|Year : 2016 | Volume
| Issue : 1 | Page : 32-36
Comparison of self-concept of children with cerebral palsy and children without impairments
Sharwari Mutsaddi, Ravinder Kaur Mahapatra
Department of Pysiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
|Date of Web Publication||10-Aug-2016|
Ravinder Kaur Mahapatra
Department of Pysiotherapy, Sancheti Healthcare Academy, Thube Park, Shivajinagar, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Self-esteem or self-concept is a feeling of self-appreciation. A positive self-concept is essential to maintain normal psychological health. Cerebral palsy results in functional impairments that limit the individual's activities. This could lead to a negative self-concept among these children.
Aim: To compare the self-concept of children having cerebral palsy with the children having no impairment.
Material and Methods: The study was an observational case-control type of study with n = 56 (28 in each group). The self-concept of the children (age 10-16 years) was assessed using Harter's Self Perception Profile for Children. The mean of each subscale was compared between the two groups using the Mann-Whitney U-test on SPSS version 20. The males and females were compared in each group.
Results: There was a significant difference in the two graphs with respect to the aspects of physical appearance (P = 0.000), behavioral conduct (P = 0.024), social competence (P = 0.001), and athletic competence (P = 0.000). Males with cerebral palsy showed a lower sense of self-concept in the field of social competence (P = 0.002), athletic competence (P = 0.00), and physical appearance (P = 0.016). On the other hand, females with cerebral palsy showed comparatively lower self-concept in the fields of athletic competence (P = 0.000) and physical appearance (P = 0.000).
Conclusion: Children having cerebral palsy showed reduced self-concept in the domains of social competence, behavioral conduct, physical appearance, and athletic competence. Gender-based differences were observed in the two groups.
Keywords: Cerebral palsy, impairments, self-concept
|How to cite this article:|
Mutsaddi S, Mahapatra RK. Comparison of self-concept of children with cerebral palsy and children without impairments. Indian J Cereb Palsy 2016;2:32-6
|How to cite this URL:|
Mutsaddi S, Mahapatra RK. Comparison of self-concept of children with cerebral palsy and children without impairments. Indian J Cereb Palsy [serial online] 2016 [cited 2017 Apr 23];2:32-6. Available from: http://www.ijcpjournal.org/text.asp?2016/2/1/32/188157
| Introduction|| |
Self-esteem or self-concept is a feeling of self-appreciation. It is the awareness of the absolute value of one's own personality or dignity.  Self-concept is now known to be multidimensional.  A positive self-concept is necessary to maintain good psychological health.  By mid-childhood, the child is said to have developed certain domain-specific evaluations of himself with regard to scholastic competence, social competence, physical appearance, behavioral conduct, athletic competence, and global self-worth or self-esteem.
Recently, cerebral palsy (CP) has been redefined as a term which "describes a group of permanent disorders of the development of movement and posture, causing activity limitation, which are attributed to nonprogressive disturbances that occurred in the developmental fetus or the infant's brain."  Functional impairments related to CP are spasticity, dystonia, sensory system affection, incoordination, muscle weakness, etc., which lead to limitations or difficulty in various day to day activities as well as other activities of leisure and recreation. It is often assumed by the society that these impairments would culminate in the child being unhappy with himself or herself and result in a negative self-concept. A negative self-concept has been correlated to depression, maladjustments, eating disorders, and inability to deal with the stresses of later life as well. 
A study conducted in Australia by Shields et al. , concluded that children having cerebral palsy lagged behind children having no impairments in certain domains of self-concept, but certain other domains did not seem to be affected. Self-concept in children having cerebral palsy in India however had not been ventured much into. The data collected from the other countries could be different than the picture in India. This could be attributed the difference in the social, environmental, and economical conditions across the countries. A better understanding of the self-concept of Indian children with cerebral palsy would help develop a better clinician and patient understanding, give the children, their families, and caregivers better knowledge and means to deal with the children. It would help the therapist determine what aspect of the child needs to be worked on and what aspect is best left alone.
Many studies conducted earlier have concluded that the prognosis of a child with low self-concept was determined by the resilience that the child showed. This resilience was altered by motivation, encouraging good relationships with the people who surround the child, and the feeling of being able to cope with his daily activities.  It would help the therapist to determine when the child needed to be referred to another medical personnel or social worker and when the parents, teachers, or friends of the child need to be counseled appropriately.
A positive self-concept would also mean better compliance by the child to the physical therapy and improved functional outcome post the treatment sessions.
To compare the self-concept of children having cerebral palsy with the children having no impairments using Harter's Self Perception Profile for Children (SPPC).
