Online ISSN: 2149-3189
2015
Monthly
Nicaea Medical Publishing
Türkiye

Mapping Participation in Children with Severe Cerebral Palsy through Structural Equation Modeling

Sinem Asena Sel, Gülsüm Gürüzmaden, Kadir Mert Balta, Şerife Cebeci, Ümran Eroğlu
DOI
https://doi.org/10.18621/eurj.1251
Abstract

Objective: Activity and participation restrictions in children with severe cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels IV–V are poorly described, and the influence of parental mental health remains unquantified. This study aims to identify determinants of participation in this group and quantify the contribution of parental depression, anxiety and stress using structural equation modelling (SEM).

Methods: Sixty-nine children with CP (2–18 years; mean 8.81±3.43 years) at GMFCS IV–V and their primary caregivers were recruited from three rehabilitation centres. Child activity measures included gross motor capacity (Gross Motor Function Measure-66), while child participation outcomes were assessed across self-care, mobility, and social function domains using the Pediatric Evaluation of Disability Inventory (PEDI). Body structures/functions were evaluated using the ICF (International Classification of Functioning, Disability and Health) Core Set. Caregivers completed the Depression Anxiety Stress Scale 21. A theoretically driven SEM was evaluated.

Results: The final model (χ²/df = 1.83, CFI  [Comparative Fit Index] =  0.95, RMSEA [Root Mean Square Error of Approximation] = 0.06) explained 71 % of the variance in participation. Participation was predicted by self care (β = 1.41, P < 0.001), mobility (β = 1.55, P<0.001) and social function (β = 0.82, P < 0.01) and was inversely related to body impairments (β = –0.69, P < 0.01). Parental distress showed a modest but significant direct effect (β = 0.25, P = 0.03) independent of motor capacity.

Conclusion: This is the first study to integrate child function and caregiver psychosocial status within one analytic model for GMFCS IV–V, illuminating an evidence gap. Rehabilitation should couple intensive self care and mobility training with screening and, when necessary, treatment of parental depression, anxiety and stress to maximise participation.

Keywords
Cerebral Palsy, Participation, Gross Motor Function Classification System, Activity, Environmental Factors
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How to Cite
1.
Sel SA, Gürüzmaden G, Balta KM, Cebeci Şerife, Eroğlu Ümran. Mapping Participation in Children with Severe Cerebral Palsy through Structural Equation Modeling. Eur Res J. Published online July 18, 2026:1-9. doi:10.18621/eurj.1251
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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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