Functional Capacity and Self-Esteem of People With Cerebral Palsy
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Functional Capacity and Self-Esteem of People With
Cerebral Palsy
Sandra Martina Espı́n-Tello, Heather Olivia Dickinson,
Manuel Bueno-Lozano, Marı́a Teresa Jiménez-Bernadó,
Ana Luisa Caballero-Navarro
OBJECTIVE. We assessed whether functional capacity predicts self-esteem in people with cerebral palsy (CP).
METHOD. We conducted a cross-sectional observational study of 108 people with CP, ages 16–65 yr, who
were residents of Spain. Self-esteem was captured using the Rosenberg Self-Esteem Scale (RSES), and
functional capacity using the Barthel Index (BI). Sociodemographic characteristics were recorded. The
relationship between the RSES score and the BI score was analyzed using linear regression.
RESULTS. RSES scores increased significantly as BI scores increased (regression coefficient 5 0.047, 95%
confidence interval [0.017, 0.078], p 5 .003). People with a higher level of education, active employment, and
independent living arrangements tended to have better functional capacity and higher self-esteem.
CONCLUSION. Greater functional capacity predicted higher self-esteem; this effect is probably partly
mediated by education, employment, and living arrangements.
Espı́n-Tello, S. M., Dickinson, H. O., Bueno-Lozano, M., Jiménez-Bernadó, M. T., & Caballero-Navarro, A. L. (2018).
Functional capacity and self-esteem of people with cerebral palsy. American Journal of Occupational Therapy, 72,
7203205120. https://doi.org/10.5014/ajot.2018.025940
S
Sandra Martina Espı́n-Tello, PhD, is Occupational elf-esteem refers to a person’s sense of his or her worth (Blascovich &
Therapist, Departamento de Fisiatrı́a y Enfermerı́a,
Tomaka, 1991). High self-esteem is important for stable personal devel-
Universidad de Zaragoza, Zaragoza, Spain;
sandraespintello@gmail.com opment (Brooks, 1992) and for life satisfaction (Borg et al., 2008). Adolescents
with low self-esteem have poorer mental and physical health, worse economic
Heather Olivia Dickinson, PhD, is Visiting prospects, and higher levels of criminal behavior during adulthood (McGee &
Researcher, Institute of Health and Society, Newcastle
University, Newcastle-Upon-Tyne, England.
Williams, 2000; Orth, Robins, & Roberts, 2008; Trzesniewski et al., 2006). In
women, self-esteem has been shown to be correlated with active employment,
Manuel Bueno-Lozano, PhD, is Pediatrician and maintenance of intimate relationships, and health-promoting behavior (Nosek,
Associate Professor, Departamento de Fisiatrı́a y Hughes, Swedlund, Taylor, & Swank, 2003).
Enfermerı́a, Universidad de Zaragoza, Zaragoza, Spain.
Self-esteem has been reported to be lower in adolescents with cerebral palsy
Marı́a Teresa Jiménez-Bernadó, PhD, is Physiatrist (CP; Riad, Broström, & Langius-Eklöf, 2013), especially girls (Magill &
and Assistant Professor, Departamento de Fisiatrı́a y Hurlbut, 1986), and in women with disabilities (Nosek et al., 2003) than in
Enfermerı́a, Universidad de Zaragoza, Zaragoza, Spain.
matched controls. One of the main factors underlying these differences is likely
Ana Luisa Caballero-Navarro, PhD, is Pediatrician to be functional ability. Alterations in body functions and structure directly
and Associate Professor, Departamento de Fisiatrı́a y affect functional capacity, hindering the performance of activities of daily living
Enfermerı́a, Universidad de Zaragoza, Zaragoza, Spain. (ADLs). These difficulties in function may, in turn, cause anxiety and psy-
chological distress; limitations in social participation and in personal and work
lives; and reduced self-esteem (Horsman, Suto, Dudgeon, & Harris, 2010).
