cerebral palsy ( cp ) refers to a group of disorders in the development of movement and 
 posture , which causes limitations of activity that are attributed to non - progressive 
 disturbances occurring in the developing fetal or infant brain1 . early diagnosis and intervention is especially critical with cp , 
 since the brain damage resulting from cp itself may be non - progressive , but it can lead to 
 various subsequent conditions . according to the 2008 statistics compiled by the division of 
 policy for persons with disabilities of the ministry of health and welfare2 , among the age - specific brain injuries of 
 koreans , cp has the highest incidence between the ages 09 , at 57.8% . as noted , cp is the 
 largest category of infant brain injuries . if the parents of children with a disability fail to cope with stress induced by the 
 unusual challenges experienced by the family and do n't develop the skills necessary for 
 parenting , it may result in a serious family crisis . among the family members , mothers who 
 are primarily responsible , show the highest rate of parenting stress , which results in 
 depression and family troubles3 . this is 
 due to the mother generally assuming more responsibility for the child4 , and undertaking most of the additional care necessary for a 
 child with disability5 . the parenting stress of mothers of children with cp can be interpreted as a composite and 
 negative response to the physical , social , economical and psychological experience of 
 families nurturing children with cp6 . moreover , stress experienced by the mothers of children with cp may be identified as 
 physiological response stress , the level of physiological stress associated with physical 
 fatigue , neuralgia , and convulsion , and emotional response stress , the level of response to 
 the discomfort associated with nervousness , anxiety , distress , grief and interaction with 
 others7 . therefore , adequate assistance 
 and opportunities must be provided to help mothers cope with such stress and to accomplish 
 excellent role performance . currently in korea , the provision and standards of various supports aiding the parenting of 
 children with cp are inconsistent , and the standards of service support or the policies 
 pertaining to problematic situations are extremely insufficient8 . furthermore , there is a deficit of social welfare service policies , as well as pertinent 
 research . in other words , until now , there has been little research into the stress of 
 mothers parenting children with cp9,10,11,12 , yet there has been little research into 
 the correlation between social support and the parenting stress of mothers , and the proposed 
 solutions are insubstantial . accordingly , this present study examined the extent and 
 necessity of practical assistance for the reduction of the parenting stress of mothers in 
 order to propose a basis for the establishment of effective welfare planning . this study surveyed 181 mothers of children under the age of 12 , diagnosed with cp , who 
 were undergoing rehabilitation therapy at university or rehabilitation hospitals located in 
 seoul and gyeonggi - do province . the scope of social support was restricted to close friends , 
 friends , family and medical facilities , which mothers of children with cp embraced as social 
 support mediums . all research subjects agreed to participation in the study , and data were 
 collected via survey . the 
 present study was supported by dongguk university and approved by dongguk university 
 institutional review boards , and written consent was provided by all the subjects . ( smcp ) was developed 
 by lee , ji - won13 , who conducted an 
 in - depth interview of 20 mothers of children with cp to evaluate their stress levels . in 
 this study it was used as the measurement tool for measuring the stress levels of the 
 mothers of children with cp . it has 44 questions , each of which are answered on a 5 point 
 scale on which strongly agree  is scored as 5 points and  strongly disagree  is scored as 1 
 point , with a higher score signifying greater parenting stress . the test - retest of the smcp shows a correlation of pearson r=0.97 , and a reliability of 
 cronbach =0.94 . first , 
 in order to measure informal support , the cpss ( carolina parents support scale ) , developed 
 by bristol14 , was modified and 
 supplemented via consultation with an associated specialist in order to correspond to korean 
 reality , resulting in a tool consisting of 8 questions . each question was scored on a scale 
 of 4 points , with  very supportive  yielding 4 points and  very unsupportive  yielding 1 
 point , a higher score implying greater acquisition of informal support . then , in order to measure the formal support , cpss 
 was modified and supplemented again to correspond to korean reality , resulting in a survey 
 consisting of 9 questions . each question was scored on a scale of 4 points , with  very 
 supportive  yielding 4 points and  very unsupportive  yielding 1 point , a higher score 
