Volume 18, Issue 4 (December 2020)                   Iranian Rehabilitation Journal 2020, 18(4): 377-386 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Dehghanizadeh M, Akbarfahimi M, Zareiyan A, Yazdani F, Khalafbeigi M, Soleimani F. Predictors of Interest in Performing Activities Among Iranian Adolescents with Cerebral Palsy. Iranian Rehabilitation Journal 2020; 18 (4) :377-386
URL: http://irj.uswr.ac.ir/article-1-1141-en.html
1- Department of Occupational therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Occupational therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
3- Department of Public Health Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran.
4- Department of Health and Life Sciences ,Occupational Therapy Program, Faculty of health and life sciences, Oxford Brookes University, Oxford, UK.
5- Pediatric Neurorehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Full-Text [PDF 599 kb]   (795 Downloads)     |   Abstract (HTML)  (2275 Views)
Full-Text:   (714 Views)
1. Introduction 
erebral Palsy (CP), as an everlasting disorder of the development of posture and movement, imposes restrictions on the affected individuals’ activities; accordingly, it is often associated with psycho-social problems [1]. The physical rehabilitation of adolescents with CP presents significant consequences in participation in other activities [2]. To achieve optimum physical rehabilitation benefits, the adolescent must be actively involved in the therapeutic process [345]. Adolescent’s interest in participating in physical rehabilitation activities along with the quality of relationship with the therapist could influence the therapy outcomes [5, 6]. Interest, as a psychological term, epitomizes by an affective component of positive emotion as well as a cognitive component of concentration [7]. Socio-cultural, physical, and temporal environments where therapy occurs could enhance or diminish adolescent’s motivation to engage in therapy [8, 9]. When individuals are interested in performing some activity, they have been intrinsically motivated for that activity [10].
Adolescence is a rapid human developmental phase defined by various emotional and bio-social changes [11]. During this phase, personal interests are vital for the generation of self-development in adolescents [12], real-life choices, future orientation [13], as well as expertise [14]. Interest in adolescents proves high intrinsic motivation to learn [7, 15] and experience positive emotions; subsequently, it results in high wellbeing over time [1617]. Goals and values sustain when being congruent with an individual’s interests [12]. Interests are raised through and embedded in interaction with social contexts; thus, it is a complex process to pursue interests in daily life [18]. 
Previous research on the predictors of interest has mainly focused on participation in leisure activities and the impact of the social environment on an individual’s interest. Only a few numbers of studies addressed the effects of different factors on the interests of children with CP and reported different results. For example, Longo et al. [19] stated that children with CP presented low diversity and intensity of participation while there existed high levels of enjoyment. They also argued that participation in leisure activities outside the school was further affected by the children and environmental factors, compared to their families [19]. While in another study by Bergin [18], the social experience was investigated. He concluded that social experiences that teens have with classmates, families, schools, and culture could be the primary influence of an individual’s interest [18]. Oliveira et al. [20] also proposed a model based on cognitive and affective components. They suggested that interest presenting in adolescents with CP in conducting activities affects their hand coordination function. Furthermore, their study data revealed that a child’s interests could be affected by the type of assistance, i.e. provided by the caregivers at home as well as the level of child’s satisfaction during daily living activities [20]. 
Adolescents with CP also find a deep sense of fulfillment when conducting the activities of their interest [20]. Therefore, it is necessary to determine the factors intensifying the interest in performing activities among adolescents with CP. However, to the best of our knowledge, there is no research on the predictors of interest in performing activities among adolescents with CP in Iran. Therefore, this research was designed to determine the predictive factors of interest in performing activities among Iranian adolescents with CP.
2. methods
A cross-sectional study was applied to detect the predictors of interest in performing activities among adolescents with CP.