Nevertheless, few studies have addressed the relationship between functional
ability and self-esteem in people with disabilities. Most of those that have done
so were restricted to adolescents (Manuel, Balkrishnan, Camacho, Smith, &
Koman, 2003; Riad et al., 2013) or young adults (Gannotti, Minter, Chambers,
Smith, & Tylkowski, 2011; Magill-Evans & Restall, 1991) with CP or to stroke
The American Journal of Occupational Therapy 7203205120p1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936803/ on 03/22/2018 Terms of Use: http://AOTA.org/termspatients (Chang & Mackenzie, 1998); based on small and functional capacity and capture the sociodemo-
samples (Magill-Evans & Restall, 1991; Manuel et al., graphic and impairment characteristics summarized in
2003); restricted to those who were able to walk (Riad Table 1. Presence or absence of intellectual impairment
et al., 2013); or conducted more than 10 yr ago. was obtained from clinical records with the participant’s
To fill this gap, we conducted a study with the ob- consent, as was information not available from the par-
jective of assessing whether functional capacity, with re- ticipant or information about which he or she was unsure.
spect to ADLs, predicted self-esteem in a sample of adults Questions were repeated and explained in more detail if
and young people with CP. CP comprises a group of necessary. Participants who did not understand the ques-
movement and posture disorders, caused by a non- tions after such explanations were excluded. Eight people
progressive insult to the developing brain of the fetus or with anarthria were interviewed using computer-aided
young infant, that may result in functional limitations methods or pictograms.
(Bax et al., 2005). Sensory, cognitive, perceptive, com- Outcome Variable. We evaluated self-esteem using the
munication, or behavioral alterations or growth disorders Total score of the Rosenberg Self-Esteem Scale (RSES;
may also be present. The prevalence of CP in Europe is Rosenberg, 1965). This instrument has been widely used
1.77 per 1,000 live births (Sellier et al., 2016), and 46% in studies of self-esteem in the general population (Roth,
of children with CP are unable to walk unaided at age Decker, Herzberg, & Brähler, 2008; Sinclair et al., 2010)
5 yr (Beckung, Hagberg, Uldall, & Cans, 2008). and among people with disabilities (Blair, 1999; Chang &
We chose CP as the disability of interest because its Mackenzie, 1998; Manuel et al., 2003; Nosek et al., 2003).
effects are present throughout the life course, including the It has been translated into Spanish (Martı́n-Albo, Núñez,
critical periods of childhood and adolescence when both Navarro, & Grijalvo, 2007) and has shown excellent psy-
functional skills and self-esteem are developing, and be- chometric properties in populations in the United States
cause it manifests as a range of impairments whose severity (Sinclair et al., 2010), Germany (Roth et al., 2008), and
varies from mild to severe. We hypothesized that people Spain (Vázquez-Morejón, Jiménez, & Vázquez-Morejón,
with better functional ability would have higher self- 2004); Item Response Theory has confirmed its unidimen-
esteem. sionality (Roth et al., 2008). The RSES was developed for
use with adolescents but has since been widely used with a
Method variety of groups, including adults. It consists of 10 items
that address global feelings of self-worth, 5 targeted positively
Participants
and 5 negatively. Each item is scored on a Likert-type scale
The inclusion criteria were (1) a diagnosis of CP, (2) with four categories of response (1 5 strongly agree, 2 5
communication ability (oral, written, or alternative), (3) ages agree, 3 5 disagree, and 4 5 strongly disagree); negatively
16–65 yr and resident in Spain. Because of the absence of targeted items are reverse scored. We summed these re-
population-based registers in Spain of people with CP, we sponses to give a total score that could range from 10 (low
used convenience sampling. The principal investigator (PI; self-esteem) to 40 (high self-esteem). Permission to use this scale
Espı́n-Tello) developed a database of all centers in Spain was granted by BiblioPRO (http://www.bibliopro.org/).
that she considered accessible, including schools, day care Putative Predictor. We evaluated functional capacity
centers, residential homes and occupational centers for using the Barthel Index (BI; Mahoney & Barthel, 1965).
people with special needs, and associations for people with This instrument has been widely used in rehabilitation
physical impairments. She next sent an information sheet research, in which it has been shown to have excellent
about the study to the manager of each center, asking him reliability and validity (Cohen & Marino, 2000). It has
or her to bring it to the attention of possible participants been used in children and young adults with CP
and, if necessary, their family or legal guardian. She then (Ketelaar, Vermeer, & Helders, 1998; van der Dussen,
contacted those who showed an interest in participating to Nieuwstraten, Roebroeck, & Stam, 2001), is brief and
resolve any queries and provide further information. Those simple to administer, and has been translated into
who agreed to participate were interviewed after they—or Spanish (Baztán et al., 1993). It consists of 10 items that
their legal guardian—had read and signed a consent form. evaluate aspects of functional capacity with respect to
ADLs: feeding, bathing, grooming, dressing, bowels and
Data bladder management, toilet use, transfers (e.g., bed to
The PI interviewed all participants face to face in their chair and back), mobility (on level surfaces), and stairs.