- To assess the self-concept of children having cerebral palsy
- To assess the self-concept of children having no impairment
- To compare the self-concept between the two groups
- To compare the self-concept among males and females in each group.
| Material and methods|| |
This study was an observational case-control study. The study was done on 56 individuals - 28 in the case group and 28 in control group. The case group consisted of children diagnosed with cerebral palsy and the control group of children without any known chronic medical conditions. The inclusion criterion for the case group was children having cerebral palsy - Gross Motor Function Classification System (GMFCS) 1, 2, and 3  within the ages of 10-16 years  who are institution-based, community-dwelling, or school going. The exclusion criterion for the case group was children who did not understand the questionnaire, if the child answered fewer than four of the six items, it was recommended by the manual of the SPPC that the scores of these children not be calculated on the average of that subscale since it is likely to be an unstable or unreliable index of the child's self-perceptions  and children who had chronic conditions in addition to cerebral palsy (Thalassemia, Muscular Dystrophies, Autism, Spinal Muscular Atrophies, Bronchitis, etc.). The sampling technique was convenient sampling. Questionnaire used was "The Self Perception Profile for Children: Manual and Questionnaire, Susan Harter (1985, rev 2012)." ,
Individuals were selected according to inclusion criteria. Ascent was taken from the teachers or parents of the individuals to be interviewed. The questionnaire and the correct technique of picking the most relatable option were explained by the examiner to the children. Each questionnaire was filled by interview method conducted by the examiner. The items were scored according to the key provided in the SPPC, Manual. Mean scores were calculated for each subscale separately. The mean of each subscale was compared between the case group and the control group. Similarly, the scores of the males and also the females with cerebral palsy were compared with their unimpaired peers of the same gender.
Mean score and standard deviation were calculated for each subscale for either of the groups.
Comparison of the means of each subscale between the two groups was done with the Mann-Whitney U-test with the IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Released 2011.
Males in the case group were compared with males in the control group using the same technique. This was repeated for the females of each group.
| Results|| |
The level of significance was set at P lesser than or equal to 0.05.
| Discussion|| |
This study aimed at comparing the self-concept of children having cerebral palsy with children having no impairments using the SPPC by Harter.
The sample considered in the study consisted of two groups. The case group included a total of 28 adolescents with cerebral palsy: 15 males (mean age - 12.8 ± 1.93) and 13 females (mean age - 10.46 ± 1.89). Only community-dwelling adolescents with GMFCS 1, 2, and 3 were considered in this study. The control group comprised 28 adolescents who had no known physical or neurological impairments. There were 15 males (age - 11.26 ± 2.37) and 13 females (age 9.12 ± 1.38) in this group [Table 1].
This study showed that, overall, the global self-worth of children having cerebral palsy was within the normative values of positive self-concept, and there was no significant difference in the two groups (P-0.246). This contradicts the common belief among people that children having cerebral palsy as a whole are unhappy with themselves. Society's outlook toward them should now move from a sympathetic one toward an empathetic one. Compared to children having no impairment, there was no significant difference in the scholastic competence level (P - 0.908) [Table 2] of children having cerebral palsy. This could be because the case group included only those adolescents who were intellectually capable of understanding and responding to this questionnaire.
|Table 2: Comparison of the self-concept of children having cerebral palsy and children having no any impairment (n=56)|
Click here to view
There was a significant difference in the aspects of physical appearance (P - 0.000), behavioral conduct (P - 0.024), social competence (P - 0.001), and athletic competence (P - 0.000). It had been observed in the previous studies that the subscales of social competence, athletic competence, and physical appearance were moderately related to one another.  Despite the rapidly changing perception of Indian society toward CP; the condition is still considered a social stigma. The Indian society is not fully aware of the condition and how it should be dealt with. Infrastructure in India is not equipped or cost-friendly enough to deal with individuals having such impairment. All these social issues combined could be one of the causes of negative concept of self in these domains. Efforts should thus be made toward developing a more "barrier free" India by spreading more awareness among the common people regarding this condition and how it should be dealt with. A friendlier and more conducive environment would thus help the children develop a better self-concept in these specific aspects.
