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Disability and capability
The association between participation of children with cerebral palsy and the physical, social and attitudinal environment: a cross-sectional European study
  1. H. O. Dickinson,
  2. A. Colver
  1. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

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    Both the UN Convention on the Rights of the Child and the UN Convention on the Rights of Persons with Disabilities affirm the right of children with disabilities to participate on an equal basis with others in family life, health maintenance, education, public life, recreational, leisure and sporting activities.


    To assess, for children with cerebral palsy, the extent of availability of needed items in the physical, social and attitudinal environment and to evaluate how this is associated with the children’s participation in life situations.


    Following preliminary qualitative studies, the European Child Environment Questionnaire (ECEQ) was developed to record which items in the physical, social, and attitudinal environment of home, school, and community are available to children with disabilities. The ECEQ was administered to parents of children with cerebral palsy. Children’s participation was assessed using the Life-H questionnaire. The 60 items of ECEQ were grouped into domains using item response models. Structural equation modelling was used to relate the child’s participation to environmental factors, allowing for impairments, pain and socio-demographic characteristics.


    Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.


    1174 children with cerebral palsy aged 8–12 years randomly selected from the population registers, 743 (63%) agreed to joined in the study; the further region recruited 75 children.

    Main Outcome Measures

    Children’s participation, assessed on 10 domains of the Life-H questionnaire.


    Children with pain and those with more severely impaired walking, fine motor skills, communication and intellectual abilities had lower participation across most domains, but the socio-demographic factors examined were not associated with participation. We identified nine domains describing the accessibility of the environment. All domains of both participation and environment showed significant (p<0.001) variation between regions. Results of the structural equation modelling will be presented.


    Some European regions facilitate participation of children with cerebral palsy better than others and some regions have a more accessible environment than others, implying some countries could improve provision.