Multifaceted investigation of factors influencing upper extremities participation in daily activities and social roles in children with cerebral palsy

In current physiotherapy and rehabilitation approaches, one of the fundamental goals for children with Cerebral Palsy (CP) is considered to be the increase in activity and participation levels. The aim of this study was to determine the body structure and function problems in the upper extremities in children with CP and to investigate the problems that most affect the activity and participation level of these problems from a multidimensional perspective by considering personal and environmental factors from the ICF perspective. 67 children with spastic CP with aged between 6-18 years and their parents were included in the study. Selective motor control was assessed with the Selective Control of the Upper Extremity Scale, trunk control with the Trunk Control Measurement Scale, spasticity with the Modified Ashworth Scale, muscle strength with a hand dynamometer, stereognosis with the tactil recognition of different objects, and proprioception was evaluated with the sense of movement and position. Activity level was assessed using ABILHAND-Kids and participation level using the using the Assessment of Life-Habits. The European Child Environment Questionnaire was used for environmental factors and the SPARCLE-cognitive assessment form for personal factors. Three different statistical models were created to determine the magnitude of the impact of body structure and function characteristics, environmental factors and cognitive problems of the child that most affect activity and participation. According to the results of the models; the most important predictors affecting the activity level were selective motor control, grip strength and environmental factors, respectively (p<0.001, R2= 60.4%). The most important predictors affecting the participation level were trunk control, selective motor control, environmental factors and cognitive level (p<0.001, R2= 76.7%, R2= 60.6%). According to the results of our study, it is of great importance to include physiotherapy and rehabilitation programs aimed at improving selective motor control, trunk control and grip strength in physiotherapy and rehabilitation interventions to be applied to the upper extremities in order to increase level of activity and participation in children with CP and thus to ensure the independence of children in daily life. According to the results, environmental factors and the child's cognitive level are also very important in increasing the level of activity and participation. We believe that it would be beneficial to take environmental factors and the cognitive level of child into consideration and provide guidance when planning physiotherapy and rehabilitation strategies for children with CP. In future studies, we think that there is a need for physiotherapy and rehabilitation programs that will be designed by taking into account the multidimensional problems of the upper extremity that have an impact on activity and participation in children with CP.