Participation in physical leisure pursuits and play in children with motor impairments: developing a theory- and evidenc

Between six and nine percent of children experience problems with their motor abilities (e.g. coordination, balance) and participation in daily life (including taking part in physical leisure pursuits and play). These children are at high risk of long-term health and social difficulties. Appropriate treatments and support potentially have considerable lifetime benefits for these children and their families, and for society more widely.

Currently, the help available to these children consists of different kinds of exercises and games recommended by occupational therapists and physiotherapists. There is little research to say whether these actually help the children. Research in other fields has shown that using strategies that support, for example, the person‘s confidence or motivation can make a difference. Although therapists include some of these strategies in the exercises and games already, they do not do this systematically.

The proposed project will work with children and their parents, and use two frameworks (from the World Health Organisation and the Medical Research Council) to develop ways to increase children‘s participation in physical leisure pursuits and play in ways acceptable to them. The project will pave the way for future development of non-drug treatments for children.

Motor impairments (e.g. difficulties with motor control, muscle tone) affect between 6-9% of children. These children are often diagnosed with conditions such as developmental coordination disorder or cerebral palsy. They experience significant difficulties in participating in everyday life and are at high risk of long-term health and social problems. Despite this high burden of disease, interventions to manage these problems have been subject to little systematic research.

Current interventions for these children consist of ‘therapeutic activities‘ (e.g. exercises) that aim to increase what the children do in their daily lives. The interventions are poorly defined, lack explicit hypotheses about why or how they might work, and have insufficient evidence to support their effectiveness. The proposed research will identify:

The ‘key ingredients‘ of an effective intervention to increase participation in physical leisure pursuits and play in children with motor impairments.
How these ingredients can be combined in a feasible and acceptable intervention.

Research in stroke and chronic pain has shown that incorporating behaviour change strategies (e.g. confidence-building techniques) into therapeutic interventions significantly improves what patients can do (i.e. activity) and actually do (i.e. participation). Carers have also been shown to have an important role, suggesting that effective interventions should systematically incorporate therapeutic, personal (e.g. child‘s confidence) and environmental (e.g. parents‘ beliefs) components.

This project draws on the WHO International Classification of Functioning, Disability and Health - a conceptual framework that integrates biomedical, personal and environmental perspectives on illness and health. The methodology is based on the MRC guidance for developing complex interventions, operationalised into five steps:
(1) identify biomedical, personal and environmental factors proposed to predict children‘s participation in leisure pursuits and play;
(2) develop an explicit model of the key predictors of participation;
(3) select therapeutic and behaviour change strategies to target the proposed predictors;
(4) operationalise the strategies in a feasible and acceptable intervention; and
(5) model the intervention processes and outcomes within single cases.

The primary output will be a detailed protocol for an intervention that is based on empirical evidence and a theoretical model of disability in terms of behaviour (i.e. what children actually do). Such an intervention, if subsequently found to be effective, will support children with motor difficulties in attaining life-long well-being and participation in society. The project will also be an exemplar for the development of non-drug interventions by allied health professionals.