Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy?
Physical barriers at home and school lower quality of life for kids with CP as much as clinical factors, so BCBAs should assess and modify environments, not just behaviors.
01Research in Context
What this study did
Parents of children and teens with cerebral palsy filled out two surveys. One asked about barriers at home and school. The other asked about the child’s quality of life.
The team then used statistics to see if more barriers predicted lower quality-of-life scores, even after accounting for the child’s motor skills and parent stress.
What they found
Home and school barriers—like narrow doors, high desks, or no ramps—significantly dragged down parent-reported quality of life.
The barriers mattered more than many clinical factors, showing that the environment itself can hurt participation.
How this fits with other research
Two years earlier, Chen et al. (2014) looked at the same question and found that caregiver stress and child behavior were the big drivers of quality of life. Badia et al. (2016) now add that physical barriers at home and school are also powerful. The studies do not clash; they simply point to different levers you can pull.
Longo et al. (2017) showed that parents often rate quality of life lower than the child does. Marta used only parent reports, so the scores may be conservative. When you assess, ask both the child and the parent.
Aza et al. (2024) later validated a Spanish version of the same quality-of-life tool. Their work extends Marta’s by giving you a second language option and by confirming that parent and child ratings can differ.
Why it matters
You already check for behavior problems and caregiver stress. Now add a quick walk-through of the home, classroom, and playground. Look for steps, heavy doors, or tables that don’t fit wheelchairs. Fixing these small barriers can lift quality of life as much as some therapy goals. Start with the spaces the child uses every day.
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02At a glance
03Original abstract
Physical, social, and attitudinal environment may affect the quality of life (QoL) of children and adolescents with cerebral palsy (CP). Participants in this study included parents of 206 children and adolescents with CP (55.8% males) aged 8-18 years (M=11.96, SD=3). Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% level I, 18% level II, 18% level III, 12.6% level IV, and 27.2 level V. Environmental barriers were assessed with the Spanish version of the European Child Environment Questionnaire (ECEQ), and QoL was assessed with the KIDSCREEN parents' version. The results of the correlation analysis revealed that GMFCS level, IQ, and type of schooling are significantly correlated with QoL. Barriers were also associated with QoL. A series of hierarchical regression analyses indicated that, after controlling for the effect of child and parent's variables, barriers at home and at school significantly contribute to QoL. These findings underscore the importance of providing interventions to produce environmental changes that contribute to the improvement of QoL.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2015.12.011