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).
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.