In total, 312 adolescents with CP participated in this study. The research participants were recruited from the exceptional sensory-motor schools and private clinics by the multistage sampling method. First, Iran, with 31 provinces, was divided into 5 areas; north, north-west, west, center-south, and east. Then, one province was randomly selected from each region (Tehran, West-Azerbaijan, Hamadan, Isfahan, & Yazd). Next, the convenience sampling method was used for recruiting the study participants from the capital of each selected province. The inclusion criteria of the study included the following: receiving a diagnosis of CP by a paediatric neurologist, an age range of 10-19 years [21], a Gross Motor Function Classification System (GMFCS) level Ⅰ-Ⅲ [2223], the Intelligence Quotient (IQ) within the healthy range [24], and an ability to cooperate and respond the relevant inventories. The exclusion criteria of the study were visual impairments that limit the children’s abilities to perform their everyday tasks; uncontrolled seizure disorder affecting motor skills, and history of orthopaedic or neurology surgery in the past 6 months.The following instruments were employed to collect the required data in the present study.
The Adolescent Interest Inventory-Cerebral Palsy (AII-CP): It is a 15-item self-report inventory, i.e. developed by the first author of this research [25]; the findings of a qualitative study using directed content analysis and a Nominal Group Technique (NGT) were used for this purpose [26]. The Model of Human Occupation (MOHO), as an occupational therapy framework, was used for developing the AII-CP. This inventory was developed to measure interest in adolescents with CP in participating in activities. 
Response choices contain a 5-point Likert-type setup, ranging from one (strongly agree) to 5 (strongly disagree), with a neither agree nor disagree midpoint. It takes about 8 minutes to complete this scale. The AII-CP was constructed in 5 domains; personal values (3 items), the perception of ability (3 items), interest in performing an activity (3 items), physical environment features (3 items), and social environment support (3 items). Concerning the quantitative face validity of the AII-CP, the item impact technique with scoring ≥1.5 [27] was conducted on 10 adolescents with CP and a healthy IQ approved by the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE) [24]. Intelligence testing was performed by an occupational therapist with 5 years of clinical experience. Respecting the quantitative content validity of the inventory, Item-level Content Validity Index (I-CVI) and Content Validity Ratio (CVR) were evaluated for the items. According to Lawshe [28], while the number of experts is 20, the minimum acceptable CVR is equivalent to 0.42. In this study, the CVR was assessed by 20 experts who had clinical experiences with children and adolescents with CP for >10 years (13-PhD graduates in occupational therapy, 5-MSc graduates in occupational therapy, 2-PhD graduates in clinical psychology). To assess the I-CVI, another 20 experts (17-PhD graduates in occupational therapy & 3-MSc graduates in occupational therapy) with a 10-year clinical experience with adolescents with CP were requested to rate the relevance of the AII-CP items [29]. Then, the modified kappa was calculated. Its minimum value for maintaining an item is considered to be >0.74 [30]. Finally, the AII-CP was composed of items with the I-CVIs of 0.78 or higher [30]. 
The Gross Motor Function Classification System (GMFCS): This scale was used as a standard observational clinical classification system to describe the gross motor function of individuals with CP concerning self-initiated movement abilities [22]. This five-level classification system is developed based on the movement ability and the need for assistive devices. In the first level of the scale, there is the highest independence in motor performance; on the other side of the scale, level V presents the least independence in motor performance [22]. The validity and reliability of this scale for adolescents with CP have been proven by a previous study in Iran [23].
Evidence about the manual capability of adolescents with CP was gathered by the Manual Ability Classification System (MACS) considering the limitations of manual skills, as well as the need for assistive tools [31]. Based on this classification, adolescents categorize into 5 levels. The first level reflects the highest independence, while level V signifies the least independence in manual skills [31]. The reliability and validity of this classification system for adolescents with CP have previously been established [32].
