Association Between Environmental Factors, Types of Cerebral Palsy and Levels of Gross Motor Function in The Participation of Children in Recreation and Leisure Activities
DOI:
https://doi.org/10.35699/2447-6218.2026.69350Keywords:
Cerebral palsy, Child, Social participationAbstract
To identify associations between environmental factors, types of cerebral palsy (CP), and GMFCS levels in children’s participation in recreation and leisure activities. Method: A cross-sectional, quantitative study was conducted with 44 caregivers of children with CP who completed the Child Participation Questionnaire for CP. Multiple Correspondence Analysis (MCA) was used to explore associations. Results: Children with hemiplegia/diplegia and GMFCS levels I–III were associated with accessible environments and social programs. Those with quadriplegia and GMFCS levels IV–V faced barriers such as inadequate environments and limited information but also benefited from assistive products and rehabilitation activities focused on leisure. Conclusion: Children with lower motor impairment experienced more facilitators, whereas those with higher impairment encountered barriers to participation in recreation and leisure activities.
References
ALGHAMDI, M. S.; CHIARELLO, L.A.; PALISANO, R. J; MCCOY, S.W.Understanding participation of children with cerebral palsy in family and recreational activities. Research in Developmental Disabilities, [s. l.], v. 69, p. 96–104, out. 2017. DOI: 10.1016/j.ridd.2017.07.006. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S0891422217301798. Acesso em: 30 jun. 2025.
ANABY, D.; KORNER-BITENSKY, N.; STEVEN, E.; TREMBLAY, S. Current rehabilitation practices for children with cerebral palsy: focus and gaps. Physical & Occupational Therapy in Pediatrics, [s. l.], v. 37, n. 1, p. 1–15, fev. 2017. DOI: 10.3109/01942638.2015.1126880. Disponível em: https://www.researchgate.net/publication/294105216_Current_Rehabilitation_Practices_for_Children_with_Cerebral_Palsy_Focus_and_Gaps. Acesso em: 30 jun. 2025.
AYUPE, Kennea Martins Almeida; GALVÃO, Élida Rayanne Viana Pinheiro; CAZEIRO, Ana Paula Martins; ANABY, Dana; TEPLICKY, Rachel; LOPES, Priscila Bianchi; MASSETTI, Thais; OLIVEIRA, Alyne Kalyane Câmara de; CAMPOS, Ana Carolina de; LONGO, Egmar. Participation and environment measure - children and youth: PEM-CY Brazil measurements properties. Brazilian Journal of Physical Therapy, [s. l.], v. 28, n. 4, p. 101103, 2024. DOI: 10.1016/j.bjpt.2024.101103. Acesso em: 30 jun. 2025.
BELTRAME, André Luís Normanton. Lazer e Deficiência: Um Diálogo com os Disability Studies. LICERE - Revista do Programa de Pós-graduação Interdisciplinar em Estudos do Lazer, Belo Horizonte, v. 28, n. 2, p. 1–30, 2025. DOI: 10.35699/2447-6218.2025.61089. Disponível em: https://periodicos.ufmg.br/index.php/licere/article/view/61089. Acesso em: 4 set. 2026.
BONNEFOY-MAZURE, A.; SAGAWAE JR, Y.; LASCOMBES, P.; DE COULON, G.; ARMAND, S. Identification of gait patterns in individuals with cerebral palsy using multiple correspondence analysis. Research in Developmental Disabilities, [s. l.], v. 34, n. 9, p. 2684–2693, set. 2013. DOI: 10.1016/j.ridd.2013.05.002. Disponível em: https://pubmed.ncbi.nlm.nih.gov/23770664/. Acesso em: 30 jun. 2025.
CHAGAS, Paula S. C.; LEMOS, Alana G.; AYUPE, Kênnea M. A.; TOLEDO, Aline M.; CAMARGOS, Ana Cristina R.; LONGO, Egmar; MORAIS, Rosane L. S.; LEITE, Hércules R.; PALISANO, Robert J.; ROSENBAUM, Peter; ROMEROS, Angélica C. S. F.; LIMA, Amanda L. O.; FONTES, Déborah E.; MAGALHÃES, Elton D. D.; SILVA, Jaíza M. M.; ALVES, Maria Luíza F.; MONTEIRO, Rayane F. L.; DE CAMPOS, Ana Carolina; MOREIRA, Rafaela. Functioning profile and related impairments of children and adolescents with cerebral palsy - PartiCipa Brazil preliminary results. BMC Pediatrics, [s. l.], v. 24, n. 1, p. 719, 11 nov. 2024. DOI: 10.1186/s12887-024-05210-2. Acesso em: 30 jun. 2025.
