Participation - a modern definition

In working with children, the main goal of every task should be to maximise participation.

Being able to participate has been shown to improve not only the enjoyment of a task but also performance, cognitive function and the outcomes set by parent, child, and physiotherapist.

At Splash, participation is our core purpose. We aim to maximise participation using the World Health Organisation’s International Classification of Function (ICF) model (Figure 1) to guide our physio interventions.

The ICF takes into consideration not only the abilities of the child, but also the environment in which we are trying to maximise participation and what personal factors are in play.

Image description: The World Health Organisation’s International Classification of Function (ICF) shows the domains of participation, activity, body structure and function, personal and environmental factors and health condition all feeding into each other.

What does participation mean?

What is known as participation has evolved in the therapy space over the last decade. Participation is no longer simply ‘participating in a task’, rather it can be defined as two discrete elements, attendance and involvement.

Attendance relates to ‘being there’, as measured by the frequency of attendance or the range of activities that they attend. Involvement is what could traditionally be known as ‘participation’ and relates to topics such as engagement, motivation, persistence, and social connection.

By maximising the elements of attendance and involvement, children grow and progress across all domains of childhood development.

What about skill level?

It should be noted that the above definition does not relate to the level of competency of the child.

Goals that relate to, for example, being able to kick a soccer ball or aid in their transfer from a couch to a wheelchair, relate more to the level of ability of a child. Relating to the ICF model, this is different to participation and falls under the heading of activity.

For some, the ability of their child may not be as important when setting participation goals. Again, using soccer as an analogy, the participation goal may be to just play a game regardless of their ability. This is why it is important for us to discuss with families as to what they mean by participation, and to realise that over time, the goals of participation may change depending on the current circumstance.

Participation is the focus

In every interaction with a child, participation is at the front of our mind. We may be working on one of the contributing factors that will make participation easier, but we are always working towards that big picture goal.

In maximising participation, children grow and their ability to interact with the world around them flourishes.

References:

Adair B, Ullenhag A, Keen D, Granlund M, Imms C. The effect of interventions aimed at improving participation outcomes for children with disabilities: a systematic review. Dev Med Child Neurol. 2015 Dec;57(12):1093-104. doi: 10.1111/dmcn.12809. Epub 2015 May 24. PMID: 26010935.

Anaby D, Avery L, Gorter JW, Levin MF, Teplicky R, Turner L, Cormier I, Hanes J. Improving body functions through participation in community activities among young people with physical disabilities. Dev Med Child Neurol. 2020 May;62(5):640-646. doi: 10.1111/dmcn.14382. Epub 2019 Oct 31. PMID: 31670397.

Imms, C., Granlund, M., Wilson, P.H., Steenbergen, B., Rosenbaum, P., & Gordon, A. (2017). Participation - both a means and an end. A conceptual analysis of processes and outcomes in childhood disability. Developmental Medicine & Child Neurology, 59(1), 16-25. DOI: 10.1111/dmcn.13237

WHO. (2007). International classification of functioning, disability and health: children and youth version: ICF-CY. World Health Organisation