Information about the age and gender of the adolescents with CP was collected using a demographic data form. After the approval of this research by the relevant Ethics Committee, the Education Organization of Tehran, West-Azarbayjan, Hamedan, Esfehan, and Yazd provinces provided a brief introduction to obtain permission from the samples of exceptional sensory-motor schools. Subsequently, after obtaining permission from the ministers of exceptional sensory-motor schools, the process of sampling started. Next, the parents of adolescents with CP signed the written informed consent forms. Subsequently, the study participants were elaborated on the research objectives and got acquainted with the procedure of completing the inventory. The healthy IQ range of the research participants was approved by the SPARCLE study [24]. Intelligence testing was performed by an occupational therapist with 5 years of clinical experience. Next, with composure in a quiet school environment from 8:00 am to 12:00 am at break times, the selected adolescents with CP completed the AII-CP. At the time of completing the questionnaire, none of the study participants reported feelings of being stressed or tired. Then, the gross motor function and the manual ability were assessed by GMFCS and MACS in random order by an expert occupational therapist with 5 years of clinical experience blinded to the study purposes.
The gender, GMFCS, and MACS were considered as the categorical variables. The personal values, perception of ability, physical environment features, social environment support, interest in conducting an activity, and age were considered as continuous variables in the data analyses.
For the statistical analysis of this study, SPSS was used. To measure correlations among the variables, appropriate statistical tests were applied. Initially, the correlation coefficient was run to screen a significant correlation between independent variables (gender, age, GMFCS, MACS, personal values, the perception of ability, physical environment features, & social environment support) and dependent variable (interest in performing an activity). Categorical variables (GMFCS and MACS) cannot directly be entered into a regression model and significantly interpreted. In general, a k level categorical variable is converted into k-1 variables, each with two levels. As in dummy coding, categorical variables are just recoded into K binary 0-1 variables [33]. Precisely, the variables that suggested a significant correlation with the dependent variable were employed into the multiple linear regression model with the enter method. Besides, P≤0.05 was considered statistically significant. Durbin-Watson value in the range of 1.5 to 2.5 was considered to be relatively normal [34].
3. Results 
In total, 312 adolescents with CP with GMFCS level Ⅰ-Ⅲ participated in the present study. The Mean age of participants was 14.08±2.34 years old (Table 1).


Correlations revealed that only personal values, the perception of ability, social environment support, age, and GMFCS were related to interest in performing an activity in the study participants. Thus, only these variables were entered in the regression analysis model. Based on correlations analysis, MACS and physical environment features were not significantly correlated with interest in conducting an activity. As a result, these variables were excluded from the model.
Then, multiple linear regression was calculated to predict interest in performing an activity based on personal values, social environment support, GMFCS level Ⅰ, and age. A significant regression equation was found (F6,305=46.083, P<0.001), with an R2 of 0.475. The research participants’ predicted interest in performing an activity equaled 7.947+0.621 (GMFCS level Ⅰ) + 0.308 (personal values) +0.195 (social environment support) -0.08 (age). The prediction model for interest in conducting activities in adolescents with CP is presented in Table 2


GMFCS level Ⅰ, personal values, social environment support, and age were significant predictors of interest in performing an activity. However, GMFCS Level Ⅱ-Ⅲ and the perception of ability were not significant predictors in this respect.
4. Discussion 
Identifying the influential and predictive factors of interest in performing activities by adolescents with CP was the main purpose of the present study. The outcomes of the initial analysis discovered that maximum independence in motor performance (GMFCS level Ⅰ), personal values, social environment support, and age had exerted more influence on interest in performing activities among the studied adolescents with CP.
Based on the obtained results, the most important factor affecting adolescent’s interest in performing activities was the highest independence in motor performance. Considering these results, GMFCS level Ⅰ was associated with a higher level of interest in performing activities. These outcomes appeared to be consistent with the study conducted by Longo et al. [19]; they argued that lower GMFCS levels in adolescents with CP are associated with a higher level of participation in leisure activities. Furthermore, they revealed that a higher level of motivation could be observed in adolescents with fewer activity limitations [35].
