Identification and description of environmental factors that influence participation of children with cerebral palsy

TLDR

Physical, social, and attitudinal environments can restrict participation in children with cerebral palsy, and while some instruments exist, most are adult‑focused with few child‑specific tools. The study aims to identify and describe environmental determinants of participation for children with cerebral palsy and proposes methods for their measurement. The authors conducted a critical review of WHO literature, searched electronic databases, and consulted specialists to locate unpublished and grey literature on environmental factors. Children with CP and their parents identified psychosocial pressures, financial difficulties, inadequate public services, building structure, loss of income, and equipment provision as key barriers and facilitators influencing participation.

Abstract

Physical, social, and attitudinal environment may restrict participation in children with cerebral palsy (CP). Here we discuss existing/possible approaches in order to identify and describe this environment. We used a critical review of evidence from the World Health Organization Literature Review on Environmental Factors; a search of electronic databases; and talked to specialists in order to find unpublished papers and‘grey’literature. Both children with disabilities and their parents identified a range of barrier and facilitator factors. These included psychosocial pressures (family, school), financial difficulties, and inadequate public services. Observational studies suggest that building structure, loss of income, and provision of specific equipment have a direct impact on levels of child participation. Some available instruments attempt to capture environmental factors by client survey or objective measurement; most relate to adult contexts, but there are a few child‐specific instruments for surveying attitudes of children to peers with disabilities and for observation of the school environment. Defining and measuring potential environmental determinants of participation for children with CP needs further development; and here we propose how this might be done.