title: Obstacles to community participation among youth with spinal cord injury.
abstract: OBJECTIVE
  Examine caregiver-report of obstacles to community participation for youth with spinal cord injury (SCI), and explore relationships between obstacles and child, caregiver, and community characteristics.
  
  
  METHODS
  Two hundred and one primary caregivers  of youth with SCI ages 7-17 years were interviewed at three pediatric SCI centers within a single-hospital system. Caregivers answered an open-ended question assessing obstacles to youth participation. A mixed-methods approach was incorporated, where qualitative methods analyzed caregiver-reported  obstacles, and exploratory multivariate analyses examined relationships between obstacles and demographic variables.
  
  
  RESULTS
  Caregivers were primarily mothers (74%), married (69%), employed (54%), had college experience (67%), and lived in small towns (55%). Youths' mean  age was 12.60 years at interview and 7.19 years at injury, 70% had paraplegia, and 55% had complete injuries. Analyses revealed that youth participation was limited by obstacles across six domains: community, disability-related, practical concerns, child-internal, social, and other. Child,  caregiver, and community characteristics were related to overall report of obstacles, and report of community obstacles, disability-related obstacles, and practical concerns. Caregiver college experience and small town living predicted overall report of obstacles. Having a child injured at  a younger age, caregiver college experience, and small town living predicted community obstacles. Having a child with an incomplete injury and recent medical complication predicted disability-related obstacles. Caregiver employment predicted practical concerns.
  
  
  CONCLUSIONS
  Youth  from small towns, those injured younger, those with incomplete injuries, and those experiencing recent medical complications may need additional supports and resources to maximize participation. Clinicians should work with caregivers to identify and problem-solve obstacles to youth participation.
authors.affiliation: Shriners Hospitals for Children, Chicago, IL, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Gorzkowski
authors.forename: Erin H
authors.initials: EH
authors.lastname: Kelly
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Klaas
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003256:Community Participation / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000451:nursing / Q000523:psychology; D011795:Surveys and Questionnaires