The Model of Children's Active Travel (M-CAT): a conceptual framework for examining factors influencing children's active travel.

BACKGROUND: The current decline in children's participation in physical activity has attracted the attention of those concerned with children's health and wellbeing. A sustainable approach to ensuring children engage in adequate amounts of physical activity is to support their involvement in incidental activity such as active travel (AT), which includes walking or riding a bicycle to or from local destinations, such as school or a park. Understanding how we can embed physical activity into children's everyday occupational roles is a way in which occupational therapists can contribute to this important health promotion agenda. AIMS: To present a simple, coherent and comprehensive framework as a means of examining factors influencing children's AT. METHODS: Based on current literature, this conceptual framework incorporates the observable environment, parents' perceptions and decisions regarding their children's AT, as well as children's own perceptions and decisions regarding AT within their family contexts across time. CONCLUSION: The Model of Children's Active Travel (M-CAT) highlights the complex and dynamic nature of factors impacting the decision-making process of parents and children in relation to children's AT. The M-CAT offers a way forward for researchers to examine variables influencing active travel in a systematic manner. Future testing of the M-CAT will consolidate understanding of the factors underlying the decision-making process which occurs within families in the context of their communities.

Environmental correlates of children's active transportation: a systematic literature review.

This systematic review investigated the environmental (physical, economic, socio-cultural and political) correlates of active transportation (AT) among young people aged 5-18 years to better inform the promotion of active living. Greater distance, increasing household income and increasing car ownership are consistently associated with lower rates of AT among children. Having a non-white ethnic background has a convincing positive association with AT. Having recreation facilities and walk or bike paths present are possibly associated with higher rates of AT. Further research requires longitudinal and intervention studies, utilizing multi-level design methodologies and objective measures of environmental attributes.

Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy.

The Pediatric Motor Activity Log (PMAL) is a parent-report measure of the use, by children with hemiplegic cerebral palsy (CP), of their affected upper limb in everyday activities. The aim of this study was to examine the psychometric properties of both scales of the PMAL ('How Often' and 'How Well' scales) using Rasch measurement modelling. Sixty-one parents of children with hemiplegic CP completed the PMAL and 31 completed it again 3 weeks later. The mean age of children was 4 years 6 months (SD 1y 9mo); 35 males, 26 females. Children were at Gross Motor Function Classification System (GMFCS) levels I (83%) and II (17%), and Manual Ability Classification System levels I (35%), II (52%), and III (14%). The original scales were found to have disordered rating scale structure. Further Rasch modelling with collapsed rating scale structures resulted in both scales conforming to the expectations of the Rasch model, yielding strong evidence for construct validity and reliability. One item from the How Often scale failed to conform to Rasch expectations and was deleted in subsequent analyses. Test-retest reliability of both scales was high (the intraclass correlation coefficient for the How Often scale was 0.94, and for the How Well scale 0.93). The revised scales possess good psychometric properties, specifically a logical item hierarchy, evidence of unidimensionality, adequate rating scale structure, and good test-retest reliability. We conclude that the revised PMAL has the capacity to yield valid and reliable scores except for children at the extremes of upper limb ability.

Conceptualising a modified system for classification of in-hand manipulation.

Occupational therapists consider in-hand manipulation (IHM) to be an important component of fine motor skills and to be related to handwriting and self-care proficiency. These relationships have not been well explored nor has the impact of intervention including IHM skill enhancement on proficiency in motor tasks. We propose that the existing conceptualisation of IHM may contribute to a dearth of evidence in this area. This paper closely examines the existing classification systems of IHM. We propose an adaptation of Exner's classification system which contains more discrete categories of IHM movements and includes: finger-to-palm translation to achieve stabilisation, palm-to-finger translation, simple shift, complex shift, simple rotation and complex rotation. Further research to test this modified classified system and to explore evidence for IHM intervention is warranted.

Reliability and validity of the Test of In-Hand Manipulation in children ages 5 to 6 years.

The Test of In-Hand Manipulation (TIHM; Case-Smith, 2000) is a five-task test that uses a 9-hole pegboard to examine 2 key components of in-hand manipulation: rotation and translation with stabilization. The authors used Rasch modeling to examine the TIHM's construct validity, interrater reliability, and test-retest reliability in 45 typically developing children ages 5.5 years to 6.5 years. A version of the test, revised using Rasch modeling, was found to have evidence for adequate construct validity and excellent interrater reliability. However, test-retest reliability over a 2-week retest period was not supported. The TIHM demonstrates potential as a clinically useful assessment of in-hand manipulation. The test does not examine all aspects of in-hand manipulation, however, and it may have limited sensitivity to the performance of finger-to-palm and palm-to-finger translation. Further validation of the test is needed before the TIHM can confidently be used in occupational therapy practice.