Is Mobility Sufficient to Understand Community Participation of Adolescents and Young Adults with Cerebral Palsy? The Mediating and Moderating Roles of Contextual Factors

Published:January 25, 2023DOI:


      • Mobility of youths with CP alone did not explain community participation breadth
      • Mobility impacts on breadth of community participation through individuals’ autonomy
      • Socioeconomic status is of particular importance for youths with limited mobility
      • Clinicians should promote youths’ autonomy, in addition to their mobility skills



      To explore whether self-determination and family's socioeconomic status (SES) mediate and/or moderate the relationship between mobility and community participation of adolescents and young adults with cerebral palsy (CP).




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      From 55 eligible adolescents/young adults with CP, 50 agreed to participate and two were excluded. The final convenience sample included 48 individuals, aged 15 to 32, levels I–IV of the Gross Motor Function Classification System and I–II of the Communication Function Classification System.

      Main Outcome Measure(s)

      The Temple University Community Participation Measure (TUCPM) documented the amount, breadth and insufficiency/sufficiency ratios of participation across 26 community settings. The ARC Self-Determination Scale and the Mobility Scale of the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) measured individuals’ self-determination (i.e., autonomy, psychological empowerment and self-realization) and mobility skills, respectively. The Brazilian Economic Classification Criteria–2021 assessed families’ SES.


      Analyses of mediating/moderating effects revealed that the influence of individuals’ mobility skills on their breadth of community participation was mediated by autonomy. Families’ SES moderated the indirect effect of mobility on community participation breadth through autonomy. When the model was adjusted for participants’ age, individuals with higher SES reported greater breadth in community participation, compared to those from moderate and lower SES, for all mobility levels. However, the magnitude of the differences among individuals of different SES levels diminished as mobility increased.


      The mobility skills of youths with CP influence their community participation through autonomy. To foster greater engagement of these individuals in the community, rehabilitation professionals should focus not only on improvement of mobility skills, but also on the promotion of self-determined behaviors, especially autonomy.

      Graphical abstract

      Key Words

      List of abbreviations:

      ABEP (Associação Brasileira de Empresas de Pesquisa), CFCS (Communication Function Classification System), CI (Confidence interval), CP (Cerebral palsy), FMS (Functional Mobility Scale), GMFCS (Gross Motor Function Classification System), MACS (Manual Ability Classification System), PEDI-CAT (Pediatric Evaluation of Disability Inventory-Computer Adaptive Test), SES (Socioeconomic status), SPSS (Statistical Package for the Social Sciences), TUCPM (Temple University Community Participation Measure)
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