An international clinical perspective on functioning and disability in adults with cerebral palsy.

BACKGROUND: This international, multi-center cross-sectional study is one of the preparatory studies in the development of the International Classification of Functioning, Disability and Health (ICF) Core Sets for adults with cerebral palsy (CP) to describe their functioning and health. OBJECTIVE: To identify the most common problems in functioning of adults with CP presenting in healthcare services, and facilitating and hindering environmental factors, using the ICF as a reference. METHODS: Participants were adults with CP who visited healthcare services in the Netherlands, Sweden, Thailand, and the United States. Structured interviews were performed using an adapted version of the generic ICF checklist 2.1a (106 categories) to rate the participant's functioning and the impact of environmental factors. Descriptive statistics were used for frequency analysis. RESULTS: In total, 101 participants were included, of whom 69 without intellectual disability (mean age ± SD of 38.4 ± 14.7 y; 85.5% with spastic type of CP; Gross Motor Function Classification System (GMFCS) levels I-V) and 32 with intellectual disability (mean age ± SD of 25.0 ± 6.4 y; 71.9% with spastic type of CP; GMFCS levels I-V). A total of 104 ICF categories in the ICF checklist were frequently present in adults with CP: 27 body functions, 4 body structures, 53 activities and participation, and 20 environmental factors. CONCLUSIONS: The most common problems of adults with CP presenting in healthcare services are diverse and highly prevalent. The study results add the clinical perspective on relevant categories of functioning to the basis for developing the ICF Core Sets for adults with CP.

Importance of peers and dating in the development of romantic relationships and sexual activity of young adults with cerebral palsy.

AIM: The aim of this study was to describe the peer group activities, romantic relationships, and sexual activity and their interrelations of young adults with cerebral palsy (CP). METHOD: A cross-sectional study was performed in 87 participants (51 males, 36 females; mean age 20 y 4 mo, SD 1 y 3 mo range age 18-22 y) without cognitive disabilities. Ninety-four per cent had spastic CP and 49% unilateral CP, while 78% were classified at Gross Motor Function Classification System level I and 84% at Manual Ability Classification System level I. Peer group activities, dating, romantic relationships, and sexual activity were assessed with an interview and questionnaire. Associations were analysed using logistic regression analyses. RESULTS: The study cohort reported having friends and participating in activities with peers; 71% had experience of dating, 23% had a current romantic relationship, and 38% had experience of intercourse. Young adults with CP had less experience in romantic and sexual relationships than an age-appropriate Dutch reference population. Peer group activities and dating favoured development of romantic relationships and sexual activity. Older age was associated with greater sexual activity. Motor functioning, education level, and gender did not correlate with romantic relationships or sexual activity. INTERPRETATION: Being involved in peer group activities and creating a context to arrange dates seems relevant for young adults with CP to develop romantic relationships and sexual activity.