Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Research Article

Prevalence of environmental barriers in children and adolescents with physical disabilities: a cross-sectional study

Leilan Santos Soares, Élida Rayanne Viana Pinheiro Galvão, Isabelle Ribeiro Barbosa, Haryelle Náryma Confessor Ferreira, Rafaela da Silva Cruz, Carla Patricia Novaes dos Santos Fechine, Alinne Beserra de Lucena Marcolino, Sheva Castro Dantas de Sousa, Egmar Longo

Downloads: 2
Views: 320


Introduction. Children and adolescents with physical disabilities (PD) still do not have the same opportunities as their non-disabled peers, which may be due to environmental factors and their effect on participation. Objective: The aim of this study was to evaluate the prevalence of environmental barriers in children and adolescents with PD and their associated factors in two states of Northeastern Brazil. Method. The parents or caregivers of 71 children and adolescents aged 18 years and younger with PD were interviewed, using a sociodemographic questionnaire and the Craig Hospital Inventory of Environmental Factors (CHIEF), which assesses the frequency and extent of environmental barriers. Results. The greatest environmental barriers were for Service and Assistance. In the Service and Assistance and Physical/Structural domains, the frequency of barriers was monthly, while Attitude and Support and Policies barriers were less frequent. In all the domains, the parents reported that the problems were serious. Children and adolescents with PD who walked faced barriers more frequently than those who used a wheelchair or were carried and those living in Rio Grande do Norte had more perceived barriers in the Policies domain. Conclusion. These results lead to a reflection on the role of the environment and how each state conducts national public policies aimed at children with disabilities. This can be a step towards improving the lives of children with disabilities in Northeastern Brazil, transforming environmental barriers into environmental facilitators.


Disability; Environment; Participation; Children; Adolescents.


1. Organização das Nações Unidas – Brasil: A ONU e as pessoas com deficiência [][accessed 2017 Aug 30].

2. Instituto Brasileiro de Geografia e Estatística:Censo Demográfico 2010: Características gerais da população, religião e pessoas com deficiência [] [accessed 2017 Aug 29].

3. Instituto Brasileiro de Geografia e Estatística: Pesquisa Nacional de Saúde [] [accessed 2017 Aug 29].

4. Banks LM, Kuper H, Polack S.Poverty and disability in low- and middleincome countries: A systematic review. PLoS One. 2017;12(12):1-19.

5. McConachie H, Colver AF, Forsyth RJ, Jarvis SN, Parkinson KN.Participation of disabled children: how should it be characterized and measured?. DisabiRehabil.2006;28(18):1157-1164

6. Longo E,Badia M,Orgaz B, Verdugo MA.Cross-cultural validation of the Children s Assessment of Participation and Enjoyment (CAPE) questionnaire in Spain. Child Care Health Dev. 2014;40(2):231-241.

7. Law M, King G, King S,Kertoy M, Hurley P, Rosenbaum P,et al . Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Dev Med Child Neurol. 2006;48(5):337-342.

8. Beckung E,Hagberg G.Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002;44(5):309-316.

9. Badia M, Longo E, Orgaz MB,Gómez-Vela M. The influence of participation in leisure activities on quality of life in spanish children and adolescents with cerebral palsy.Res DevDisabil. 2013;34(9):2864–2871.

10. Law M,Anaby D, Teplicky R,Khetani MA,Coster W, Bedell G. Participation in the home environment among children and youth with and without disabilities. Br J OccupTher. 2013;76(2):58–66.

11. Ullenhag A,Bult MK, Nyquist A, Ketelaar M, Jahnsen R, KrumlindeSundholm L, et al. An international comparison of patterns of participation in leisure activities for children with and without disabilities in Sweden, Norway, and the Netherlands.DisabilRehabil. 2012;15(5):369–385.

12. Khetani, M, Graham JE, Alvord C. Community participation patterns among preschool-aged children who have received Part C early intervention services. Child Care Health Dev. 2013;39(4):490–499.

13. Benjamin T, Lucas-Thompson RG, Little LM, Davies P,Khetani M. Participation in Early Childhood Educational Environments for Young Children with and Without Developmental Disabilities and Delays: A Mixed Methods Study. Phys OccupTherPediatr.2017;37(1):87-107.

14. Shikako-Thomas K, Majnemer A, Law M,Lach L.Determinants of participation in leisure activities in children and youth with cerebral palsy: systematic review. PhysOccupTherPediatr.2008;28(2):155-169.

