized as a robust predictor of child health. 5,6 Studies to date suggest that children with CP, born to disadvantaged families, have more severe phenotypes as defined by spastic quadriparesis, 7 poor mobility, 8-10 and cognitive impairment. 7 We hypothesize that, b...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Variation in cerebral palsy profile by socio‐economic status

Oskoui

Messerlian

Blair

et al. 2015

Develop Med Child Neuro

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“…Children with similar types of cerebral palsy (CP) living in places with facilitating disability services and structures have been found to have higher participation scores 7 . Furthermore, children with CP with the same motor function classification showed different patterns of mobility in different contexts 6 . Parents perceived factors such as lack of social support, negative attitudes, and inadequate physical environment as barriers to the participation of their children in school 10 .…”

Section: Introductionmentioning

confidence: 99%

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

Furtado¹,

Sampaio²,

Kirkwood³

et al. 2015

Braz. J. Phys. Ther.

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BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

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“…Rodby-Bousquet e Hagglund 15 destacam que quase um terço das crianças com paralisia cerebral é dependente de equipamentos para a locomoção. Cury, Figueiredo e Mancini 16 explicitam que crianças e adolescentes com paralisia cerebral rotineiramente precisam de equipamento de assistência e treino para mobilidade funcional, definido de acordo com as habilidades do usuário e com o ambiente em que a mobilidade irá ser desempenhada. Uma cadeira de rodas pode prover deslocamento, permitindo envolvimento em tarefas desejadas e/ou necessárias ao longo de um dia, ampliando a oportunidade de envolvimento em atividades e na participação.…”

Section: Discussionunclassified

Percepção dos responsáveis de crianças e adolescentes sobre prescrição da cadeira de rodas e satisfação com o equipamento.

Souza

Borges

Magalhães

et al. 2018

Rev. Ter. Ocup. Univ. São Paulo (Online)

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Objetivo: Investigar a percepção dos pais/responsáveis sobre o motivo da solicitação de cadeira de rodas para suas crianças/adolescentes e descrever se existe conforto ou desconforto deles na cadeira, assim como os itens de satisfação ou não no equipamento concedido em um serviço de concessão no município de Uberaba, MG. Métodos: Participaram do estudo 29 crianças/adolescentes com faixa etária mínima de três anos e máxima de 17. Para a coleta dos dados foram aplicados um instrumento estruturado e um roteiro de entrevista. Resultados: A idade média dos participantes foi de 10,03 anos, com predomínio de crianças. O diagnóstico clínico que prevaleceu foi paralisia cerebral. Os resultados mostraram que o motivo da solicitação de prescrição da cadeira de rodas foi mobilidade (46,7%). 86,2% dos pais/responsáveis apontaram perceber desconforto da criança/adolescente durante o uso da cadeira de rodas. Uma maioria declarou estar satisfeito com à mobilidade que a cadeira fornece, e se dizem insatisfeitos com os acessórios (cinto, sistema de sentar, opção de reclínio, dentre outros) da cadeira de rodas. Conclusões: Frente aos apontamentos de desconforto e insatisfação conclui-se que é importante rever o processo de prescrição da cadeira de rodas no serviço de concessão estudado e o acompanhamento das crianças/adolescentes de forma mais próxima, melhorando o serviço de prescrição e seleção dos equipamentos.

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Environmental settings and families' socioeconomic status influence mobility and the use of mobility devices by children with cerebral palsy

Cited by 13 publications

References 11 publications

Variation in cerebral palsy profile by socio‐economic status

Variation in cerebral palsy profile by socio‐economic status

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

Percepção dos responsáveis de crianças e adolescentes sobre prescrição da cadeira de rodas e satisfação com o equipamento.

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