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A STUDY ON THE KNOWLEDGE ATTITUDE AND PRACTICE OF

CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY.

THESIS SUBMITTED IN PARTIAL FULFILLMENT

FOR THE AWARD OF DEGREE OF

DOCTOR OF PHILOSOPHY IN NURSING

By

GRACY V.C

VINAYAKA MISSIONS UNIVERSITY

SALEM, TAMILNADU, INDIA.

2014


CERTIFICATE BY THE GUIDE

I DR. REBECCA SAMSON professor and Dean of PIMS

Pondicherry, certify that thesis entitled “A study on the Knowledge

Attitude and Practice of Caregivers of Children with Cerebral Palsy”,

submitted for the award of degree of Doctor of Philosophy in Nursing by

GRACY V.C is the record of research work carried out by her during the

period from 2009 to 2014 under my guidance and supervision and that

this work has not formed the basis for the award of any degree or diploma

associate-ship, fellowship, or other titles in this or any other University or

institutions of higher learning.

Place:

Date: Seal and Signature of the Guide


DECLARATION BY THE GUIDE

This is to certify that the thesis entitled “A study on the

Knowledge Attitude and Practice of Caregivers of Children with

Cerebral Palsy” is an original research work carried out by

Mrs. Gracy V .C who had registered for PhD in the year 2009.

Place:

Date: Seal and Signature of the Guide


DECLARATION

I GRACY V.C declare that the thesis entitled “A study on


Cerebral Palsy”, submitted by me for the degree of Doctor of Philosophy

in Nursing is the record of research work carried out by me during the

period from 2009 to 2014 under the guidance of DR. REBECCA

SAMSON professor and Dean of PIMS Pondicherry and has not formed

the basis for the award of any degree or diploma, associate-ship,

fellowship, titles in this or any other University or any other institutions of

higher learning.

Place: Signature of the candidate.

Date:

ACKNOWLEDGEMENT

Success is possible only by others help .The research scholar has been

fortunate to receive sufficient help from various sources.

Gratitude can never be expressed in words. First of all I thank God

almighty for his abundant blessing showered on me to complete the study

successfully. There are several hands and heart behind this work.

I am immensely grateful to Dr. A. Shanmugasundaram Chancellor,

Vinayaka Missions University Salem for providing me an opportunity to

pursue my doctoral degree under Vinayaka Missions University.

I would like to take the privilege to thank Dr. V.R Rajendran, Vice

Chancellor and Dr. K. Rajendran, Dean (Research), Vinayaka Missions

University, Salem for permitting me to carry out this study.

I express my respectful gratitude to my research guide

Dr. Rebecca Samson M.Sc. PhD, Professor and Dean of PIMS

Pondicherry, for her inspiring suggestions, guidance, encouragement and

patience for the completion of this study.

I am grateful to Experts who validate the tool and for their valuable

suggestions and recommendations

The investigator expresses heartfelt thank to Mr. Solomon Prabhakar

editor and statistician, Chennai for his help and support given in doing

statistical analysis and English editing.

My sincere gratitude to caregivers of children with cerebral palsy, for

having participated in this study.

I am forever indebted and grateful to my husband Sri. Abraham for his

love, Patience, encouragement and understanding which allow me to

dedicate most of my time on this research work. I thank my little angel

Shreyas, the spark of life who rekindled the dream to succeed in life.

My warm appreciation to all those, who have helped me directly and

indirectly to complete this thesis.

GRACY V. C

LIST OF CONTENT

CHAPTERS CONTENT PAGE NO

I

INTRODUCTION

1-20

II

REVIEW OF LITERATURE

21-35

III

METHODOLOGY

36 - 53

IV

DATA ANALYSIS AND INTERPRETATION

54 -108

V

DISCUSSION

109-123

VI

SUMMARY , CONCLUSION AND

RECOMMENDATIONS

124-135

VII

BIBLIGRAPHY

136

VIII

APPENDIX

LIST OF TABLES

SL.NO TITLE PAGE NO

1 Distribution of care givers according to their Age. 56

2 Distribution of care givers according to their Gender 58

3 Distribution of care givers according to their

Educational status. 59

4 Distribution of care givers according to their marital

status. 60

5 Distribution of care givers according to Type of

family 61

6 Distribution of care givers according to Employment

status 62

7 Distribution of caregivers according to Religion. 63

8 Distribution of caregivers according to Area of

Residence 64

9 Distr. of caregivers according to Type of House 65

10 Distribution of caregivers according to Ownership

Status 66

11 Distribution of caregivers according to income 67

12.a)

Frequency and percentage distribution of level of

knowledge of caregivers in providing care to

children with cerebral palsy with regard to general

information

68

12.b)


Knowledge of caregivers in providing care to

children with cerebral palsy with regard to Signs

and symptoms

69

12.c)


Knowledge of caregivers in providing care to

children with cerebral palsy with regard to Self-care

needs & Self-care support

70

12.d)



children with cerebral palsy with regard to Feeding

& Nutrition

71

12.e)



children with cerebral palsy with regard to Hygiene

& Elimination

72

12.f)



children with cerebral palsy with regard to Exercise

& Prevention of complications

74

13 Mean, standard deviation, skew, and kurtosis on

the level of knowledge in each domain 76

14 Descriptive statistics for knowledge 77

15

Distribution of caregivers according to the level of

knowledge

77

16


attitude of caregivers of children with cerebral palsy

with regard to special education

78

16.a)



with regard to Parenting & caring.

80

16b.)



with regard to bowel training and activities

82

16c.)



with regard to exercise

83

16d.)



with regard to socialization

84

17 Mean, standard deviation, Skew, Kurtosis on the

level of attitude in each domain 85

18 Descriptive statistics for attitude 86

19 Percentage Distribution of caregivers according to

the level Attitude. 86

20.a)


Practice of caregivers to children with cerebral

palsy with regard to hygiene

87

20.b)



palsy with regard to Nutrition.

88

20.c)



palsy with regard to Toileting.

90

20.d)



palsy with regard to Medications

91

20.e)


Practice of caregivers with regard to self-help and

self-care.

92

21 Descriptive statistics for practice 93

22 Percentage distribution of caregivers according to

the level of Practice. 94

23 Mean, standard deviation, Skew, Kurtosis on the

level of practice in each domain 95

24 Data on Association of Knowledge score and

selected demographic Variables 97

25 Data on association of Attitude with selected

Demographic Variables. 99

26 Data on Association of practice with the

Demographic Variables. 101

27 Descriptive statistics to reveal the effect of

information brochure on the level of knowledge 102

28 Descriptive statistics to confirm the effect of

information brochure on the level of knowledge 103


information brochure on the level of attitude 104


information brochure on the level of attitude 105


information brochure on the level of Practice 106


information brochure on the level of practice 107

LIST OF FIGURES

SL NO FIGURES PAGE NO

1 Distribution of care givers according to their Age. 57


Gender. 58


Educational status 59

4 Distribution of care givers according to their marital

status. 60

5 Distribution of care givers according to Type of

family 61

6 Distribution of care givers according to Employment

status 62

7 Distribution of caregivers according to Religion 63

8 Distribution of caregivers according to Area of

Residence 64

9 Distribution of caregivers according to Type of

House 65

10 Distribution of caregivers according to Ownership

Status 66

11 Distribution of caregivers according to their income 67

12 Percentage distribution of caregivers according to

the level of Practice 94

13 Number of Correct Answers Post distribution of

Information Brochure 104

14 Number of Correct Answers Post Distribution of


15 Number of Correct Answers Post Distribution of


LIST OF APPENDICES

APPENDIX CONTENT

1 Permission letters

II Letter requesting to validate the tool

III Acceptance form for tool validation

IV Content validation Certificate

V List of Experts

VI Letter seeking Consent for Participation

VII Instruments -Tool (English and Kannada)

VIII Certificate for English editing

IX Certificate for Kannada editing

X Information brochure (English and Kannada)

ABSTRACT

A Non experimental Descriptive research study on the


Cerebral Palsy was carried out. Data was collected from 400 subjects

by using structured interview - schedule to assess the knowledge,

Lickert scale to assess the attitude and observational check list to

assess the Practice of caregivers of children with Cerebral palsy.

BACKGROUND OF THE STUDY

Cerebral Palsy (C P) is a neurological disorder caused by damage to

the brain cells that occur before, during or after birth. It is characterized by

loss of movements (crawling, and walking) and nerve functions resulting in

problems of use of hands (eating, writing and dressing) and communication.

During the process of delivery or after delivery any head injury and lack of

sufficient oxygen to the brain cells results in cerebral palsy. Jaundice,

premature birth and infections of the mother (e.g. German measles) are also

causing cerebral palsy.

Cerebral Palsy (CP) is a non-progressive disorder characterized

by uncontrolled movement and posture, resulting from damage to the

brain cells that occur before, during, or shortly after birth. It may be

accompanied by speech and hearing defects and visual problems,

mental retardation, seizures, and loss of nerve functions. Children with

CP may have problems in movement (crawling, and walking),use of

hands (eating, writing, and dressing) and communication (Aravind

Taneja).The motor disorders of CP are often accompanied by

disturbance of sensation and perception ,cognition, communication

behavior, epilepsy and other secondary musculoskeletal problems.

Cerebral palsy is the most common cause of chronic childhood

disability, estimated to be between 2 and 2.5 per 1000 live births in

developed countries. According to Indian statistics, about 25 lakhs of

children are affected by cerebral palsy. The occurrence of cerebral

palsy is higher in males than in females. The caregivers, especially

parents of cerebral palsy children are highly desperate. Nobody can

understand the inner feelings of pain. Moreover, their public life stands

limited.

The children who are severely affected need twenty-four hours

care. Others need help and support to meet their self-care needs. The

caregivers (mother or mother substitutes) need to have proper

knowledge regarding meeting the self-care needs of the children

especially in feeding, toileting, dressing, writing, and walking. They

need to develop a positive attitude and skill towards the care of

children with cerebral palsy. Like any other child, children with cerebral

palsy also need care, love, and affection from the caregivers.

Children with cerebral palsy need special care and special

education to reduce their disability. Parenting an exceptional child is

unique in degree and intensity. The birth of an exceptional child adds a

situational crisis, which results from an unanticipated, traumatic event

beyond parent’s control. Parents progress through emotional stages on

finding their child's exceptionality. Caregivers need to have the proper

knowledge, a positive attitude and proper skill to look after these children

STATEMENT OF THE PROBLEM

A Study on the Knowledge, Attitude and Practice of

Caregivers of Children with Cerebral Palsy.

OBJECTIVES

1. To assess the knowledge of caregivers regarding care of the

children with Cerebral Palsy.

2. To find out the attitude of care givers of children with Cerebral

Palsy.

3. To assess the practice of care givers of children with Cerebral

Palsy

4. To find the association of knowledge, attitude and practice with

selected demographic variables.

5. To know the effect of an information brochure among the

caregivers of Children cerebral palsy.

HYPOTHESES

Section A:

Ho: Knowledge of the caregivers is not influenced by any of the

selected demographic variables

H1: Knowledge of the caregivers is influenced by at least one of

the selected demographic variables

Section B:

Ho: Attitude of the caregivers is not influenced by any of the


H1: Attitude of the caregivers is influenced by at least one of the


Section C:

Ho: Practice of the caregivers is not influenced by any of the


H1: Practice of the caregivers is influenced by at least one of the


Section D:

Ho: The information brochure does not have any influence on

the knowledge, attitude, and practice of caregivers of

children cerebral palsy.

H1: The information brochure does have some influence on the

Knowledge, attitude, and practice of caregivers of children

Cerebral palsy.

METHODS OF DATA COLLECTION

1. Structured interview - schedule to assess the knowledge of

caregivers of Children with cerebral palsy.

2. Likert scale to assess the attitude of caregivers of Children with

cerebral palsy.

3. Observational check list to assess the Practice of caregivers of

children with Cerebral palsy.

SPSS version 20 for windows is used for Statistical analysis.

Data was summarized using mean and standard deviation for

continuous variables and percentage for categorical variables. X2 test

was used to test for association between selected demographic

variables and knowledge, attitude, and practice (prior to distribution of

the information brochure).

The level of significance used was P<0.05.

The plan for data analysis was to:

a) Describe the socio-demographic variables of caregivers by

frequency and percentage distribution.

b) Frequency and percentage distribution, arithmetic mean, and

standard deviation were used to analyze the level of knowledge,

attitude, and practice.

c) Chi-square test was used to determine if the selected socio

demographic variables influenced the level of knowledge

attitude, and practice (prior to distribution of the information

brochure).

d) Pearson Correlation, T-Test, and F-Test were used to establish

the effectiveness of the brochure.

THE FINDINGS ARE AS FOLLOWS

Section A. Socio demographic variables

Majority, 169 (42.3%) of the caregivers belong to the age group

of 36-45 years

Majority 362 (90.5%) of the caregivers were females.

Majority, 304 (76.0%) of the caregivers attended school up to

SSLC.

Majority 400 (100%) of the caregivers were married

Majority 254 (63.5%) of the caregivers belong to nuclear family.

Only 27 (6.8%) of the caregivers were salaried.

Majority 204 (51.0 %) of caregivers belong to Muslim.

200 (50.0%) of the caregivers belong to rural and 200 (50.0%)

belong to urban areas.

Majority 350 (87.5 %) of the caregivers reside in concrete

houses.

168 (42.0%) of the caregivers resides in rented House.

196 (49.0%) of the caregivers are between Rs.5001/- to

Rs.10000/-.

Section B. was to assess the knowledge of caregivers regarding care

of the children with Cerebral Palsy

The finding reveals that 20 (5%) of the caregivers had good (>65 %)

knowledge, 229 (57.3%) of the caregivers had average (51% -65%)

knowledge, and 37.8% (151) of the caregivers had poor (≤50%)

knowledge.

The mean, standard deviation, skew, and kurtosis on the level of

knowledge in six domains reveals that the mean score in the domains of

‘General information regarding cerebral palsy’ was 3.2 with standard

deviation of 0.6. The mean score in the aspects of ‘Signs and symptoms of

cerebral palsy’ was 1.4 with standard deviation of 0.6. The mean score in

the aspects of ‘Self-care needs and support’ was1.4 with standard

deviation of 0.6. The mean score in the aspects of ‘Feeding and nutrition’

was 0.01 with standard deviation of 0.3. The mean score in the aspects of

‘Hygiene and elimination’ was 3.7 with standard deviation of 1.0. The

mean score in the aspects of ‘Exercise and prevention’5.5 with standard

deviation of 1.3.

The Percentage distribution of level of knowledge of caregivers

reveals that 5% of the caregivers had good knowledge, with a mean score

of 70.33 and standard deviation of 2.62. 57.5% of the caregivers had

average knowledge, with a mean score of 56.96 and standard deviation

of 3.3. 37.5% of the caregivers had poor knowledge with a mean score of

46.42 and standard deviation of 4.48.

Section C. was to find out the attitude of caregivers of children with

Cerebral Palsy

The finding reveals the percentage distribution of level of attitude of

caregivers of children with cerebral palsy. The Mean, standard deviation,

Skew, Kurtosis on the level of attitude in each domain reveals that the

mean score on Special education was 16.15 with standard deviation 0.61.

The mean score on Parenting & caring was 15.20 with standard deviation

1.03. With regard to Bowel training and activities the mean score

was10.99 with a standard deviation of 0.05. The mean score on Exercise

was 5.95 with a standard deviation of 0.50. The mean score on

Socialization was13.51 with standard deviation of 1.08.

The findings revealed that the level of attitude, in general, is within

the acceptable range. However, for the purpose of the study, we set a very

high benchmark (75%) to consider the attitude level to be considered as

‘favorable’. Accordingly, it was noted that NONE of the caregivers had

favorable attitude (at the predefined level of 75%) prior to the intervention;

ALL of the caregivers had unfavorable attitude (at the predefined level of

75%).

Section. D was to assess the practice of caregivers of children with

Cerebral Palsy.

It reveals that 80 (20%) of the caregivers had good Level of

Practice. 54 (13.5%) of the Caregivers had Average Level of Practice, 266

(66.5%) of caregivers had Poor Level of Practice.

The findings reveal the frequency and percentage distribution of

level of Practice of caregivers to children with cerebral palsy. Mean,

standard deviation, Skew, and Kurtosis on the level of attitude in each

domain. It reveals that the mean score on Special education was 16.15

with standard deviation 0.61.The mean score on Parenting & caring was

15.20 with standard deviation 1.03. With regard to Bowel training and

activities, the mean score was 10.99 with a standard deviation of 0.05. The

mean score on Exercise was 5.95 with a standard deviation of 0.50. The

mean score on Socialization was13.51 with standard deviation of 1.08.

Section. E was to find the association of knowledge, attitude, and

practice with selected demographic variables.

Association of knowledge with selected demographic variables

reveals that the probability of obtaining Chi-square value by chance is

>0.05 (p > 0.05). Therefore, the null hypothesis is accepted, and it is thus

concluded that there is no association between knowledge and selected

demographic variables.

Association of Attitude with selected demographic variables reveals

that age alone seems to have influenced the level of attitude. The p-value

is 0.03, and thus we reject the null hypothesis, which states that there is

no association between the selected demographic variables and level of

attitude. Instead, we accept the alternative hypothesis and conclude that

there is an association between attitude and age group.

Association of practice with the Demographic Variables shows that

age alone seems to have influenced the level of practice. The p-value is

0.009, and thus we reject the null hypothesis, which states that there is no

association between the selected demographic variables and level of

practice. Instead, we accept the alternative hypothesis and conclude that

there is an association between practice and age group.

Section. F was to know the effect of an information brochure on the

caregivers of children cerebral palsy.

The findings reveals that the level of knowledge increased positively

and shifted to the higher end (right) and thus skewed to the right. In

addition, the score became more clustered at the positive end with slight

reduction in the variance. This clearly gives the primary evidence that the

information brochure had a high impact on the level of knowledge.

The correlation, confirmed by Pearson value, indicates that the rise

in knowledge level is uniform and substantial across the sample. The T-

Test value is almost zero, indicating that the increase in score cannot be

due to chance or some other factor. The considerably low F-Test p-value

indicates that the variance in the sample after the intervention is

significantly different from that of one prior to the intervention.

The level of attitude increased positively and shifted to the higher

end (right) and thus skewed to the right. In addition, the score became

more clustered at the positive end with slight reduction in the variance.

This clearly gives the primary evidence that the information brochure had a

considerable impact on the level of attitude.


in attitude level is uniform and considerable across the sample. The T-Test

value is almost zero, indicating that the increase in score cannot be due to

chance or some other factor. The low F-Test p-value indicates that the

variance in the sample after the intervention is significantly different from

that of one prior to the intervention. Compared to the effect on knowledge,

we can say that the effect of the intervention in terms of attitude is slightly

low.

The level of practice increased positively and shifted to the higher



This clearly gives the primary evidence that the information brochure had a

high impact on the level of practice.


in knowledge level is uniform and substantial across the sample. The T-

Test value is almost zero, indicating that the increase in score cannot be

due to chance or some other factor. F-Test p-value of zero indicates that

the variance in the sample after the intervention is expressively different

from that of one prior to the intervention.

