Younger Children with Cerebral Palsy Respond Better Than Older Ones to Therapist-Based Constraint-Induced Therapy at Home on Functional Outcomes and Motor Control.

AIMS: To examine the differences in efficacy of home-based constraint-induced therapy (CIT) on functional outcomes and motor control in two age groups of children with cerebral palsy (CP). METHODS: Twenty-three children with spastic unilateral CP receiving 4-week home-based CIT by a therapist were divided into younger (6-8 years; n = 11) and older (9-12 years; n = 12) groups. The home-based CIT involved intensive functional training of the more affected upper-limb while restraining the less affected upper-limb. The outcome measures were Peabody Developmental Motor Scale-2nd edition (PDMS-2) that was being used in a modified way, Functional Independence Measure for Children (WeeFIM), and reach-to-grasp kinematic parameters, including reaction time (RT), normalized movement time (MT), normalized movement units (MUs), peak velocity (PV), and maximum grip aperture (MGA). The outcome measures were assessed at baseline, 4-weeks (post-treatment), 3- and 6-months (follow-up). RESULTS: The younger group showed greater changes in visual motor integration skills and RT at all post-tests after intervention than the older group. Groups had comparable changes on any other measures. CONCLUSIONS: Younger children with CP responded better to home-based CIT on some areas of upper-limb functions and reach-to-grasp motor control strategies than older children.

Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: immediate and long-term effects.

OBJECTIVE: To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP). DESIGN: Randomized controlled trial. SETTING: Home based. PARTICIPANTS: Children with unilateral CP (N=45; aged 6-12 y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22). INTERVENTIONS: Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training. MAIN OUTCOME MEASURES: All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM). RESULTS: The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group. CONCLUSIONS: The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.

Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study.

OBJECTIVE: To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy. DESIGN: A single-blinded, randomized controlled trial. SUBJECTS: Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6-12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23). INTERVENTIONS: Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5-4 hours/day, two days a week for four weeks. MAIN MEASURES: Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity. RESULTS: There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition - Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P < 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P < 0.001) and shorter reaction time, normalized movement time (P < 0.001) and higher peak velocity (P = 0.004) of reaching movement. CONCLUSIONS: Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Initial evaluation of an environment-based intervention for participation of autistic children: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. MATERIALS AND METHODS: Twenty-one autistic children 6-10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. RESULTS: The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. CONCLUSIONS: Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research.

Environmental barriers are important attributes to participation restriction in autistic children.Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children.The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time.The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines.

Development and usability of an app-based instrument of participation in children with disabilities.

BACKGROUND: Picture My Participation (PmP) is a picture-supported child-report instrument of participation of children with disabilities. AIMS: This study described the development of a mobile application of the PmP Traditional Chinese version (PmP-C) and evaluated its usability. METHODS: The PmP-C App includes features that allow the input of a child's demographics, identification of frequency and involvement of 22 culturally appropriate activities, selection of the three most important activities and the specification of the environmental facilitators and barriers. The usability test was conducted with 10 healthcare workers, who interviewed 10 children with disabilities aged 6-12 years. The healthcare workers completed a usability questionnaire and were asked to provide feedback on the ease of use, learning, satisfaction and perceived usefulness. RESULTS: The mean score for the usability questionnaire ranged from 2.7 to 4.6 out of 5.0. The feedback indicated that the interface was simple to operate by the healthcare workers and was attractive and motivating to children. Improvements of layout design, operation instructions and technical problems were recommended, which contributed to the app program optimization. CONCLUSIONS: The PmP-C App provides a practical tool with initial support for usability to enable active engagement and communication of children with disabilities with healthcare providers.

Participation in Play and Leisure Activities of Young Children with Autism Spectrum Disorder and Typically Developing Children in Taiwan: A Preliminary Study.

Participation in enjoyable activities is essential for the health and development of young children with and without disabilities. For preschool children with autism spectrum disorder (ASD), there is limited knowledge regarding their participation in play, learning, recreation, and social activities. This was a preliminary study that compares the participation between children 2-6 years of age with ASD (n = 25) and age- and sex-matched typically developing (TD) (n = 25) children. The Chinese version of the Assessment of Preschool Children's Participation (APCP-C) measures participation in play, skill development, active physical recreation, and social activities. Parents of the children in this study completed the APCP-C by structured interview. The results showed that children with ASD had lower participation diversity and intensity than TD children in play activities. A lower percentage of children participating in individual activity was found for children with ASD than TD children in most APCP-C activities. Professionals that serve young children with special needs are encouraged to partner with parents to provide playful and socially enhancing activities for preschool children with ASD.

Transcultural adaptation, content validity and reliability of the instrument 'Picture My Participation' for children and youth with and without intellectual disabilities in mainland China.

BACKGROUND: 'Picture My Participation' (PMP) is a validated questionnaire for assessing participation in everyday activities by children with disabilities in low and middle income countries, but it is not yet available in simplified Chinese. AIM: To describe the cross-cultural adaptation of the simplified Chinese version of 'Picture My Participation' (PMP-C; Simplified) and explore its validity and reliability. METHODS: A cross-sectional study using convenience sampling was conducted using PMP-C (Simplified) with structured interviews supported by pictures for children and youth with and without intellectual disabilities (ID) in mainland China. The validity of the PMP-C (Simplified) was demonstrated by face validity and content validity while the reliability was evaluated for internal consistency and test-retest reliability. RESULTS: Five items were slightly modified and eight pictures were revised to improve their fit with the culture of mainland China. All the items in PMP-C (Simplified) had excellent content validity, and face validity. The internal consistency, reliability coefficient and test-retest reliability of the subscale attendance for children and youth with and without ID were excellent. CONCLUSION: Preliminary evidence of the content validity of PMP-C (Simplified) items and reliability of the subscale attendance for use with children and youth in mainland China has been gathered. However, psychometric properties in terms of construct validity for the whole instrument and reliability for the engagement subscale need further exploration.

Structural validity and internal consistency of Picture My Participation: A measure for children with disability.

BACKGROUND: Picture My Participation (PMP) intended to measure participation, defined as attendance and involvement in everyday situations, of children with disabilities, particularly in low- and middle-income settings. OBJECTIVES: To explore structural validity of PMP by identifying possible subcomponents in the attendance scale and examining internal consistency of the total score and each subcomponent. METHOD: A picture-supported interview was conducted with 182 children, 7-18 years, with and without intellectual disability (ID). Frequency of attendance in 20 activities was rated on a four-point Likert scale (never, seldom, sometimes and always). RESULTS: An exploratory principal component analysis extracted four subcomponents: (1) organised activities, (2) social activities and taking care of others, (3) family life activities and 4) personal care and development activities. Internal consistency for the total scale (alpha = 0.85) and the first two subcomponents (alpha = 0.72 and 0.75) was acceptable. The two last subcomponents alpha values were 0.57 and 0.49. CONCLUSION: The four possible subcomponents of PMP can be used to provide information about possible domains in which participation and participation restrictions exist. This study provided further psychometric evidence about PMP as a measure of participation. The stability and the utility of these subcomponents needed further exploration.

Participation in home, extracurricular, and community activities among children and young people with cerebral palsy.

AIM: Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP. METHOD: Five hundred participants (277 males, 223 females) were grouped by age and Gross Motor Function Classification System (GMFCS) level. There were 291 children aged 6 to 12 years and 209 young people aged 13 to 21 years. There were 128 participants in GMFCS level I, 220 in levels II/III, and 152 in levels IV/V. Participants completed the Children's Assessment of Participation and Enjoyment to measure number of activities (diversity) and how often they were performed (intensity) in the past 4 months. RESULTS: Children had higher overall participation diversity and intensity than young people (p<0.001). Children and young people in GMFCS level I had the highest overall participation, followed by children and young people in levels II/III and IV/V. Children had higher participation in recreational (p<0.001) but not formal (such as team sports or clubs) or physical activities. Children (p<0.01) and young people (p<0.001) in level I had the highest participation in physical activities; diversity and intensity were generally low. INTERPRETATION: The findings provide evidence of the effect of age and gross motor function on participation of children and young people with CP. Low participation in physical activities may have implications for fitness and health, especially for children and young people in GMFCS levels IV and V.

