Commentary on “Facilitators and Barriers in Performing Activities and Participation in Children With Cerebral Palsy: Caregivers' Perspective”
Physical therapists are “transforming society by optimizing movement,” and oftentimes interventions focus on changing the environment, not the child. Solutions for low-cost adaptive equipment, training paraprofessionals, and creating accessible, inclusive movement groups are critical priorities. Lack of participation of people with disabilities is a global public health crisis and human rights issue.1 Youth with disability participate less in social activities than peers without disability,2 and most never participate in organized or unstructured physical activity.3
Studies from developed countries have reported similar findings regarding environmental and personal barriers and facilitators for participation.4 Access to assistive devices and navigability of the built environment are key findings that should drive practice. Living in poverty and in rural areas increases risk for disease and difficulty accessing resources. Capitalizing on extended family networks, which may be more established in developing countries, is an avenue to enhance participation. Physical therapists should participate in advocacy efforts to promote health and accessible environments.
“What should I be mindful about when applying this information?”
The International Classification of Functioning, Disability and Health framework for the constructs investigated in this study provides a clear structure for the qualitative findings. Although the authors audiotaped and transcribed interviews to demonstrate rigor, using more than 1 person to perform interviews reduces bias. The disability experience is often influenced by socioeconomic status and urban or rural region. Access issues are universal despite sociocultural context. Findings are based on a small sample from an urban locale in a developing country; generalizability of findings is limited to similar populations. The authors provide little insight into specific sociocultural influences on disability status in Thailand. All school-aged children with cerebral palsy need appropriate physical, social, and environmental supports to enable full participation. Enactment of support will be unique, given sociocultural context. Physical therapists are ideally suited to advocate for and provide these services, regardless of culture, socioeconomic status, or region of residence.