Certain gender variations were observed in the scores. Males with cerebral palsy showed a lower sense of self-concept in the field of social competence (P - 0.002), athletic competence (P - 0.00), and physical appearance (P - 0.016) as compared to their male peers who did not suffer from the condition [Table 3]. On the other hand, females with cerebral palsy showed comparatively lower self-concept in the field of athletic competence (P - 0.000) and physical appearance (P - 0.000) [Table 4]. These gender-based differences, although present, differ from the ones recorded in a previous study conducted in Australia.  This could be because of a difference in the various personal and environmental barriers and facilitators faced by the children in the two continents.
|Table 3: Comparison of the self-concept of males with cerebral palsy and males without any impairment (n=30)|
Click here to view
|Table 4: Comparison of the self-concept of females with cerebral palsy and females without any impairment (n=26)|
Click here to view
A recent review reported that many studies concluded the prognosis of a specially-abled child with low self-esteem was determined by the resilience that the child showed. This resilience could be altered by motivation, encouraging good relationships with peers, parents, and teachers and making the children feel that they were able to cope with one's daily demands. It has also been observed that low self-concept leads to limitation of social activities and adaptation problems. Inability to develop adequate self-esteem as an adolescent or a child results in the inability to deal with stress and the onset of mental disorders. 
Recent studies reported that the parents of children having cerebral palsy were incapable of adequately judging their own child's self-concept. , It is thus important for a physical therapist to evaluate a child's self-concept periodically during the course of his therapy to appropriately set and modify his treatment goals. Spreading more awareness among not only the parents and teachers but also among society in general would help improve the child's self-concept and thus also improve functional outcome and thus quality of life of the child.
| Conclusion|| |
Children having cerebral palsy showed overall self-concept (global self-worth) and scholastic competence levels similar to their age-matched unimpaired peers. Children having cerebral palsy showed affected self-concept in the domains of social competence, behavioral conduct, physical appearance, and athletic competence. Gender-based differences were observed in the two groups.
The therapist should keep in mind the affected domains and motivate the child accordingly. Treatment session should be planned accordingly.  Timely evaluation of self-concept of Indian children having cerebral palsy should be conducted by the therapist. A previous study reported that the parents of children having cerebral palsy had a different perception of their child's self-concept as compared to the child's actual self-concept. The parents of the child should be made aware of the child's psychological demands. , A higher self-concept would also mean better compliance from the child during therapy sessions. The therapy sessions and goals could thus be planned appropriately for each child.
Majority of the children included in the case group were attending specialized institutions and not regular schools as opposed to studies conducted in other countries.
Scope for further study
- To compare the self-concept of institution-based children having cerebral palsy and children with cerebral palsy who went to regular schools
- To conduct the study in both urban and rural setups in India and compare the self-concept between the two groups
- To compare the Indian parents assessment of the self-concept of the child and the child's actual self-concept.
The authors would like to thank Dr. Rachana Dabadghav (Research Coordinator and Assistant Professor, Sancheti Institute College of Physiotherapy) and Dr. Ashok Shyam (MS-Ortho, Sancheti Hospital for Orthopaedics and Rehabilitation) for their guidance. We would also like to thank all the participants for their cooperation during assessment and for helping in the completion of the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hosogi M, Okada A, Fujii C, Noguchi K, Watanabe K. Importance and usefulness of evaluating self-esteem in children. Biopsychosoc Med 2012;6:9.
Harter S. Self-Perception Profile for Children: Manual and Questionnaires, Revision of the Self Perception Profile for children 1985. Denver, University of Denver, Department of Psychology; 2012.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al.
A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14.
Shields N, Murdoch A, Loy Y, Dodd KJ, Taylor NF. A systematic review of the self-concept of children with cerebral palsy compared with children without disability. Dev Med Child Neurol 2006;48:151-7.
Shields N, Loy Y, Murdoch A, Taylor NF, Dodd KJ. Self-concept of children with cerebral palsy compared with that of children without impairment. Dev Med Child Neurol 2007;49:350-4.
Muris P, Meesters C, Fijen P. The self-perception profile for children: Further evidence for its factor structure, reliability, and validity. Pers Individ Dif 2003;35:1791-802.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-23.
Dunn N, Shields N, Taylor NF, Dodd KJ. A systematic review of the self-concept of children with cerebral palsy and perceptions of parents and teachers. Phys Occup Ther Pediatr 2007;27:55-71.
Dunn N, Shields N, Taylor NF, Dodd KJ. Comparing the self concept of children with cerebral palsy to the perceptions of their parents. Disabil Rehabil 2009;31:387-93.
Van Wely L, Balemans AC, Becher JG, Dallmeijer AJ. The effectiveness of a physical activity stimulation programme for children with cerebral palsy on social participation, self-perception and quality of life: A randomized controlled trial. Clin Rehabil 2014;28:972-82.
[Table 1], [Table 2], [Table 3], [Table 4]