Development of a direct observation Measure of Environmental Qualities of Activity Settings.

AIM: The aim of this study was to develop an observer-rated measure of aesthetic, physical, social, and opportunity-related qualities of leisure activity settings for young people (with or without disabilities). METHOD: Eighty questionnaires were completed by sets of raters who independently rated 22 community/home activity settings. The scales of the 32-item Measure of Environmental Qualities of Activity Settings (MEQAS; Opportunities for Social Activities, Opportunities for Physical Activities, Pleasant Physical Environment, Opportunities for Choice, Opportunities for Personal Growth, and Opportunities to Interact with Adults) were determined using principal components analyses. Test-retest reliability was determined for eight activity settings, rated twice (4-6wk interval) by a trained rater. RESULTS: The factor structure accounted for 80% of the variance. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy was 0.73. Cronbach's alphas for the scales ranged from 0.76 to 0.96, and interrater reliabilities (ICCs) ranged from 0.60 to 0.93. Test-retest reliabilities ranged from 0.70 to 0.90. INTERPRETATION: Results suggest that the MEQAS has a sound factor structure and preliminary evidence of internal consistency, interrater, and test-retest reliability. The MEQAS is the first observer-completed measure of environmental qualities of activity settings. The MEQAS allows researchers to assess comprehensively qualities and affordances of activity settings, and can be used to design and assess environmental qualities of programs for young people.

Psychosocial determinants of out of school activity participation for children with and without physical disabilities.

Psychosocial determinants of children's out of school participation were examined, using secondary analyses of data from 427 children with physical disabilities (from 12 service locations in Ontario Canada) and 354 children without disabilities, ages 6 to 14. For both groups of children, hierarchical regression analyses indicated that psychosocial variables added significant incremental variance (6% to 14%) to the prediction of active physical intensity and social activity enjoyment, beyond that accounted for by family income, child age and sex, and physical functioning. As well, there were significant psychosocial determinants, with medium to large effect sizes. Athletic competence and hyperactivity had specific effects on active physical activities and social activities, respectively, for both groups of children. Disability-specific determinants included social acceptance, emotional functioning, and peer difficulties (only significant for children with disabilities). It was concluded that psychosocial variables play an important role in children's enjoyment and intensity of participation in leisure activities.

The assessment of preschool children's participation: internal consistency and construct validity.

Participation in activities provides the means for young children to learn, play, develop skills, and develop a sense of personal identity. The Assessment of Preschool Children's Participation (APCP) is a newly developed measure to capture the participation of children aged 2 to 5 years and 11 months in the areas of play, skill development, active physical recreation, and social activities. Data from a clinical trial involving 120 children with cerebral palsy indicated that the APCP has moderate to very good internal consistency. The measure distinguishes between children below or above 4 years of age across levels of the Gross Motor Classification System, and between income levels below or above the median regional income range. The APCP, with a focus on preschool children, has potential use for assessment and identification of activity areas in which the child is participating and areas in which participation may be restricted.

Predictors of Change Over Time in the Activity Participation of Children and Youth with Physical Disabilities.

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children/youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on three occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in five types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity, and vary as a function of children's sex and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention.

Children with disabilities' perceptions of activity participation and environments: a pilot study.

BACKGROUND: Children with disabilities are particularly vulnerable to participation restrictions resulting from the interactions between children and their physical and social environments. PURPOSE: The purpose of this study was to gain a better understanding of how children with disabilities view their participation in out-of-school-time (OST) activities in a range of environmental settings. METHODS: A case-study design was used to examine six children's views on their OST activities using the Children's Assessment of Participation and Enjoyment (CAPE), photographs of their OST activity settings, and semi-structured interviews. FINDINGS: CAPE results indicated that the children participated most often in recreational activities. Through the use of photographs and interviews, four major themes emerged that emphasized a deep interconnection between childhood activities and settings. IMPLICATIONS: This unique pilot study contributes to developing an understanding for occupational therapists about how children with disabilities view their participation, their activity environments, and how photographs can be used to engage children in research.

Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities.

OBJECTIVE: To comprehensively describe parent perceptions of environmental barriers to recreational, community, and school participation for children with physical disabilities. DESIGN: Secondary analysis of cross-sectional data gathered in the first wave of a longitudinal study of the child, family, and environmental factors affecting the recreational and leisure participation of school-age children with physical disabilities. SETTING: General community. PARTICIPANTS: Parent-child pairs (N=427). Child participants included 229 boys and 198 girls with physical disabilities in 3 age cohorts (6-8, 9-11, 12-14 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Craig Hospital Inventory of Environmental Factors. RESULTS: Barriers to participation were encountered in school and work environments (1.54+/-1.88), physical and built environments (1.36+/-1.35), within institutional and government policies (1.24+/-1.71), services and assistance (1.02+/-1.2), and attitudes and social support (.87+/-1.17). Age, socioeconomic status, level of physical functioning, and behavioral difficulties were related to the impact of barriers reported in certain areas. No significant differences by the sex of the children or rural versus urban community were found. CONCLUSIONS: Parents report environmental barriers in several areas, providing valuable information about the environmental factors that support or hinder participation while showing the complexity of these issues. Future research is required to further identify potential avenues for intervention.

Focus on Function - a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy.

BACKGROUND: Children with cerebral palsy receive a variety of long-term physical and occupational therapy interventions to facilitate development and to enhance functional independence in movement, self-care, play, school activities and leisure. Considerable human and financial resources are directed at the "intervention" of the problems of cerebral palsy, although the available evidence supporting current interventions is inconclusive. A considerable degree of uncertainty remains about the appropriate therapeutic approaches to manage the habilitation of children with cerebral palsy. The primary objective of this project is to conduct a multi-site randomized clinical trial to evaluate the efficacy of a task/context-focused approach compared to a child-focused remediation approach in improving performance of functional tasks and mobility, increasing participation in everyday activities, and improving quality of life in children 12 months to 5 years of age who have cerebral palsy. METHOD/DESIGN: A multi-centred randomized controlled trial research design will be used. Children will be recruited from a representative sample of children attending publicly-funded regional children's rehabilitation centers serving children with disabilities in Ontario and Alberta in Canada. Target sample size is 220 children with cerebral palsy aged 12 months to 5 years at recruitment date. Therapists are randomly assigned to deliver either a context-focused approach or a child-focused approach. Children follow their therapist into their treatment arm. Outcomes will be evaluated at baseline, after 6 months of treatment and at a 3-month follow-up period. Outcomes represent the components of the International Classification of Functioning, Disability and Health, including body function and structure (range of motion), activities (performance of functional tasks, motor function), participation (involvement in formal and informal activities), and environment (parent perceptions of care, parental empowerment). DISCUSSION: This paper presents the background information, design and protocol for a randomized controlled trial comparing a task/context-focused approach to a child-focused remediation approach in improving functional outcomes for young children with cerebral palsy. TRIAL REGISTRATION: [clinical trial registration #: NCT00469872].