Commentary on "I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities".

“How could I apply this information?” This qualitative study describes perspectives on participating in leisure activities of 16 school-aged children with cerebral palsy (CP). Children discussed barriers to sports or active leisure participation such as impairments of their limbs, activity limitations such as inability to walk, environmental barriers such as inaccessible buildings, and attitudinal barriers of peers or professionals. Facilitators included adaptive equipment, peer support, and physical support from family and friends. Some facilitators were also described as barriers. Therapists should be aware of barriers and facilitators to participation in leisure activities. Therapists should listen to the views of children about leisure participation since their perspectives may be different from those of their parents. Interventions that focus on decreasing barriers and guiding children toward facilitators to increase leisure participation should be considered. Barriers and facilitators at multiple levels of the International Classification of Functioning, Disability, and Health should be addressed in interventions to increase participation in leisure activities for children with CP. “What should I be mindful about when applying this information?” Focus groups were conducted with children with CP (7-17 years old, Gross Motor Function Classification System I-V), with only one child classified at level V and all with an IQ of more than 70. Children needed to have the cognitive ability to participate in focus group discussions. Therefore, participants may not represent a “typical population” of children with CP because up to 50% have intellectual disabilitiy.1 It is important to be mindful that qualitative findings may be biased toward socially desirable responses. Although the purpose of qualitative studies is to learn participant experiences, findings may not reflect actual facilitators and barriers in the environment. The sample size (n = 16), though adequate for this study, is small when considering the generalizability of the findings to other groups. Finally, it is important to be mindful that the study was conducted in 2 regions of Spain, reducing generalizability to other regions in that country or to other countries. Maria A. Fragala-Pinkham, PT, DPT, MS Department of Physical and Occupational Therapy, Boston Children's Hospital Boston, Massachusetts Margaret E. O'Neil, PT, PhD, MPH Programs in Physical Therapy Vagelos College of Physician and Surgeons Columbia University Irving Medical Center New York City, New York