Factors Affecting Lifelong Participation in Physical Activity for Adults with Cerebral Palsy

Cerebral palsy (CP) is a non-progressive disorder caused by trauma to or malformation of the developing brain which leads to limitations in motor planning, posture, perception, and sensation. Due to the pediatric onset of CP, much of the current research focuses on childhood outcomes even though 90% of children with CP age into adulthood with life expectancies similar to that of the general population. It is well established that adults with CP experience several barriers to lifelong participation in physical activity (PA) and many of these barriers are related to physical limitations. An understanding of the factors that keep adults with CP from remaining physically active throughout the course of their lives is still largely unknown. The purpose of this dissertation is to obtain a better understanding of these factors and how they may affect the lifelong participation in PA among adults with CP. The first study examined how attitudes and experiences with lifelong PA opportunities affected adult PA trajectory. Participants (n= 68) were categorized according to age (young, middle, or older adults). A new survey was created and validated that asked adults with CP to recall their experiences with PA at different developmental stages of life. Additionally, they were asked to reflect on how those experiences affected their current levels of physical activity. Participants also engaged in a semi-structured recall interview that focused on type and intensity of activity completed over three days. All surveys and interviews were conducted via teleconferencing software. Regardless of age, adults with CP had relatively positive attitudes towards past experiences with PA. However, positive attitudes towards PA were negatively correlated with time spent in moderate activities of daily living. These findings suggest that the PA opportunities offered to individuals with CP are sufficient to create positive associations with PA but may require additional effort to impact PA trajectory. The second study examined the factors that may facilitate ongoing participation in PA. Surveys of pain, quality of life, self-perception and independence were administered concurrently with the survey and interview conducted in study one. The current level of activity that was determined using the semi-structured interviews was used again in this study. Factor domain contributions of self-perception and pain were strongly associated with activities of high perceived exertion, whether it was required tasks of daily living or self-selected leisure activities. Self-perception of athletic ability, pain severity, affective distress, and pain associated with general activities were significant predictors of time spent in leisure activities. The final study addressed the need to enhance the healthcare reach for adults with CP. This study tested the feasibility of assessing physical function, encompassing mobility, functional leg strength, balance, sensory integration, and gait speed, using a telehealth approach. From the original sample, twenty participants were randomly selected to take part in this study. Most participants were able to complete the assessments, demonstrating the feasibility of using a telehealth model to monitor physical function in adults with CP. Collectively, these findings illustrate the importance of continuous monitoring of adults with CP to maintain function. Adults with CP have positive attitudes towards lifetime PA but are still less active than the general population. Functional maintenance through telehealth-based assessments may facilitate increased physical and psychological well-being while indirectly increasing lifetime participation in PA.PHDMovement Science PhDUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/174571/1/lrmarra_1.pd