school, day care center, or residential home between Responses have two, three, or four possible categories,
January 1, 2013, and December 31, 2014, to assess self-esteem each of which is assigned a number of points depending
7203205120p2 May/June 2018, Volume 72, Number 3
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936803/ on 03/22/2018 Terms of Use: http://AOTA.org/termsTable 1. Distribution of Sociodemographic Variables, the Barthel Index, and the Total Score of the Rosenberg Self-Esteem Scale
M (SD) pa
Variable N % BI RSES BI RSES
Total 108 100 48.4 (31.1) 32.0 (5.2)
Sex
Male 55 51 51.3 (33.3) 32.3 (5.3) .502 .564
Female 53 49 45.4 (28.6) 31.7 (5.1)
Age group, yr
16–25 12 11 49.2 (33.7) 32.7 (5.8) .646 .059
26–45 58 54 50.8 (32.9) 32.9 (4.8)
46–65 38 35 44.5 (27.5) 30.3 (5.3)
Highest education level
None 14 13 33.2 (29.1) 29.1 (4.0) .012 .002
Primary school 43 40 44.3 (29.8) 31.7 (4.8)
Secondary school 16 15 45.9 (30.8) 31.3 (5.7)
Postcompulsory education 12 11 48.8 (27.4) 30.4 (5.8)
Higher education 23 21 66.7 (30.7) 35.6 (4.4)
Employment status
Active employment or student 23 21 69.8 (32.5) 35.3 (4.7)sexes, we repeated this for males and females separately. the most frequent marital status was single. Almost half
The model with both sexes combined was then adjusted were living in a care home, and only 7% were living in-
for each covariate in turn. Both RSES and BI were treated dependently. Most participants (81%) had spastic CP, 77%
as continuous variables. Covariates were treated as cate- were unable to walk without help, and 19% had intellectual
gorical variables. The largest group was chosen as the impairment. Both RSES and BI scores were significantly
reference group to yield narrower confidence intervals for (p < .02) higher among people with a higher level of ed-
estimated effects in nonreference groups; similar cate- ucation, in active employment, and living independently
gories were amalgamated if they were not significantly or with family.
different. We checked that the final model satisfied the
assumptions of linear regression (Altman, 1990). Signif- Hypothesis Testing
icance was set at p < .05. Figure 1 shows the relationship between RSES and BI
This study was approved by the Departamento de scores along with the simple linear regression line and its
Fisiatrı́a y Enfermerı́a of the Faculty of Health Sciences of 95% confidence interval (CI). The regression coefficient
the University of Zaragoza and by the Clinical Research was 0.047, 95% CI [0.017, 0.078], p 5 .003; see first
Ethics Committee of Aragón. line of Table 2), indicating that the RSES score increased
on average 0.047 points when the BI increased 1 point.
The R2 was 8%, reflecting the wide scatter of points seen
Results in Figure 1 and indicating that the BI explained only 8%
A total of 108 people participated in the study. The mean of the variation in the RSES. Residuals from this model
age of the sample was 41.3 yr. The average RSES score was were checked visually and showed no indication of de-
32.0 (standard deviation [SD] 5 5.2, range 5 18–40). viations from the assumptions of homoscedasticity, line-
The median BI score was 37.5 (range 5 0–100), an arity, and normality that underlie linear regression or of
indication that most participants had severe functional outlying points that could have had undue influence on
dependence. the model. The relationship was similar for both sexes
(regression coefficient 5 0.038, 95% CI [20.004, 0.081]
Descriptive Statistics for men and 0.059, 95% CI [0.011, 0.107] for women).
The sample included similar proportions of men (51%) Adjustment for age as a possible confounder made little
and women (49%; Table 1). Most participants (89%) were difference to this relationship (see Table 2); the regression
older than age 25 yr. Approximately 20% had completed coefficient for the BI remained virtually unchanged and
higher education, but most had not progressed beyond highly significant, although participants ages 46–65 yr
primary school. Most were unemployed or pensioners, and had significantly lower RSES scores than others.
Figure 1. Scatterplot of the Total scores on the Rosenberg Self-Esteem Scale and the Barthel Index, showing the estimated regression line
and its 95% confidence interval in shading.
7203205120p4 May/June 2018, Volume 72, Number 3
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936803/ on 03/22/2018 Terms of Use: http://AOTA.org/termsTable 2. Regression of the Total Score of the Rosenberg Self-Esteem Scale on the Barthel Index, Adjusted For Sociodemographic Variables
Coefficient for
Coefficient for Barthel Index Sociodemographic Variable
Sociodemographic Variable Used for Adjustment B 95% CI p B 95% CI p R2
None (simple linear regression, unadjusted) 0.047 [0.017, 0.078] .003 8
Age group: 46–65 yr (ref.: 16–45 yr) 0.044 [0.014, 0.074] .005 -2.3 [24.3, 20.3] .023 13
Highest level of education: higher education (ref.: none, primary, or secondary) 0.032 [0.001, 0.063] .044 3.8 [1.4, 6.1] .002 16
Employment situation: Active employment/student (ref.: inactive/pensioner) 0.031 [20.001, 0.064] .054 3.3 [0.9, 5.8] .007 14
Marital status: with partner (ref.: single) 0.047 [0.016, 0.078] .004 0.6 [22.1, 3.4] .636 8
Living arrangements: with family or independent (ref.: care home or day care center) 0.026 [–0.007, 0.058] .122 3.7 [1.4, 5.9] .002 16
Note. Empty cells indicate data that were not applicable. Statistically significant values (p < .05) are in bold. R2 is the percentage of variance on the Rosenberg
Self-Esteem Scale that is explained by the model. B 5 regression coefficient; CI 5 confidence interval; ref. 5 reference group.
We included each potential mediating variable in the also a complete absence of missing data, despite the col-
regression in turn (see Table 2). Education, employment, lection of a large amount of information describing socio-
and living arrangements were significant: Participants with demographic factors.
higher education had a higher RSES score than others by Although we found that functional capacity was a
an average of 3.8 points, 95% CI [1.4, 6.1]; those who statistical predictor of self-esteem, it is difficult to infer that
lived independently or with family had a higher RSES this relationship is causal. In principle, the most con-
score by 3.7 points, 95% CI [1.4, 5.9]; and those who vincing evidence for causality is provided by longitudinal
were students or in active employment had a higher RSES studies, but these may not be enlightening in populations
score by 3.3 points, 95% CI [0.9, 5.8]. However, inclusion such as those we have studied in which disability is stable
of employment or living arrangements resulted in the re- over time. Nevertheless, the robustness of the association
gression coefficient for the BI decreasing substantially and found in our cross-sectional study suggests that functional
becoming nonsignificant, reflecting the high correlations capacity influences self-esteem.
between these covariates and the BI (p from Mann– More education, active employment, and living in-
Whitney test < .002). The models that included education dependently or with one’s family were also statistical
and living arrangements accounted for the most variance in predictors of higher self-esteem. However, these socio-
the RSES scores (16%). After excluding 16- to 25-yr-olds demographic factors were so highly correlated with each
who might not have completed their education, entered other and with the BI that it was difficult to determine
employment, or started living independently, these effects the underlying factor. They may, as postulated, be on a
changed little. Because education, employment, and living causal pathway between functional capacity and self-
arrangements were highly correlated (p from xResearch on closely related populations supports our allow stronger inferences about causality. A larger sample
findings. In a study of adolescents with CP, Manuel et al. would allow one to conduct an analysis using structural
(2003) found that self-esteem was significantly correlated with equation modeling, a multivariate technique used to es-
physician-assessed functional ability. In a cross-sectional study timate and test supposed causal relationships (Kline,
of 881 women, approximately half of whom had disabilities, 2010). National population-based registers of people
Nosek et al. (2003) found that self-esteem was significantly with CP should be created in Spain, to facilitate epide-
associated with both disability and employment. Although, miological studies of higher quality, which would allow a
like us, they postulated that disability influenced self-esteem, better understanding of the prevalence of CP and of the
they assumed that self-esteem influenced employment, situation and needs of those affected. Future studies should
whereas we assumed the opposite direction of causality. also consider additional factors that might influence self-
esteem of people with CP, in particular personality traits such
as the Big Five: openness to experience, conscientiousness,
Limitations and Future Research extraversion, agreeableness, and neuroticism (Karwowski,
Selection bias may have arisen in two ways. First, because of Lebuda, Wisniewska, & Gralewski, 2013).
