Determinants of Elementary School Participation For Students with Cerebral Palsy: A Systematic Review   Brenda Pratt PT MS PCS, Natalie Larsen, Jessica Rients Department of Physical Therapy and Health Sciences, Bradley University, ,Peoria, Illinois USA Introduction Results Results cont’d Limited school participation of children with disabilities can have negative outcomes in their academic, social, physical, and cognitive-behavioral development. The literature that examined the school participation of children with cerebral palsy was reviewed, in order to understand the extent of participation and the factors that may influence participation. Using the International Classification of Function (ICF) as a framework, the factors that may potentially influence school participation are discussed. According to this model, school participation results from the dynamic interaction of the child’s characteristics and school environment. The characteristics of the child with cerebral palsy include their health characteristics (body system impairments and resultant activity limitations) and other personal factors (age, gender, etc). The school environment includes products/technology, natural/built environments, support, attitudes and services-systems-policies characteristics. Participation in the routines of school is more restricted for children with cerebral palsy than their typically developing peers. Those educated in a general education classroom participate more than those in a self-contained classroom. Greatest areas of restriction are in playground/recess, classroom, transitions and transportation settings with the least in eating and toileting settings. Academic: Classroom time may be affected by increased absences or other demands. Social Adjustment: Areas of peer relationship challenges - less popularity, fewer reciprocated friendships and greater risk for victimization. Physical Tasks: Decreased participation with more time and/or assistance required from others. Cognitive/Behavioral Tasks: Decreased participation with areas of particular difficulty in on-task behavior, behavior regulation, and negotiation. School Environmental Factors: The school’s physical, social and attitudinal environment can act as a barrier, facilitator, or both to participation in school routines. Products/Technology: Barrier or facilitator depending on the technology’s attributes and the AT services. Natural/Built Environment: Characteristics of the natural environment that were often barriers- crowding, climate, productivity expectations. Architectural and school design features were often barriers. Support: Use of teacher assistants can be a facilitator, barrier or both-dependent on the teacher assistant proximity and implicit/explicit job responsibilities. Attitudes: Differential treatment and lack of knowledge,-understanding by school personnel and peers were barriers. Parental advocacy was a facilitator. Policies, Systems, Services: Administrative support and team characteristics can act as a barrier and/or facilitator. Placement may be influenced by residency. Conclusion Children with cerebral palsy have restricted school participation compared to their typically developing peers. Influences on school participation: Child’s health characteristic - Logically a major influence on school participation. Thirteen studies level 3b, 1 study level 4, 1 qualitative study. Environmental factors: Influence on school participation less clear. One study level 1b, 8 studies level 3b, 15 qualitative studies, 2 literature reviews. Personal factors: Influence on school participation unclear. Gender – 3 studies level 3b; Age – 1 study 1b level, 2 studies level 3b; Personal characteristics – 1 qualitative study Methods Health characteristics may influence: Attendance: Increased school absences with malnutrition associated with GMFCS III-V Educational Placement: May be influenced by the severity of impairments and activity limitations. Participation: Greater restriction was associated with topography of involvement, increasing severity and number of impairments and activity limitations. Personal factors -age, gender- may influence social participation. Being a girl was associated with greater risk for social adjustment challenges. A search of electronic databases retrieved 819 citations using the key words participation, school, school participation, childhood disability, restricted mobility, school function assessment, cerebral palsy, social status, friendship, and friendship development. In addition, the reference lists of relevant studies were examined. Forty-two papers met the criteria for inclusion. Quantitative and qualitative studies and review articles were eligible for inclusion if they involved(1) children with cerebral palsy, (2) participation in elementary school routines, (3) and were published in English. Studies were classified using the levels of evidence from the Center for Evidence Based Medicine (http: //www.cebm.net/index.aspx?o =1025).