INFERENCE

The present study was conducted on the Knowledge Attitude and

Practice of caregivers of children with cerebral palsy. The following

conclusions were drawn from the study.

1. Only 5% of the caregivers had good knowledge, 57.3% of the

caregivers had average knowledge and. 37.8% of the caregivers

had poor knowledge regarding giving care to the children with

cerebral palsy.

2. It revealed that None of the caregivers had a favourable attitude (as

per the set standards) prior to the intervention.

3. After the intervention, it revealed that at least 15% of the caregivers

of cerebral palsy crossed the threshold to reach the set level of

favourable attitude (at the set standard of 75% and above); yet, 85

% of the caregivers of cerebral palsy had unfavourable attitude (at

the set standard of 75%).

4. Only 20% of the caregivers had good level of practice. 13.5% of the

caregivers had average level of practice and majority 66.5% of

caregivers had poor level of Practice.

5. There was no association between knowledge and demographic

variables of caregivers of children with cerebral palsy at (p>0.05)

6. There is an association between attitude and age, and practice age

at (p>0.01).

7. The information brochure had very positive effect on the level of

knowledge, attitude, and practice. In each case, the probability of

observing such a huge change by chance is ZERO.

8. The impact of information brochure eliminated the effect of age or

any other demographic variable observed in the pre-intervention

setup.

RECOMMENDATIONS

It is recommended that this study can be replicated.

A comparative study can be conducted regarding the knowledge,

attitude, and practice between urban and rural caregivers of children

with cerebral palsy.

A study can be conducted to evaluate the usefulness of an

information brochure among the caregivers of children cerebral

palsy.

IMPLICATIONS FOR NURSING EDUCATION, NURSING PRACTICE,

AND NURSING RESEARCH

Information brochure will help the caregivers to improve their

practice by having right knowledge and develop favourable attitude.

Every centre or home for the disabled should have Information

brochure

Role of the caregivers in giving care to children with cerebral palsy

must be included in nursing curriculum.

Parents of children with cerebral palsy need support from

professionals. Nurses have a vital role in providing support for these

families.

CONCLUSION

The entire research proved that a small change in the level of

knowledge in caregiver of children with CP would have an effect on the

attitude to some extent and, on the practices to a great extent.

INTRODUCTION

CHAPTER - I

1

CHAPTER - 1

INTRODUCTION

BACKGROUND OF THE STUDY

“All parents hope to have normal and happy children they can be

proud of. It is natural that parents are greatly distressed when they

learn that their child is handicapped”.

The birth of a baby is the most joyful moment for both parents

and the Family. If the baby is found to be born with any kind of

developmental disabilities, then the whole situation changes. Physical

or mental disability reduces the performance of everyday function or

makes one to seek the aid of another person or a device. Disability is a

substantial handicap, with onset before the age of 18 years. It includes

mental retardation, autism, cerebral palsy, epilepsy, or other

neuropathies (Medina 2008). An estimate states that 15 percent of the

child population is born with developmental disabilities. According to a

recent US Censes, about 4 million American children have a disability.

Cerebral palsy is the most common cause of chronic childhood

disability, estimated to be between 2 and 2.5 per 1000 live births in

developed countries. According to Indian statistics, about 25 lakhs of

children are affected by cerebral palsy. The occurrence of cerebral

palsy is higher in males than in females. The caregivers, especially

parents of cerebral palsy children are highly desperate. Nobody can

2

understand the inner feelings of pain. Moreover, their public life stands

limited.

Cerebral Palsy (CP) is a non-progressive disorder characterised

by uncontrolled movement and posture, resulting from damage to the

brain cells that occur before, during, or shortly after birth. It may be

accompanied by speech and hearing defects and visual problems,

mental retardation, seizures, and loss of nerve functions. Children with

CP may have problems in movement (crawling, and walking),use of

hands (eating, writing, and dressing) and communication (Aravind

Taneja).The motor disorders of CP are often accompanied by

disturbance of sensation and perception ,cognition, communication

behaviour, epilepsy and other secondary musculoskeletal problems.

Cerebral Palsy has secondary associated conditions. No two

children are affected in the same way. Cerebral Palsy is one of the

major developmental disability found in varying degrees and the

affected person becomes dependent on the caregivers until death.

The children who are severely affected need twenty-four hours

care. Others need help and support to meet their self-care needs. The

caregivers (mother or mother substitutes) need to have proper

knowledge regarding meeting the self-care needs of the children

especially in feeding, toileting, dressing, writing, and walking. They

need to develop a positive attitude and skill towards the care of children

3

with cerebral palsy. Like any other child, children with cerebral palsy

also need care, love, and affection from the caregivers.

Children with cerebral palsy need special care and special

education to reduce their disability. Parenting an exceptional child is

unique in degree and intensity. Children with cerebral palsy need love,

care, guidance, and protection from parents. According to Neeru

Sharma (2004), the birth of an exceptional child adds a situational

crisis, which results from an unanticipated, traumatic event beyond

parent‟s control. Parents progress through emotional stages on finding

their child's exceptionality vis. disbelief, guilt, shame, denial and a

feeling of Helplessness (Mc Dowell, 1976).

INCIDENCE AND PREVALENCE

In the industrialised world, the incidence of cerebral palsy is

about two per 1000 live births. The incidence is higher in males than in

females; the Surveillance of Cerebral Palsy in Europe (SCPE) reports

an M: F ratio of 1.33:1, the incidence rates converge towards the

average rate of 2:1000.

In the United States, approximately 10,000 infants and

babies are diagnosed with CP each year, and 1200 –1500 diagnosed at

preschool age. The incidence of CP increases with premature or very

low-weight babies regardless of the quality of care.

4

Prevalence of cerebral palsy is best calculated around the

school entry age of about six years; in U.S., it is estimated to be 2.4 out

of 1000 children.

AETIOLOGY

Cerebral palsy occurs due to multiple factors. It may be due to

malformation of the brain. Other factors are prenatal hypoxia,

intraventricular haemorrhages, Kernictres, birth trauma, acid base

imbalance, and intrauterine infections. Low birth weight and congenital

malformations are considered as important aetiological factors. APGAR

scores have been also used as a factor to predict whether an individual

will develop cerebral palsy or not.

PATHOLOGY

In mild cerebral palsy, the brain appears normal, but may be

underweight and has sub cortical white matter and spares nerve fibres.

In severe cerebral palsy, there may be various pathological lesions like

atrophy of the basal ganglia, leukomalacia, Porencephaly, Microcephaly

cerebellar lesions, and vascular occlusions.

CAUSES OF CEREBRAL PALSY

o Insufficient oxygen to the brain may damage the brain cells of the

child

o Maternal infections such as rubella , cytomegalovirus, or

toxoplasmosis in the first 4-5 months of the pregnancy

http://www.doctorndtv.com/topics/searchdetailtopics.asp?id=611

5

o Metabolic disorders in the mother such as diabetes, heart

problem, severe asthma and thyroid disorders

o Use of certain drugs during antenatal period without doctor‟s

consultation

o Trauma to the fetal head during labour or delivery, cerebral

haemorrhage, and use of forceps

o Prematurity and other complications at birth such as difficulty in

breathing or very low birth weight

o In most cases, the cause is some abnormality around the time of

conception.

POSSIBLE SIGNS OF CEREBRAL PALSY

1. Physical signs

It includes poor head control after 3 months of age, stiff or rigid

arms or legs, pushing away or arching back, floppy or limp body

posture. Baby may not sit up without support by 8 months, uses only

one side of the body or only arms to crawl, clenched hands after 3

months of birth. Persistence of primitive reflexes such as morrow and

atonic neck past 6 months, Hand preference demonstrated before 18

months, Leg scissoring, seizure and sensory impairment (hearing,

vision).

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6

2. Behavioural signs

Extreme irritability or crying, feeding difficulties after 6 months of

age. Persistent tongue thrusting, little interest in surroundings, and

excessive sleeping.

COMMON SIGNS AND SYMPTOMS

Sucking difficulty with the breast or bottle

Absence of normal muscle tone and slow development of

milestones

Abnormal body postures

Uncontrolled body movements and poor coordination

Mental retardation and speech problems.

Unusual muscle tone, reflexes, or motor development and

coordination

Deformities in Joints and bones and contractures

The classical symptoms are spasms, other involuntary

movements (e.g. facial gestures), unsteady gait, problems with

the balance, and decreased muscle mass

Scissor walking and toe walking

Secondary conditions can include seizures, epilepsy, apraxia,

dysarthria or other communication disorders, eating problems,

sensory impairments

http://en.wikipedia.org/wiki/Seizures

http://en.wikipedia.org/wiki/Epilepsy

7

Mental retardation, learning disabilities, and/or behavioural

disorders

Babies born with severe CP often have irregular posture; their

bodies may be either very floppy or very stiff

CLASSIFICATION ACCORDING TO SEVERITY

1. Mild (20%) cerebral palsy: Mild cerebral palsy children are

ambulatory and their only fine movements are impaired.

2. Moderate cerebral palsy (50%) These children achieve

ambulation by self-help. There is impaired gross motor, fine

motor, and speech development.

3. Severe cerebral palsy (80%) These children are with multiple

defects and unable to perform usual activities of daily living.

CLASSIFICATION (GENERAL)

1. Spastic (Pyramidal)

This is the most common type of cerebral palsy. It may affect a

single limb, one side of the body (spastic hemiplegic), legs (spastic

diplegia), or both arms and legs (spastic quadriplegia). There may be

partial (paresis) or full loss of movement (paralysis), abnormalities of

sensation and defects of hearing and vision. Epileptic fits, speech

impediments, mental retardation are other associated problems.

http://en.wikipedia.org/wiki/Mental_retardation

http://en.wikipedia.org/wiki/Learning_disabilities

8

2. Athetoid or Dyskinetic

In Athetoid or dyskinetic type of cerebral palsy, the damage

occurs to the extra pyramidal motor system and the basal ganglia

.Children with Athetoid CP have difficulty in holding themselves in an

upright, steady position for sitting or walking; they often show

involuntary movements. For some children with Athetoid CP, it just

takes a lot of concentration to get their hand to a certain spot (like

scratching their nose or reaching for a cup). Because of their mixed

tone and difficulty in keeping a position, they may be unable to hold on

to objects (such as a toothbrush or pencil). In newborn infants, elevated

bilirubin levels in the blood, if left untreated, can lead to brain damage.

This may also lead to Athetoid cerebral palsy.

3. Ataxic cerebral palsy (ICD-10 G80.4) type

In ataxic cerebral palsy, the damage goes to the cerebellum.

Ataxic cerebral palsy is not common. Motor skills such as writing,

typing, or using scissors might be affected, as well as balance,

especially while walking. It is often the case that individuals who have

difficulty with visual and/or auditory processing.

4. Hypotonic

People with hypotonic CP appear limp and can move only a little

or cannot move at all.

9

5. Mixed cerebral palsy

This occurs when two or more types are mixed together in the

same person. Early diagnosis is essential so that the child can be given

help in the early years of development. The following tests such as the

MRI, CT scan, blood, and urine tests help to diagnose.

Topographic pattern of limb involvement in children with cerebral

palsy

1) Monoplegia: In monoplegia ,one limb is involved

2) Paraplegia: Both legs are affected

3) Diaplegia: Both legs or arms are affected.

Occasionally minimal arm involvement also may be there.

4) Hemiplegic: Both arms or legs are affected. The arm typically

more severely involved than the leg.

5) Double hemiplegic: Both sides of the body display hemiplegic

characteristics.

6) Triplegia: Three extremities are involved, the legs are slightly

worse than arms.

TREATMENT

There is no specific cure for cerebral palsy, but the goal of

treatment is to enable the child self-sufficient. This can be achieved by

physiotherapy, orthopaedic correction, and use of braces, splints, and

10

casting. Adaptive equipment such as scooters, bicycles, tricycles and,

wheel chairs also can be utilized.

For occupational therapy, utensils for functional use (eating,

writing) and computers are also worth. Speech and language therapy

contribute to improving oral and motor skills. Appropriate visual help

such as spectacles, hearing aids, medications, and special schooling, is

very useful.

Unique education must include early intervention programmes,

specialized learning programmes, and support services in school, and

socialization to promote self-concept developments. The child can be

directed to a normal school if his physical disabilities or mental

development allow. Medications may include drugs to reduce muscle

tension or control seizures.

Surgical intervention includes orthopaedic (e.g., tendon transfers,

muscle strengthening, and correction of spinal deformities), Neurologic

(e.g., neuroectomies) and selective dorsal rhisotomy; Medication

therapy to treat spasticity, pain and to treat secondary conditions such

as seizure disorder, constipation urinary tract infection, and decubitus

ulcer. Treat for acute child childhood illness.

Behavior therapy by neuromuscular electrical stimulation. Above

all, the parents need to understand and cope with the problem that their

child has, in order to help him in the best possible way. They can join a

11

support group ( Spastic society), where they can learn more about the

problem by experts in the field, they can meet parents having children

with similar problems, discuss problems, and share experiences

common to both thereby working towards better management of the

child at home. Care coordination of specialized services and community

resources in collaboration with the child‟s family.

PREVENTION OF CEREBRAL PALSY:

Prevention of cerebral palsy by preventing maternal infection,

good maternal care, and from postnatal damage reduces the

prevalence. Early diagnosis, prompt adequate treatment plans can

reduce the residual neurological and psychosocial, emotional

handicaps for the child and his family.

NEED FOR THE STUDY

Every parent dreams of having a healthy baby. When a child is

born with some disabilities parents panic and they need to adjust to the

new situation and learn to take care of the baby. The goal of care giving

is to make their children reach their maximum potential. There are

many areas of care to be addressed: meeting the hygienic needs,

nutritional needs, bathing, toileting, playing with the child, and in doing

physical therapy to prevent contractures. Many a time, lack of

knowledge and negative attitude of the caregivers may lead to faulty

practices and may not show any progress in life of children with

12

cerebral palsy. The families (caregivers) may not have sufficient

knowledge regarding the disease condition and the care to provide.

According to Indian Medical Statistics:-

Indian statistics revealed that in India about 25-lakh children are

affected by cerebral palsy.

Lack of knowledge and negative attitude may lead to faulty

practices and the care will be affected negatively. The investigator

noticed that most of the children with cerebral palsy are neglected, not

exposed to the public, some are put in to the dark room of the house

,sometimes locked in a cage and not given care properly, and leading a

vegetative life. The parents are desperate specially mothers. Their inner

feeling of pain nobody can understand and their public life is limited.

The investigator noticed that a mother was forcefully putting a

steel spoon in to the mouth of a child (8 years) and pressing the tongue

with the spoon to feed him. This child was not able to bring his hand up

1 Incidence of cerebral

palsy 2 to 2.5 per 1,000 births

2 Incidence rate one in 34,000 or 8000 people in U S A

3 Incidence

extrapolations

8,000 per year, 666 per month 153

per week, 21 per day, 0 per hour, 0

per minute, 0 per second

13

to his mouth to feed himself, he was struggling to control his movement

and posture, and was not able to speak, neither to stand nor to sit. This

incident made the investigator to conduct a study regarding the

knowledge, attitude, and practice of caregivers of children with cerebral

palsy.

STATEMENT OF THE PROBLEM

A Study on the Knowledge, Attitude and Practice of Caregivers

of Children with Cerebral Palsy

OBJECTIVES

1) To assess the knowledge of caregivers regarding care of the

children with Cerebral Palsy

2) To find out the attitude of caregivers of children with Cerebral

Palsy

3) To assess the practice of caregivers of children with Cerebral

Palsy

4) To find the association of knowledge, attitude, and practice

with selected demographic variables.

5) To know the effect of an information brochure on the


14

HYPOTHESES

SECTION A:





SECTION B:





SECTION C:





SECTION D:

Ho: The information brochure does not have any influence on the

knowledge, attitude, and practice of caregivers of children

cerebral palsy.

15



cerebral palsy.

OPERATIONAL DEFINITIONS

1) Cerebral palsy

Cerebral palsy refers to the disability due to non-progressive

damage to the motor areas of the brain and causes self-care deficits of

varying degrees in meeting the activities of daily living because of

spastic, involuntary movements of the body.

2) Children

Children include infants, toddler, preschool, school age, and

adolescents between the age group of 6 months to 18 years.

3) Caregivers

Caregivers refer to Mother/mother substitutes who are involved in

providing care to children with cerebral palsy.

4) Knowledge

Knowledge refers to the level of understanding of caregivers in

meeting the physical and emotional needs of children with cerebral

palsy, expressed during interviews.

16

5) Attitude

In this study attitude refers to the feelings, values, and beliefs of

the caregivers on giving care to children with cerebral palsy on long-

term basis.

6) Practice

Practice refers to the activities that are carried out by the

caregivers in meeting the physical and emotional needs of children with

cerebral palsy such as hygiene, nutrition, toileting, medication, self-

care, and exercise, prevention of complications, love and affection.

ASSUMPTIONS

1. The inadequate knowledge of caregivers may affect in meeting

the needs of the children with cerebral palsy promptly.

2. The long term care of children may affect the attitude and

practice of caregivers.

DELIMITATIONS

1. This study is confined to Mysore District.

2. It is limited to caregivers of children with cerebral palsy.

3. Caregivers who are willing to participate in the study

4. Care givers who are available during the period of study.

17

THEORETICAL FRAMEWORK OF THE STUDY

Theoretical framework of this study is based on Imogene M. kings

(1990) goal attainment theory. King has interrelated the concepts of

perception, action, reaction, interaction and transaction into a theory of

goal attainment.

PERCEPTION

Perception is each persons understanding of reality. The

individuals come together and perceive each other about the reality.

In this study, the researcher and the caregivers of children with

cerebral palsy come together. Each makes judgment to increase the

knowledge attitude and practice.

ACTION

Action is defined as a sequence of behaviours involving mental

and physical action. At first mental action to recognise the present

conditions; then physical action to start activities related to those

conditions; and later, mental action combined with physical action

seeking to achieve goals.

In this study, the researcher administered tools to assess the

Knowledge, Attitude, and Practice of caregivers, which includes

structured questionnaire, Likert Scale to assess the attitude, checklist

for practice. The aspects of structured interview schedule includes 30

questions regarding general information ,signs and symptoms, self-care

18

needs and support, feeding and nutrition, hygiene and elimination,

Exercise and prevention. Four-point Likert Scale includes 24

statements (12 positive and 12 negative) used to assess the attitude.

Checklist includes 26 statements to assess the practice of caregivers of

children with cerebral palsy.

REACTION

Reaction is the sequence of behaviours described in action. In

this study response of the caregivers to the interview questions are the

reactions. Caregivers give consent and readiness to be assessed on

Knowledge, Attitude, and Practice.

INTERACTION

King defines interactions as the observable behaviours of two or

more individuals in mutual presence.

In this study, Interaction involves self-introduction, getting

consent in participating the study, administration of the tool to the

caregivers and collection of data. The caregivers actively participated in

the study and responded to interview schedule, attitude scale and to the

checklist.

Transaction

Transaction is a process of interactions in which human beings

communicate with the environment to achieve goals that are valued;

transactions are goal-directed human behaviours.