CHUNG, Chia-Ying; CHEN, Chia-Ling; WONG, Alice May-Kuen. Pharmacotherapy of spasticity in children with cerebral palsy. Journal of the Formosan Medical Association, [s. l.], v. 110, n. 4, p. 215–222, abr. 2011. DOI: 10.1016/S0929-6646(11)60033-8. Disponível em: https://pubmed.ncbi.nlm.nih.gov/21540003/. Acesso em: 30 jun. 2025.
COLUCI, Marina Zambon Orpinelli; ALEXANDRE, Neusa Maria Costa; MILANI, Daniela. Construction of measurement instruments in the area of health. Ciência & Saúde Coletiva, [s. l.], v. 20, n. 3, p. 925–936, mar. 2015. DOI: 10.1590/1413-81232015203.04332013. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25760132/. Acesso em: 30 jun. 2025.
COLVER, A.; THYEN, U.; ARNAUD, C.; BECKUNG, E.; FAUCONNIER, J.; MARCELLI, M.; MCMANUS, V.; MICHELSEN, S.; PARKES, J.; PARKINSON, K.; DICKINSON, H. Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: a cross-sectional multicenter European study. Archives of Physical Medicine and Rehabilitation, [s. l.], v. 93, n. 12, p. 2154–2164, dez. 2012. DOI: 10.1016/j.apmr.2012.07.011. Disponível em: https://pubmed.ncbi.nlm.nih.gov/22846455/. Acesso em: 1 jul. 2025.
EKIZ, Timur; ÖZBUDAK DEMIR, Sibel; SÜMER, Hatice Gözde; ÖZGIRGIN, Neşe. Wheelchair appropriateness in children with cerebral palsy: a single center experience. Journal of Back and Musculoskeletal Rehabilitation, [s. l.], v. 30, n. 4, p. 825–828, 2017. DOI: 10.3233/BMR-150522. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28387656/ Acesso em: 1 jul. 2025.
FREEMAN, M.; STEWART, D. CUNNINGHAM, C.E.; GORTER, J. W.. “If I had been given that information back then”: an interpretive description exploring the information needs of adults with cerebral palsy looking back on their transition to adulthood. Child: Care, Health and Development, [s. l.], v. 44, n. 5, p. 689–696, set. 2018. DOI: 10.1111/cch.12579. Disponível em: https://www.researchgate.net/publication/325693048_If_I_had_been_given_that_information_back_then_An_interpretive_description_exploring_the_information_needs_of_adults_with_cerebral_palsy_looking_back_on_their_transition_to_adulthood. Acesso em: 1 jul. 2025.
GRAHAM, H. Kerr. Classifying cerebral palsy. Journal of Pediatric Orthopaedics, [s. l.], v. 25, n. 1, p. 127, fev. 2005. Disponível em: https://journals.lww.com/pedorthopaedics/citation/2005/01000/classifying_cerebral_palsy.26.aspx. Acesso em: 30 jun. 2025. Acesso em: 1 jul. 2025.
HUANG, I.‐C.; SUGDEN, D.; BEVERIDGE, S. Assistive devices and cerebral palsy: factors influencing the use of assistive devices at home by children with cerebral palsy. Child: Care, Health and Development, [s. l.], v. 35, n. 1, p. 130–139, jan. 2009. DOI: 10.1111/j.1365-2214.2008.00898.x. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2214.2008.00898.x. Acesso em: 1 jul. 2025.
LAI, Byron; LEE, Eunbi; KIM, Yumi; MATTHEWS, Coke; SWANSON-KIMANI, Erin; DAVIS, Drew; VOGTLE, Laura; RIMMER, James H. Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review. Developmental Medicine and Child Neurology, [s. l.], v. 63, n. 2, p. 162–171, fev. 2021. DOI: 10.1111/dmcn.14751. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33241561/. Acesso em: 30 jun. 2025.
LANSDOWN, Gerison. Article 31: The Rights to Rest, Play, Recreation, and Cultural and Artistic Activities. In: VAGHRI, Ziba; ZERMATTEN, Jean; LANSDOWN, Gerison; RUGGIERO, Roberta (org.). Monitoring State Compliance with the UN Convention on the Rights of the Child: An Analysis of Attributes. Cham: Springer International Publishing, 2022. p. 281–290. DOI: 10.1007/978-3-030-84647-3_29. Acesso em: 30 jun. 2025.
