800 Section - Beyond the Hospital: Environmental Barriers to Social Participation for Children with Medical Complexity in Japan

Objectives : This study quantifies the social participation of Japanese children with physical disabilities, focusing on the impact of medical care needs. We identify environmental and logistical barriers in school and community settings to provide internationally relevant evidence on the challenges for children with medical complexity living in the community.

Design: In this cross-sectional study, we compared typically developing children (n=34) with children with physical disabilities (n=78), subdivided by medical care needs (n=43 with, n=35 without). We used the Participation and Environment Measure for Children and Youth (PEM-CY) to assess participation and environmental factors in home, school, and community settings. T-tests were used for group comparisons.

Results:

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  Compared to typically developing peers, children with physical disabilities had significantly lower participation in school (p< .001) and community (p< .001) settings, but not at home. Within the physically disabled group, those requiring medical care had more restricted participation in community (p< .001) and school (p=.018) activities. Respirator use was most strongly associated with severe restrictions in community (p=.003) and school (p=.007) participation. The participation gap was prominent in social events and outings, not just physical activities, indicating environmental barriers.
  

Conclusion: The need for medical care, particularly respirator use, is a critical factor limiting social participation for Japanese children with physical disabilities. The barriers they face are strongly linked to environmental and logistical factors, not just functional impairments. This study highlights a universal challenge for rehabilitation medicine: as medical advances improve survival, we must focus on creating inclusive social environments that support quality of life beyond the hospital.