19

In this study, transaction involves distribution of information

brochure with a goal to improve knowledge, attitude, and practice of

caregivers and their understanding of the same. Information brochure

improves the knowledge attitude and practice of caregivers.

20

APPLICATION OF KINGS GOAL ATTAINEMENT THEORY

REACTION:

1.Consent and

readiness to be

assessed on KAP

of caregivers

to children with

cp.

2. Responses of

the caregivers on

assessment of

knowledge

,attitude and

practice.

INTERACTION

1. Administer

information

brochure

to the caregivers

and their

understanding

of the same.

2.Reassessment

on K A P

TRANSACTION

Improvement of

knowledge ,

Attitude and

Practice

of caregivers to

children with

cerebral palsy.

ACTION :

Administer Tool

to assess the KAP of

caregivers

1. Structured

questionnaire to

assess the

knowledge of

caregivers

2. Likert scale to

assess the

attitude of

caregivers

3. Check list for

practice on

caregivers of

children with cp

PERCEPTION –

investigator :

Decreased level of

knowledge, attitude

and practice of

caregivers of children


JUDGMENT:

To increase level of

knowledge, attitude and

practice of caregivers of

children with cerebral

palsy

REVIEW OF

LITERATURE

CHAPTER – II

21

CHAPTER – II

REVIEW OF LITERATURE

Literature was reviewed relevant to the study variable on

Knowledge, Attitude, and Practice of caregivers of children with C P.

Resaej M et al (2014) conducted a study (N =77) on knowledge

of Iranian occupational therapists in handling children with cerebral

palsy and the application of their knowledge into practice. A

questionnaire with two scales of a self-report and a knowledge-based

test was used to collect the data. Data analysis was done by descriptive

statistics and Spearman correlation. Of 77 participants, 64.9%

participants reported their knowledge of handling children with cerebral

palsy at moderate, 14.3% at low, and 6.5% at very low level. The result

of the test showed that 57.1% participants had knowledge at moderate

and 16.9% at low level. The results suggest that the participants need

further training to increase their knowledge in toileting and bathing.

Burkhard A (2013) conducted a study on caring for adolescents

with severe cerebral palsy for 11 mothers using semi-structured

interviews and analysed using Van Manners approach. Results

revealed four interrelated essential themes related to managing an

unexpected life, balancing caregiver demands, assuming advocacy

roles, and facing uncertain future. Findings suggest the need for

22

improved supports and services to optimise family care giving during

this transitional period of family life.

Bunning K et al (2013) conducted a descriptive study on

investigation of practices to support the complex communication needs

of children with hearing impairment and CP in rural district of Kenya. A

convenient sampling technique was used for six practitioner child dyads

assigned to partner types. (a) Three children with hearing impairment

and their teachers (b) Three children with cerebral palsy and their

occupational therapists. The study concluded that the assignment of

speech and language therapy duties to teachers and occupational

therapists has resulted in suboptimal practice for children with complex

communication needs.

Gannotti M (2013) conducted a study regarding the caregiver

practices of children with physical disability, for 450 subjects each from

with and without physical disability in U.S. Caregiver-practices were

measured using consensus analysis. Results showed that, more

negative caregiver practices are associated with families of children

with lower socio-emotional skills and behaviours. It is recommended

that health professionals working with children with physical disability

should target developing socio-emotional skills to support positive child-

parent interactions and promote positive out-come.

23

Olajide A Olawale et al (2013) conducted a cross – sectional

descriptive survey in the physiotherapy department of a tertiary

hospital, Africa, for 52 parents of children with cerebral palsy regarding

psychological stress on the families and strategies adopted to cope with

the stress. Descriptive statistics were used to show the responses. The

study concluded that families caring for the children with CP generally

have a positive attitude towards their children. It also suggested that

there is a need to educate the public on the causes of CP and

treatment options available to families.

Huang YP et al (2012) conducted a study (n=15) on being

concerned: care giving for Taiwanese mothers of a child with cerebral

palsy. Data collection method used was in depth interviews and

Journaling method, for mothers who were primary caregivers for

children aged between 0-18 years with cerebral palsy. This study

concluded that Taiwanese mothers face the strain of managing barriers

to care giving contexts in which their children are not supported or

acknowledged as being important contributors to family and society at

large. This study highlights how family can be important to care giving

mothers in traditional Chinese family life.

Eduardo Chaves Crus et al (2011) conducted a study on

caregiver‟s attitude towards Augmentative and Alternative

Communication (AACS) for young children with cerebral palsy in

24

Portugal. The study has been recommended that for children who are

severely impaired in their development of communicative abilities, it

was assumed that caregivers attitude towards AACS would be driven

by children‟s degree of cognitive and linguistic Impairments. In order to

verify that, 40 dyads of children with CP and their primary caregivers

(mothers) participated in this study evaluated the children‟s degree of

cognitive and linguistic impairments using Battelle‟s questionnaire, and

the caregiver‟s attitude AACS by means of a Likert Scale containing 15

items. Results showed that the caregivers most negative attitudes

towards the use of AACS were found among those caring for children

with most severe impairments.

Hwang M et al (2011) conducted a Cross-sectional study (N=100)

on Measuring care and comfort in children with cerebral palsy.

Primary caregivers of children with CP whose Gross Motor Function

Classification System (GMFCS) levels were III-V, were selected. The

Care Q was administered to primary caregivers of children with CP.

Internal consistency of the Care Q and its three domains (Personal

Care, Positioning/Transfers, and Comfort) were evaluated with the

Cronbach α. Construct validity of the Care Q was evaluated by its

correlation with the Paediatric Functional Independence Measure (Wee

FIM). Associations between Care Q scores and child and caregiver

characteristics were assessed. Results showed that no caregiver

characteristics were associated with Care Q scores.

25

Morgan F and Tan BK (2011) conducted a qualitative study on

rehabilitation of children with cerebral palsy in rural Cambodia,

regarding parental perception of family-centred practices. This study

examined the perceptions of 24 parents living in rural Cambodia

regarding family-centred rehabilitation practices. Semi structured

individual and small group interviews are used as tools and convenient

sampling technique is used. Result showed that almost all parents

valued family-centred practices in rehabilitation of children with cerebral

palsy.

Tseng MH et al (2011) conducted a study on the determinants of

daily function in children with cerebral palsy. The aim of the study was

to identify determinants of daily function in a population-based sample

of children with cerebral palsy, considering the function, disability, and

health. Here, 216 children and their caregivers participated in the study.

Result showed that knowledge of daily function helps the caregivers to

plan and intervene to improve the capacity and performance in daily

function for children with cerebral palsy.

Guyard A et al (2010) conducted a Study on impact on parents of

cerebral Palsy in children. Here, 40 subjects were selected. The study

confirmed that parents of cerebral Palsy have greater risk of

experiencing a sense of burden than the parents normally developing

children. The study showed that the knowledge of parents were

26

insufficient. It was concluded that more research is needed for

identifying families with a risk of maladaptation and suggesting

solutions to decrease negative impact.

Santos MT et al (2010) conducted (n=65) a cross-sectional study

on Caries prevalence in patients with cerebral palsy and the burden of

caring for them to investigate the correlation between caries prevalence

in individuals with cerebral palsy (CPG) and the burden on their

caregivers (CGCP) compared to nondisabled individuals (CG) and

their caregivers.

In this cross -sectional assessment, 65 subjects with cerebral

palsy were evaluated for their caries prevalence. The CGCP answered

the Caregiver Burden Scale (CBS) questionnaire. Using the same

methodology, 58 CG were evaluated. The CGCP had statistically

significant higher scores on general strain, isolation, disappointment

and environment. The CPG had significantly higher values using the

Decayed, Missed, and Filled (DMF) index than the CG. Values for the

CBS domains in general strain and disappointment and DMF index

were found to have a statistically significant correlation. This study

concluded that taking care of an individual with CP is a potential source

of continual burden for caregivers.

Brinkey et al (2009) conducted a study (n= 107) to determine the

level of knowledge about wheelchair transportation safety practices

27

among wheelchair users (WCUs) and caregivers, therapists,

physicians, and other professionals (CTPs) using convenience sample

. Two 10-question surveys were administered to 107 WCUs.

Results indicated that most WCUs (67%) and about half of the

CTPs had not received education about best transportation practices.

Sixty-seven percent of WCUs and 46% of CTPs felt lack

of knowledge in use of best transportation practices.

This study concluded that there is a poor level

of knowledge about wheelchair transportation safety practices among

WCUs, caregivers, and professionals who prescribe wheelchairs.

This knowledge deficit leads to a lack of standardised transport and a

potential compromise of safety.

Esdaile S A (2009) conducted a qualitative study (n=7) on valuing

difference: care giving by mothers of children with disabilities. Mothers

who are caregivers of children with disabilities seek to have

their children accepted and valued by others in society. In this paper,

qualitative research data from interviews with seven mothers

of children with disabilities were reanalysed using Bourdieu's theory

of practice and van Manen's phenomenological methodology.

The results showed that these mothers, who

were caregivers of children with disabilities, valued their children

despite ongoing challenges, and wanted others to do likewise. This

28

study supports the importance of valuing difference in terms of the

insights and understanding gained from those with disabilities and

their caregivers.

Maria Ingrid (2009) conducted a cross – sectional study

regarding parental adaptation in families of young children with CP for

51 parents in Germany. Assessed their personal reactions to diagnosis

interview, and assumed their personal reaction to these children

diagnosis. Relationships between these reactions were investigated

using univariate and multivariate logistic regression analysis. Results

showed that majority (77%) of the parents of children with CP have

come to terms with this diagnosis.

Rigby P J et al (2009) conducted (N=30), a Baseline-intervention-

baseline study on the effect of adaptive seating devices on the activity

performance of children with cerebral palsy to evaluate the short-term

impact of 2 adaptive seating devices on the activity performance and

satisfaction with performance of children with cerebral palsy (CP), as

observed by their parents.

Parents and their children mean age of 4 years 6 months, with

Gross Motor Function Classification System levels III and IV CP

participated. Two special-purpose seating devices, one for sitting

support on the floor or on a chair, another for postural control on a

toilet. Changes in activity performance and satisfaction were measured

29

through parent ratings on the Canadian Occupational Performance

Measure. Interviewed parents biweekly using the Home Activity Log to

describe and explain their child's activity performance during the three

study phases. Parents identified 139 activity performance issues (4.6 a

child): 58.3% in self-care, 34.5% in play, and 7.2% in socialisation and

quiet recreation. Paired t tests used to demonstrate significantly

improved performance and satisfaction with self-care and play activities

when the children used the adaptive seating devices during the 6-week

intervention phase.

Parents reported that their young children with CP were more

able engage in self-care and play activities when using specific

adaptive seating devices in their home.

Parks J et al (2008) conducted a cross sectional study on

psychological problems in children with cerebral palsy. A cross

sectional Multi-centre survey on 818 children with cerebral palsy aged

8-12 was selected from eight European regions. Multi-level,

multivariable logistic regression analysis was done. The study

concluded that a significant proportion of children with cerebral palsy

have psychological symptoms or social impairments that need

specialist services and care must be taken by the caregivers to assess

and manage children with cerebral palsy.

30

Morrow A.M et al (2008) conducted a qualitative cross sectional

study on comparison of parents and health professionals‟ perceptions

of quality of life in quadriplegic Cerebral Palsy in Australia on 24

parents. Semi-structured focus group interview conducted with parents.

Result showed that the health professionals did not consider the full

range of issues important to families. The difference in priorities for

treatment outcomes negatively affected the parent and health

professional relationship. Study highlighted the parent‟s expert role in

assessing the child‟s emotional and social wellbeing.

Verral T.C et al (2008) conducted a study on nutrition knowledge,

attitude, and belief of caregivers of cerebral palsy children. A

questionnaire was administered to cerebral palsy caregivers (n=52,)

and to a comparison group of non-cerebral palsy caregivers (n=35).

Result showed that non - CP caregivers scored higher nutrition

knowledge (p<0.001), had a more positive attitude about the

importance of nutrition (p<0.05), and had a more positive beliefs about

the relationship between nutrition and health p<0.05).

Aran A et al (2007) conducted a study on parenting style impacts

on quality of life in children with cerebral palsy. Study involved 39

children with cerebral palsy. Their siblings and their parents participated

in this study using questionnaire .Results showed that in children with

cerebral palsy parenting style positively correlated with questionnaire

31

scores. The study concluded that parenting style is a significant factor

on quality of life in children with cerebral palsy.

Sahar etal (2007) conducted a study to examine family

caregiver‟s knowledge skill and attitude in caring for older people

following the implementation of a family caregiver - training programme

(FCTP). Findings indicated significant increase in knowledge skills and

attitudes in the intervention group compared to those of the control

group. Hence, the FCTP demonstrated a positive effect on family

caregiver‟s capabilities and attitudes in caring. In this study, attitudes of

the family caregivers are the major areas of study.

Sen Esine et al (2007) conducted a study to determine the

difficulties experienced by the families with disabled children regarding

social life, working life, and family relationship, in one public and two

private rehabilitation centres by using a questionnaire. Findings of the

study revealed that the caregivers‟ social life, working life, and family

relationship were affected and they had financial problems.

Murphy N.A et al (2006) conducted a study (n=40) on the

caregivers of children with disabilities. This study explores caregiver

perspectives of the health implications of long-term informal care giving

for children with disabilities. Results showed that 41 percent of the

caregivers reported that their health had worsened over the past year,

32

and attributed these changes to a lack of time, Lack of control and

decreased psychosocial energy.

It is concluded that caregivers of children with disabilities

describe negative Physical, emotional and functional health

consequences of long term, informal care giving.

Masasa T et al (2005) conducted a study on Knowledge of,

beliefs about and attitudes to disability: implications for health

professionals in South Africa. Sixty primary caregivers were interviewed

by using a knowledge, attitude, and belief (KAB) survey in a structured

interview format. Probability and non-probability (systematic and

purposive) sampling were used. Results showed all caregivers had only

a rather rudimentary knowledge of the causes of disability, but held

positive attitudes towards people with disabilities. There appears to be

a need for improved disability awareness amongst the caregivers, in

schools and amongst transport service providers.

Raina P et al (2005) conducted a cohort study on the health and

wellbeing of caregivers of children with cerebral palsy, with data from

caregivers of children with cerebral palsy. The design allowed the

examination on the direct and indirect relationship between child health,

behaviour and functional status and caregiver characteristics (n=468).

Data on demographic variables and caregivers physical and

33

psychological health were assessed using standardised, self-completed

parent questionnaires as well as face-to-face home interview.

Results showed that most important predictors of caregiver‟s

wellbeing were child behaviour, care giving demands and family

function. Higher levels of behaviour problems were associated with

lower levels of both psychological and physical health of caregivers.

It is concluded that with psychological and physical health of

caregivers are strongly influenced by child behaviour and care giving

demands.

Brehant et al (2004) conducted a study (n = 468) at Canada on

the health of primary caregivers of children with CP, using self-

completed questionnaires and face-to-face interview. Results showed

that the caregivers of children with CP had lower incomes than the

general population, and they were expressing more stress.

Gabriela E (2004) conducted a study (n=110) at Nigeria on

knowledge, attitude, and expectations of mothers of children with

neurological disorders attending the paediatric neurology clinic, using

semi - structured questionnaire on mothers aged between 21 to 65

years. Majority of the mothers lack knowledge about the possible

cause, diagnosis, and outcome of their children‟s neurological disorder.

Pennington L et al (2004) conducted a study on speech and

Language therapy to improve the communication skills of children with

34

Cerebral Palsy. The study determined the effectiveness of speech and

Language therapy that focuses on their child or their communication

partners, and to find if individual types of SLT intervention are more

effective than others, in terms of changing the interaction patterns. It is

concluded that from evidence of the positive effect of SLT for children

with CP has not been demonstrated by this study. Further research is

needed to describe this client group, and its possible client subgroups,

and methods of treatment used in SLT and rigor in research practice

needs to be extended to enable firm associations between therapy and

communication.

King Gillian et al (1999) Conducted a study on family-centred

caregiving and wellbeing of parents of children with disabilities: Linking

process with outcome (n=164).This study examined the strength of the

relationship between parents of family-centred professionally provided

care giving and their emotional wellbeing using structural equation

modelling. Results showed that more family centred care giving was a

significant predictor of parent‟s wellbeing. It is concluded that services

are most beneficial when they are delivered in a family-centred manner

and when they address parent-identified issues such as the availability

of social support, family functioning, and child behaviour problems.

Amosun SL et al, (1995) conducted a comparative study on

rehabilitation of handicapped children (n=40) using general health

35

questionnaire. The caregivers of handicapped children had a

significantly higher mean score (6.8), which was above the threshold

score of four. This suggests that the task of caring the disabled children

may have stressful impact on the caregivers, which may contribute to

psychiatric morbidity.

Donovan T.J et al (1989) conducted a study on Health literature

of parents of children with cerebral Palsy at Melbourne .The study

examined the use of and need for written educational material by

parents of children with cerebral Palsy aged between 5 and 63 months.

After initial counselling, the majority felt that they needed written

information. The parents of 31 children attempted find a suitable books

or pamphlets. A significant association found between reading material

which parents found satisfactory and their knowledge about the basic

features of cerebral palsy.

METHODOLOGY

CHAPTER - III

36

CHAPTER III

RESEARCH METHODOLOGY

Research methodology refers to the steps, procedures, and

strategies for obtaining, organising, and analysing data in research

investigations. It addresses the development, validation, and evaluation

of research tools or techniques. It is away to systematically solve the

research problem. It is science of studying how research is done

scientifically. Methodology is a significant part of the research under

which the researcher is able to project a blue print of the research

undertaken.

This chapter describes the research methodology adopted to

assess the knowledge, attitude, and practice of caregivers of children

with cerebral palsy at Mysore.

Research methodology of this study includes the following:

Research design

Setting of the study

Population

Sample

Criteria for selection of samples

o Inclusion criteria

o Exclusion criteria

Variables under study

37

Sample size

Sampling technique

Development and description of the tools

Validity of the tool

Reliability of the tool

Reliability

Pilot study

Procedure for data collection

Plan for data analysis

SETTINGS OF THE STUDY

It is essential for the researcher to consider the setting in which

the study is conducted. The study is conducted in Mysore district.

Mysore is populated with more than 1000 CP children residing from

various parts of the country to get treatment from institutions such as All

India Institute of speech and hearing, JSS Hospital and other voluntary

organisations. Majority are staying in Gangothri layout. For the present

study, 400 samples were selected from Gangothri layout Mysore using

systematic random sampling method.

RESEARCH DESIGN

Research design is the researchers overall plan for obtaining

answers to all questions for testing the hypothesis (Polit.F).It spells out

the basic strategies that the researcher adopts to develop information

that is accurate and interpretable. It is the blueprint for study

38

implementation, that maxims and control over factors that could

interfere with the validity of the findings (Polit and Hungler, 1999).

Selection of the design is based on the purpose of the study. Research

design chosen by the researcher to assess the knowledge attitude and

practice of caregivers of children with cerebral palsy was Non

Experimental Descriptive study.

Non-experimental studies are the second broad class of

descriptive research. The purpose of descriptive studies are to

observe, describe, and document aspects of a situation, as it naturally

occurs, and sometimes to serve as a starting point for hypothesis

generation or theory development (Polit & Beck 1978).

