Children and youth with cerebral palsy (CP) experience difficulties in their ability to move, problem solve, socialize, and communicate, associated with limitations in activities in all environments. They are at risk for lower participation in social and leisure activities critical in fostering friendships, developing interests, and promoting well-being. Little is known about involvement in leisure activities and their determinants. This systematic review aims to describe participation in leisure activities by children with CP and identify personal and environmental factors that influence participation. The following databases were reviewed--CINAHL, Medline, Cochrane, Web of Science, OT-seeker, and REHABDATA--using the keywords participation, cerebral palsy, leisure, and recreation. The literature to date suggests that children with physical disabilities are less involved in leisure activities than their peers; activities are more passive, home based, and lack variety. Several factors influence participation in leisure activities, including age, gender, activity limitations, family preferences and coping, motivation, and environmental resources and supports.

Determinants of participation in leisure activities in children and youth with cerebral palsy: systematic review.

Occupational balance is a frequently used concept in occupational therapy, but it is complex and differences in content exist. Further knowledge would be valuable for scholars, practitioners, and measurement development. Concept analysis is a way to clarify concepts. The present concept analysis used Walker and Avant's procedure for analysing the concept of occupational balance, with 43 articles included in the analysis. The results showed that occupational balance can be defined as the individual's perception of having the right amount of occupations and the right variation between occupations. Three perspectives of occupational balance were identified: in relation to occupational areas, in relation to occupations with different characteristics, and in relation to time use. The knowledge gained may guide the use of the concept, and some suggestions are made for its use and for further research.

Occupational balance as used in occupational therapy : A concept analysis

Purpose: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. Method: A review of literature identified research and theory on participation of children with physical disabilities. The authors’ incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. Results: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A disting...

Participation-based therapy for children with physical disabilities

In this lecture, I have reviewed theoretical discussions and definitions of occupational balance, findings from selected studies, and highlighted some methods for measuring aspects of occupational balance. Are any of these ideas directly applicable to occupational therapy practice, education and research? Consider the hassles of everyday life, and add the complicating factors of illness, injury, disability, and limited income. Life, and the pursuit of necessary, desirable and obligatory occupations, can become overwhelming. Given that occupational therapists aim to enable individuals, regardless of ability, to successfully engage in a range of occupations, the answer to the question is yes. Furthering our understanding of occupational balance can improve our ability to serve individual clients and society. In 2001, Fearing stated in her Muriel Driver Memorial Lecture: We will not only recognize and value the skill of maintaining balance, our own and that of our clients, but we will live it. Balance will not be viewed as a set of scales that has equal parts such as work on one side and play on the other but rather the kind of balance that comes from being centred so that we act from a stable base. From that stable base, we will gain a keen sensitivity to rhythm--knowing when to move and when to let go. (Fearing, 2001 pp. 214-215) Perhaps these reflections have added a little coherence to the study of occupational balance. Occupational balance is a relative state, recognizable by a happy or pleasant integration of life activities and demands. There are indicators of imbalance, more so than tangible ways to measure it, and once recognized occupational therapists have the strategies to help restore a sense of occupational balance. Given our collective history and skill in client-centred practice, occupational therapists are capable of both advancing this line of inquiry and attaining occupational balance for ourselves and our clients.

Occupational balance: exploring the relationships among daily occupations and their influence on well-being.

Due to limitations in their physical abilities, adults with cerebral palsy (CP) have relatively few opportunities to engage in independent leisure activities. This pervasive lack of opportunity often leads to the development of dependent behavioral patterns and learned helplessness. The objective of this pilot study was to explore ways in which virtual reality can provide positive and enjoyable leisure experiences during physical interactions with different game-like virtual environments and potentially lead to increased self-esteem and a sense of self-empowerment. The study sample consisted of five young male adults with CP and severe intellectual disabilities who are non-speaking and who use wheelchairs for mobility. Each participant experienced three game-like virtual scenarios via VividGroup's Gesture Xtreme video capture virtual reality (VR) system. The participant's video captured image was processed on the same plane as screen graphical animations that react in real time in response to his movement...

Virtual reality provides leisure time opportunities for young adults with physical and intellectual disabilities.

Although occupational therapists emphasize a balance among the three occupational areas of self-care, productivity, and leisure in people's lives, leisure often is focused on less than the other areas in both the research literature and clinical practice. Very little research has been conducted on the benefits of leisure activities in adults with congenital disabilities. The information contained in this article is a secondary analysis of the interview protocols of nine adults (30-50 years of age) with either cerebral palsy or spina bifida. The primary purpose of the interview was to determine protective processes surrounding turning points in the lives of persons with disabilities. This secondary analysis allowed us to determine the benefits and meaning of leisure for this population. Consistent with literature that focused on either persons without disabilities or persons with acquired disabilities, the participants in the present study reported that involvement in leisure activity provides mental and physical health benefits, enjoyment, opportunity to develop a self-concept and increase self-esteem, and opportunities to build and enhance social relationships. All these benefits enable people to find meaning in life through doing, belonging, and understanding self in the context of their worlds.

Carey Foris

Papers

The importance of leisure in the lives of persons with congenital physical disabilities.