Quality of Life in Children With Cerebral Palsy

Overview

Cerebral Palsy (CP) is an umbrella term that defines a group of permanent disorders of movement and posture, happening during the developing foetal or infant brain. In addition to the main motor symptoms, other clinical disturbances are associated. CP represents a clinical condition with an impact in Quality Of Life (QOL) and social participation, as reported in different countries. QOL is a multidimensional construct defined as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns" (WHOQOL, 1998). In order to best capture the peculiarities of CP, specific questionnaires were carried out to analyse the QOL in this clinical population. The Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child) is an internationally recognized CP-specific instrument based on the International Classification of Functioning, Disability and Health (ICF) framework. Many studies have used this instrument, showing a lower QOL in children with CP compared to their typical developing peers. In literature, several studies have shown that children with CP are at risk of experiencing activity limitations and participation restriction and which can potentially affect their QOL. Participation in daily-life activities, defined as a person's "involvement in a life situation," and participation restriction, characterised as "problems an individual may experience in involvement in life situations" (ICF, World Health Organization, 2001). Studies aimed at describing participation in daily-life activities in CP have consistently found lower frequencies and fewer activities in children and adolescents with CP. In order to gain an overall picture of the QOL and participation of children and adolescents with CP, several studies underline the importance of analysing other background factors, such as motor and cognitive functioning, pain perception, and individual characteristics. The present study aims to deeper understand the perception of QOL and social participation in a group of Italian children with CP, as reported by their parents, using two commonly used questionnaires in the CP population (CP-QOL and PEM-CY). In addition, this study aims to explore the roles of specific clinical variables, such as motor function and cognitive level, on parental perceptions of QOL, in the development of QOL and participation.

Cerebral Palsy (CP) is defined as "a group of permanent disorders of movement and posture occurring in the developing foetal or infant brain" (Rosenbaum et al., 2007). Various clinical disturbances, including behavior, cognition, communication, sensation perception, epilepsy, musculoskeletal problems, are also associated. CP represents a clinical condition with an impact in Quality Of Life (QOL) and social participation, as reported in different countries (Böling et al., 2016; Omura et al., 2018). Quality of life (QOL) is a multidimensional construct defined as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns" (WHOQOL, 1998). QOL concerns several domains such as material conditions, health status, functional abilities, social interactions, and emotional well-being. In the case of children and adolescents, these aspects can be assessed by gathering information from the children themselves or their parents. The literature frequently documents notable differences between the quality of life (QOL) reports of children and their parents. In many instances, children and adolescents tend to express higher QOL assessments across different domains when compared to the evaluations provided by their caregivers (Davis et al., 2009). Parental distress also plays a crucial role in influencing their perception of their child's condition. Given the particularity of CP and the variety of associated disorders, specific questionnaires were developed to analyse the QOL in this clinical population, in order to deeper understand the difficulties that arise. An example is the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child), it is an internationally recognized CP-specific instrument based on the International Classification of Functioning, Disability and Health (ICF) framework. It was developed by an international, multidisciplinary team of clinical and child health researchers in collaboration with parents and children with CP and has been used in various countries. Many studies, using this instrument, have observed that children with CP show a good level of QOL, but lower than typically population (Radsel et al., 2016). Furthermore, it has been shown in the literature that children with CP often experience restriction in participation and activities compared to their peers, these limitations may contribute to affecting QOL of this clinical population. Participation in daily-life activities, defined as a person's "involvement in a life situation," and participation restriction, characterised as "problems an individual may experience in involvement in life situations" (ICF, World Health Organization, 2001). Several studies, exploring daily functioning in social and home activities and the relationship between the individual and their environment, found lower participation in children and adolescents with CP respect to their peers. The level of participation seems to be a factor that influences the QOL of this clinical population. In order to better comprehend QOL and social participation in children and adolescents with CP, it is important analyse different background factors, such as motor functioning, pain perception, and individual characteristics (Makris et al., 2021) There is widespread consensus in the literature on the potential predictive role of cognitive functioning in QOL and social participation, although there are few studies on the impact of intellectual disability on the QOL of children and adolescents with CP. The present study aims to deeper understand the perception of QOL and social participation of a group of Italian children with CP. To pursue this, their parents complete the CP QOL-Child Primary Caregiver and PEM-CY questionnaires, commonly used in the CP population. In addition, this study aims to explore the roles of specific clinical variables, such as motor function and cognitive level, on parental perceptions of QOL, in the development of QOL and participation. For this reason, psychological assessment is conducted to evaluate intellectual abilities and motor assessment to describe the manual ability and gross motor skills and the independence in daily activities.