The investigator conducted descriptive study to assess the

knowledge attitude and practice (dependent variable) of caregivers of

children with cerebral palsy. An information brochure (Independent

variable) is administered to the caregivers to find out the effect of

information brochure on knowledge, attitude, and practice of caregivers

of children cerebral palsy. The researcher recorded the information that

was present in a population, without manipulating the variables.

Research design could interfere in the blue print of the study for

implementation that maximises and control over factors that could

interfere with the validity of the findings (Polits and Hungler, 1999)

39

In view of the problem under the study and the objectives of the

study, the research design selected for this study was Non-

experimental descriptive design.

40

Fig-1.Schematic Representation of research study Design

Population:

All caregivers of children with cerebral

palsy

Sampling Technique:

Systematic random sampling method

Sample: Caregivers of children with

cerebral palsy (N=400) who fulfill the

inclusion criteria

Data analysis:

Descriptive and inferential statistics

Impact of the Information

Brochure on

Knowledge, Attitude, and

Pracice

Structured interview schedule to

assess the knowledge

Observational check list

to assess the practice

Likert Scale to assess the

attitude

41

POPULATION

Polit (2008) referred population as the entire set of individuals or

subjects having common characteristics sometimes referred to as

universe. Population may be of two types, accessible population, and

target population.

The population selected for this study was all caregivers of


ACCESSIBLE POPULATION

Accessible population refers to the aggregate of cases that

conform to the designated criteria and that are assessable as subjects

for the study.

In this study, the accessible population was caregivers of children

with cerebral palsy in Mysore district. The investigator selected two

institutions (All India institute of speech and hearing and JSS Hospital

physiotherapy unit) where children with cerebral palsy are attending for

speech therapy and physiotherapy with their caregivers.

TARGET POPULATION

Target population is the aggregate of cases about which the

researcher would like to generalise.

In this research, the target population was the caregivers of

children with cerebral palsy who are staying in Gangothri layout for

easy access to speech therapy and physiotherapy, at Mysore.

42

SAMPLE

Polit (2008), state that the sample consists of the subset of the

population selected to participate in the research study.

To fulfil the objectives of the study the researcher selected the

caregivers of children with cerebral palsy of Mysore based on the

inclusive and exclusive criteria.

INCLUSION CRITERIA

The criteria that specify population characteristics are referred to

as inclusion criteria. Inclusive criteria of the present study were,

1. Caregivers of who are directly involved in the care of children


2. Caregivers who are willing to participate in the study.

3. Caregivers of who are present at the time of study.

EXCLUSION CRITERIA

Exclusive criteria of the present study were,

1. Caregivers who are not involved in the direct care of the


2. Caregivers who were not staying in Mysore district.

3. Caregivers who refused to participate in the study

43

VARIABLES

According to Sunder Rao (2008), variables are the items or

characteristics on which observations are made. The variables

discussed in the present study are

Knowledge

Attitude

Practice

Age

Gender

Education status

Marital status

Type of family

Employment status

Religion

Area of residence

Type of house

Ownership status

Income

SAMPLE SIZE

Polit (2008), Sample size is the number of study subjects

selected from the population. The main purpose of the researcher is to

obtain a sample large enough to show statistical significance, also to be

44

expedient and economical at the same time. The sample size is

determined based on the study variables being studied, the statistical

significance required, and availability of the sample and feasibility of

conducting the study.

The sample size for the present study was 400. Factors like

nature of the study, availability of the sample, time, money, and material

were considered while deciding the sample size.

SAMPLING TECHNIQUE

Sampling is an important step in research process. It is the

process of selecting the representative units or subset of a population

of the study in a research. Present study adopted Systematic-sampling

method. Systematic Sampling involves the selection of sample

members such that every kth (e.g., every tenth) person or element from

a list (sampling frame) is chosen. In the present study the desired

sample size was established at four hundred (N=400). The estimated

size of the population was thousand (1000).By dividing N by n the

sampling interval width (k) was established. The sampling interval is the

standard distance between elements chosen for the sample. The

formula used for the study was k = 800 / 400 = 2. In other words, every

second person (every even number) in the list was chosen. The first

person was selected randomly, using a table of random numbers. The

caregivers of children with cerebral palsy corresponding to numbers 4,

6, 8, and so forth were sampled to reach a sample size of 400.

45

DEVELOPMENT AND DESCRIPTION OF RESEARCH TOOL

The tool is a written device that a researcher uses to collect the

data. Treece and Treece (1986) states that, instrument selected in the

research must be the vehicle that obtain the best data for drawing

conclusions to the study. In this study, the researcher developed the

tool after an extensive and careful review of literature, internet search,

and discussion with experts in order to select the most suitable and

appropriate assessment tool for data collection. The tool was developed

in English and the same was used for data collection process.

The tool consists of four sections.

SECTION: I

Performa for Socio demographic data such as age,

gender, education status, marital status, type of family, employment

status, religion, area of residence, type of house ownership status, and

income.

SECTION: II

Structured questionnaire for assessing the knowledge of

caregivers of children with cerebral palsy. Multiple-choice questions of

30 items were categorised under the following six domains.

General information regarding cerebral palsy

Signs and symptoms of cerebral palsy

Self-care needs and support of children with cerebral palsy

46

Feeding and nutrition

Hygiene and elimination

Exercise and prevention.

Scoring and interpretation

One mark is given for the correct answer and zero mark is given

for the incorrect answer.

SECTION: III

To measure the level of attitude, four point Likert Scale was used.

A Likert Scale is an ordered scale from which respondents choose one

option that best aligns with their view. It is often used to measure

respondent‟s attitudes by asking the extent to which they agree or

disagree with a particular question or statement. A typical scale might

be “strongly disagree, disagree, neutral, agree, and strongly agree”

.Likert scaling is a bipolar scaling method, measuring either positive or

negative response to a statement. Sometimes an even – point scale is

used, where the middle option “Neither agree nor disagree “is not

available. This is sometimes called a “forced choice” method since the

neutral option is removed.

In this study, the researcher used a four point Likert Scale and

removed the neutral option. Among the 24 items, 12 items were positive

and 12 items were belonging to negative attitude. Responses were

scored between negative and positive items.

47

The level of attitude was classified as follows.

Scoring key was given for each item with SA (strongly agree) = 4

Mark, A (agree) = 3 Mark, D (disagree) = 2 Mark, SD (strongly

disagree) = 1 Mark, for all positive questions and vice-versa for all

negative questions.

SECTION IV:

To measure the practice of caregivers, observational checklist is

used. Checklists are useful when observing specific unambiguous

behaviours. The checklist usually has a rating scale that asks the

observer to indicate the presence or absence of a behaviour and

sequence of events.

In this study Observational Check list has 26 items to assess the

practice of caregivers regarding meeting the self-care needs of children

with C P. On observation, the investigator marked the presence or

absence of events.

Scoring and interpretation

One mark is given for the presence of the trait and zero mark is

given for the absence.

Attitude score Classification

>= 75% Favourable Attitude

< 75% Unfavourable Attitude

48

VALIDITY OF THE TOOL

According to Polit (2008), validity refers to the degree to which

an instrument measures what is supposed to measure. Twelve experts

comprising experts in the field of Community Health Nursing and Child

Health Nursing valued the present tool. Child Health Nursing Expert

and one statistician were requested to judge the tool for its clarity,

relatedness, sequences meaningfulness, and content. Modifications

were made as per the suggestions given by the experts and in

consultation with the guide. Corrections were made as follows:

The investigator framed questionnaire initially with 35 Knowledge

questionnaires, 30 attitude questions, and 30 questions on

observational checklist for assessing practice. With experts opinion

Questions were reframed as 30, 24, and 26 respectively.

The tool was administered and checked for its feasibility and

appropriateness. The subjects chosen were similar in characteristics to

those of population under study. The tool prepared by the researcher

was administered to 30 caregivers (mother / mother substitutes) who

were directly involved in the care of children with cerebral palsy .It was

found that the items were clear and understandable to the subjects.

49

RELIABILITY

Polit (2008) reliability refers to the accuracy and consistency of

information obtained in a study. The three main attributes of a reliability

scale are stability, homogeneity, and equivalence. The stability of an

instrument refers to the extent to which similar results are obtained on

two separate occasions. The homogeneity of the instrument means that

all the items in a tool measure the same concepts or characteristics. An

instrument issued to exhibit equivalent or parallel instrument or

procedure is used.

In the present study the reliability of the study was established by

test – re test method .The tool was administered on 1st and 3rd day.

The tool was administered to 30 caregivers who were directly involved

in care giving. Correlation coefficient „r‟ was 0.75, which showed highly

positive correlation of the tool. Hence, the tool was considered highly

reliable for preceding the main study.

VALIDITY OF THE INFORMATION BROCHURE

The initial draft of the information brochure was given to the guide

to validate. The information brochure was modified and finalised in

consultation with the guide.

PILOT STUDY

Burns &Grove (2007) states that a pilot study is a smaller version

of a proposed study conducted to develop and refine the methodology,

50

such as the treatment, instruments, or data collection process to be

used in a large study.

Pilot study was conducted prior to the actual full-scale study after

obtaining administrative approval from the authorities concerned and in

consultation with the guide and statistician. The researcher selected 30

caregivers as samples who registered their children with cerebral Palsy

at Sneha kirana Spastic Society of Mysore. Pilot study was conducted

in the month of November 2012 .Consent was taken from the samples

before conducting the study and their confidentiality was assured.

ETHICAL ISSUES

The following ethical factors were considered during the period of

the study.

1. The study was approved by the Doctoral Advisory Committee of

Vinayaka Missions University Salem.

2. Formal permission was obtained from the research guide,

Professor Dr. Rebecca Samson, Dean, College of Nursing

Pondicherry Institute of Medical Sciences, Pondicherry.

3. Formal permission was obtained from the Director All India

Institute of Speech and Hearing and Medical Superintendent of

JSS Hospital, Mysore to get the name list of children with

cerebral palsy that registered their names in those institutions to

get treatment .

51

4. The content Validity of the tool was obtained with the

concurrence of all the experts and the guide.

5. Informed consent from each respondent was taken before

participation in the study. Questionnaires were assigned with an

identification number.

Thus, the ethical issues were ensured in the study.

DATA COLLECTION PROCEDURE:

Burns & Grove (2007) states, data collection are the identification

of subjects and the precise systematic gathering of information relevant

to the research purpose or the specific objectives, questions or

hypotheses of a study. The formal permission was obtained from the

research guide who is a professor and Dean of the college of nursing,

Pondicherry institute of Medical sciences before data collection.

Four hundred samples that fulfilled the inclusive criteria were

selected by systematic random sampling technique. On selection of

each study subject, a brief self-introduction was given, followed by

detailed explanation regarding the purpose of the study. The informed

consent was obtained in written form and confidentiality of the subjects

was assured.

Mysore is populated with more than 1000 CP children residing

from various parts of the country to get treatment from institutions like

All India Institute of speech and hearing, JSS Hospital and other

52

voluntary organisations. The names and address of the children with

C P was collected from the institutions and the list of the caregivers

(sampling frame) was made. Every even number was chosen for the

study. Visited the caregivers (mothers or mother substitutes) of children

with cerebral palsy at their houses with prepared questionnaire. Each of

the study subjects were asked to sit comfortably, and collected the

information on demographic data, and the knowledge with structured

questionnaire. Likert Scale was used to collect data regarding the

attitude. Information regarding Practice was collected with observational

checklist. Data collection was done from December 2012 to June 2013.

STATISTICAL TECHNIQUE EMPLOYED

Polit (2008): to answer the research questions and to test the

hypothesis, researchers need to process, and analyse their data in an

orderly coherent fashion, Quantitative information is analysed through

statistical procedures. In this study, the researcher collected data from

the subjects, entered in M.S Excel sheet, and analysed by using both

descriptive and inferential statistical methods. Statistical analysis was

done by statistical package for social sciences (SPSS) version 20 for

windows. Data was summarised using mean and standard deviation for

continuous variables and percentage for categorical variables. X2 test

was used to test for association between selected demographic

variables and knowledge, attitude, and practice (prior to distribution of

the information brochure).

53

The level of significance used was P<0.05.

The plan for data analysis was to:

a) Describe the socio-demographic variables of caregivers by

frequency and percentage distribution.

b) Frequency and percentage distribution, arithmetic mean,

and standard deviation were used to analyse the level of

knowledge, attitude, and practice.

c) Chi-square test was used to determine if the selected socio

demographic variables influenced the level of knowledge

attitude, and practice (prior to distribution of the information

brochure).

d) Pearson Correlation, T-Test, and F-Test were used to

establish the effectiveness of the brochure.

Research Approach: Research Approach selected was

Evaluative approach.

DATA ANALYSIS AND

INTERPRETATION

CHAPTER - IV

54

CHAPTER - IV

DATA ANALYSIS AND INTERPRETATION

Data analysis is a systematic organisation and synthesis of

research and testing of hypothesis using those data. Statistics is an

estimate of a parameter, calculated from sample data. Statistical

procedures enable the researcher to reduce, summarise, organise,

evaluate, interpret, and communicate numerical information. Without

the aid of statistics, the quantitative data collected in a research project

would be little more than a chaotic mass of numbers.

The data after collection, lying in a haphazard mass are of no use

unless they are properly sorted, presented, compared, analysed and

interpreted. They mean something more than figures, give a dimension

to the problem, and even suggest the solution. For such a study of

figures, one has to apply certain mathematical techniques such as

mean, standard deviation, and presentation of life table. Biostatistics is

applied in nursing as they deal with human beings.

Data collection was done for 400 samples to assess the level of

knowledge, attitude, and practice of caregivers of children with cerebral

palsy. The collected data were grouped and analysed as per the

objectives of the study using descriptive and inferential statistics.

Descriptive statistics were used to describe and synthesise data.

Inferential statistics were used to make effective inferences.

55

ORGANISATION OF THE DATA

The data was tabulated and analysed according to the objectives

and hypothesis of the study. Analysis of the data was done after

conferring the entire data to master coding sheet. It was done through

an integrated system of computer programme known as statistical

package for social sciences (SPSS) version 20. The analysed data are

presented under the following sections.

Section A:

Analysis of socio demographic variables of caregivers of children

with cerebral palsy

Section B:

Assessment of level of knowledge of caregivers regarding the

care of children with cerebral palsy

Section C:

Assessment of level of attitude of caregivers using Likertscale

Section D:

Assessment of the level of practice of caregivers of children with

Cerebral Palsy

Section E:

Association of knowledge, attitude, and practice with selected

demographic variables

56

Section F:

Effect of an information brochure on the caregivers of children

cerebral palsy

PRESENTATION OF DATA

SECTION A:

Analysis of socio demographic variables of caregivers of children


Table-1.Distribution of caregivers according to their Age;

N=400.

Sl. No Variable Frequency Percentage

1 15-25yrs 46 11.5

2 26-35 yrs 160 40.0

3 36-45 yrs 169 42.3

4 46-55 yrs 25 6.2

Total 400 100

57

Fig-1: Distribution of caregivers according to their Age

Table -1 and Fig-1 show the distribution of caregivers with regard

to their Age. It reveals that majority, 42.3% of the caregivers belong to

the age group of 36-45 years, 40.0 % belong to the age group of 26-35

years, 11.5% belong to the age group of 15-25 years, and 6.2 % belong

to the age group of 46-55 years.

0

50

100

150

200

250

15-25yrs 26-35yrs 36-45yrs 46-55yrs

46

160 169

25

11.5

40 42.3

6.2

Percentage

Frequency

58

Table – 2. Distribution of caregivers according to their Gender;

N=400.


1 Male 38 9.5

2 Female 362 90.5

Total 400 100

Fig-2: Distribution of caregivers according to their Gender

Table – 2 and Fig- 2 exhibited data on distribution of caregivers

based on their Gender. It revealed that majority, 90.5% of the

caregivers were females and 9.5% of them were males.

38

362

9.5

90.5

0

50

100

150

200

250

300

350

400

450

500

Male Female

Percentage

Frequency

59

Table-3.Distribution of caregivers according to their educational

status; N=400.

Fig-3: Distribution of caregivers according to their educational status

0

50

100

150

200

250

300

350

400

No

Fo

rma

l E

du

cati

on

Sch

oo

l dro

po

ut

Sch

oo

l u

pto

SS

LC

PU

C/H

igh

er

De

gre

e a

nd

ab

ove

261

304

66

3

6.5

0.3

76

16.5

0.7

Percentage

Frequency


1 No formal education 26 6.5

2 School dropout 1 .3

3 School up to S S L C 304 76.0

4 P U C / Higher secondary 66 16.5

5 Degree and above 3 0.7

Total 400 100

60

Table – 3 and Fig- 3 revealed that majority, 76 % of the

caregivers attended school up to SSLC, and 16.5 % of the caregivers

studied P U C/ Higher secondary. 0.7 % had degree and above

qualification, 6.5 % had no formal education and 0.3 were school

dropout.

Table 4. Dist. of caregivers according to their marital status;

N=400.

Fig- 4. Dist. of caregivers according to their marital status

Table – 4 and Fig- 4 depicts that 100% of the caregivers were

married.

400

0

Frequency , Percentage

Married

Sl.No Variable Frequency Percentage

1 Married 400 100

2 Unmarried 00 00

Total 400 100

61

Table – 5.Distribution of caregivers according to Type of family;

N=400.

Fig-5: Distribution of caregivers according to Type of family

Table –5 and Fig- 5 revealed that according to the type of family,

63.5% of the caregivers belong to Nuclear family, and 36.5% belong to

Joint family.

0

50

100

150

200

250

300

NuclearJoint

254

146

63.5

36.5

Frequency

Percentage


1 Nuclear 254 63.5

2 Joint 146 36.5

Total 400 100

62

Table – 6.Distribution of caregivers according to Employment

status; N=400.

Fig-6: Distribution of caregivers according to Employment status

Table – 6 and Fig- 6 depicted distribution of caregivers

employment status, they highlighted that majority, 74.0 % of caregivers

belong to other category, 19.2 % were self-employed and 6.8 % were

salaried.

0

100

200

300

Self employedSalaried

Others

77

27

296

19.36.8

74Frequency

Percentage


1 Self employed 77 19.3

2 Salaried 27 6.8

3 Others 296 74.0

Total 400 100

63

Table – 7. Distribution of caregivers according to Religion.

N=400.

Fig-7: Distribution of caregivers according to Religion.

Table – 7and Fig- 7 depicted distribution of caregivers religion,

51.0 % belong to Muslim, 45.3% belong to Hindu and 3.8% belong to

Christian.

0

50

100

150

200

250

300

Hindu Muslim Christian

181204

15

45.2

51

3.8

Percentage

Frequency


1 Hindu 181 45.2

2 Muslim 204 51.0

3 Christian 15 3.8

Total 400 100

64

Table – 8.Dist. of caregivers according to Area of Residence.

N=400.

Fig- 8: Distribution of caregivers according to Area of Residence

Table –8 and Fig- 8 depicted caregivers according to Area of

Residence .It is evident that 50.0% of the caregivers belong to rural and

50.0% belong to urban areas.