15. Organização Mundial De Saúde – OMS, Organização Panamerica De Saúde – OPAS. CIF - Classificação Internacional De Funcionalidade, Incapacidade E Saúde. São Paulo: Universidade De São Paulo; 2003.

16. Santos PD, Silva FC, Sousa BA, Pires GKW, Iop RR, Ferreira EG, et al. Functionality and quality of life of children with disability. J Hum Growth Dev. 2018;28(2):154-164.

17. Organização Mundial De Saúde – OMS. World report on disability. [book online]. 2011. [][accessed 2017 Sep 10].

18. Badia M,BegoñaOrgaz M, Gómez-Vela M, Verdugo MA,UllánM, Longo E. Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy?. Res DevDisabil.2016;49-50:312-321.

19. Anaby D,Mercerat C, Tremblay S. Enhancing Youth Participation Using the PREP Intervention: Parents’ Perspectives. Int J Environ Res Public Health. 2017;14(9):1005.

20. Anaby D, Law M,Teplicky R, Turner L. Focusing on the environment to improve youth participation: experiences and perspectives of occupational therapists. Int J Environ Res Public Health. 2015;12(10):13388-13398.

21. Anaby DR, Law M, Feldman D,Majnemer A, Avery L. The effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention: improving participation of adolescents with physical disabilities. Dev Med Child Neurol. 2018;60(5):513-519.

22. Dahan-Oliel N, Shikako-Thomas K, Mazer B,Majnemer A.Adolescents with disabilities participate in the shopping mall: facilitators and barriers framed according to the ICF.DisabilRehabil. 2016;38(21):2102-2113.

23. Seron BB, de Arruda GA, Greguol M. Facilitadores e barreiras percebidas para a prática de atividade física por pessoas com deficiência motora. RevBras Ciênc. Esporte. 2015;37(3):214-221.

24. Alghamdi MS, Chiarello LA, Palisano RJ, McCoy SW. Understanding participation of children with cerebral palsy in family and recreational activities. Res Dev Disabil. 2017;69:96-104.

25. Albrecht EC, Khetani MA. Environmental impact on young children’s participation in home‐based activities. Dev Med Child Neurol. 2017;59(4):388-394.

26. Palisano RJ, ChiarelloLA, King GA, Novak I, Stoner T, Fiss A. Participationbased therapy for children with physical disabilities. Disabil Rehabil. 2012;34(12)1041-1052.

27. Chiarello LA, Bartlett DJ, Palisano RJ, McCoy SW, Fiss AL, Jeffries L, et al. Determinants of participation in family and recreational activities of young children with cerebral palsy. Disabil Rehabil . 2016;38(25):2455-2468.

28. Khetani M, Little L, Lucas-Thompson R, Davies P, Benjamin T. Participation Disparities Between Children With and Without Disabilities in Early Childhood Educational Environments. Am J Occup Ther. 2015;69.

29. Steinhardt F, Ullenhag A, Jahnsen R, & Dolva A. Perceived facilitators and barriers for participation in leisure activities in children with disabilities: perspectives of children, parents and professionals. Scand. J. Occup. Ther. 2019: 1-15.

30. Coster W, Bedell G, Law M,KhetaniMA,Teplicky R, Liljenquist K, Gleason K, et al. Psychometric evaluation of the Participation and Environment Measure for Children and Youth. Dev Med Child Neurol. 2011;53(11):1030- 1037.

31. Dickinson HO,Colver AF. Measurement of the environment of people with disabilities. Arch Phys Med Rehabil. 2010;91(8):1310-1311.

32. Dickinson HO,Colver A.Sparcle Group. Quantifying the physical, social and attitudinal environment of children with cerebral palsy. DisabilRehabil. 201; 33(1):36-50.

33. Pfeiffer B,Coster W, Tucker C,Piller A. Development and Content Validity of the Participation and Sensory Environment Questionnaire. Occupational Therapy in Mental Health. 2017;13(2):105-121.

34. Harrison-Felix C: Introduction to the Craig Hospital Inventory of Environmental Factors [].

35. Craig Hospital Department Research.Craig Hospital Inventory of Environment Factors [online manual]. 3 ed. Englewood: 2001. [].

36. Nobakht Z, Rassafiani M, Reza SoltaniP. Validity and Reliability of Persian Version of Craig Hospital Inventory of Environmental Factors (CHIEF) in Children with Cerebral Palsy. IRJ. 2011;9(13):3-10

37. Furtado SRC, Sampaio RF, Vaz DV,Pinho BAS,Nascimento IO, Mancini MC. Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, crosscultural adaptation and reliability. Braz J PhysTher. 2014;18(3):259-267.

38. Fleming J, Nalder E, Alves-Stein S, Cornwell P.The Effect of Environmental Barriers on Community Integration for Individuals With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil. 2014;29(2):125– 135.

39. Law M, Petrenchik T, King G, Hurley P.Perceived Environmental Barriers to Recreational, Community, and School Participation for Children and Youth With Physical Disabilities.Arch. Phys. Med.Rehabi.2007;88(12):1636-1642.

40. McCauley D,Gorter JW, Russell DJ, Rosenbaum P, Law M, Kertoy M. Assessment of environmental factors in disabled children 2–12 years: development and reliability of the Craig Hospital Inventory of Environmental Factors (CHIEF) for Children–Parent Version. Child Care Health Dev. 2013;39(3):337-344.

41. Vogts N, Mackey, AH,Ameratunga S, Stott NS. Parent‐perceived barriers to participation in children and adolescents with cerebral palsy. J Paediatr Child Health. 2010;46(11):680-685.

42. Kertoy MK, Russell DJ, Rosenbaum P, Jaffer S, Law M, McCauley D, et al. Development of an outcome measurement system for service planning for children and youth with special needs. Child Care Health Dev. 2013;39(5):750-759.

43. Imms C, Froude E, Adair B, Shields N. A descriptive study of the participation of children and adolescents in activities outside school. BMC Pediatr. 2016;16:84.

44. Imms C, King G,Majnemer A, Avery L,Chiarello L,Palisano R,et al. Leisure participation–preference congruence of children with cerebral palsy: a Children’s Assessment of Participation and Enjoyment International Network descriptive study. Dev Med Child Neurol. 2017;59(4):380-387.

45. Anaby DR, Law MC,Majnemer A, Feldman D. Opening doors to participation of youth with physical disabilities: An intervention study. Can J OccupTher. 2016;83(2):83-90.

46. Imms C, Mathews S, Nicola Richmond K, Law M,Ullenhag A. Optimising leisure participation: a pilot intervention study for adolescents with physical impairments. DisabilRehabil. 2016;38(10):963-971.

47. Anaby D, Law M,Coster W, Bedell G,Khetani M, Avery L. The role of the environment in explaining participation in the home, school and community: Results of a structural equation modelling. Int J Dev Neurosci. 2015;47:53-54.

48. Nobakht Z, Rassafiani M, Rezasoltani P,Sahaf R,Yazdani F. Environmental Barriers to Social Participation of Children with Cerebral Palsy in Tehran. IRJ. 2013;11:40-45.

49. Shikako-Thomas K, Law M. Policies supporting participation in leisure activities for children and youth with disabilities in Canada: from policy to play. Disabil. Soc. 2015: 381-400.

50. Kang LJ, Hsieh MC, Liao HF, Hwang AW. Environmental Barriers to Participation of Preschool Children with and without Physical Disabilities. Int J Environ Res Public Health.2017; 14(5):518.

51. Henderson S, Skelton H, Rosenbaum P. Assistive devices for children with functional impairments: impact on child and caregiver function. Dev Med Child Neurol. 2008;50(2):89-98.

52. Christian HE,Klinker CD, Villanueva K,Knuiman MW, Foster SA, Zubrick SR,et al. The effect of the social and physical environment on children’s independent mobility to neighborhood destinations. J Phys Act Health. 2015;12(6): 84-93.

53. Colver A, Thyen U, Arnaud C, Beckung E, Fauconnier J, Marcelli M, et al. Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: a cross-sectional multicenter European study. Arch Phys MedRehabil. 2012;93(12):2154-2164.

54. Parkes J, McCullough N, Madden A. To what extent do children with cerebral palsy participate in everyday life situations?.Health Soc Care Community. 2010;18(13):304-315.

55. Brasil. Ministério da Saúde. Política Nacional de Saúde da Pessoa com Deficiência [book online]. Brasília: Editora do Ministério da Saúde, 2010. [] [accessed 2017 Sep 15].

5ed148d90e8825dc6ae6aafa mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections