Associations between outdoor play features and children's behavior and health: A systematic review.

The decline of children's opportunities to play outdoors raises a new concern about the quality of outdoor play environments, and their developmental and well-being benefits for children. This systematic review aims to synthesize the associations between outdoor play features and children's behavior and health. PRISMA guidelines were followed (2021). The inclusion criteria were studies with children aged between 5 and 12 (Population); that addressed presence, absence or disposition of equipment, natural elements, loose parts, resources availability, type of terrain and space modifications (Intervention or Exposure); in pre-post intervention or between groups (Comparison); related to health and behavior in different domains (Outcomes); with an experimental, observational, descriptive or longitudinal design (Study design). Indoor context, adult-led activities and structured activities were excluded. A literature search of five databases (PubMed, Web of Science, ERIC, Scopus, and PsycINFO) was concluded in March 2022. After identifying 28,772 records, duplicates and irrelevant titles were removed, and abstracts and full-text articles were screened in duplicate. The remaining 51 eligible articles (45 primary studies) were assessed for risk of bias with QualSyst. A narrative synthesis of the results was conducted. The most frequent behavioral or health outcome addressed was physical activity. Included studies focused on the following space features: fixed structures, space naturalness, floor markings, loose parts/equipment, area available, and the combination of factors. Although some positive effects were found, the heterogeneity between studies did not allow to draw firm conclusions on the effects of each environmental feature on primary children's health and behavior. Systematic review registration: PROSPERO CRD42020179501.

I Would Like to Do It Very Much! Leisure Participation Patterns and Determinants of Brazilian Children and Adolescents With Physical Disabilities.

PURPOSE: To describe the patterns, preferences, and predictors of participation in leisure activities of children and young people with physical disabilities from Brazil. METHODS: This is a cross-sectional study that included 50 children/young people with physical disabilities from the southeast of Brazil. The children were assessed using the Children's Assessment of Participation and Enjoyment and Preferences for Activities. RESULTS: Children/young people participated in an average of 38% of the activities, with a greater number and frequency of informal, recreational, social, and self-improvement activities. The average frequency of participation in the activities was twice in the previous 4 months. The enjoyment in the participated activities was high. There was a greater preference for recreational, social, and physical activities. Age and functional classification were predictors of participation. CONCLUSION: This study of children with disabilities from the southeast of Brazil supports studies in other low- and middle-income countries, demonstrating low diversity and intensity of participation in leisure activities, but with high levels of enjoyment.

Parent-report health-related quality of life in school-aged children with cerebral palsy: A cross-sectional study.

Quality of life is both a goal and an outcome in Cerebral Palsy (CP) rehabilitation. Children with CP may show impaired health-related quality of life (HRQoL) compared to their typical peers. Parents' perceptions of HRQoL of their children could help rehabilitation professionals to identify areas for intervention aiming to improve health and wellbeing. This study aims to compare the proxy HRQoL of Portuguese school-aged children with CP and the general population, and to analyze child and family correlation. Differences were examined using European normative data for children from 8 to 18 years. Correlation and regression analysis examined the association between child and family variables in the CP group with statistically significant low scores. Sixty-eight parents of children and adolescents with CP (12.5 ± 2.91 years) answered the KIDSCREEN-52 parent version. We identified clinically significantly lower HRQoL in four out of ten HRQoL domains (Physical well-being, Autonomy, Moods & Emotions, and Bullying) than the norm peers. Correlations were found between the number of siblings and Autonomy (r = .315), meaning that having more siblings was associated with greater autonomy, and between mobility and Moods & Emotions (r = -.261), where children with impaired mobility shown low scores as perceived by their parents. Age, sex, mobility and cognitive impairment explained 32% of Physical well-being scores (p < .001). Mobility and cognitive impairment explained 16% of Bullying scores (p = .001). Although the family and child variables identified in this study are non-modifiable, they can help in the identification and early intervention aimed at improving HRQoL. Rehabilitation professionals should assess parent perceptions, extending the HRQoL assessment to children who can report and other informants, aiming at fostering wellbeing in children and adolescents with CP.

Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy.

AIM: To compare participation in leisure physical activities in children with typical development (TD) and cerebral palsy (CP). METHODS: A total of 170 children with TD (n = 101) and CP (n = 69) aged 8 to 18 years reported participation in 16 extracurricular physical activities. Non-parametric statistics examined differences between groups. RESULTS: Children with TD participated more frequently in individual physical activities (p = .018), team sports (p = .026), and bicycling (p = .001), and less in horseback riding (p = .031) than children with CP in GMFCS II-V. The differences between children with TD and CP in GMFCS I and within the CP group were not statistically significant. We did not find differences between groups in enjoyment. CONCLUSION: Children with CP in GMFCS II-V tend to participate less in leisure physical activities that require higher motor and perceptual skills. Support in the adaptation of physical recreation and sports may help improve participation.

