Describing hearing in individuals with cerebral palsy

ical, social, and attitudinal aspects and it may influence participation, either as a barrier or a facilitator. Since the publication of the ICF model, experts have been driven to explore these concepts and their interactions and corollaries. The lack of appropriate measures to assess children’s participation and the environment was the first barrier that needed to be surmounted. Consequently, profound discussions have taken place about how to measure these concepts operationally, and furthermore, in the last few years, we have witnessed the dynamic development of a variety of new tools. These updated participation measures share the same theoretical approach that perceives participation as a multi-dimensional construct comprising both objective and subjective aspects (for example, participation frequency versus satisfaction or desire for change). Additionally, participation is measured along different domains and activities of daily life (for example, activities of daily living, leisure, learning). Yet, environmental measurements lag behind. Coster et al. present a new tool, the Participation and Environment Measure for Children and Youth (PEM-CY), which is intended for use in large-scale studies. The PEM-CY examines the extent to which young people, with and without disabilities, participate in important spheres of activity within different environments. It is a comprehensive and feasible parent-report questionnaire for children and young people aged 5 to 17 years. Along with the multi-dimensional approach to participation, the PEM-CY examines participation frequency, extent of involvement, and desire for change in three different settings: home, school, and community. Along with emerging knowledge on the effect of the environment on participation, items in the environment section of the PEM-CY examine perceived facilitators and barriers to participation within each setting. Hence the uniqueness of this tool lies in its ability to perform simultaneous measurement of both participation and environment. With a sample of 576 parents, Coster et al. assessed the reliability and validity of the PEM-CY. The results indicated moderate to good reliability. Significant known groups’ differences, across all the participation and environmental scales, support validity. Yet age differences do not follow a consistent pattern. Based on its promising psychometric properties and its unique electronic format, the PEM-CY joins other documented and valid participation measurements. In comparison to other participation measurements, the PEM-CY items represent types of activities rather than specific activity. This format reduced questionnaire length; however, it may also limit the specificity of the information retrieved from it. The PEM-CY broadens researchers’ potential to study participation within the environment in a large-scale population-level patterns. It is suitable for comparative studies which may contribute to our knowledge and understanding of participation within the environment of diverse populations and cultures. Concurrently, other tools will help experts to gather more specific data for other purposes, such as clinical level studies. In view of the fact that the enhancement of children’s participation is an ultimate goal of rehabilitation in children with diverse health status and disabilities, evaluating participation is essential for setting goals, implementation of treatment programs, and evaluation of intervention efficacy. Thus the interest taken and efforts invested in the development of these new tools are of value and reflect the propagation of the new conceptualization of functioning and disability presented in the ICF model.