the lack of population-based registers of people in Spain
with CP, we were unable to select a random sample from all
Spanish people with CP. Thus, our sample overrepresented Implications for Occupational
older adults and those with more severe impairment. Therapy Practice
However, selection bias is more likely to affect estimates of The results of this study have the following implications
means than of associations, which were the statistic of for occupational therapy practice:
interest in the current study (Korn & Graubard, 1999). • It is important that occupational therapy programs
Second, our study was conducted in Spain, which help people with impairment to perform ADLs as in-
could compromise its relevance to other countries. However, dependently as possible. In addition to the intrinsic
societal attitudes toward disability in Spain appear to be benefits gained, our study shows this is likely to lead to
close to the average of a diverse range of countries (Room, higher self-esteem.
Rehm, Trotter, Paglia, & Ustun, 2001). Furthermore, • By working with individuals to improve function and
Spain is one of the 171 countries that have ratified the advocating for improved accessibility, occupational
United Nations Convention on the Rights of Persons therapy practitioners can facilitate access to higher ed-
With Disabilities (United Nations, 2006), which obliges ucation, independent living, and active employment.
states to promote mobility, independent living, education,
an accessible environment, employment, and social par-
ticipation for people with disabilities. Although the United Conclusion
States has not ratified this convention, the Americans With Greater functional capacity predicts higher self-esteem in
Disabilities Act of 1990 (Pub. L. 101-336) has similar aims. people with CP. It is likely that education, employment,
Both frameworks address the situation during childhood, and independent living mediate the effect of functional
when functional skills and self-esteem are developing. capacity on self-esteem. National policies should facilitate,
Therefore, the results of our study are likely to be applicable through the removal of social, physical, and attitudinal
outside Spain, given that the countries that subscribe to barriers, the access of people with severe impairment to
these legal instruments are likely to have similar facilitators higher levels of education, homes in which they can live
and barriers to disability. independently, and an active working life. s
In addition, intellectual or communication difficulties
may have resulted in erroneous responses, which could Acknowledgments
have attenuated the estimate of the relationship between We thank all participants in the study and all professionals
self-esteem and functional capacity. Finally, interviewer and colleagues who helped recruit the sample. We also
bias may have arisen because the sole interviewer had the thank Allan Colver for helpful comments on the article.
same pathology as those interviewed. This may have
resulted in interviewees responding more openly with References
more confidence, and possibly exaggerating. Altman, D. (1990). Practical statistics for medical research.
Future studies should use random sampling, stratified London: Chapman & Hall.
by age, so that the results can be generalized to the wider Americans With Disabilities Act of 1990, Pub. L. 101-336, 42
population of people with CP. Longitudinal studies would U.S.C., xx 12101–12213 (2000).
7203205120p6 May/June 2018, Volume 72, Number 3
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936803/ on 03/22/2018 Terms of Use: http://AOTA.org/termsBax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, Karwowski, M., Lebuda, I., Wisniewska, E., & Gralewski, J.
N., Dan, B., . . . Damiano, D. (2005). Proposed defini- (2013). Big Five personality traits as the predictors of
tion and classification of cerebral palsy. Developmental creative self-efficacy and creative personal identity: Does
Medicine and Child Neurology, 47, 571–576. https://doi. gender matter? Journal of Creative Behavior, 47, 215–232.
org/10.1017/S001216220500112X https://doi.org/10.1002/jocb.32
Baztán, J., Pérez del Molino, J., Alarcón, T., San Cristóbal, E., Ketelaar, M., Vermeer, A., & Helders, P. J. (1998). Functional
Izquierdo, G., & Manzarbeitia, J. (1993). Índice de Bar- motor abilities of children with cerebral palsy: A systematic
thel: Instrumento válido para la valoración funcional de literature review of assessment measures. Clinical Rehabilitation,
pacientes con enfermedad cerebrovascular [Barthel Index: 12, 369–380. https://doi.org/10.1191/026921598673571117
The validity of an instrument for the functional assessment Kline, R. (2010). Principles and practice of structural equation
of patients with cerebrovascular disease]. Revista Espanola modeling. New York: Guilford Press.