200200

Frequency

Rural

Urban


1 Rural 200 50.0

2 Urban 200 50.0

Total 400 100

65

Table – 9. Dist. of caregivers according to Type of House;

N=400.

Fig- 9: Distribution of caregivers according to Type of House

Table – 9 and Fig -9 depicted caregivers according to the type of

house they reside. On analysis of type of house majority, 87.5 % of the

caregivers reside in concrete house and 12.5% reside in mud house.

0

50

100

150

200

250

300

350

Mud

house

Concrete

house

50

350

12.5

87.5

Frequency

Percentage


1 Mud House 50 12.5

2 Concrete House 350 87.5

Total 400 100

66

Table –10 Dist. of caregivers according to Ownership Status.

N=400.

Fig- 10: Distribution of caregivers according to Ownership Status

Table –10 and Fig- 10 depicted caregivers according to their

Ownership Status. Concerning Ownership Status, 42.0% of the

caregivers reside in rented House, 37.2 % in leased house and 20.8 %

reside in their own house.

0

50

100

150

200

250

Own House Rented On Lease

83

163 149

20.8

42

37.2

Percentage

Frequency


1 Own House 83 20.8

2 Rented 168 42.0

3 On lease 149 37.2

Total 400 100

67

Table – 11. Distribution of caregivers according to income;

N=400.

Fig- 11: Distribution of caregivers according to their income

Table –11and Fig- 11 depicted caregivers according to their

income. With regard to income, 49.0% of the caregivers are between

Rs.5001/- to Rs.10000/-, and 28.2 % of the caregivers are Rs.10001/-

and above, and 22.8% are below and equal to Rs.5000/- income.

0

50

100

150

200

Below and equal to

Rs.5000/- Rs.5001/-to Rs

10000/- Rs.10001/-and

above

91

196

11322.8 49

28.2

Frequency

Percentage


1 Below and equal to Rs. 5000/- 91 22.8

2 Rs. 5001/- to Rs. 10000/- 196 49.0

3 Rs. 10001/- and above 113 28.2

Total 400 100

68

SECTION B:

Assessment of level of knowledge of caregivers regarding

the care of children with cerebral palsy.

Table.12.a) Frequency and percentage distribution of level of

knowledge of caregivers in providing care to children with cerebral

palsy with regard to General information. N = 400.

Sl.

No Knowledge questions

Correct Answer Incorrect Answer

n % n %

1 Which of the following are

the causes of Cerebral

palsy in children

293 73.3 107 26.8

2 Which of the following

disease causes Spasm &

difficulty in coordination

358 89.5 42 10.5

3 When did you notice that

your child is suffering from

Cerebral palsy

354 88.5 46 11.5

4 How long children with CP

(Cerebral palsy) will be

dependent on caregiver

272 68.0 128 32.0

Table -12.a) reveals the percentage distribution of the level of

knowledge among the caregivers of children with cerebral palsy with

regard to General information. It is evident from the above table that

69

majority, 73.3% of the caregivers answered, brain injury is the cause of

cerebral palsy in children. Majority, 89.5 % of the caregivers answered

that cerebral palsy causes Spasm & difficulty in coordination. 88.5 % of

the caregivers answered that while observing the movement, noticed

that the child is suffering from Cerebral palsy. 68.0 % of the caregivers

answered that children with CP (Cerebral palsy) will be dependent on

caregivers up to lifetime.

Table12.b) Frequency and percentage distribution of level of


palsy with regard to Signs and symptoms; N = 400

Table –12.b) reveals the percentage distribution of the level of


regard to Signs and symptoms. It is evident from the above table that

only 43.8% of the caregivers answered that early sucking difficulty with

breast or bottle is the early sign of CP during infancy. Majority, 90.0 %

Sl. No Knowledge questions Correct Answer Incorrect Answer

n % n %

1 What is the early sign

of C P during infancy 175 43.8 225 56.3


is a sign of C P 360 90.0 40 10

70

of the caregivers of children with cerebral palsy answered that

purposeless body movements is a sign of cerebral palsy.

Table-12.c) Frequency and percentage distribution of level of


palsy with regard to Self-care needs &Self-care support. N = 400.

Sl.

No Knowledge questions


n % n %

1 Self-care needs of

children with C.P include:

385 96.3 15 3.8

2 How do you maintain

safety for your special

child

24 6.0 376 94

3 How do you promote self-

care activities for your

child

51 12.8 349 87.3

4 How do you promote

locomotion for your child

104 26.0 296 74.0

Table-12.c) reveals the percentage distribution of the level of


regard to self-care needs &self-care support. Majority, 96.3% of the

caregivers replied that self-care needs of children include bathing, toilet

training; dressing and feeding. Only 6.0% of the caregivers answered

71

that to maintain safety for the special child teach him to obey the rules

and regulations. 12.8 % of the caregivers answered that to promote

self-care activities, boost the child‟s ability in self-care activities. 26.0 %

of the caregivers answered that to promote locomotion, supportive aids

are necessary.

Table -12.d) Frequency and percentage distribution of level

of knowledge of caregivers in providing care to children with

cerebral palsy with regard to Feeding & Nutrition. N = 400

Table-12.d) reveals the percentage distribution of the level of


regard to feeding & nutrition. Majority, 92.5 % of the caregivers replied

that feeding problems in children with CP can identified by poor lip and

tongue control. Only 1.8 % of the caregivers answered that maintaining

the adequate nutrition of the child by recognising the caloric needs.

Sl. No Knowledge questions

Correct Answer

Incorrect Answer

n % n %

1 How do you identify feeding problems in children with C.P

370 92.5 30 7.5

2 How do you maintain adequate nutrition

7 1.8 393 98.3

72

Table12.e) Frequency and percentage distribution of level of


palsy with regard to Hygiene & Elimination; N = 400.

Sl.

No

Knowledge questions


n % n %

1 How do you maintain

cleanliness of the body of your

child

380 95.0 20 5.0

2 What type of bath is

appropriate for children with

CP

350 87.5 50 12.5

3 How do you maintain oral

hygiene

14 3.5 386 96.5

4 How do you prevent Dental

carries

23 5.8 377 94.3


complication can arise if the

perineum is not Cleaned

properly

36 9.0 364 91.0

6 What is the best time for toilet

training for your child

350 87.5 50 12.5

7 Children with Cerebral Palsy

frequently suffer from

constipation due to:

96 24.0 304 76.0

8 How can you prevent

constipation

215 53.8 185 46.3

73

Table 12.e) reveals the percentage distribution of the level of


regard to Hygiene & Elimination. Majority, 95.0 % of the caregivers

replied that daily bath in hot water is necessary to maintain cleanliness

of the body of the child. 87.5% of the caregivers answered that hot

water bath is appropriate for the child with cerebral palsy. Only 3.5 % of

the caregivers replied that rinsing the mouth after each feed help to

maintain oral hygiene. 5.8 % of the caregivers replied that brushing the

teeth twice daily prevent dental carries. Only 9.0% of the caregivers

answered that redness and rashes are the two complications that can

arise if the perineum is not cleaned properly. Majority, 87.5 % of the

caregivers answered that the best time for toilet training is between the

ages of 18 - 48 months. 24.0 % of the caregivers answered that the

children with cerebral palsy frequently suffer from constipation due to

insufficient fibre and liquid in their diet. 53.8 % of the caregivers

answered that constipation can be prevented by encouraging regular

bowel habits.

74

Table12.f) Frequency and percentage distribution of level of


palsy with regard to Exercise & Prevention of complications.

N = 400.

Sl. No Knowledge questions

Correct Answer

Incorrect Answer

n % n %

1 Your child may require equipmentto help with:

346 86.5 54 13.5

2 Which of the following activity needs equipment to exercise your child

344 86.0 56 14.0

3 How do you help your child in walking

319 79.8 81 20.3

4 Some disabilities in children with C P can be prevented by

154 38.5 246 61.5

5 How can you prevent Contractures

267 66.8 133 33.3

6 How do you help your child with C P to be independent

201 50.3 199 49.8

7 A child with C P can acquire social skills by:

10 2.5 390 97.5

8 How can a physiotherapist be helpful

166 41.5 234 58.5

9 What are the Problems encountered by the parents of children with C P

205 51.3 195 48.8

10 What are the facilities provided by Govt. of India to rehabilitate the children with C P

193 48.3 207 51.8

75

Table -12.f) reveals the percentage distribution of the level of


regard to Exercise & Prevention of complications. Majority, 86.5 % of

the caregivers replied that a child with cerebral palsy require equipment

to help with walking/ mobility and talking / communication. 86.0 % of the

caregivers replied that walking is an activity, which needs equipment to

exercise the child. 79.8% of the caregivers answered that a walker

helps the child in walking. 38.5% of the caregivers replied that some

disabilities in children with cerebral palsy could be prevented by taking

extra care during delivery. 66.8 % of the caregivers replied that

contractures could be prevented by movement through all ranges of

motion. 50.3 % of the caregivers answered that special schooling help

the child to be independent. Only 2.5 % of the caregivers answered that

a child with CP can acquire social skills by giving directions to get

home. 41.5 % of the caregivers answered that a physiotherapist helps

the parents to become skilful in assisting their child. 51.3 % of the

caregivers replied that the problems encountered by the parents of

children with cerebral palsy are shock, anger, and financial problems.

48.3 % of the caregivers replied that the facilities provided by the

government of India to rehabilitate the children with cerebral palsy are

concession for travelling, education, and employment opportunities.

76

Table -13. Mean, standard deviation, skew, and kurtosis on the

level of knowledge in each domain.

Sl. No Domains Mean S. D Skew Kurtosis

1 General information

regarding cerebral palsy

3.22 0.94 2.42 28.67

2 Signs and symptoms of

cerebral palsy

1.34 0.57 -0.14 -0.69

3 Self-care needs and

support

1.41 0.62 0.80 0.18

4 Feeding and nutrition 0.02 0.13 7.39 52.83

5 Hygiene and elimination 3.67 0.98 0.14 -0.12

6 Exercise and prevention 5.52 1.33 -0.02 -0.03

Table -13. depicts the mean, standard deviation, skew, and

kurtosis on the level of knowledge in six domains. It reveals that the

mean score in the domains of „General information regarding cerebral

palsy‟ was 3.2 with standard deviation of 0.6. The mean score in the

aspects of „Signs and symptoms of cerebral palsy‟ was 1.4 with

standard deviation of 0.6.The mean score in the aspects of „Self-care

needs and support‟ was1.4 with standard deviation of 0.6.The mean

score in the aspects of Feeding and nutrition‟ was 0.01 with standard

deviation of 0.3. The mean score in the aspects of Hygiene and

elimination was 3.7 with standard deviation of 1.0. The mean score in

the aspects of „Exercise and prevention‟ was 5.5 with standard

deviation of 1.3.

77

Table-14.Descriptive statistics for knowledge

Variable Knowledge

Mean SD Skew Kurtosis

Knowledge 16.1025 2.231466 0.119608 1.821952

Table – 14. describes the mean Knowledge score of caregivers

were 16.1 with standard deviation 2.23.

Table –15 Distribution of caregivers according to the level of

knowledge

Sl. No Level of Knowledge n % Mean SD

1 Good (>65 %) 20 5% 70.33 2.62

2 Average (51 % -65%) 230 57.5% 56.96 3.39

3 Poor (≤50%) 150 37.5% 46.42 4.48

Table- 15 depicts the Percentage distribution of level of

knowledge of caregivers. It reveals that 5% of the caregivers had good

knowledge, with a mean score of 70.33 and standard deviation of 2.62;

57.5% of the caregivers had average knowledge, with a mean score of

56.96 and standard deviation of 3.39; 37.5% of the caregivers had poor

knowledge with a mean score of 46.42 and standard deviation of 4.48.

78

SECTION C:

Assessment of level of attitude of caregivers of children with

cerebral palsy using Likert Scale.

Table-16: Frequency and percentage distribution of level of

attitude of caregivers of children with cerebral palsy with regard to

special education; N = 400.

Sl. No

Attitude statement

Responses

Strongly agree

Agree Disagree Strongly disagree

n % n % n % n %

1 If a baby is born

with any disability

it is a curse for

the family

- - - - 17 4.3 383 95.8

2 Physically

challenged

children needs

special education

362 90.5 38 9.5 - - - -

3 Physically

challenged

children need not

be sent for

special education

- - - - 372 93.2 28 7.0

4 Special education

will not prevent

disability

- - 322 80.5 78 19.5 - -

5 Special education

reduces the

disability

13 3.3 387 97.0 - - - -

79

Table -16: reveals the percentage distribution of level of attitude

of caregivers of children with cerebral palsy with regard to special

education. It is evident from the above table that majority, 95.8% of the

caregivers strongly disagreed that, if a baby is born with any disability it

is a curse for the family. Only 9.5 % of the caregivers agreed that,

physically challenged children needs special education. 93.2 % of the

caregivers feel that physically challenged children need not be sent for

special education. Majority, 80.5 % of the caregivers agreed that

special education would not prevent disability. Majority, 97.0 % of the

caregivers think that special education reduces the disability.

80

Table -16.a) Frequency and percentage distribution of level of


Parenting & caring. N = 400

Sl. No

Attitude statement

Responses

Strongly agree


N % N % N % N %

1 Parenting a special

child gives more

satisfaction

- - 389 97.4 11 2.8 - -

2 Caring a child with

CP is troublesome.

- - 6 1.5 394 98.5 - -

3 A child with CP

becomes lifelong

dependent on

caregivers.

- - 393 98.3 7 1.8 - -

4 One day my child will

be able to walk like

other normal children

- - 277 69.4 123 30.8 - -

5 Like other children

exceptional child

needs love, care and

protection from

parents

258 64.5 142 35.6 - - - -

6 Children with CP

needs hugging and

holding just like other

children

41 10.3 359 90.0 - - - -

7 Both parents must be

involved in caring

- - 351 87.8 49 12.3 - -

8 Both parents need

not be involved in

caring a child with CP

- - 48 12.0 352 88.0 - -

81

Table- 16. a) reveals the percentage distribution of level of


Parenting & caring. It is evident from the above table that 97.4 % of

the caregivers agreed that parenting a special child gives more

satisfaction. Only 1.5 % of the caregivers feel that caring a child with

CP is troublesome. Majority 98.3% of the caregivers think that a child

with CP becomes lifelong dependent on caregivers. 69.4% of the

caregivers agreed that one day their child would be able to walk like

other normal children. 64.5% of the caregivers strongly agreed that like

other children exceptional child needs love, care, and protection from

parents. 10.3 % of the caregivers strongly agreed that children with CP

needs hugging and holding just like other children. 87.8 % of the

caregivers agreed that both parents must be involved in caring a child

with cp. Only 12.0% of the caregivers feel that both parents need not

involve in caring for a child with cp.

82

Table- 16.b) Frequency and percentage distribution of level of


bowel training and activities; N= 400

Table-16.b) reveals the percentage distribution of level of attitude of

caregivers of children with cerebral palsy with regard to bowel training

and activities. 91.7% of the caregivers disagreed that bowel training can

be challenging for children with cp. 92.0 % of the caregivers disagreed

that bowel training is easy for children with cp. Majority, 93.5 % of the

caregivers disagreed that children with CP are often relatively inactive.

6.5 % of the caregivers disagreed that children with CP are very active.

Sl.No Attitude statement

Responses

Strongly agree


n % n % n % n %

1 Bowel training can be

challenging for

children with CP

- - 34 8.5 366 91.5 - -

2 Bowel training is easy

for children with CP - - 368 92.0 32 8.0 - -

3 Children with CP are

often relatively

inactive.

- - - - 373 93.25 27 6.75

4 Children with CP are

very active - - 374 93.5 26 6.5 - -

83

Table -16.c) Frequency and percentage distribution of level of


exercise. N = 400

Table -16.c) reveals the percentage distribution of level of attitude

of caregivers of children with cerebral palsy with regard to exercise.

83.5 % of the caregivers agreed that regular exercise is important to

prevent contractures in children with CP. 86.5 % of the caregivers

disagreed that without exercise children with CP are able to lead a

normal life.

Sl. No Attitude

statement

Responses

Strongly agree


n % n % n % n %

1 Regular exercise

helps to prevent

contractures in

children with CP

- - 334 83.5 66 16.5 - -

2 Without exercise,

children with CP

are able to lead a

normal life

- - 346 86.5 54 13.5 - -

84

Table – 16.d) Frequency and percentage distribution of level of


socialization. N = 400

Table -16.d) reveals the percentage distribution of level of attitude

of caregivers of children with cerebral palsy with regard to Socialisation.

84.0 % of the caregivers agreed that a child with CP must be

encouraged to mingle with other people. Majority, 92.0 % of the

caregivers agree that a child with CP needs to pick up social skills. 84.0

Sl.No

Attitude statement

Responses

Strongly agree


n % n % n % n %

1 A child with CP must be encouraged to mingle with other people

- - 335 84.0 65 16.3 - -

2 A child with CP needs to pick up social skills

- - 368 92.0 32 8.0 - -

3 Children with CP need not mingle with other people

- - 65 16.3 335 84.0 - -

4 A child with CP need not pick up social skills

- - 31 7.75 369 92.25 - -

5 Socialisation is not necessary for children with CP

- - 64 16.0 336 84.0 - -

85

% of the caregivers disagreed that children with CP need not mingle

with other people. Majority, 92.25% of the caregivers disagreed that

child with CP need not pick up social skills. 84.0% of the caregivers

disagreed that socialisation is not necessary for children with cp.

Table -17: Mean, standard deviation, Skew, Kurtosis on the level of

attitude in each domain.

Sl.No Domains Mean S.D Skew Kurtosis

1 Special education 16.15 0.61 0.48 0.89

2 Parenting & caring 15.20 1.03 -0.90 0.61

3 Bowel training and

activities

10.99 0.05 -20 400

4 Exercise 5.95 0.50 -0.10 1.01

5 Socialisation 13.51 1.08 -1.82 1.42

Table -17: Mean, standard deviation, Skew, and Kurtosis on the

level of attitude in each domain. It reveals that the mean score on

Special education was 16.15 with standard deviation 0.61.The mean

score on Parenting & caring was 15.20 with standard deviation 1.03.

With regard to Bowel training and activities, the mean score was 10.99

with a standard deviation of 0.05.The mean score on Exercise was 5.95

with a standard deviation of 0.50. The mean score on Socialisation

was13.51 with standard deviation of 1.08.

86

Table-18: Descriptive statistics for attitude

Variable Attitude


Overall 61.81 1.71 -0.47 -0.33

Table-18: Describes that the overall mean score was 61.81 with a

SD of 1.71. The scores were slightly skewed to the right with nil

peakedness.

Table- 19: Percentage Distribution of caregivers according to the

level Attitude.

Sl. No Level of Attitude Frequency Percentage

1 >= 75% (Favourable Attitude) 00 00

2 < 75% (Unfavourable Attitude) 400 100

Table -19) describes the distribution of caregivers according to

the level of attitude. It reveals that NONE of the caregivers had

favourable attitude (at the predefined level of 75%) prior to the

intervention; ALL of the caregivers had unfavourable attitude (at the

predefined level of 75%).

87

SECTION D:

Assessment of the level of practice of caregivers of children with

Cerebral Palsy.

