Determinants of participation of children with diplegic cerebral palsy in educational, home, and social settings

Aim: Although most children with spastic diplegic cerebral palsy (SDCP) achieve independent walking levels, they are still prone to participation restrictions due to impairments in body functions, activity limitations, and child factors.This study aimed to verify a structural model of the determinants of participation of children with SDCP.Material and Methods: A convenience sample of 40 children with SDCP (mean 9.13 standard deviation 3.2) was recruited.Body function parameters were measured using the five-times-sit-to-stand test, Timed Up and Go test, and Pediatric Balance Scale.Activity measures were Gross Motor Function Measure-88, The Gillette Functional Assessment Questionnaire 22-item skill, and the One-Minute Walk Test.Participation was measured using the Child and Adolescent Scale of Participation.A structural model of the determinants of participation was conceptualized based on the theoretical relationships available, common problems observed in spastic diplegic cerebral palsy, and the perspectives of researchers.Results: Path analysis demonstrated that impairments in body function had a significant direct effect of 0.98 (P < 0.001) on the activity construct.The activity construct had a significant direct effect on participation ( weight = 0.26; P < 0.05).The child factors construct was revealed to influence the participation of children with spastic diplegic cerebral palsy significantly, with a direct effect of 0.10 (P < 0.05).Finally, the proposed structural model explained 30% of the variance in the participation outcomes of children with spastic diplegic cerebral palsy.Discussion: The participation of children with SDCP is multidimensional and requires the consideration of various factors, including physical impairments, activity limitations, and child-related factors.