The achieved findings also revealed that personal values significantly impact interest in performing activities by adolescents with CP. These results appeared to be consistent with those of Hofer’s and Krapp’s studies [12, 36], stating that perusing goals and values are associated with interests. Such goal pursuit intensifies the enjoyment of the positive activity [37]. Furthermore, Oliveira et al. [20] explored task values and interest in engaging in activities in children. They proposed a model highlighting that subjective task value was a character influencing children’s interest in activities. Personal values seem to be the second influential factor affecting interest in performing activities among adolescents with CP despite their movement limitations. 
The present research results suggested that the higher levels of social environment support were related to the greater interest in performing activity among adolescents with CP. Based on these findings, and considering that the personal values, age, and GMFCS level are fixed factors, rehabilitation therapists should focus on improving the social environment support to increase interest in performing activities among adolescents with CP. Other studies also emphasized the social-environmental support influencing social participation among adolescents with CP [3839]. Research on the interest in different contexts discovered that parents, as the most influential implementers of developing and experiencing interest, need to provide their children with the resources (e.g. taking them to music lessons, sports events, & different museums) [18].
Based on the current study findings, the younger adolescents with CP are more interested in engaging in performing activities, duties, and roles. This result appeared to be inconsistent with those of Hoff et al.’s study [40]; they reported that mean-level interest scores broadly increase with age. However, further investigating the data revealed that during young adulthood, interest in performing the activities that involve working with hands, tools, and materials, as well as scientific and research activities, remained constant [40]. However, by increasing age, adolescents with CP generate more movement limitations and are progressively frustrated by the limitations of conducting their activities of interest. Thus, it seems that their interest in performing activities decreases with age.
Interestingly, the physical environment features, which could be among the factors that affect the interest of adolescents with CP, were not significant in this area. These findings were inconsistent with those of Majnemer and associates [41]. They revealed that accessibility is a hindrance to participation in leisure activities for individuals with physical disabilities. Accessibility problems did not seem to affect their interest in performing activities owing to their parents’ support in daily movements.
The present study sample was selected from adolescents with CP (GMFCS level Ⅰ-Ⅲ); therefore, it is recommended that future studies investigate characteristics affecting interest in adolescents with CP (GMFCS level Ⅳ-Ⅴ) using a parent-report inventory. The strength of the present study was conducting research based on the MOHO context in adolescents with CP for the first time. Moreover, sampling was performed in a large statistical population in this study. The present study had some limitations. Since most adolescents with CP (GMFCS level Ⅳ-Ⅴ) are at greater risks to present IQ scores in the severity levels [42], they could not complete the self-report inventory. As a result, we had restrictions in sampling in this group. Furthermore, an individual’s interests are related to their values and environmental features [25]. The values of these individuals also could depend on their family and friends. Thus, it can affect their interests. Since motivation and participation of individuals in performing their activities help reduce the burden on caregivers [43], It is suggested the relationship between the motivation of adolescents with cerebral palsy and the burden of caregivers will be studied in future study.
5. Conclusion
Based on this research data, interest in performing activities was associated with maximum independence in motor performance, personal values, social environment support, and the age of adolescents with CP. Consequently, identifying the factors that predict and affect the interest of adolescents with CP can facilitate rehabilitation in promoting their motivation and participation in performing daily living activities. Furthermore, adolescents with the highest independence in motor activity are further interested in conducting activities. Thus, physical rehabilitation for adolescents with CP is recommended, as it can improve their motivation. The adolescents’ engagements in different activities could increase their participation. Furthermore, by getting involved with community activities and social support of adolescents with CP, it is more likely to keep them interested in performing activities.

Ethical Considerations
Compliance with ethical guidelines

This research was approved by the Iran University of Medical Sciences Ethics Committee on 24 June 2018, (Code: IR.IUMS.REC.1397.048). Informed consent forms were obtained from all study participants and their parents prior to gathering information.

Funding
This study was endorsed by the Iran University of Medical Sciences (Grant number: 97-3-6-12888).