Table-20.a) Frequency and percentage distribution of level of

Practice of caregivers to children with cerebral palsy with regard

to hygiene. N = 400

Table -20.a) depicts the frequency and percentage distribution of

level of Practice of caregivers to children with cerebral palsy. It reveals

that 100% of the caregivers answered yes for the traits, washing the

face every day morning and brushing the teeth every day. 62.3 % of the

Sl. No Traits Yes No

n % n %

1 Washing the face every day

morning 400 100 - -

2 Brushing the teeth everyday 400 100 - -

3 Bathing the child with hot

water 249 62.3 151 37.8

4 Keeping the skin dry and

clean 206 51.5 194 48.5

5 Applying cream on the body

after bath 400 100 - -

6 Cutting the nails every week 140 35.0 260 65.0

88

caregivers answered yes for bathing the child in hot water. 51.5 % of

the caregivers answered yes for keeping the skin dry and clean. 100 %

of the caregivers answered yes for applying cream on the body after

bath. 65.0 % of the caregivers answered yes for cutting the nails every

week.

Table - 20.b) Frequency and percentage distribution of level of


to Nutrition. N = 400

Table- 20. b) depicts the frequency and percentage distribution of

level of Practice of caregivers to children with cerebral palsy with regard

to Nutrition. It reveals that 37.8 % of the caregivers answered yes for

Sl.

No Traits

Yes No

n % n %

1 Feeding the child with porridges 151 37.8 248 62.0

2 Providing small and frequent feed 8 2.0 392 98.0

3 Allowing longer time for meal 400 100 - -

4 Providing sufficient water at meal time 392 98.0 8 2.0

5 Giving calcium rich food to prevent

dental carries 3 0.8 397 99.3

6 Rinsing the mouth after each feed 9 2.3 391 97.8

7 Providing High roughage diet daily 243 60.8 157 39.3

89

feeding the child with porridges. Only 2.0 % of the caregivers answered

yes for providing small and frequent feed. 100 % of the caregivers

answered yes for allowing longer time for meal. 98.0 % of the

caregivers answered yes for providing sufficient water at mealtime.

Only 0.8 % of the caregivers answered yes for giving calcium rich food

to prevent dental carries. Only 2.3 % of the caregivers answered yes for

rinsing the mouth after each feed. 60.8 % of the caregivers answered

yes for providing High roughage diet daily.

90

Table- 20.c) Frequency and percentage distribution of level of


to Toileting. N = 400

Table - 20. c) depicts the frequency and percentage distribution

of level of Practice of caregivers to children with cerebral palsy with

regard to Toileting.53.8 % of the caregivers answered yes for making

the child to sit on the toilet stool every day at the same time. 50.0 % of

the caregivers answered yes for praising the child for sitting in the toilet

as you wished.100percentage of the caregivers answered yes for

providing perennial care.

Sl.

No Traits

Yes No

n % n %

1 Making the child to sit on the

toilet stool every day at the same

time

215 53.8 185 46.3

2 Praising the child for sitting in

the toilet as you wished 200 50.0 200 50.0

3 Providing perennial care 400 100

4 Administering medications to

regularise bowel habits 269 67.3 131 32.8

91

Table -20.d) Frequency and percentage distribution of level of


to Medications. N= 400

Table - 20. d) depicts the frequency and percentage distribution

of level of Practice of caregivers to children with cerebral palsy with

regard to Medications. 44.3% of the caregivers answered yes for taking

the child for regular medical check-up. 67.3 % of the caregivers

answered yes for administering medications to regularise bowel habits.

Only 1.0 % of the caregivers answered yes Putting side rails to maintain

safety. 100 % of the caregivers answered yes for teaching the child to

obey rules and regulations.

Sl.

No Traits

Yes No

n % n %

1 Taking the child for regular

medical check up 177 44.3 223 55.8

2 Administering medications to

regularise bowel habits 269 67.3 131 32.8

3 Putting side rails to maintain

safety 4 1.0 396 99.0

4 Teaching the child to obey

rules and regulations 400 100 - -

92

Table -20.e) Frequency and percentage distribution of level of

Practice of caregivers with regard to self-help and self-care.

N = 400

Table - 20 e) depicts the frequency and percentage distribution of

level of Practice of caregivers to children with cerebral palsy with regard

to self-help and self-care. 35.0 % of the caregivers answered yes for

cutting the nails every week. Majority, 88.0 % of the caregivers

answered yes for providing walker to walk with. 54.5 % of the

caregivers answered yes for using chair with chest strap while sitting.

Only 7.8 % of the caregivers answered yes for developing skill in self-

Sl.

No Traits

Yes No

n % n %

1 Providing walker to walk with 352 88.0 48 12.0

2 Using chair with chest strap

while sitting

218 54.5 182 45.5

3 Developing skill in self-care

activities

31 7.8 369 92.3

4 Encouraging the child for self-

care activities

67 16.8 333 83.3

5 Modifying the utensils and cloths

for self help

157 39.3 243 60.8

6 Using supportive aids for

locomotion

233 58.3 167 41.8

93

care activities. Only 16.8 % of the caregivers answered yes for

encouraging the child for self-care activities. 39.3 % of the caregivers

answered yes for modifying the utensils and cloths for self-help. 58.3 %

of the caregivers answered yes for using supportive aids for locomotion.

Table - 21. Descriptive statistics for practice

Variable Practice


Practice 12.31 3.8 0.01 -0.69

Table - 21 describes that the mean percentage of practice of

caregivers is 12.31 and standard deviation is 3.8. The responses for

practice questionnaire are almost symmetrical with almost equal right

and wrong answers.

94

Table - 22. Percentage distribution of caregivers according to the

level of Practice.

Sl. No Level of Practice Frequency Percentage

1 Good (>65 %) 80 20

2 Average (51 % -65%) 54 13.5

3 Poor (≤50%) 266 66.5

Fig -12: Percentage distribution of caregivers according to the

level of Practice

Table -22 and figure. 12 depicts that the Percentage distribution

of caregivers according to the level of Practice. It reveals that 20% of

the caregivers had good Level of Practice. 13.5% of the Caregivers had

Average Level of Practice, 66.5% of caregivers had Poor Level of

Practice

0

50

100

150

200

250

300

Good (>65 %) Average (51 % -

65%)

Poor ≤50%

Frequency

Percentage

95

Table -23: Mean, standard deviation, Skew, Kurtosis on the level of

practice in each domain.

Sl.

No

Domains Mean S.D Skew Kurtosis

1 Hygiene 3.51 0.89 -0.072 -0.65

2 Nutrition 3.51 0.77 -0.02 0.03

3 Toileting 2.62 1.07 -0.01 -1.27

4 Medication 1.24 0.6 -0.84 -0.4

5 Self-help and self-care 1.77 1.28 0.23 -0.58

Table -23: depicts the mean, standard deviation, skew, and

kurtosis on the level of practice in each domain. The mean score of

domain Hygiene is 3.51 and standard deviation is 0.89 .The mean

score of domain Nutrition is 3.51 and standard deviation is 0.77. The

mean score of domain Toileting is 2.62 and standard deviation is 1.07.

The mean score of domain Medication is 1.24 and standard deviation is

0.6. The mean score of domain Self-help and self-care is 1.77 and

standard deviation is 1.28.

96

Section E:

Demographic variables (Association Analysis)

The following section analyses the data to see if the selected

demographic variables influenced the level of knowledge, attitude, or

practice (prior to distribution of the information brochure). Chi-square

values were calculated for each variable and the p-value for the statistic

was calculated. Each values is marked with labels such as NS (Not

Significant) and SS (Statistically Significant), correspondingly, when p-

value is greater or lesser than 0.05. The association analysis was

conducted on pre-intervention data only.

97

Knowledge Vs Demographics

Table -24: Data on Association of Knowledge score and

selected demographic Variables.

Sl.No Demographic

Variables

Level of Knowledge

X2

value P

value

>65% 51-65% (Average

Knowledge)

50% or less (Poor

knowledge) (Good

Knowledge)

n % n % n %

1

Age

15-25 yrs 1 5 22 9.6 23 15.2

4.625 0.328 (NS)

26-35 yrs 7 35 92 40.2 61 40.4

36-45 yrs 12 60 115 50.2 67 44.4

Gender

Male 1 5 2 9.6 15 9.9 0.507

0.776 (NS) Female 19 95 207 90.4 136 90.1

3

Religion

Hindu 6 30 110 48 65 43

3.998 0.406 (NS)

Muslim 13 65 109 47.6 82 54.3

Christian 1 5 10 4.4 4 2.6

4

Type of family

Nuclear 12 60 143 62.4 99 65.6 0.493

0.782 (NS) Joint 8 40 86 37.6 52 34.4

5

Area of Residence

Rural 11 55 116 50.7 76 50.3 0.156

0.925 (NS) Urban 9 45 113 49.3 75 49.7

6

Educational status

No formal education/

School dropout 1 5 15 6.6 11 7.3

0.561 0.967 (NS) School up to

S S L C 16 80 176 76.9 112 74.2

P U C/ Above 3 15 38 16.6 28 18.5

7

Employment status

Self employed 4 20 46 20.1 27 17.9.

2.158 0.707 (NS) Salaried 2 10 12 5.2 13 8.6

Others 14 70 171 74.7 111 73.5

8

Income

Below and equal to

Rs.5000/- 5 25 57 24.9 29 19.2

2.223 0.695 (NS)

Rs.5001/- to Rs.10000/-

9 45 112 45 75 49.7

Rs.10001/- and above

6 30 60 26.2 47 31.1

98

Conclusion:

For each of the above demographic variable, the probability of

obtaining Chi-square value by chance is >0.05 (p > 0.05). Therefore,

the null hypothesis is accepted, and it is thus concluded that there is no

association between knowledge and selected demographic variables.

99

Attitude Vs Demographics

Table – 25: Data on association of Attitude with selected

Demographic Variables.

Sl.No Demographic

Variables

Level of Attitude

X2 P value

>=75%

(Favourable

Attitude)

<75%

(Unfavourable

Attitude)

N % N %

1

Age

15-25 yrs 2 3.6 44 12.8

6.985 0.03

(SS) 26-35 yrs 30 53.6 130 37.8

>35 yrs 24 42.9 170 49.4

2

Gender

Male 5 8.9 33 9.6 0.025

0.875

(NS) Female 51 91.1 311 90.4

3

Religion

Hindu 7 3.9 108 59.7

3.498 0.174

(NS) Muslim 13 6.4 137 67.2

Christian 0 0 11 73.3

Type of family

4 Nuclear 34 60.7 220 64 0.218

0.641

(NS) Joint 22 39.3 124 36

5

Area of Residence

Rural 28 50 175 50.9 0.015

0.904

(NS) Urban 28 50 169 49.1

6

Educational status

No formal

education/School

dropout

4 7.1 23 6.7

0.073 0.964

(NS) School up to S S L C 43 76.8 261 75.9

P U C/Above 9 16.1 60 17.4

7

Employment status

Self employed 12 21.4 65 18.9

0.234 0.89

(NS) Salaried 4 7.1 23 6.7

Others 40 71.4 256 74.4

8

Income

≤ 5000/- 11 19.6 80 23.3

0.392 0.822

(NS) Rs.5001/- to Rs.10000/- 28 50 168 48.8

Rs.10001/- and above 17 30.4 96 27.9

100

Conclusion:

From the above table, age alone seems to have influenced the

level of attitude. The p-value is 0.03, and thus we reject the null

hypothesis, which states that there is no association between the

selected demographic variables and level of attitude. Instead, we

accept the alternative hypothesis and conclude that there is an

association between attitude and age group.

101

Practice Vs Demographics

Table - 26: Data on Association of practice with the Demographic

Variables.

Sl.N

o

Demographic

Variables

Level of practice

X2

P

value Good Average Poor

n % n % n %

1

Age group

15-25 yrs 6 7.5 4 7.4 36 13.5

13.644 0.009

(SS) 26-35 yrs 40 50 30 55.6 90 33.8

>35 yrs 34 42.5 20 37 140 52.6

2

Gender

Male 9 11.2 3 5.6 26 9.8 1.285

0.526

(NS) Female 71 88.8 51 94.4 240 90.2

3

Religion

Hindu 41 51.2 28 51.9 112 42.1

5.509 0.239

(NS) Muslim 35 43.8 26 48.1 143 53.8

Christian 4 5 0 0 11 4.1

Type of family

4 Nuclear 51 63.8 30 55.6 173 65 1.744

0.418

(NS) Joint 29 36.2 24 44.4 93 35

5

Area of Residence

Rural 40 50 27 50 136 51.1 0.045

0.978

(NS) Urban 40 50 27 50 130 48.9

Educational status

No formal education/

School dropout 7 8.8 5 9.3 15 5.6

1.602 0.808

(NS) School up to SSLC 60 75 40 74.1. 204 76.7

PUC or above 13 16.2 9 16.7 47 17.7

7

Employment status

Self employed 14 17.5 7 13 56 21.1

5.31 0.257

(NS) Salaried 2 2.5 4 7.4 21 7.9

Others 64 80 43 79.6 189 71.1

8

Income

≤ 5000/- 22 27.5 9 16.7 60 22.6

3.069 0.546

(NS) Rs.5001/- to 10000/- 40 50 28 51.9 128 48.1

Rs.10001/- and above 18 22.5 17 31.5 78 29.3

102

Conclusion:

From the above table, age alone seems to have influenced the

level of practice. The p-value is 0.009, and thus we reject the null

hypothesis, which states that there is no association between the

selected demographic variables and level of practice. Instead, we

accept the alternative hypothesis and conclude that there is an

association between practice and age group.

SECTION E:

This section compares and evaluates knowledge, attitude,

and practice of caregivers of children with CP before and after the

intervention.

Knowledge

Table - 27. Descriptive statistics to reveal the effect of information

brochure on the level of knowledge

Knowledge Descriptive statistics

Mean Median Mode Var SD

Pre

Intervention 16.10 16 16 4.98 2.23

Post

Intervention 24.98 25 26 4.38 2.09

As seen in the above table, the level of knowledge increased

positively and shifted to the higher end (right) and thus skewed to the

right. In addition, the score became more clustered at the positive end

103

with slight reduction in the variance. This clearly gives the primary

evidence that the information brochure had a high impact on the level of

knowledge.

It is worth noting the fact that the skew has eliminated

observations in the lower end and thus made a comparison with the

Chi-square test, post intervention, impossible (because of zero values).

Table 28: Descriptive statistics to confirm the effect of information

brochure on the level of knowledge

Descriptive statistics

Knowledge Correlation Pearson T-Test F-Test

0.97 0.97 0 0.20

The correlation, confirmed by Pearson value, indicates that the

rise in knowledge level is uniform and substantial across the sample.

The T-Test value is almost zero, indicating that the increase in score

cannot be due to chance or some other factor. The considerably low F-

Test p-value indicates that the variance in the sample after the

intervention is significantly different from that of one prior to the

intervention.

The figure below represents the rise in the level of knowledge for

each question, by number of caregivers who answered correctly.

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Fig.13: Number of Correct Answers Post Distribution of

Information Brochure

Attitude

Table - 29: Descriptive statistics to reveal the effect of

information brochure on the level of attitude

Attitude Descriptive statistics


Pre

Intervention 63.98 64.58 64.58 2.49 1.58

Post

Intervention 72.60 72.92 73.96 4.68 2.16

As seen in the above table, the level of attitude increased



1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930

Pre Intervention 2 3 3 2 1 3 3 3 6 1 3 1 3 3 2 4 5 3 1 2 3 3 3 1 2 2 3 1 2 2

Post Intervention 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3

0

50

100

150

200

250

300

350

400

450

105


evidence that the information brochure had a considerable impact on

the level of attitude.




Table - 30: Descriptive statistics to confirm the effect of

information brochure on the level of attitude


Attitude Correlation Pearson T-Test F-Test

0.96 0.96 0 0.42


rise in attitude level is uniform and considerable across the sample. The

T-Test value is almost zero, indicating that the increase in score cannot

be due to chance or some other factor. The low F-Test p-value



Compared to the effect on knowledge, we can say that the effect

of the intervention in terms of attitude is slightly low.

106

The figure below represents the rise in the level of attitude for


Fig 14: Number of Correct Answers Post Distribution of


Practice

Table 31: Descriptive statistics to reveal the effect of

information brochure on the level of Practice

Practice Descriptive statistics


Pre

Intervention 12.31 12 12 14.24 3.77

Post

Intervention 21.08 21 21 6.94 2.63

As seen in the above table, the level of practice increased



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Pre Intervention 1 1 1 8 1 1 1 8 1 1 1 1 1 1 8 1 1 1 1 1 1 1 8 1

Post Intervention 1 1 1 8 1 1 1 7 1 1 1 8 1 1 1 1 1 1 1 1 1 1 8 1

0

500

1000

1500

2000

107



practice.




Table - 32: Descriptive statistics to confirm the effect of

information brochure on the level of practice


Knowledge Correlation Pearson T-Test F-Test

0.73 0.73 0 0




cannot be due to chance or some other factor. The F-Test p-value of

zero indicates that the variance in the sample after the intervention is

expressively different from that of one prior to the intervention.

108

The figure below represents the rise in the level of practice for


Fig 15: Number of Correct Answers Post Distribution of



knowledge in caregiver of children with CP would have an effect on the


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Pre Intervention 4 3 2 2 0 1 8 4 3 3 9 2 2 2 4 1 2 1 4 0 3 2 3 6 1 2

Post Intervention 4 4 3 3 3 3 2 4 3 2 3 3 2 2 4 3 3 3 3 3 3 2 3 2 2 2

0

100

200

300

400

500

DISCUSSION

CHAPTER - V

109

CHAPTER - V

DISCUSSION

This chapter deals with the detailed discussion on the findings of

the study interpreted from the statistical analysis. The findings are

discussed in relation to the objectives of the study and hypotheses. The

problem stated is “A study to assess the Knowledge Attitude and

Practice of Caregivers of children with Cerebral Palsy”. This study was

conducted among the caregivers who were giving care to children with

cerebral Palsy.

The researcher collected the information with regard to socio

demographic data of the study subjects as part of the study. The socio

demographic characteristics were analysed using frequency and

percentage. There are 11 tables to describe them .The total number of

the subjects included in the study was 400.

Description of socio demographic characteristics of study

subjects:

The section A, deals with the socio demographic variables of

caregivers of children with cerebral palsy. Distribution of caregivers

according to their age group revealed that majority, 169 (42.3%) of the

caregivers belong to the age group of 36-45 years and 362 (90.5%) of

the caregivers were females.

110

Distribution of caregivers according to their educational status

revealed that majority, 304 (76.0%) of the caregivers attended school

up to SSLC. 400 (100%) of the caregivers were married and 254

(63.5%) of the caregivers belong to nuclear family.

Considering the caregivers employment status, it revealed that

only 27 (6.8%) of the caregivers were salaried. Majority 204 (51.0 %) of

caregivers belong to Muslim. It was evident that 200 (50.0%) of the

caregivers belong to rural and 200 (50.0%) belong to urban areas. On

analysis of type of house majority, 350 (87.5 %) of the caregivers reside

in concrete houses. Concerning ownership status 168 (42.0%) of the

caregivers resides in rented House. With regard to income, 196 (49.0%)

of the caregivers are between Rs.5001/- to Rs.10000/-.

