Association Between Characteristics of Locomotion and Accomplishment of Life Habits in Children With Cerebral Palsy

Association Between Characteristics of Locomotion and Accomplishment of Life Habits in Children With Cerebral Palsy literature as "a disruption in the accomplishment of a person's life habits (activities of daily living and social roles) ." The purpose of this study was to determine the strength of association between various types of locomotion and the accomplishme~ltof life habits, which is an indicator of the occurrence of handicap situations in children with cerebral palsy. Subjects. Ninety-eight children with cerebral palsy, aged 5 to 17.8 years (X=10.5, SD=3.5), were recruited. Methods. The Life Habits Assessment was used to evaluate handicap situations in activities of daily living and social roles, Types of locomotion, the Pediatric Functional Independence Measure (locomotion section), and 2 tests representing functional activities (walking speed and stair climbing) were used as characteristics of locomotion. Results. Locomotion capabilities were associated with the accomplishment of activities of daily living and social roles. Performance in variables related to locomotion, number of associated problems, and type of cerebral palsy explained 17% to 74% of the total variance in accomplishment of life habits in children who walked without technical aids. Conclusion and Discussion. The results suggest that locomotion might influence the accomplishment of life habits. Other factors, however-such as environmental barriers-should also be examined to determine their impact on the occurrence of handicap situations. [Lepage C, Noreau L, Bernard P-M. Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy. Phys Thm 1998;'78:458-469.1 Key Words: Cerebral palsy, Handicap, Locomotion, Social integration. Cbline Lepage Luc Noreau PauhMarie Bernard Physical Therapy . Volume 78 . Number 5 . M a y 1998 Background and Purpose. "Handicap situation" is defined in the interaction is summarized in a conceptual framework: The Handicap Creation Process (Fig. I ) . ~ To our knowledge, only two studies6a7 have addressed the issue of handicap or the quality of social life in children with CP. Janis and HeyG evaluated the level of handicap by a questionnaire on various aspects of daily living such as mobility, dependence, school integration, and social resources (71 items). A three-level ordinal scale was used for the quantification of handicap. This study suggested that CP affects the child's ability to participate in normal everyday activities and that children with quadriplegia or diplegia are generally more handicapped than children with h e m i ~ l e g i aThe . ~ total handicap score was highly correlated with measures of physical disability and with limited mobility (r>.70). In a more general manner, Hirst7 measured the quality of social life in 89 children with CP and reported that 40% of these children experienced a very restricted social life. Moreover, various combinations of severe functional limitations were associated with a poor quality of social life, and about two thirds of children with walking problems encountered a restricted social life.7 The results of these two studies suggest that a low level of locomotor capabilities for walking or using a wheelchair will affect mobility and may interfere with activities of C Lepage, MSc(PT), is Physical Therapist, Rehabilitation lnstitute of Quebec City, 2975 Chemin St-Louis, Sainte-Foy, Quebec, Canada GlW 1P9 ().Address all correspondence to Ms Lepage. 1. Norealr PhD, is Assistant Professor, Department of Rehabilitation, Laval University, Quebec, Canada, and Research Associate, Rehabilitation lnstitute vf Quebec City, Quebec, Canada. P-M Bernard, MSc, is Professor, Department of Social and Preventive Medicine, Laval University. This study was approved by the Centre Cardinal-Villenelrve Human Subjects Ethics Committee. U1e acknowledge support from The Quebec Health Research Funds, The Rehabilitation Research Consortium of Eastern Quebec, The Cerebral Palsy Research Chair of Laval University, and the Centre Cardinal-Villeneuve (Quebec City). This articltz was submitted Junualy 6, 1997, and was accepted October 1, 1997. Physical Therapy. Volume 78 . Number 5 . May 1998 Lepoge et al , 4 5 9 erebral palsy (CP) is the most frequent cause of severe physical disabilities in children.' Defined as a permanent disorder of movement and posture, it is caused by a defect or a nonprogressive lesion in the immature brain.' Children with CP can show a delay in the acquisition of various motor skills such as gross and fine motor functions or speech. This delay may produce functional limitations and bring about disturbance in societal f ~ n c t i o n i n gIn . ~ 1980, the World Health Organization introduced a model of disablement (the ICDIH conceptual framework) that defined handicap as "a disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfillment of a role that is normal for that in~lividual."~ Over the last decade, a conceptual evolution has led to the introduction of the concept of handicaj~situations, which are defined as "disruptions in the accomplishment of a person's life habits (activities of daily living and social roles), taking into account his age, sex and socio-cultural identity, resulting on the one hand from impairments or disabilities and, on the other hand, from environmental factor^."^ This concept illustrates the interaction between (1) the individual characteristics linked to organic and functional consequences of diseases or trauma and (2) the environmental attributes appearing in the person's life context. This L Per bits Method Recruitment and Subjects Ninety-eight children, aged 5 to 17.8 years (X=10.5, SD=3.5), were recruited on a voluntary basis from a Figure 1. potential population of 265 children The Handicap Creation Process: explanatory model of the causes and consequences of disease, trauma, and other health disorders. (Reprinted with permission from Fougeyrollas P, with CP (residence in Quebec City, St-Michel G, Bergeron H, et al. Revision of the Quebec Classification: Handicap Creation Quebec, Canada, metropolitan area) Process. Quebec City, Quebec, Canada: The Quebec Committee on the ICIDH; 1997.) who were admitted into the CP program and the rehabilitation service daily living (ADL), community activities, recreation, or of the Centre Cardinal-Villeneuve (CCV) (Quebec City, work-related tasks. For example, a child who has reduced Quebec, Canada). A first contact was initiated by mail to locomotion could have difficulties in performing activithe parents of all potential subjects. The letter described ties related to personal care, gaining access to public the nature of the study and encouraged the parents and buildings (eg, school, post office, community center) on children to participate. The sample was made up of the his or her own, or regularly participating in recreational (...truncated)