Authors' contributions
Methodology: Moslem Dehghanizadeh, Malahat Akbarfahimi, Armin Zareiyan, Farzaneh Yazdani, Mitra Khalafbeigi, Software: Moslem Dehghanizadeh, Armin Zareiyan; Validation and formal analysis: Moslem Dehghanizadeh, Malahat Akbarfahimi, Armin Zareiyan; Investigation: Moslem Dehghanizadeh; Resources, data curation: Moslem Dehghanizadeh; Writing – original draft: Moslem Dehghanizadeh, Malahat Akbarfahimi, Armin Zareiyan, Farzaneh Yazdani, Mitra Khalafbeigi; Preparation, writing – review & editing, visualization, supervision: All authors; Project administration and funding acquisition: Malahat Akbarfahimi.

Conflict of interest
The authors stated no conflicts of interest.

Acknowledgments
This study was impossible to be conducted without the contribution of the parents and adolescents with CP. Furthermore, the authors would like to express their gratitude to these subjects as well as the colleagues at the Iran University of Medical Sciences. In addition, the authors appreciated the occupational therapists helping the researchers in completing the study tools.


References
  1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: The definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology Supplement. 2007; 109:8-14. [PMID]
  2. Chiarello LA, Palisano RJ, Bartlett DJ, McCoy SW. A multivariate model of determinants of change in gross-motor abilities and engagement in self-care and play of young children with cerebral palsy. Physical occupational therapy in pediatrics. 2011; 31(2):150-68. [DOI:10.3109/01942638.2010.525601] [PMID]
  3. Gopalan G, Goldstein L, Klingenstein K, Sicher C, Blake C, McKay MM. Engaging families into child mental health treatment: updates and special considerations. Journal of the Canadian Academy of Child Adolescent Psychiatry. 2010; 19(3):182-96. [PMCID]
  4. King G, Currie M, Petersen P. Child and parent engagement in the mental health intervention process: A motivational framework. Child Adolescent Mental Health. 2014; 19(1):2-8. [DOI:10.1111/camh.12015] [PMID]
  5. Poulsen AA, Ziviani J, Cuskelly M. Understanding motivation in the context of engaging children in therapy. In: Ziviani J, Poulsen AA, Cuskelly M, editors. The art and science of motivation: a therapist’s guide to working with children. London: Jessica Kingsley Publishers; 2012. https://www.amazon.com/Art-Science-Motivation-Therapists-Children-ebook/dp/B00BW8QQS4
  6. Lawlor MC. The particularities of engagement: Intersubjectivity in occupational therapy practice. OTJR: Occupation, Participation Health Expectations. 2012; 32(4):151-9. [DOI:10.3928/15394492-20120302-01]
  7. Hidi S, Renninger KA. The four-phase model of interest development. Educational Psychologist. 2006; 41(2):111-27. [DOI:10.1207/s15326985ep4102_4]
  8. Dunn W, Ziviani J. Structuring and working with the environment. In: Ziviani J, Poulsen AA, Cuskelly M, editors. The art and science of motivation: a therapist’s guide to working with children. London: Jessica Kingsley Publishers; 2012. https://books.google.com/books/about/The_Art_and_Science_of_Motivation.html?id=DbRzcl0nfwoC&source=kp_book_description
  9. Poulsen AA, Rodger S, Ziviani JM. Understanding children’s motivation from a self-determination theoretical perspective: Implications for practice. Australian Occupational Therapy Journal. 2006; 53(2):78-86. [DOI:10.1111/j.1440-1630.2006.00569.x]
  10. Deci EL, Ryan RM. Intrinsic motivation. The corsini encyclopedia of psychology. 2010:1-2. [DOI:10.1002/9780470479216.corpsy0467] [PMID]
  11. Crone EA, Dahl RE. Understanding adolescence as a period of social-affective engagement and goal flexibility. Nature Reviews Neuroscience. 2012; 13(9):636-50. [DOI:10.1038/nrn3313] [PMID]
