The Determinants of Primary School Participation in Children with Cerebral Palsy

• Main Authors: Chien-Yu Huang, 黃千瑀
• Other Authors: Mei-Hui Tseng
• Format: Others
• Language: en_US
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/90507552167876261138

碩士 === 臺灣大學 === 職能治療研究所 === 98 === Background School participation in children with cerebral palsy (CP) is often restricted due to their motor impairments or accompanied disturbance of cognition, sensory, etc, which further affect their knowledge learning and socialization. Thus, for children with CP, the ultimate goal of rehabilitation and education is to facilitate their participation in school. The determinants of the school participation in children with CP encompassed multiple dimensions, including children’s functioning and contextual factors. However, to our knowledge, no study investigated the determinants of participation in school activities from multiple dimensions. Therefore, the aim of the study was to investigate the determinants of participation in school activities from a holistic view, including functioning and contextual aspects. Method Participants were 128 children with CP (mean age 9.88, SD 1.96) recruited from the following facilities: (1) 3 pediatric rehabilitation clinics, (2) 65 primary schools and 3 schools of special education, and (3) 2 Cerebral Palsy Associations. Inclusion criteria were (1) school-aged students, and (2) consents given from caregivers and school teachers. Exclusion criteria included (1) homeschooled children, and (2) caregivers who can not communicate/read in Chinese. School participation and performance of both physical and cognitive/behavioral tasks were measured by the School Function Assessment (SFA). A range of variables related to children’s functioning, including body function and body structures, activity and participation, as well as context factors were measured by appropriate tools as the predictors of school participation. The determinants of school participation and performance of both physical and cognitive/behavioral tasks of children with CP were investigated using multiple stepwise regression models. Path analysis was used to explore the relationships between those three regression models, and build a path model of school participation. Results The final path model revealed that school participation was direct influenced by the performances of both physical and cognitive/behavioral tasks, as well as affected parts of CP. There were 6 determinants of the performance of physical tasks, including affected parts of CP, GMFCS level, hyperactivity, school size and daily function. The determinants of the performance of cognitive/behavioral tasks were daily function, mother’s citizenship, intellectual impairment, socioeconomic status, prosocial behaviors, social skills, receiving special education as well as academic performance. The determinants of performance of both physical and cognitive/behavioral tasks indirectly influenced the school participation. The three regression models explained 73%, 85%, 79% of the total variances respectively. Conclusion School participation was directly influenced by the performances of physical and cognitive/behavioral tasks, and affected parts. Both performances of physical and cognitive/behavioral tasks were respectively affected by variables related to body structure/function, activity, and contextual factors which indirectly influenced the school participation. Thus, intervention targeted at those factors may help children with CP to be better integrated into school. Besides, there are three concepts in school participation, including school attendance, participation in activities, social participation. As the SFA measured participation in activities which is only one aspect of the whole concept of school participation, further study on the determinants of social participation in school is warranted.