Longitudinal Trends of Participation in Relation to Mental Health in Children with and without Physical Difficulties.

Children with physical disabilities (PD) are known to have participation restrictions when in inclusive settings alongside typically developing (TD) children. The restrictions in participation over time may affect their mental health status. This study aimed to investigate the longitudinal relationship between independence in activities (capability) and frequency of attendance in activities, in relation to perceived mental health status in children with and without PD. The participants were a convenience sample of parents of 77 school children with PD and 94 TD children who completed four assessments with a one-year interval between each assessment. Parents of these children were interviewed with the Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child). Three dimensions of mental health problems-loneliness, acting upset, and acting nervous-were rated by parents with the Child Health Questionnaire (CHQ). Linear trend was tested by repeated-measure ANOVA. The results revealed different longitudinal patterns of independence and frequency of attendance over time for children with PD and TD. Frequency of attending activities may be more important than independence in performing activities for experiencing fewer mental health problems. The findings highlight the need for supporting children's actual attendance in daily activities which may benefit their later mental health.

Structural Validity of an ICF-Based Measure of Activity and Participation for Children in Taiwan's Disability Eligibility Determination System.

To assess activity and participation for children in Taiwan's Disability Eligibility Determination System (DEDS), we developed a questionnaire, the Functioning Disability Evaluation Scale (FUNDES-Child), based on the Child and Adolescent Scale of Participation (CASP). The study follows a methodology research design to investigate the construct validity of the frequency and independence dimensions of FUNDES-Child 7.0. Two samples were randomly stratified from the databank of 13,835 children and youth with disabilities aged 6.0-17.9 years to examine structural validity by exploratory factor analysis (EFA, n = 4111, mean age of 11.3 ± 3.5) and confirmatory factor analysis (CFA, n = 4823, mean age of 11.4 ± 3.5)). EFA indicated a 4-factor structure for the frequency dimension (51.3% variance explained) and a 2-factor structure for the independence dimension (53.6% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (Goodness fit Index, GFI; Normed Fit Index, NFI; Comparative Fit Index, CFI; and Tucker-Lewis Index, TLI ≥ 0.95, Root Mean Square Error of Approximation, RMSEA < 0.06). Results provide evidence that the participation part of FUNDES-Child 7.0 has acceptable structural validity for use in Taiwan's DEDS. Utility of FUNDES-Child 7.0 in rehabilitation, welfare, and educational services needs further study.

Cultural adaptation and construct validation of the Arabic version of children's assessment of participation and enjoyment and preferences for activities of children measures.

PURPOSE: To establish the construct validity and internal consistency of the Arabic Children Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) and to determine the effects of age, gender, and disability status on diversity and intensity of participation. METHODS: The World Health Organization guidelines for translation of measures were applied to translate the CAPE and PAC, 75 children with cerebral palsy (mean age = 10.7 ± 2.9 years) and 75 children with typical development (mean age = 10.8 ± 2.7 years) completed the translated measures. The construct validity of the translated measures was demonstrated by principle component analyses in addition to the known-groups method by examining the effects of age, gender, and presence of disability on diversity and intensity scores. The internal consistencies of the extracted components were examined by Cronbach's alpha. RESULTS: Four components emerged: (1) physical activities; (2) home-based activities; (3) self-improvement activities; and (4) social activities. Cronbach's alpha varied from 0.61 (social activities) to 0.83 (physical activities). Age, gender, and disability were significant determinants of types of activities. CONCLUSIONS: The Arabic CAPE and PAC are culturally valid in measuring participation of children with or without disabilities in Jordan. The child's age, gender, and disability should be considered to provide participation-based plans of care that are considerate for children and their families. Implications for rehabilitation The Arabic CAPE and PAC are culturally valid measures for participation of children with or without disabilities in Jordan. The Arabic CAPE and PAC measures can guide participation-based plans of care that are meaningful and considerate for children and their families. Child age and gender should be considered to provide appropriate activities and to facilitate participation of children with and without disabilities. Families and service providers in Jordon are encouraged to provide children opportunities to participate in desired physical, self-improvement, and social activities.

