Cerebral palsy (CP) not only affects movement and posture, but also is accompanied with cognition, speech, or social problems. These problems further cause limitation in participation in life activities in children with CP. This study aims to investigate the changes in participation outcomes in various activities for children with CP of different motor severities.

Sixty-five parents of schoolchildren with CP (6–18 years) were enrolled and classified into two groups based on the Gross Motor Function Classification System (GMFCS) levels: mild (GMFCS levels I-III, n=41) and severe group (GMFCS level IV-V, n=24). Participation outcome was assessed by the children's assessment of participation and enjoyment (CAPE) at baseline and 6-month follow-up. CAPE measures participation diversity and intensity in five activities (recreational, active physical, social, skill-based, and self-improvement), ANCOVA was used to compare the participation changes in various domains between two groups.

At baseline and follow-up, mild groups had better participation diversity and intensity in all activities except the intensity in social activities at follow-up than severe groups (P<0.05). ANCOVA results showed mild groups had better changes in the participation diversities for total and all activities except the social and skill-based activities than severe groups (P<0.05). Furthermore, mild groups had better changes in the participation intensities for total, active physical, and self-improvement activities, than severe groups (P<0.05).

The GMFCS levels were associated with participation changes in the diversities and intensities for various activities in children with CP. Mild groups had better changes in the participation diversities and intensities for some activities than severe groups. These findings may allow clinicians early predict the changes in the participation outcomes for these children based on simple GMFCS levels.