The first objective is to assess the knowledge of caregivers

regarding care of the children with Cerebral Palsy:

The finding reveals that 20 (5%) of the caregivers had good (>65

%) knowledge, 229 (57.3%) of the caregivers had average (51% -65%)

knowledge, and 37.8% (151) of the caregivers had poor (≤50%)

knowledge.

With regard to the domain general information on cerebral palsy

the findings reveals that majority, 293 (73.3%) of the caregivers

answered, brain injury is the cause of cerebral palsy in children.

Majority, 358 (89.5 %) of the caregivers answered that cerebral palsy

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causes Spasm & difficulty in coordination. 354 (88.5 %) of the

caregivers answered that on observing difficulty in movement, noticed

that the child is suffering from C.P. 272 (68.0 %) of the caregivers

answered that children with CP will be dependent on caregivers up to

lifetime.

On observation of the domain signs and symptoms the results

reveals that the only 175 (43.8%) of the caregivers answered that early

sucking difficulty with breast or bottle is the early sign of CP. Majority,

360 (90.0 %) of the caregivers of children with cerebral palsy answered

that purposeless body movements is a sign of cerebral palsy.

On considering the domain self-care needs & self-care support

reveals Majority, 385 (96.3%) of the caregivers replied that self-care

needs of children include bathing, toilet training; dressing and feeding.

Only 24 (6.0%) of the caregivers answered to maintain safety for the

special child, teach him to obey the rules and regulations. 51 (12.8%) of

the caregivers answered to promote self-care activities, boost the

child‟s ability in self-care activities. 104 (26.0 %) of the caregivers

answered to promote locomotion, supportive aids are necessary.

With regard to the domain feeding & nutrition reveals the

percentage distribution of the level of knowledge among the caregivers

of children with cerebral palsy. Majority, 370 (92.5 %) of the caregivers

replied that feeding problems in children with CP can be identified by

poor lip and tongue control. Only 7 (1.8 %) of the caregivers answered

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that maintaining the adequate nutrition of the child by recognizing the

caloric needs.

On observation of the domain hygiene & elimination reveals that

majority, 380 (95.0%) of the caregivers replied that daily bath in hot

water is necessary to maintain cleanliness of the body of the child. 350

(87.5%) of the caregivers answered that hot water bath is appropriate

for the child with cerebral palsy. Only 14 (3.5 %) of the caregivers

replied that rinsing the mouth after each feed help to maintain oral

hygiene. 23 (5.8%) of the caregivers replied that brushing the teeth

twice daily prevent dental carries. Only 36(9.0%) of the caregivers

answered that redness and rashes are the two complications that can

arise if the perineum is not cleaned properly. Majority, 350 (87.5%) of

the caregivers answered that the best time for toilet training is between

the ages of 18 - 48 months. 96 (24.0%) of the caregivers answered that

the children with cerebral palsy frequently suffer from constipation due

to insufficient fibre and liquid in their diet. 215 (53.8 %) of the caregivers

answered that constipation can be prevented by encouraging regular

bowel habits.

On considering the domain exercise & prevention of

complications reveals that majority, 346 (86.5 %) of the caregivers

replied that a child with cerebral palsy require equipment to help with

walking/ mobility and talking / communication. 344 (86.0%) of the

caregivers replied that walking is an activity which needs equipment to

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exercise the child. 319 (79.8%) of the caregivers answered that a

walker helps the child in walking. 154 (38.5% )of the caregivers replied

that some disabilities in children with cerebral palsy can be prevented

by taking extra care during delivery. 267 (66.8 %) of the caregivers

replied that contractures can be prevented by movement through all

ranges of motion. 201 (50.3 %)of the caregivers answered that special

schooling help the child to be independent. Only 10 (2.5%) of the

caregivers answered that a child with cp can acquire social skills by

giving directions to get home. 166 (41.5%) of the caregivers answered

that a physiotherapist helps the parents to become skilful in assisting

their child. 205 (51.3%) of the caregivers replied that the problems

encountered by the parents of children with cerebral palsy are shock,

anger, and financial problems. 193 (48.3%) of the caregivers replied

that the facilities provided by the government of India to rehabilitate the

children with cerebral palsy are concession for travelling, education and

employment opportunities.

The mean, standard deviation, skew, and kurtosis on the level of

knowledge in six domains reveals that the mean score in the domains

of „General information regarding cerebral palsy‟ was 3.2 with standard

deviation of 0.6. The mean score in the aspects of „Signs and

symptoms of cerebral palsy‟ was 1.4 with standard deviation of 0.6. The

mean score in the aspects of „Self-care needs and support‟ was1.4 with

standard deviation of 0.6. The mean score in the aspects of „Feeding

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and nutrition‟ was 0.01 with standard deviation of 0.3. The mean score

in the aspects of „Hygiene and elimination‟ was 3.7 with standard

deviation of 1.0. The mean score in the aspects of „Exercise and

prevention‟5.5 with standard deviation of 1.3.

The Percentage distribution of level of knowledge of caregivers

reveals that 5% of the caregivers had good knowledge, with a mean

score of 70.33 and standard deviation of 2.62. 57.5% of the caregivers

had average knowledge, with a mean score of 56.96 and standard

deviation of 3.3. 37.5% of the caregivers had poor knowledge with a

mean score of 46.42 and standard deviation of 4.48.

The findings are consistent with the results of the study

conducted by Resaej M etal (2014) (N =77) on assessment of

knowledge of Iranian occupational therapists of

handling children with cerebral palsy and the application of their

knowledge into practice. Data analysis was done by descriptive

statistics and Spearman correlation. Of 77 participants, 64.9%

participants reported their knowledge of handling at moderate, 14.3% at

low, and 6.5% at very low level. The result of the test showed that

57.1% participants had knowledge at moderate and 16.9% at low level.

These results suggest that the participants need further training to

increase their knowledge in toileting and bathing.

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The second objective was to find out the attitude of caregivers of


The findings revealed that the level of attitude, in general, is

within the acceptable range. However, for the purpose of the study, we

set a very high benchmark (75%) to consider the attitude level to be

considered as „favourable‟. Accordingly, it was noted that NONE of the

caregivers had favourable attitude (at the predefined level of 75%) prior

to the intervention; ALL of the caregivers had unfavourable attitude (at

the predefined level of 75%).

The findings reveal the percentage distribution of level of attitude

of caregivers of children with cerebral palsy. It is evident from the above

table that majority, 383 (95.8%) of the caregivers strongly disagreed

that, if a baby is born with any disability it is a curse for the family. 372

(93.2 %) of the caregivers think that physically challenged children need

not be sent for special education. Majority, 322 (80.5 %) of the

caregivers agreed that special education will not prevent disability.

Majority, 387 (97.0%) of the caregivers think that special education

reduces the disability. 389 (97.4%) of the caregivers agreed that

parenting a special child gives more satisfaction. Only 6 (1.5 %) of the

caregivers think that caring a child with CP is troublesome. Majority 393

(98.3, %) of the caregivers feel that a child with CP becomes lifelong

dependent on caregivers. 277 (69.4, %) of the caregivers hopes that

one day their child would be able to walk like other normal children. 258

116

( 64.5% ) of the caregivers strongly agreed that like other children

exceptional child needs love, care and protection from parents. 386

(92.0 %) of the caregivers disagreed that bowel training is easy for

children with CP. Majority, 374 (93.5 %) of the caregivers disagreed

that children with CP are often relatively inactive. 334 (83.5 %) of the

caregivers agreed that regular exercise is important to prevent

contractures in children with CP. 346 (86.5 %) of the caregivers

disagreed that without exercise children with CP are able to lead a

normal life. 10.3 % of the caregivers strongly agreed that children with

CP needs hugging and holding just like other children. 87.8 % of the

caregivers agreed that both parents must be involved in caring a child

with CP. 334 (84.0) % of the caregivers agreed that a child with CP

must be encouraged to mingle with other people. Majority, 369 (92. 2

%) of the caregivers agreed that a child with CP need to pick up social

skills. 335 (84.0 %) of the caregivers disagreed that children with CP

need not mingle with other people. 336 (84.0 %) of the caregivers

disagreed that socialization is not necessary for children with CP.

The Mean, standard deviation, Skew, Kurtosis on the level of

attitude in each domain reveals that the mean score on Special

education was 16.15 with standard deviation 0.61. The mean score on

Parenting & caring was 15.20 with standard deviation 1.03. With regard

to Bowel training and activities the mean score was10.99 with a

standard deviation of 0.05. The mean score on Exercise was 5.95 with

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a standard deviation of 0.50. The mean score on Socialization

was13.51 with standard deviation of 1.08.


conducted by Verral T.C etal (2008) examine the nutrition knowledge,

attitude, and belief of caregivers of cerebral palsy children.

Questionnaire was administered to cerebral palsy caregivers (n=52,)

and a comparison group of non-cerebral palsy caregivers (n=35).

Result showed that non-CP caregivers scored higher nutrition

knowledge (p<0.001), had a more positive attitude about the

importance of nutrition (p<0.05), and had more positive beliefs about

the relationship between nutrition and health p<0.05). It is concluded

that Knowledge is lacking about the feeding relationship between

caregivers and children with cerebral palsy (CP).


conducted by Masasa T etal (2005) on Knowledge of, beliefs about and

attitudes to disability: implications for health professionals in South

Africa. Sixty primary caregivers were interviewed by using a knowledge,

attitude, and belief (KAB) survey in a structured interview format.

Probability and non-probability (systematic and purposive) sampling

were used. Results showed all caregivers had only a rather rudimentary

knowledge of the causes of disability, but held positive attitudes

towards people with disabilities. There appears to be a need for

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improved disability awareness amongst the caregivers, in schools and

amongst transport service providers.

The third objective was to assess the practice of caregivers of


It reveals that 80 (20%) of the caregivers had good Level of

Practice. 54 (13.5%) of the Caregivers had Average Level of Practice,

266 (66.5%) of caregivers had Poor Level of Practice.

The findings reveal the frequency and percentage distribution of

level of Practice of caregivers to children with cerebral palsy. It reveals

that 100% of the caregivers answered yes for the traits, washing the

face every day morning and brushing the teeth every day. 62.3% of the

caregivers answered yes for bathing the child in hot water. 51.5% of the

caregivers answered yes for keeping the skin dry and clean. 100% of

the caregivers answered yes for applying cream on the body after bath.

37.8 % of the caregivers answered yes for feeding the child with

porridges. Only 2.0 % of the caregivers answered yes for providing

small and frequent feed. 100% of the caregivers answered yes for

allowing longer time for meal. 98.0 % of the caregivers answered yes

for providing sufficient water at mealtime. Only 0.8 % of the caregivers

answered yes for giving calcium rich food to prevent dental carries.

Only 2.3 % of the caregivers answered yes for rinsing the mouth after

each feed. 60.8 % of the caregivers answered yes for providing High

roughage diet daily. 53.8 % of the caregivers answered yes for making

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the child to sit on the toilet stool every day at the same time. 50.0 % of

the caregivers answered yes for praising the child for sitting in the toilet

as you wished. 100% of the caregivers answered yes for providing

perennial care. 44.3% of the caregivers answered yes for taking the

child for regular medical check-up. Majority, 67.3 % of the caregivers

answered yes for administering medications to regularize bowel habits.

35.0 % of the caregivers answered yes for cutting the nails every week.

Only1.0 % of the caregivers answered yes Putting side rails to maintain

safety. 100% of the caregivers answered yes for teaching the child to

obey rules and regulations. Majority, 88.0 % of the caregivers answered

yes for providing walker to walk with. 54.5 % of the caregivers

answered yes for using chair with chest strap while sitting. Only 7.8 %

of the caregivers answered yes for developing skill in self-care

activities. Only 16.8 % of the caregivers answered yes for encouraging

the child for self-care activities. 39.3 % of the caregivers answered yes

for modifying the utensils and cloths for self-help. 58.3 % of the

caregivers answered yes for using supportive aids for locomotion.


conducted by Tseng MH etal (2011) on “The determinants of daily

function in children with cerebral palsy. The aim of the study was to

identify determinants of daily function in a population-based sample of

children with cerebral palsy, considering the function, disability, and

health. 216 children and their caregivers participated in the study.

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Result showed that knowledge of daily function helps the caregivers to

plan and intervene to improve the capacity and performance in daily

function for children with cerebral palsy.

The fourth objective was to find the association of knowledge,

attitude, and practice with selected demographic variables.

Association of knowledge with selected demographic variables

reveals that the probability of obtaining Chi-square value by chance is

>0.05 (p > 0.05). Therefore, the null hypothesis is accepted, and it is

thus concluded that there is no association between knowledge and

selected demographic variables.

Association of Attitude with selected demographic variables

reveals that age alone seems to have influenced the level of attitude.

The p-value is 0.03, and thus we reject the null hypothesis, which states

that there is no association between the selected demographic

variables and level of attitude. Instead, we accept the alternative

hypothesis and conclude that there is an association between attitude

and age group.

Association of practice with the Demographic Variables shows

that age alone seems to have influenced the level of practice. The p-

value is 0.009, and thus we reject the null hypothesis, which states that

there is no association between the selected demographic variables

121

and level of practice. Instead, we accept the alternative hypothesis and

conclude that there is an association between practice and age group.

The fifth objective was to know the effect of an information

brochure on the caregivers of children cerebral palsy.

The findings reveals that the level of knowledge increased





knowledge.




cannot be due to chance or some other factor. The considerably low

F-Test p-value indicates that the variance in the sample after the

intervention is significantly different from that of one prior to the

intervention.

The level of attitude increased positively and shifted to the higher



This clearly gives the primary evidence that the information brochure

had a considerable impact on the level of attitude.

122


rise in attitude level is uniform and considerable across the sample. The

T-Test value is almost zero, indicating that the increase in score cannot

be due to chance or some other factor. The low F-Test p-value



Compared to the effect on knowledge, we can say that the effect of the

intervention in terms of attitude is slightly low.

The level of practice increased positively and shifted to the higher



This clearly gives the primary evidence that the information brochure

had a high impact on the level of practice.




cannot be due to chance or some other factor.

The F-Test p-value of zero indicates that the variance in the

sample after the intervention is expressively different from that of one

prior to the intervention.

123


knowledge in caregivers of children with CP would have an effect on the


SUMMARY,

CONCLUSION AND

RECOMMENDATIONS

CHAPTER - VI

124

CHAPTER VI

SUMMARY, CONCLUSIONS, IMPLICATIONS

RECOMMENDATIONS AND LIMITATIONS

This chapter deals with the summary, conclusions, implications,

recommendations, and limitations.

SUMMARY

Cerebral Palsy (C P) is a neurological disorder caused by

damage to the brain cells that occurred before, during or shortly after

birth. It is characterized by loss of movements and nerve functions

resulting in problems of use of hands and communication. Children with

cerebral palsy are struggling to lead a normal life. They are facing

problem with self-care activities. In order to meet their self-care needs,

caregivers are necessary.

Like any other children, C P children also need love and affection

from the caregivers. The goal of cerebral palsy parenting and care

giving is to help children reach their maximum potential. The

investigator has come across with children with cerebral palsy who are

neglected, not exposed to the public; some are put in to the dark room

of the house, sometimes locked in a cage and not given care properly,

and leading a vegetative life.

125

The investigator noticed that a mother was forcefully putting a

steel spoon in to the mouth of a child (8 years) and pressing the tongue

with the spoon to feed him. This child was not able to bring his hand up

to his mouth to feed himself, he was struggling to control his movement

and posture, and was not able to speak, neither to stand nor to sit. This

incident made the investigator to conduct a study on the knowledge,

attitude, and practice of caregivers of children with cerebral palsy.

. Caregivers need to have the proper knowledge, a positive

attitude, and proper skill to look after these children. Many a time, lack

of knowledge and negative attitude may lead to faulty practices and the

care will be affected negatively.

The objectives of the study were:

1. To assess the knowledge of caregivers regarding care of the


2. To find out the attitude of care givers of children with Cerebral

Palsy

3. To assess the practice of care givers of children with Cerebral

Palsy



5. To know the effect of an information brochure among the


126

The hypotheses of the study were:

SECTION A:





SECTION B:





SECTION C:





SECTION D:





127

SECTION E:

Ho: The information brochure does not have any influence on the


cerebral palsy.



cerebral palsy.

The assumptions of the study were:

1. The inadequate knowledge of caregivers may affect the care of

children in meeting the needs promptly.

2. The long term care of children may affect the attitude of

caregivers.

The delimitations of the study were:

1. This study is confined to Mysore District.

2. It is limited to caregivers of children with cerebral palsy.

3. Caregivers who are willing to participate in the study

4. Care givers who are available during the period of study

Review of the related literature was done on the following

dimensions:

1. Studies and literature related to general information regarding

the children with cerebral palsy

128

2. Studies and literature related to knowledge of caregivers of


3. Studies and literature related to attitude of caregivers of


4. Studies and literature related to practice attitude of caregivers

of children with cerebral palsy.

The conceptual framework of the study was based on Imogene

M. King‟s Goal attainment theory. King has interrelated the concepts of

interaction, perception, action, reaction, transaction into a theory of goal

attainment. It gives comprehensive framework for achieving the

objectives of the study. This framework clearly depicts what exactly the

caregivers do and they develop knowledge, attitude, and practice of

caregivers of children with cerebral palsy.

Non - Experimental Descriptive design was adopted for the study.

The investigator was interested to study the knowledge, attitude, and

practice of caregivers of children with cerebral palsy. Therefore, the

investigator has selected this design for her study. The researcher has

recorded the information that was present in the population without

manipulating the variables. Population comprises of all caregivers of

children with cerebral palsy

Sample was Caregivers (N=400) of children with cerebral palsy

who fulfils the inclusion criteria. Sampling Technique used was

Systematic random sampling method

129

Structured interview schedule was used to assess the Knowledge

of caregivers of children with CP. Likert scale was used to assess the

attitude of caregivers of children with CP. Observational checklist was

used to assess the practice of caregivers of children with CP.

The findings are as follows:

Section –A .Socio demographic variables of caregivers of


Majority, 42.3% of the caregivers belong to the age group of 36-45

years.

The higher percentage 90.5% of the caregivers was females.

Majority, 76 % of the caregivers attended school up to SSLC.

100% of the care givers were married

Majority 63.5% of the care givers were belonging to nuclear family

Only 6.8% of the caregivers were salaried.

Majority 51.0 % of caregivers belong to Muslim.

It was evident that 50.0% of the caregivers belong to rural and

50.0% belong to urban areas.

Majority, 87.5 % of the caregivers were residing in concrete houses.

Concerning ownership status 42.0% of the caregivers reside in

rented House.

With regard to income, 49.0% of the caregivers are between

Rs.5001/- to Rs.10000/-. And it shows that majority of the

caregivers were belonging to low income group.

130

Section – B.

Data was analysed using descriptive and inferential statistics.

The findings shows that , the percentage distribution of level of

knowledge of caregivers reveals that 20 (5%) of the caregivers had

good (>65 %) knowledge, with a mean score of 70.33 and standard

deviation of 2.62. 229 (57.3%) of the caregivers had average (51% -

65%) knowledge, with a mean score of 56.96 and standard deviation

of 3.3. 151 (37.5% ) of the caregivers had poor (≤50%) knowledge with

a mean score of 46.42 and standard deviation of 4.48.

After the intervention the level of knowledge increased positively

and shifted to the higher end (right) and thus skewed to the right. In

addition, the score became more clustered at the positive end with

slight reduction in the variance. This clearly gives the primary evidence

that the information brochure had a high impact on the level of

knowledge.

The distribution of caregivers according to the level of attitude the

findings reveal that NONE of the caregivers had favourable attitude (at

the set level of 75%) prior to the intervention; ALL of the caregivers had

unfavourable attitude (at the set level of 75%). After the intervention,

the level of attitude increased positively and shifted to the higher end

(right) and thus skewed to the right. In addition, the score became more

clustered at the positive end with slight reduction in the variance. This

131

clearly gives the primary evidence that the information brochure had a

considerable impact on the level of attitude.

The distribution of caregivers according to the level of practice

reveals that 20% of the caregivers had good level of practice. 13.5% of

the caregivers had average level of practice, 66.5% of caregivers had

poor level of practice. After the intervention the level of practice

increased positively and shifted to the higher end (right) and thus

skewed to the right. In addition, the score became more clustered at the

positive end with slight reduction in the variance. This clearly gives the

primary evidence that the information brochure had a high impact on

the level of practice. Age alone seems to have influenced the level of

practice. The p-value is 0.009, and thus we reject the null hypothesis,

which states that there is no association between the selected

demographic variables and level of practice. Instead, we accept the

alternative hypothesis and conclude that there is an association

between practice and age group

INFERENCE

The present study was conducted on the Knowledge Attitude and

Practice of caregivers of children with cerebral palsy. The following

conclusions were drawn from the study.

1. Only 5% of the caregivers had good knowledge, 57.3% of the

caregivers had average knowledge and. 37.8% of the caregivers

132

had poor knowledge regarding giving care to the children with

cerebral palsy.

2. It revealed that None of the caregivers had a favourable attitude

(as per the set standards) prior to the intervention.

3. After the intervention, it revealed that at least 15% of the

caregivers of cerebral palsy crossed the threshold to reach the set

level of favourable attitude (at the set standard of 75% and above);

yet, 85 % of the caregivers of cerebral palsy had unfavourable

attitude (at the set standard of 75%).

4. Only 20% of the caregivers had good level of practice. 13.5% of

the caregivers had average level of practice and majority 66.5% of

caregivers had poor level of Practice.

5. There was no association between knowledge and demographic

variables of caregivers of children with cerebral palsy at (p>0.05)

6. There is an association between attitude and age, and practice age

at (p>0.01).

7. The information brochure had very positive effect on the level of

knowledge, attitude, and practice. In each case, the probability of

observing such a huge change by chance is ZERO.

8. The impact of information brochure eliminated the effect of age or

any other demographic variable observed in the pre-intervention

setup.

133

IMPLICATIONS

The following implications are derived from the study by the

investigator, which is important in the field of nursing education, nursing

practice and nursing administration.

IMPLICATION FOR NURSING EDUCATION.

• Role of the caregivers in giving care to children with cerebral

palsy must be included in the nursing curriculum.

IMPLICATION FOR NURSING ADMINISTRATION

• The finding of the study implies that there is a need to plan,

arrange, and conduct, in-service education programs for the staff

nurses regarding the care of children with cerebral palsy.

• Caregivers‟ knowledge, attitude and practice can be improved

by distributing information brochure.

IMPLICATION FOR NURSING PRACTICE

• Nurses play a major role in rendering care to children with

cerebral palsy in the hospital and in the community. It is the

responsibility of nurses to educate the caregivers to improve their

knowledge attitude and practice.

• Distribute information brochure through hospitals and during

home visits to help the caregivers to improve their practice by having

the right knowledge and develop a favorable attitude.

134

• Provide information brochure to home for the disabled.

• Parents of children with cerebral palsy need support from

nursing professionals.

• Nurses are the vital force for providing care for these families.

IMPLICATION FOR NURSING RESEARCH

• More studies are needed to be conducted regarding the

knowledge, attitude, and practice of children with cerebral palsy in

different settings.

• Disseminate the findings through Internet services, web portals

and journals.

RECOMMENDATIONS

• It is recommended that this study can be replicated.

• A comparative study can be conducted regarding the

Knowledge, attitude, and practice between urban and rural

caregivers of children with cerebral palsy.

• A study can be conducted to assess the usefulness of an

information brochure among the caregivers of children with cerebral

palsy.

LIMITATIONS

• This study was limited to Mysore district.

• It was limited to care givers of children with cerebral palsy.

135

CONCLUSION

o The study was carried out on the Knowledge, attitude, and practice

of the caregivers of children cerebral palsy.

o There is an association between attitude and age group, Practice

and age group

o Information brochure had a high impact on the level Knowledge,

attitude, and practice of the caregivers of children with cerebral

palsy.

o The information brochure provides significant information to the

caregivers that would influence the Knowledge, attitude, and

practice. Thus, the present study would help all the caregivers‟ of

children cerebral palsy.

o The entire research proved that a small change in the level of

knowledge in caregiver of children with CP would have an effect on

the attitude to some extent and, on the practices to a great extent.

BIBLIOGRAPHY

136

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palsy. Developmental Medicine and Child Neurology 43:

601-608.

29 Parks, et al. (2008) Psychological problems in children with

cerebral palsy; a cross sectional European study. Journal

of child psycho psychiatry, 49 (4) 405-13.

30 Verrall T C, et al, (2000) Children with cerebral palsy:

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APPENDIX

i

APPENDIX – 1

ii

iii

APPENDIX - 2

Letter seeking opinion and suggestions of the experts for

establishing content validity of the research tool.

From,

To,

Respected Sir / Madam,

Sub: Opinion and suggestion for validity of the tool - Reg.

I am a registered candidate for PhD at Vinayaka Mission’s

University, Salem, Tamilnadu. I am working on the thesis titled “A Study

on the Knowledge and Attitude and Practice of caregivers of

children with cerebral palsy”.

Objectives

1. To assess the knowledge of caregivers regarding care of the children

with Cerebral Palsy.

2. To find out the attitude of care givers of children with Cerebral Palsy

3. To assess the practice of care givers of children with Cerebral Palsy



5. To know the effect of an information brochure among the caregivers

of children cerebral palsy.

I humbly request you for the perusal of the tool and give your

expert opinion and valuable suggestions in relation to the objective of

the study. It will be kind of you to return the same to the undersigned at

the earliest by ……….

Thanking you,

Date: Yours sincerely,

Encl: Tools and Content Validity Certificate Gracy V.C

iv

APPENDIX - 3

ACCEPTANCE FORM FOR TOOL VALIDATION

Name………………………………………………………….

Designation………………………………………………….

Name of the institution…………………………………….

Statement of acceptance/ Non acceptance to validate the tool

I give acceptance/ Non acceptance to validate the tool.

Topic: “A Study on the Knowledge, Attitude and Practice of

Caregivers of Children with Cerebral Palsy”.

Date:

Place: Signature

v

APPENDIX - 4

CONTENT VALIDATION CERTIFICATE

I, hereby certify that I have validated the tool of Mrs.GracyVC PhD

candidate of Vinayaka Missions University Salem who is undertaken the

following study

Topic: “A Study on the Knowledge, Attitude and Practice of

Caregivers of Children with Cerebral Palsy”.

:

Date: Signature of the Expert

Place: Designation and Address

vi

APPENDIX – 5

LIST OF EXPERTS

1. Dr. Mangala gowri , PhD ( N )

15 8 , Baba llum ,

Samaj Nagar,Sembakkam,

Chennai -73.

2. Dr. Tamilmani, PhD (N)

Principal

Annai J.K.K Sampoorani Ammal College of Nursing,

Ethirmedu, Komarapalayam-638183

3. Dr. Chellarani Vijaykumar, PhD (N )

No.123, Annai Teresa, 2nd street,

Sathuvachari Phase 3,

Vellore 632 009, Tamilnadu.

4. Dr. Jolly Jose ,PhD ( N )

Principal,

Government College of Nursing,

Near Govt. T.D. Medical College,

Vandanam, Alappuzha, Kerala.

5. Dr. Punitha V. Ezhilarasu, PhD ( N )

Professor & Head

CNE & Research Dept

College of Nursing CMC,

Vellore- 632004. TN

vii

6. Dr. Assuma Beevi T M ,PhD ( N )

Principal,

MIMS College of Nursing,

Vadakkedath Paramba, PO-Vazhayur,

Dist -Malapuram-673633, Kerala.

7. Dr. Judie, PhD (N)

Principal

MMM College of Nursing

131, Sakthi nagar, Nalamboor post

Mogappair west, Chennai-95

8. Dr. Revathy PhD (N )

Principal,

College of Nursing,

JIPMER, Puducherry-605006.

9. Dr. Sharadha Ramesh, PhD (N)

Principal

Saveetha college of Nursing

Chennai

10. Dr. Jeyaseelan M. Devadason, PhD (N),

Dean

Annai J.K.K Sampoorani Ammal College of Nursing,

Ethirmedu, Komarapalayam-638183

viii

APPENDIX - 6

Letter seeking consent for participation to the study

Dear Participant,

I Mrs. Gracy VC PhD scholar of Vinayaka Missions University,

intend to do a study on the “Knowledge Attitude and practice of care

givers of children with cerebral palsy”.

Therefore I request you to co-operate and participate in the

study without any hesitation. I assure you that the information given

by you will be kept confidential and use only for this purpose. Your

participation will help me to complete my study and contribute to the

field of health.

Thanking You, Yours Sincerely

Place: (Gracy V.C)

Date:

ix

APPENDIX - 7

ASSESSMENT TOOL ON KNOWLEDGE, ATTITUDE AND PRACTICE BY

CAREGIVERS TO CHILDREN WITH CEREBRAL PALSY (C.P)

Section – I

Interview Schedule

Instruction

Dear respondent,

This interview schedule requires your response with regard to your personal

characteristics. Kindly listen carefully and tell the most appropriate answers freely. All

information given by you will be kept in confidence.

Socio Demographic Data Code no:

1. Age

15 -25 years

26 -35 years

36 -45 years

46 -55 years

55 years and above

2. Gender

Male

Female

x

3. Educational status

No formal education

School dropout

School up to S S L C

P U C/ Higher secondary

Degree above

4. Marital status

Single

Married

Divorced

Widowed

5. Type of Family

Nuclear Family

Joint family

Extended Family

6. Employment Status

Coolie/Daily Wages

Self employed

Salaried

Business

Others specify

xi

7. Religion

Hindu

Muslim

Christian

Any other

8. Area of Residence

Rural

Urban

9. Type of House

Mud House

Tent

Concrete House

Apartment

10. Ownership Status

Own

Rented

On lease

11. Income (Rs/ Month)

Below and equal to Rs.5000/-

Rs.5001/- to Rs.10000/-

Rs.10001/- and above

xii

SECTION-B

I. Structured interview - schedule to assess the knowledge of caregivers of

Children with cerebral palsy.

II. Likert scale to assess the attitude of caregivers of Children with cerebral

palsy.

III. Observational check list to assess the Practice of caregivers of children

with Cerebral palsy.

I. Structured interview schedule to assess the knowledge of Caregivers of


Structured interview schedule has been subdivided into 6 heads

General information

o Signs and symptoms

o Self care needs & support

o Feeding & Nutrition

o Hygiene & Elimination

o Exercise & Prevention

General information

1. Which of the following are the causes of Cerebral palsy in children?

a) Inherited from parents

b) Brain injury

c) Accident

d) Malnutrition

xiii

2. Which of the following disease causes Spasm & difficulty in coordination?

a) Cerebral palsy

b) Meningitis

c) Chicken pox

d) Mental retardation

3. When did you notice that your child is suffering from Cerebral palsy?

a) While bathing the baby

b) While observing the movement

c) While helping him to stand

d) Making him to sit on the potty

4. How long children with CP (Cerebral palsy) will be dependent on caregivers?

a) Up to Toddler period

b) Up to Teenage

c) Up to Adulthood

d) Up to Lifetime

Signs and symptoms

5. What is the early sign of CP during infancy?

a) Early sucking difficulty with breast or bottle

b) Intake of more food

c) Intake of less food

d) Continuous diarrhea

xiv

6. Which of the following is a sign of CP?

a) Purposeless body movements

b) Redness all over the body

c) Swelling on the leg

Self care needs &Self care support

7. Self care needs of children with C.P include:

a) Toilet training

b) Bathing

c) Play

d) Bathing, Toilet training, dressing and feeding

8. How do you maintain safety for your special child?

a) Keep him at home

b) Teaching the child to obey the rules and regulations

c) Leave him freely

d) Keep him with restraints

9. How do you promote self care activities for your child?

a) Doing everything for your child

b) Not allowing him to eat his food by himself

c) Boosting the child’s ability in self care activities

d) Allow the child to bath by leaving him alone

xv

10. How do you promote locomotion for your child?

a) Encouraging the child to sit

b) Providing incentives to get up

c) Having supportive aides to encourage locomotion

d) Encouraging the child to crawl

Feeding & Nutrition

11. How do you identify feeding problems in children with C.P?

a) Vomiting frequently

b) Poor lip and tongue control

c) Intake of less amount of food

d) Frequent Urination

12. How do you maintain adequate nutrition?

a) Recognizing the caloric needs

b) Feeding whenever the child cries

c) Including more water in his diet

d) Allowing him to sit in the toilet

Hygiene &Elimination

13. How do you maintain cleanliness of the body of your child?

a) Daily bath in hot water

b) Cold bath

c) Applying cream on the body

d) Applying powder on the body

xvi

14. What type of bath is appropriate for children with cp?

a) Oil bath

b) Cold water bath

c) Hot water bath

d) Sun bath

15. How do you maintain oral hygiene?

a) Washing the face

b) Rinsing the mouth after each feed

c) Brushing the teeth once daily

d) Brushing the teeth twice daily

16. How do you prevent Dental carries?

a) Brushing the teeth twice daily

b) Cleaning the tongue

c) Brushing the teeth once daily

d) Cleaning the face

17. Which of the following complication can arise if the perineum is not

Cleaned properly?

a) Fever

b) Itching

c) Redness & rashes

d) Diarrhea

xvii

18. What is the best time for toilet training for your child?

a) Between the age of 18-48 months

b) Between the age of 18-40 months

c) Between the age of 16-48 months

d) Between the age of 16-40 months

19. Children with Cerebral Palsy frequently suffer from constipation due to

a) Over feeding

b) Vomiting

c) Drinking Cold Water

d) Insufficient fiber and liquid in their diet

20. How can you prevent Constipation?

a) Giving bland diet

b) Providing cold fluids

c) Encouraging regular bowel habits

d) Providing balanced diet

Exercise& Prevention of complications

21. Your child may require equipment to help with:

a) Walking/Mobility

b) Talking/ Communication

c) Eating, Bathing and toileting

d) Walking/Mobility ,Talking/ Communication

xviii

22. Which of the following activity needs equipment to exercise your child?

a) Walking

b) Talking

c) Bathing

d) Sleeping

23. How do you help your child in walking?

a) Provide a walker to walk with

b) Provide a chair

c) Leave him in the courtyard

d) Instruct him to walk

24. Some disabilities in children with C.P can be prevented by

a) Healthy diet

b) Home safety

c) Home delivery

d) Taking extra care during delivery

25. How can you prevent Contractures?

a) Movement through all ranges of motion

b) Injections

c) Consulting the Doctor

d) Medications

xix

26. How do you help your child with C.P to be independent?

a) By providing healthy food

b) Advise him to walk

c) Playing with him

d) Special schooling

27. A child with C.P can acquire social skills by:

a) Keeping him at home

b) Bathing

c) Toileting

d) Giving directions to get home

28. How can a physiotherapist be helpful?

a) Writing on the board

b) Helping the parents to become skillful in assisting their child.

c) Playing with the child

d) Feeding the child

29. What are the Problems encountered by the parents of children with

C.P?

a) Mental

b) Social

c) Shock, anger, and financial problems

xx

30. What are the facilities provided by Govt. of India to rehabilitate the children

with C.P?

a) Concession for traveling, education & Employment opportunities

b) Free treatment

c) Insurance

d) Free food

SCORING KEY:

One mark for correct answer and zero mark for incorrect answer.

xxi

2. FOUR POINT LICKERT SCALE TO ASSESS, THE ATTITUDE OF

CAREGIVERS TO CHILDREN WITH CEREBRAL PALSY

Sl

No

Direction

of scoring

Item

Responses

1

- If a baby is born with any disability it is a

curse for the family

S A A D SD

2 + Physically challenged children needs special

education

3 - Physically challenged children need not sent

for special education

4 - Special education will not prevent disability

5 + Special education reduces the disability

6 + Parenting a special child gives more

satisfaction

7 - Caring a child with CP is troublesome

8 - A child with CP becomes lifelong dependent

on care givers

9 + One day my child will be able to walk like

other normal children

10

+

Like other children exceptional child needs

love care and protection from parents

11 - Bowel training can be challenging for

children with C.P

12 - Bowel training is easy for children with C.P

13 - Children with C.P are often relatively

inactive

14

+

Children with C.P are very active

xxii

15 + Regular exercise helps to prevent

contractures in children with C.P

16 - Without exercise children with C.P are able

to lead a normal life

17 + Children with C.P needs hugging and

holding just like other children

18 + Both parents must be involved in caring a

child with CP

19 - Both parents need not be involved in caring

a child with CP

20 + A child with CP must be encouraged to

mingle with other people

21 + A child with CP need to pick up social skills

22 - Children with CP need not mingle with

other people

23 + A child with CP need not pick up social

skills

24 _ Socialization is not necessary for children

with CP

Total Score

SCORING KEY

S A (STRONGLY AGREE) = 4, A (AGREE) = 3,

D (DISAGREE) = 2, S A (STRONGLY DISAGREE) =1

xxiii

3. Observational check list to assess the Practice by caregivers to

children with cerebral palsy

SL.No Traits Yes No

1 Washing the face every day morning

2 Brushing the teeth every day

3 Bathing the child in hot water

4 Keeping the skin dry and clean

5 Applying cream on the body after bath

6 Feeding the child with porridges

7 Providing small and frequent feed

8 Allowing longer time for meal

9 Providing sufficient water at mealtime

10 Giving calcium rich food to prevent dental

carries

11 Rinsing the mouth after each feed

12 Providing high roughage diet daily

13 Making the child to sit on the toilet stool

everyday at the same time

14 Praising the child for sitting in the toilet as you

wished

15 Providing perineal care

16 Taking the child for regular medical check up

17 Administering medications to regularize bowel

habit

xxiv

18 Cutting the nails every week

19 Putting side rails to maintain safety

20 Teaching the child to obey rules and regulations

21 Providing walker to walk with

22 Using chair with chest strap while sitting

23 Developing skills in self care activities

24 Encouraging the child for self care activities

25 Modifying the utensils and cloths for self help

26 Using supportive aids for locomotion

SCORING KEY: One mark for “yes” and zero mark for “No”.

xxv

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