  12. Krapp A. Structural and dynamic aspects of interest development: Theoretical considerations from an ontogenetic perspective. Learning and Instruction. 2002; 12(4):383-409. [DOI:10.1016/S0959-4752(01)00011-1]
  13. Rounds J, Su R. The nature and power of interests. Current Directions in Psychological Science. 2014; 23(2):98-103. [DOI:10.1177/0963721414522812]
  14. Renninger KA. Individual interest and its implications for understanding intrinsic motivation. In: Sansone C, editor. Intrinsic and extrinsic motivation: The search for optimal motivation and performance. Cambridge: Academic Press; 2000. [DOI:10.1016/B978-012619070-0/50035-0]
  15. Harackiewicz JM, Durik AM, Barron KE, Linnenbrink-Garcia L, Tauer JM. The role of achievement goals in the development of interest: Reciprocal relations between achievement goals, interest, and performance. Journal of Educational Psychology. 2008; 100(1):105-22. [DOI:10.1037/0022-0663.100.1.105]
  16. Renninger KA, Hidi S. The power of interest for motivation and engagement. Oxfordshire United Kingdom: Taylor & Francis; 2015. https://books.google.com/books/about/The_Power_of_Interest_for_Motivation_and.html?id=e5j4CgAAQBAJ&source=kp_book_description
  17. Schulz P, Schulte J, Raube S, Disouky H, Kandler C. The role of leisure interest and engagement for subjective well-being. Journal of Happiness Studies. 2018; 19(4):1135-50. [DOI:10.1007/s10902-017-9863-0]
  18. Bergin DA. Social influences on interest. Educational Psychologist. 2016; 51(1):7-22. [DOI:10.1080/00461520.2015.1133306]
  19. Longo E, Badia M, Orgaz BM. Patterns and predictors of participation in leisure activities outside of school in children and adolescents with cerebral palsy. Research in developmental disabilities. 2013; 34(1):266-75. [DOI:10.1016/j.ridd.2012.08.017] [PMID]
  20. Oliveira RHSd, Brandão MdB, Mambrini JVdM, Mancini MC. Interest of children with unilateral spastic cerebral palsy in bimanual daily activities. Scandinavian Journal of Occupational Therapy. 2020; 27(5):385-93. [DOI:10.1080/11038128.2018.1561938] [PMID]
  21. World Health Organization. The health of young people: A challenge and a promise. Geneva: World Health Organization; 1993. https://apps.who.int/iris/handle/10665/37353
  22. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology. 1997; 39(4):214-23. [DOI:10.1111/j.1469-8749.1997.tb07414.x] [PMID]
  23. Riahi A, Rassafiani M, Binesh M. [The cross-cultural validation and test-retest and inter-rater reliability of the Persian translation of parent version of the gross motor function classification system for children with cerebral palsy (Persian)]. Journal of Rehabilitation. 2013; 13(5):25-30. http://rehabilitationj.uswr.ac.ir/article-1-1097-en.html
  24. Colver AF, Dickinson HO. Study protocol: determinants of participation and quality of life of adolescents with cerebral palsy: a longitudinal study (SPARCLE2). BMC public Health. 2010; 10:280. [DOI:10.1186/1471-2458-10-280] [PMID] [PMCID]
  25. Dehghanizadeh M, Khalafbeigi M, Akbarfahimi M, Yazdani F, Zareiyan A. Exploring the contributing factors that influence the volition of adolescents with cerebral palsy: A directed content analysis. Scandinavian Journal of Occupational Therapy. 2020:1-11. [DOI:10.1080/11038128.2020.1723686] [PMID]
  26. Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The Nominal group technique: A research tool for general practice? Family Practice. 1993; 10(1):76-81. [DOI:10.1093/fampra/10.1.76] [PMID]
  27. Ebadi A, Zareiyan A, Zarshenas L. [Instrument development in health sciences (Persian)]. 2th ed. Tehran: Jame-e-Negar; 2019.