LAWLOR, K.; MIHAYLOV, S.; WELSH, B.; JARVIS, S.; COLVER, A. A qualitative study of the physical, social and attitudinal environments influencing the participation of children with cerebral palsy in northeast England. Pediatric Rehabilitation, [s. l.], v. 9, n. 3, p. 219–228, jan. 2006. DOI: 10.1080/13638490500235649. Disponível em: http://www.tandfonline.com/doi/full/10.1080/13638490500235649. Acesso em: 30 jun. 202
MASI, Anne; MENDOZA DIAZ, Antonio; TULLY, Lucy; AZIM, Syeda Ishra; WOOLFENDEN, Susan; EFRON, Daryl; EAPEN, Valsamma. Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents. Journal of Paediatrics and Child Health, [s. l.], v. 57, n. 5, p. 631–636, maio 2021. DOI: 10.1111/jpc.15285. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33426739/. Acesso em: 1 jul. 2025.
MCINTYRE, S.; GOLDSMITH, S.; WEBB, A.; EHLINGER, V.; HOLLUNG, S. J.; MCCONNELL, K.; ARNAUD, C.; SMITHERS-SHEEDY, H.; OSKOUI, M.; KHANDAKER, G.; HIMMELMANN, K.; GLOBAL CP PREVALENCE GROUP. Global prevalence of cerebral palsy: a systematic analysis. Developmental Medicine and Child Neurology, [s. l.], v. 64, n. 12, p. 1494–1506, dez. 2022. DOI: 10.1111/dmcn.15346. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35952356/. Acesso em: 1 jul. 2025.
MENEZES, Ilma; CURI, Haidar Tafner; JURDI, Andrea Perosa Saigh. Barreiras e facilitadores ambientais na participação da criança com paralisia cerebral em atividades de recreação e lazer: uma revisão integrativa. Cadernos Brasileiros de Terapia Ocupacional, [S. l.], v. 32, p. e3623, 2024. DOI: 10.1590/2526-8910.ctoAR278236231. Disponível em: https://www.cadernosdeterapiaocupacional.ufscar.br/index.php/cadernos/article/view/3623. Acesso em: 30 jun. 2025.
NAARIS, Mari; BEKTESHI, Saranda; AUFHEIMER, Maria; GERLING, Kathrin; HALLEZ, Hans; ORTIBUS, Els; KONINGS, Marco; MONBALIU, Elegast. Effectiveness of wheeled mobility skill interventions in children and young people with cerebral palsy: a systematic review. Developmental Medicine and Child Neurology, [s. l.], v. 65, n. 11, p. 1436–1450, nov. 2023. DOI: 10.1111/dmcn.15597. Acesso em: 1 jul. 2025.
NASCIMENTO, Aline Amorim do; MONTENEGRO, Gustavo Maneschy. A Produção de Conhecimentos sobre Lazer e Pessoas com Deficiência. LICERE - Revista do Programa de Pós-graduação Interdisciplinar em Estudos do Lazer, Belo Horizonte, v. 27, n. 3, p. 1–28, 2024. DOI: 10.35699/2447-6218.2024.54915. Disponível em: https://periodicos.ufmg.br/index.php/licere/article/view/54915. Acesso em: 30 jun. 2025.
OSTOJIC, Katarina; KAREM, Isra; PAGET, Simon P.; BERG, Alison; DEE-PRICE, Betty-Jean; LINGAM, Raghu; DALE, Russell C.; EAPEN, Valsamma; WOOLFENDEN, Sue; EPIC-CP Group. Social determinants of health for children with cerebral palsy and their families. Developmental Medicine and Child Neurology, [s. l.], v. 66, n. 1, p. 32–40, jan. 2024. DOI: 10.1111/dmcn.15640. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37179527/. Acesso em: 1 jul. 2025.
PALINKAS, Lawrence A.; HORWITZ, Sarah M.; GREEN, Carla A.; WISDOM, Jennifer P.; DUAN, Naihua; HOAGWOOD, Kimberly. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, [s. l.], v. 42, n. 5, p. 533–544, set. 2015. DOI: 10.1007/s10488-013-0528-y. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012002/. Acesso em: 30 jun. 2025.
PALISANO, Robert J.; ROSENBAUM, Peter; BARTLETT, Doreen; LIVINGSTON, Michael H. Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, [s. l.], v. 50, n. 10, p. 744–750, out. 2008. DOI: 10.1111/j.1469-8749.2008.03089.x. Acesso em: 1 jul. 2025.
PATEL, Dilip R.; NEELAKANTAN, Mekala; PANDHER, Karan; MERRICK, Joav. Cerebral palsy in children: a clinical overview. Translational Pediatrics, [s. l.], v. 9, supl. 1, p. S125–S135, fev. 2020. DOI: 10.21037/tp.2020.01.01. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32206590/. Acesso em: 1 jul. 2025.
