Moving Through The Day: The 24-hour physical activities throughout the life course of people with cerebral palsy

This thesis provides a comprehensive life course perspective on the 24-hour physical activities – sleep, physical activity, and sedentary behaviour – of individuals with cerebral palsy (CP). By integrating objective measurements with lived experiences, it advances our understanding of daily activity patterns in both children and adults with CP. We highlight implications for care, research, and clinical practice.

Overall, the findings demonstrate that challenges in the 24-hour physical activities are present across the lifespan. Adults with CP report poorer sleep quality compared with reference populations, and experience difficulties in balancing rest and activity, independent of age or physical function. Sleep, physical activity, and fatigue are interrelated and influenced by a complex interplay of physical, mental, and environmental factors. In children with CP, associations between sleep, physical activity, and sensory processing were limited or absent, suggesting that relationships between these activities and domains are complex and not easily captured when studied in isolation.

A central message of this thesis is that adopting a life course perspective is essential. CP is not a childhood condition, but a lifelong neurological disorder with changing manifestations and needs. With age, individuals with CP often face new or increased challenges, including fatigue, reduced participation, pain and changes in sleep and physical activity. These neurological and systemic challenges are increasingly recognized in adults with CP. Despite this, research and healthcare remain largely focused on childhood.

The findings support viewing sleep, physical activity, and rest as an integrated 24-hour continuum rather than separate behaviours. Rest and sedentary time are not inherently negative but can play a restorative role in maintaining energy balance and participation. Supporting individuals with CP therefore requires attention to the interplay between activity and rest, tailored to personal context and life circumstances.

Finally, this thesis demonstrates the value of device-based assessments for capturing detailed and fluctuating patterns in 24-hour physical activities that are often missed by questionnaires. Such methods provide important opportunities for monitoring daily behaviours and supporting self-management in individuals with CP. However, challenges remain in translating these tools into clinical practice. Data interpretation can be time-consuming, and further improvements in usability and clinical integration are needed.

In conclusion, improving outcomes for individuals with CP requires a shift towards a holistic, lifespan-oriented approach that integrates sleep, activity, and rest; leverages emerging measurement techniques; and acknowledges the evolving needs of individuals with CP across their lives.