de Geriatrcia y Gerontologia, 28, 32–40. Korn, E., & Graubard, B. (1999). Analysis of health surveys. New
Beckung, E., Hagberg, G., Uldall, P., & Cans, C. (2008). York: Wiley. https://doi.org/10.1002/9781118032619
Probability of walking in children with cerebral palsy in Magill, J., & Hurlbut, N. (1986). The self-esteem of adolescents
Europe. Pediatrics, 121, e187–e192. https://doi.org/ with cerebral palsy. American Journal of Occupational Ther-
10.1542/peds.2007-0068 apy, 40, 402–407. https://doi.org/10.5014/ajot.40.6.402
Blair, C. E. (1999). Effect of self-care ADLs on self-esteem Magill-Evans, J. E., & Restall, G. (1991). Self-esteem of per-
of intact nursing home residents. Issues in Mental sons with cerebral palsy: From adolescence to adulthood.
Health Nursing, 20, 559–570. https://doi.org/10.1080/ American Journal of Occupational Therapy, 45, 819–825.
016128499248367 https://doi.org/10.5014/ajot.45.9.819
Blascovich, J., & Tomaka, J. (1991). Measures of self-esteem. Mahoney, F. I., & Barthel, D. W. (1965). Functional evalua-
In J. P. Robinson, P. R. Shaver, & L. S. Wrightsman tion: The Barthel Index. Maryland State Medical Journal,
(Eds.), Measures of personality and social psychological 14, 61–65.
attitudes (pp. 115–160). Houston: Gulf Professional. Manuel, J. C., Balkrishnan, R., Camacho, F., Smith, B. P., &
https://doi.org/10.1016/B978-0-12-590241-0.50008-3 Koman, L. A. (2003). Factors associated with self-esteem
Borg, C., Fagerström, C., Balducci, C., Burholt, V., Ferring, in pre-adolescents and adolescents with cerebral palsy.
D., Weber, G., . . . Hallberg, I. R. (2008). Life satisfaction Journal of Adolescent Health, 32, 456–458. https://doi.org/
in 6 European countries: The relationship to health, self- 10.1016/S1054-139X(03)00050-8
esteem, and social and financial resources among people (aged Martı́n-Albo, J., Núñiez, J. L., Navarro, J. G., & Grijalvo, F.
65–89) with reduced functional capacity. Geriatric Nursing, (2007). The Rosenberg Self-Esteem Scale: Translation and
29, 48–57. https://doi.org/10.1016/j.gerinurse.2007.05.002 validation in university students. Spanish Journal of Psychology,
Brooks, R. B. (1992). Self-esteem during the school years: Its 10, 458–467. https://doi.org/10.1017/S1138741600006727
normal development and hazardous decline. Pediatric McGee, R., & Williams, S. (2000). Does low self-esteem pre-
Clinics of North America, 39, 537–550. https://doi.org/ dict health compromising behaviours among adolescents?
10.1016/S0031-3955(16)38343-2 Journal of Adolescence, 23, 569–582. https://doi.org/
Chang, A. M., & Mackenzie, A. E. (1998). State self-esteem 10.1006/jado.2000.0344
following stroke. Stroke, 29, 2325–2328. https://doi.org/ Nosek, M. A., Hughes, R. B., Swedlund, N., Taylor, H. B., &
10.1161/01.STR.29.11.2325 Swank, P. (2003). Self-esteem and women with disabil-
Cohen, M. E., & Marino, R. J. (2000). The tools of disability ities. Social Science and Medicine, 56, 1737–1747. https://
outcomes research functional status measures. Archives doi.org/10.1016/S0277-9536(02)00169-7
of Physical Medicine and Rehabilitation, 81(Suppl. 2), Orth, U., Robins, R. W., & Roberts, B. W. (2008). Low self-
S21–S29. https://doi.org/10.1053/apmr.2000.20620 esteem prospectively predicts depression in adolescence
Gannotti, M. E., Minter, C. L., Chambers, H. G., Smith, and young adulthood. Journal of Personality and Social
P. A., & Tylkowski, C. (2011). Self-concept of adults with Psychology, 95, 695–708. https://doi.org/10.1037/0022-
cerebral palsy. Disability and Rehabilitation, 33, 855–861. 3514.95.3.695
https://doi.org/10.3109/09638288.2010.514017 Riad, J., Broström, E., & Langius-Eklöf, A. (2013). Do movement
Horsman, M., Suto, M., Dudgeon, B., & Harris, S. R. (2010). deviations influence self-esteem and sense of coherence in mild
Ageing with cerebral palsy: Psychosocial issues. Age and Age- unilateral cerebral palsy? Journal of Pediatric Orthopedics, 33,
ing, 39, 294–299. https://doi.org/10.1093/ageing/afq018 298–302. https://doi.org/10.1097/BPO.0b013e31827d0b5b
Instituto Nacional de Estadı́stica. (2008). Encuesta de discapa- Room, R., Rehm, J., Trotter, R., Paglia, A., & Ustun, T.
