Communication and Social Interaction among Children with Cerebral Palsy: A Cross-Sectional Study in Lahore, Pakistan

Abstract

Background: Cerebral palsy (CP) is a group of permanent, non-progressive disorders of movement and posture caused by disturbances that occur in the developing fetal or infant brain. These motor impairments are frequently accompanied by difficulties in communication and social interaction, which can significantly affect a child's participation and quality of life. Evidence on communication and social interaction among children with CP in the Pakistani context remains limited. Objective: To assess communication and social interaction among children with cerebral palsy in Lahore, Pakistan, using caregiver-reported quality-of-life ratings. Methods: A cross-sectional study was conducted at three private institutions in Lahore. Rising Sun Institute for Special Children, Dimensions, and Rehab Care from January to June 2024. Using convenience sampling, the communication- and social-interaction-related items of the Cerebral palsy Quality of Life Questionnaire for Children (CP QOL-Child, Primary Caregiver Questionnaire, Version 2, July 2013) were administered to parents/caregivers of children with CP aged 4–12 years, of all CP subtypes; children with epilepsy or visual impairment were excluded. The minimum required sample size was calculated as 169 (97% confidence level, 3% margin of error). Questionnaires were distributed to 240 parents/caregivers; 190–192 valid responses were obtained per item and included in the analysis. Data were analyzed descriptively (means, standard deviations, frequencies) using SPSS version 21.0; no inferential statistical tests were performed. Results: Of the 190 children included, 112 (58.9%) were male and 78 (41.1%) were female. Across 22 CP QOL-Child items covering relationships, acceptance, participation, and communication, caregiver-rated scores (1 = very unhappy, 9 = very happy) averaged 5.21 overall, ranging from 4.74 (participation in recreational activities) to 5.96 (getting along with siblings), indicating a generally moderate, mixed picture rather than a strong tendency toward either end of the scale. Conclusion: This cross-sectional survey of 190 children with cerebral palsy in Lahore, Pakistan, found that caregivers rated their children's communication and social interaction as moderate on average, with considerable variability across families and across domains. Participation-related items scored somewhat lower on average than relationship-related items, suggesting participation may be an area of unmet need. As a descriptive, cross-sectional study, it cannot establish the causes of this variability.