Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Health and Rehabilitation Sciences


Brunton, Laura K.



Fifty-seven percent of children with cerebral palsy (CP) experience mental health symptoms including symptoms of anxiety and depression. Although CP is non progressive, secondary conditions can have progressive effects on an individuals’ functional abilities. Particularly, untreated mental health symptoms can negatively affect a child’s quality of life. Children with CP also experience fatigue, pain, poor physical activity, and sleep disturbances. The presence of these physiological symptoms, separate and in combination, may impact mental health; however, it has not been systematically examined. Identifying factors that contribute to mental health symptoms may prevent the maintenance of these issues into adulthood.


This study aimed to understand the associations between fatigue, pain, sleep, physical activity and mental health symptoms for children with CP. We hypothesized that moderate levels of fatigue, pain and/or sleep difficulties were associated with presence of psychological symptoms. In addition, we hypothesized that lower levels of physical activity were associated with mental health symptoms.


An observational study was conducted to assess physiological and mental health symptoms and physical activity in children with CP. Twenty-six participants and their caregivers responded to risk factor specific questionnaires before wearing accelerometers for one week, providing non-invasive data on movement patterns and sleep cycles. Using pairwise correlations and backward stepwise linear regressions, we examined the associations between the risk factors and severity of mental health symptoms.


Significant regression models demonstrated associations for behavioural, depressive and anxiety related symptoms in children with CP. Models were able to explain 61%, 18% and 41% of the variance in child report internalizing behaviours, caregiver reported depression and anxiety, respectively.


Fatigue, pain severity, sleep efficiency and physical activity outcomes all contributed in some way to mental health outcomes. Longitudinal research is required to determine causal relationships.

Future Applications

This study will help develop evidence-based interventions to treat these factors and have the potential to inform clinicians on the determinants of mental health outcomes in this population. Individualized, targeted interventions can be developed and implemented to address the modifiable risk factors that threaten the wellbeing of children with CP.

Summary for Lay Audience

Cerebral palsy (CP) is the most prevalent and most impactful long-term motor disability in children. As children with CP grow, they experience new or worsening symptoms, including mental health symptoms, that can have negative effects on their quality of life. Identifying factors that contribute to mental health symptoms can prevent these issues from being maintained into adulthood. The objective in this study was to understand the association between fatigue, pain, sleep, physical activity and mental health symptoms for children and youth with CP. We determined that fatigue, pain, sleep and physical activity were all associated with mental health outcomes. We hypothesized that moderate levels of these physical symptoms would be related to the presence of having mental health symptoms. This study will help inform the development of evidence-based interventions to treat the physical symptoms that contribute to poor mental health.