RODRIGUEZ-SABATE, C.; MORALES, I.; SANCHEZ, A.; RODRIGUEZ, M. The Multiple Correspondence Analysis Method and Brain Functional Connectivity: Its Application to the Study of the Non-linear Relationships of Motor Cortex and Basal Ganglia. Frontiers in Neuroscience, [s. l.], v. 11, p. 345, 20 jun. 2017. DOI: 10.3389/fnins.2017.00345. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477566/. Acesso em: 14 jul. 2025.
SCHMIDT, Ann Katrin; VAN GORP, Marloes; VAN WELY, Leontien; KETELAAR, Marjolijn; HILBERINK, Sander R.; ROEBROECK, Marij E.; PERRIN-DECADE PIP STUDY GROUPS. Autonomy in participation in cerebral palsy from childhood to adulthood. Developmental Medicine & Child Neurology, [s. l.], v. 62, n. 3, p. 363–371, mar. 2020. DOI: 10.1111/dmcn.14366. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/dmcn.14366. Acesso em: 15 jul. 2025.
SILVA, Daniela Baleroni Rodrigues; MARTINEZ, Cláudia Maria Simões; SANTOS, Jair Licio Ferreira. Participação de crianças com paralisia cerebral nos ambientes da escola. Revista Brasileira de Educação Especial, [s. l.], v. 18, p. 33–52, mar. 2012. DOI: 10.1590/S1413-65382012000100004. Disponível em: https://www.scielo.br/j/rbee/a/QDvTysHbJpByBhNsgcJxWhg/. Acesso em: 15 jul. 2025.
SILVA, Maria Carolina; CRUZ-SANTOS, Anabela. Caracterização das atividades de lazer e recreação para alunos com necessidades educativas especiais na região norte de Portugal. Licere – Revista do Programa de Pós-Graduação Interdisciplinar em Estudos do Lazer, Belo Horizonte, v. 28, n. 2, p. 1–24, 2025. DOI: 10.35699/2447-6218.2025.61087. Disponível em: https://periodicos.ufmg.br/index.php/licere/article/view/61087. Acesso em: 15 jul. 2025.
SOURIAL, Nadia; WOLFSON, Christina; ZHU, Bin; QUAIL, Jacqueline; FLETCHER, John; KARUNANANTHAN, Sathya; BANDEEN-ROCHE, Karen; BÉLAND, François; BERGMAN, Howard. Correspondence analysis is a useful tool to uncover the relationships among categorical variables. Journal of Clinical Epidemiology, [s. l.], v. 63, n. 6, p. 638–646, jun. 2010. DOI: 10.1016/j.jclinepi.2009.08.008. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718710/. Acesso em: 15 jul. 2025.
SUTTER, Ellen N.; FRANCIS, Linda Smith; FRANCIS, Sunday M.; LENCH, Daniel H.; NEMANICH, Samuel T.; KRACH, Linda E.; SUKAL-MOULTON, Theresa; GILLICK, Bernadette T. Disrupted access to therapies and impact on well-being during the COVID-19 pandemic for children with motor impairment and their caregivers. American Journal of Physical Medicine & Rehabilitation, [s. l.], v. 100, n. 9, p. 821–830, 1 set. 2021. DOI: 10.1097/PHM.0000000000001818. Acesso em: 15 jul. 2025.
TURAN, Zeynep Celik; KAYIM, Aleyna; ENGELEN, Anne-Mie; SEZER, Kubra Sahadet; DUNFORD, Carolyn; AKI, Esra. Parental perspectives on environmental factors affecting participation of children with disabilities: a scoping review to inform inclusive healthcare and support services. Healthcare, [s. l.], v. 13, n. 11, p. 1282, 28 maio 2025. DOI: 10.3390/healthcare13111282. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12155385/. Acesso em: 15 jul. 2025.
VAMEGHI, Roshank; HOSEINI, Seyed Ali; HEYDARIAN, Samira; AZADEH, Hossein; GHARIB, Masoud. Walking ability, participation, and quality of life in children with spastic diplegic cerebral palsy: a path analysis study. Iranian Journal of Child Neurology, [s. l.], v. 17, n. 2, p. 75–91, 2023. DOI: 10.22037/ijcn.v17i1.34924. Acesso em: 15 jul. 2025.
VARGUS-ADAMS, Jilda N.; MAJNEMER, Annette. International Classification of Functioning, Disability and Health (ICF) as a framework for change: revolutionizing rehabilitation. Journal of Child Neurology, [s. l.], v. 29, n. 8, p. 1030–1035, ago. 2014. DOI: 10.1177/0883073814533595. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24850572/. Acesso em: 15 jul. 2025.
WORLD HEALTH ORGANIZATION. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization, 2001.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 LICERE - Revista do Programa de Pós-graduação Interdisciplinar em Estudos do Lazer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