  28. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975; 28(4):563-75. [DOI:10.1111/j.1744-6570.1975.tb01393.x]
  29. Waltz CF, Faan RN, Strickland OL, Lenz ER. Measurement in nursing and health research. New York: Springer publishing company; 2010. https://books.google.com/books/about/Measurement_in_Nursing_and_Health_Resear.html?id=1xAdjkR14ocC
  30. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing health. 2007; 30(4):459-67. [DOI:10.1002/nur.20199] [PMID]
  31. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall AM, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Developmental medicine child neurology. 2006; 48(7):549-54. [DOI:10.1017/S0012162206001162] [PMID]
  32. Riyahi A, Rassafiani M, AkbarFahimi N, Sahaf R, Yazdani F. Cross-cultural validation of the Persian version of the manual ability classification system for children with cerebral palsy. International Journal of Therapy and Rehabilitation. 2013; 20(1):19-24. [DOI:10.12968/ijtr.2013.20.1.19]
  33. Daly A, Dekker T, Hess S. Dummy coding vs effects coding for categorical variables: Clarifications and extensions. Journal of choice modelling. 2016; 21:36-41. [DOI:10.1016/j.jocm.2016.09.005]
  34. Pallant J. SPSS survival manual: A step by step guide to data analysis using IBM SPSS. New York: McGraw-Hill Education; 2016. https://books.google.com/books/about/SPSS_Survival_Manual.html?id=TSzOjwEACAAJ
  35. Majnemer A, Shevell M, Law M, Poulin C, Rosenbaum P. Level of motivation in mastering challenging tasks in children with cerebral palsy. Developmental Medicine & Child Neurology. 2010; 52(12):1120-6. [DOI:10.1111/j.1469-8749.2010.03732.x] [PMID]
  36. Hofer M. Adolescents’ Development of individual interests: A product of multiple goal regulation? Educational Psychologist. 2010; 45(3):149-66. [DOI:10.1080/00461520.2010.493469]
  37. Higgins ET, Cesario J, Hagiwara N, Spiegel S, Pittman T. Increasing or decreasing interest in activities: The role of regulatory fit. Journal of Personality Social Psychology. 2010; 98(4):559-72. [DOI:10.1037/a0018833] [PMID]
  38. Shields N, Synnot AJ, Barr M. Perceived barriers and facilitators to physical activity for children with disability: a systematic review. British Journal of Sports Medicine. 2012; 46(14):989-97. [DOI:10.1136/bjsports-2011-090236] [PMID]
  39. Wintels SC, Smits DW, van Wesel F, Verheijden J, Ketelaar M, Group PPS. How do adolescents with cerebral palsy participate? Learning from their personal experiences. Health Expectations. 2018; 21(6):1024-34. [DOI:10.1111/hex.12796] [PMID] [PMCID]
  40. Hoff KA, Briley DA, Wee CJM, Rounds J. Normative changes in interests from adolescence to adulthood: A meta-analysis of longitudinal studies. Psychological bulletin. 2018; 144(4):426-51. [DOI:10.1037/bul0000140] [PMID]
  41. Majnemer A, Shikako-Thomas K, Chokron N, Law M, Shevell M, Chilingaryan G, et al. Leisure activity preferences for 6-to 12-year-old children with cerebral palsy. Developmental Medicine Child Neurology. 2010; 52(2):167-73. [DOI:10.1111/j.1469-8749.2009.03393.x] [PMID]
  42. Dalvand H, Dehghan L, Hadian MR, Feizy A, Hosseini SA. Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study. Archives of physical medicine rehabilitation. 2012; 93(3):480-4. [DOI:10.1016/j.apmr.2011.10.019] [PMID]
  43. Farajzadeh A, Akbarfahimi M, Maroufizadeh S, Rostami HR, Kohan AH. Psychometric properties of Persian version of the Caregiver Burden Scale in Iranian caregivers of patients with spinal cord injury. Disability and Rehabilitation. 2018; 40(3):367-372. [DOI:10.1080/09638288.2016.1258738] [PMID]
Article type: Original Research Articles | Subject: Occupational therapy
Received: 2020/03/5 | Accepted: 2020/06/16 | Published: 2020/12/1

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb