The present study aims to investigate the social participation of children with severe and multiple disabilities (SMD) and to examine the relation of the children's social participation to personal and environmental variables. Parents of 1,105 students at schools for students who are physically challenged reported their children's social participation during the past year, as well as the students' needs for medical care, their motor function level and communication ability, and characteristics of the family and their use of support services. Some students engaged in a relatively wide range of activities, whereas about 5% were severely restricted in their social participation. Several personal variables (different grade level in school, the children's motor functioning and communication ability, and some types of medical care) and environmental variables (whether or not the child lives in the family's home, others' cooperation with the main caregiver, and use of mobility support services) were associated with social participation. Factors such as the heavy burden of caring for children with severe and multiple disabilities and a lack of human resources for care appeared to have a negative influence on the children's social participation. The focus should be on the main caregiver and the environment that supports these children's social participation.
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