Participation in Leisure Activities by Portuguese Children With Cerebral Palsy.

Leisure participation contributes to the health and wellbeing of children with and without physical disabilities. In the present cross-sectional study, we aimed to assess the influence of child and family factors on leisure activity participation of children with cerebral palsy (CP) aged 8-18 years. A convenience sample of 69 participants with CP (M age = 12.75 years, SD = 2.95; 45 males) responded to the Children's Assessment of Participation and Enjoyment questionnaire to report participation diversity, frequency, companies, environment and enjoyment in leisure activities. From these questionnaires, we used descriptive statistics to summarize overall participation, two activity domains (formal and informal) and five activity types (recreational, social, active physical, skill-based, and self-improvement). Regression analysis assessed child and family factors' influence on participation. On average, children with CP were involved in 21 leisure activities in the last four months. Within activity types, social and recreational activities were the most frequently reported. Participation in physical and skill-based activities was low. Overall children with CP experienced high enjoyment with engagement in leisure activities. Collectively, factors of age, cognitive function, gross motor function, and mother's education level predicted 33% of activity diversity and 30% of activity frequency. We concluded that children with CP show diverse leisure activity participation and high leisure activity enjoyment. Health, education and sports professionals should consider the child's functional profile and family context when promoting participation.

Corrigendum: Cross-Cultural Validation of Children's Assessment of Participation and Enjoyment Portuguese Version.

[This corrects the article DOI: 10.3389/fped.2019.00033.].

Cross-Cultural Validation of Children's Assessment of Participation and Enjoyment Portuguese Version.

Background: Participation is a major pediatric rehabilitation goal according to The International Classification of Functioning, Disability and Health Children and Youth version (ICF-CY). ICF-based leisure participation measures for Portuguese-speaking children with cerebral palsy are currently not available. The aim of this study is to assess validity and reliability of the Portuguese (European) version of the Children's Assessment of Participation and Enjoyment (CAPE). Methods: CAPE Portuguese version was applied to 170 children with cerebral palsy (n = 69) and typical development (n = 101) aged between 8 and 18 years (mean = 12.5 years; SD = 2.91). Construct validity was assessed by using the know-groups method and the correlation between participation and quality of life. Reliability was determined by internal consistency and test-retest. Results: CAPE discriminates between participation scores of children with cerebral palsy and typical development. A positive correlation was found between participation frequency and physical well-being. Internal consistency was not entirely satisfactory but comparable with that from the original CAPE study. Test-retest reliability was considered good. Conclusions: CAPE Portuguese (European) version showed satisfactory validity and test-retest reliability to assess leisure participation in children with cerebral palsy and typical development aged between 8 and 18 years.

Reproducibility of two functional field exercise tests for children with cerebral palsy who self-propel a manual wheelchair.

AIM: The aim of this study was to examine the test-retest reproducibility (reliability and agreement) of the 6-minute push test (6MPT) and the one-stroke push test (1SPT), and construct validity of the 6MPT in children with cerebral palsy (CP) who self-propel a manual wheelchair. METHOD: Seventy-three children and adolescents with spastic CP (51 males, 22 females; mean age 11 y 9 mo, SD 3 y 7 mo, range 4-18 y; three unilateral, 70 bilateral) using a manual wheelchair for at least part of the day were recruited from and tested in different rehabilitation settings in the Netherlands and Brazil. Participants were classified as Gross Motor Function Classification System (GMFCS) level II (n=7), III (n=36), or IV (n=30). RESULTS: Intraclass correlation coefficients (ICCs) for distance covered on the 6MPT (mean distance 266.5 m, SD 120.6 m) and the 1SPT (mean distance 4.5 m, SD 2.7 m) showed excellent reliability (ICC=0.97) for both tests. There was a significant correlation between the 6MPT and the 1SPT (r=0.73; p<0.001), and between the 6MPT and heart rate during the 6MPT (r=0.29, p=0.014). INTERPRETATION: These results indicate that both the 6MPT and the 1SPT test are reproducible functional tests for young people with CP who self-propel a wheelchair. Agreement for the 6MPT seems relatively large for children who perform short distances. Construct validity is supported for the 6MPT in children with CP.