Understanding the Participation in Home, School, and Community Activities Reported by Children with Disabilities and Their Parents: A Pilot Study.

Participation has significant impact on children's health and well-being. Knowledge is limited on how children with disabilities perceive their participation and whether their perceptions differ from their parents. This pilot study aimed to explore whether self-reported frequency of participation and prioritized activities differ between children with disabilities and their parents. Thirty children with disabilities eligible for special education in elementary school and their parents were included. Each of them were interviewed with the Chinese version of Picture My Participation (PMP), separately, to identify the child's participation frequency in 21 activities at home, school, and community, desire-to-change activities, and the level of involvement in these activities. The results indicated that children's ratings of participation frequency were significantly lower than parents' ratings in home activities but not in school and community activities, as analyzed by the Wilcoxon Signed Ranked test. Nineteen (63%) child-parent pairs had selected entirely different items as their desire-to-change activities. Children selected the activities that they were somewhat to very involved in; while parents selected the activities they thought their children were less involved in. Our findings suggest that children with disabilities had unique views on life and this should be supported in their health care and individualized education plans.

Use of virtual reality to improve upper-extremity control in children with cerebral palsy: a single-subject design.

BACKGROUND AND PURPOSE: Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP). PARTICIPANTS: Four children with spastic CP were recruited. METHOD: A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales-Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation-band method were used to compare the outcome measures. RESULTS: Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children's change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up. DISCUSSION AND CONCLUSION: A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Environmental Barriers to Participation of Preschool Children with and without Physical Disabilities.

Environment plays a vital role in affecting participation of young children in home, school, and community. Knowledge of environmental barriers helps to develop solutions or strategies that enable participation. The study compared the environmental barriers perceived by parents of preschool children with physical disabilities (PD, n = 142) and with typical development (TD, n = 192) in Taiwan. Parents identified environmental barriers by structured interview using the Chinese version of the Child and Adolescent Scale of Environment (CASE-C). The CASE-C is an 18-item measure of the impact of problems with physical, social, and attitudinal environmental features. Differences between the PD and TD groups in the summary scores for the CASE-C and the percentages of parents who perceived a problem for each item were examined by the analysis of covariance (ANCOVA) and Chi-square test. Parents of children with PD more often identified barriers related to family resources and community programs or services, social attitudes, assistance and supports outside of home, physical design of home and community, transportation, and assistive devices or equipment. Greater impacts of barriers were also reported by parents of preschool children with PD. Our findings provide evidence of environmental barriers that inform practice and policies to modify the barriers and provide an accessible and inclusive environment for families with young children.

Validation of the Chinese version of the Assessment of Preschool Children's Participation for children with physical disabilities.

PURPOSE: To examine the psychometric properties of the Chinese version of the Assessment of Preschool Children's Participation (APCP-C). METHOD: The APCP, a measure of participation in play, skill development, active physical, and social activities of preschool children, was translated into Traditional Chinese. Data on 94 Taiwanese children with physical disabilities aged 2 to 6 years were analyzed. RESULTS: Internal consistency (Cronbach's α = 0.85 and 0.86) and test-retest reliability (ICCs = 0.79) were excellent for total scores, and varied from excellent to poor for activity type scores. Items were generally relevant to the Taiwanese culture. Correlations between scores for the APCP-C and the Chinese version of the Pediatric Evaluation of Disability Inventory Mobility and Social Functioning scales in general supported convergent validity (r = 0.33-0.68) but less support for discriminant validity. CONCLUSIONS: The results provide evidence of reliability, cross-cultural validity, and limited support for construct validity of the APCP-C in measuring participation of children with physical disabilities.

Psychometric properties of the Chinese version of the child and adolescent factors inventory (CAFI-C).

The Child and Adolescent Factors Inventory (CAFI) is a parent-report measure that assesses type and severity of impairments experienced by children and youth with a range of disabling conditions. The CAFI was translated from English into Traditional Chinese (CAFI-C) and has been used in the Disability Evaluation System (DES) in Taiwan. The aim of this study was to validate the use of the CAFI-C in the DES. Participants included 18,119 children and youth with disabilities between the ages of 6.0-17.9 (Mean=11.6; SD=3.46). The factor structure, internal consistency, convergent validity, and discriminant (known groups) validity were examined. The results indicated that the CAFI-C had a two-factor structure (Mental/speech and Physical/sensory impairment) that explained 54.3% of the variance, and had adequate internal consistency (α=0.80-0.90). Children and youth with higher CAFI-C scores had significantly more participation restrictions and environment barriers. CAFI-C scores were significantly different among children and youth with different disability types and of four severity levels (mild, moderate, severe, and profound) rated by physicians. These findings support the internal consistency and validity of the CAFI-C for assessing type and severity of impairment in children and youth with disabilities in Chinese-speaking population.

The Chinese version of the Child and Adolescent Scale of Environment (CASE-C): validity and reliability for children with disabilities in Taiwan.

Measurement of children's participation and environmental factors is a key component of the assessment in the new Disability Evaluation System (DES) in Taiwan. The Child and Adolescent Scale of Environment (CASE) was translated into Traditional Chinese (CASE-C) and used for assessing environmental factors affecting the participation of children and youth with disabilities in the DES. The aim of this study was to validate the CASE-C. Participants were 614 children and youth aged 6.0-17.9 years with disabilities, with the largest condition group comprised of children with intellectual disability (61%). Internal structure, internal consistency, test-retest reliability, convergent validity, and discriminant (known group) validity were examined using exploratory factor analyses, Cronbach's α coefficient, intra-class correlation coefficients (ICC), correlation analyses, and univariate ANOVAs. A three-factor structure (Family/Community Resources, Assistance/Attitude Supports, and Physical Design Access) of the CASE-C was produced with 38% variance explained. The CASE-C had adequate internal consistency (Cronbach's α=.74-.86) and test-retest reliability (ICCs=.73-.90). Children and youth with disabilities who had higher levels of severity of impairment encountered more environmental barriers and those experiencing more environmental problems also had greater restrictions in participation. The CASE-C scores were found to distinguish children on the basis of disability condition and impairment severity, but not on the basis of age or sex. The CASE-C is valid for assessing environmental problems experienced by children and youth with disabilities in Taiwan.

Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency.

BACKGROUND: Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored. METHODS: A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children's daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment. FINDINGS: A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment. CONCLUSIONS: Children's participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.

A multidimensional model of optimal participation of children with physical disabilities.

PURPOSE: To present a conceptual model of optimal participation in recreational and leisure activities for children with physical disabilities. METHODS: The conceptualization of the model was based on review of contemporary theories and frameworks, empirical research and the authors' practice knowledge. A case scenario is used to illustrate application to practice. RESULTS: The model proposes that optimal participation in recreational and leisure activities involves the dynamic interaction of multiple dimensions and determinants of participation. The three dimensions of participation are physical, social and self-engagement. Determinants of participation encompass attributes of the child, family and environment. Experiences of optimal participation are hypothesized to result in long-term benefits including better quality of life, a healthier lifestyle and emotional and psychosocial well-being. CONCLUSION: Consideration of relevant child, family and environment determinants of dimensions of optimal participation should assist children, families and health care professionals to identify meaningful goals and outcomes and guide the selection and implementation of innovative therapy approaches and methods of service delivery. Implications for Rehabilitation Optimal participation is proposed to involve the dynamic interaction of physical, social and self-engagement and attributes of the child, family and environment. The model emphasizes the importance of self-perceptions and participation experiences of children with physical disabilities. Optimal participation may have a positive influence on quality of life, a healthy lifestyle and emotional and psychosocial well-being. Knowledge of child, family, and environment determinants of physical, social and self-engagement should assist children, families and professionals in identifying meaningful goals and guiding innovative therapy approaches.