cidad, autonomı́a personal y situaciones de dependencia 2008 (2001). Cross-cultural views on stigma, valuation, parity,
[Survey on disability, independence and dependence situa- and societal values towards disability. In T. Üstün (Ed.),
tions 2008]. Retrieved from http://www.ine.es/jaxi/Datos. Disability and culture: Universalism and diversity (pp.
htm?type5pcaxis&path5/t15/p418/a2008/hogares/p02/ 247–297). Seattle: Hogrefe & Huber.
modulo1/l0/&file503028.px Rosenberg, M. (1965). Society and the adolescent self-image.
Instituto Nacional de Estadı́stica. (2016). Main series since Princeton, NJ: Princeton University Press. https://doi.
1971: National results. Resident population by date, sex org/10.1515/9781400876136
and age. Retrieved from http://www.ine.es/jaxiT3/Tabla. Roth, M., Decker, O., Herzberg, P. Y., & Brähler, E. (2008).
htm?t510256&L51 Dimensionality and norms of the Rosenberg Self-Esteem
The American Journal of Occupational Therapy 7203205120p7
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936803/ on 03/22/2018 Terms of Use: http://AOTA.org/termsscale in a German general population sample. European Europe. Developmental Medicine and Child Neurology, 44,
Journal of Psychological Assessment, 24, 190–197. https:// 633–640.
doi.org/10.1027/1015-5759.24.3.190 Trzesniewski, K. H., Donnellan, M. B., Moffitt, T. E., Robins,
Rothman, K., & Greenland, S. (1998). Modern epidemiology. R. W., Poulton, R., & Caspi, A. (2006). Low self-esteem
Philadelphia: Lippincott-Raven. during adolescence predicts poor health, criminal behav-
Sellier, E., Platt, M. J., Andersen, G. L., Krägeloh-Mann, I., ior, and limited economic prospects during adulthood.
De La Cruz, J., & Cans, C. (2016). Decreasing prevalence Developmental Psychology, 42, 381–390. https://doi.org/
in cerebral palsy: A multi-site European population-based 10.1037/0012-1649.42.2.381
United Nations. (2006). Resolution 60/232: Convention on the
study, 1980 to 2003. Developmental Medicine and Child Neu-
Rights of Persons With Disabilities. New York: Author.
rology, 58, 85–92. https://doi.org/10.1111/dmcn.12865
van der Dussen, L., Nieuwstraten, W., Roebroeck, M., &
Sinclair, S. J., Blais, M. A., Gansler, D. A., Sandberg, E., Bistis,
Stam, H. J. (2001). Functional level of young adults with
K., & LoCicero, A. (2010). Psychometric properties of the cerebral palsy. Clinical Rehabilitation, 15, 84–91. https://
Rosenberg Self-Esteem Scale: Overall and across demo- doi.org/10.1191/026921501670159475
graphic groups living within the United States. Evaluation Vázquez-Morejón, A., Jiménez, R., & Vázquez-Morejón, R.
and the Health Professions, 33, 56–80. https://doi.org/ (2004). Escala de Autoestima de Rosenberg: Fiabilidad y
10.1177/0163278709356187 validez en población clı́nica española [Rosenberg Self-
Surveillance of Cerebral Palsy in Europe. (2002). Prevalence Esteem Scale: Reliability and validity in the Spanish clinical
and characteristics of children with cerebral palsy in population]. Apuntes de Psicologı́a, 22, 247–255.
7203205120p8 May/June 2018, Volume 72, Number 3
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