 implying greater acquisition of formal support . data regarding additional variables influencing parenting stress for mothers , such as the 
 sex of children ( 1=male , 2=female ) , age ( 1=less than 24 month , 2=between 2472 months , 
 3=more than 72 months ) , term of disability ( 1= less than 1  year , 2= between 13  years , 
 3=between 35  years , 4= more than 5  years ) , severity of disability ( 1= mild , 2= average 
 severity , 3= very severe ) , age of mothers ( 1= less than 30  years of age , 2= more than 
 30  years of age ) , level of education ( 1=high school graduate or lower , 2=university graduate 
 or higher ) , family income ( 1= less than 1,000,000 krw , 2=between 1,000,0003,000,000 krw , 
 3=between 3,000,0005,000,000 krw , 4=more than 5,000,000 krw ) were collected . furthermore , a tool ( 1 question ) developed by ware , davis , and donald15 , scored on a scale of 4 points , with  very healthy  
 yielding 4 points and  very unhealthy  yielding 1 point , a higher score implying better 
 health conditions , was utilized to examine the health conditions for mothers of children 
 with cp . analysis 
 of variance ( anova ) was conducted in order to examine the relevance between the parenting 
 stress of mothers and the characteristics of the children . hierarchial multiple regression 
 analysis was employed to uncover variations ( p<0.05 ) significant in the univariate 
 analysis with respect to factors influencing the parenting stress of mothers while solution 
 enter was utilized to identify predictable factors . the characteristics of children were 
 entered in the first step and the characteristics of the mothers in the next . in the final step the total scores of social support were entered into the prediction model independently 
 as formal and informal supports . as shown in table 1 , the correlation between 
 factors associated with the parenting stress of mothers and the parenting stress itself , 
 resulted in positive correlations with severity of disability , while the correlations 
 pertaining to education levels and health conditions of mothers and family income were 
 negative . the results of hierarchial multiple regression analyses are presented in tables 2 . as a result of analyzing factors 
 influencing the parenting stress of mothers of children with cp , as well as modifying the 
 efficacy of other variables in the final step , the overall model , the severity of disability 
 of children , health condition of mothers and social support were identified as significant 
 predictors of parenting stress . among others , independent examination of social support , as 
 formal and informal support , subsequently identified informal support as a significant 
 predictor of parenting stress . the present research surveyed 181 mothers of children diagnosed with cp who are currently 
 undergoing rehabilitation treatment at university hospitals or special rehabilitation 
 hospitals , in order to examine the factors influencing the parenting stress of mothers of 
 children with cp with reference to social support provided to the mother . the general characteristics of the children with cp , such as sex and age were not 
 significantly different , though parenting stress was positively associated with the severity 
 of the disorder of the children with cp , revealing that parenting stress increases with 
 increased severity of the disorder ( r=0.302 , p<0.01 ) . this outcome is in agreement with 
 the results of preceding studies3 , 8,9,10 , 16 
 reporting that parenting stress of the parent increases with the severity of a child 's 
 disability . our results are analogous to those of lena e. svedberg17 , who concluded that parents nurturing cp children who 
 can not walk perceive more stress than those with cp children who can walk . moreover , there 
 are many circumstances of cp , in which mental retardation accompanies physiological 
 disability , exacerbating the stress of parents18 . on the 
 other hand , parenting stress demonstrated negative correlations with the mother 's level of 
 education , level of income and health conditions , indicating that parenting stress increases 
 with lower level of education ( r=0.168 , p<0.05 ) , lower level of income ( r=0.281 , 
 p<0.01 ) and poorer health condition ( r= 0.227 , p<0.01 ) . haley19 also reported lower stress levels in mothers possessing 
 higher level of education , and kim soo - hyeon12 revealed that the financial status of mothers of children diagnosed 
 with cp influenced parenting stress in a negative correlation , concluding that the lower 
 stress level may be due to a better ability to resolve economical difficulties experienced 
 as a result of parenting children with disabilities . our results are in agreement with lee ji - won13 , who described the influence of the health condition of mothers on 
 parenting , and lena e. svedberg17 , who 
 identified a relationship between parents health condition and the stress they experienced 
 in parenting children with cp , verifying that caring for children with cp has a physically 
 negative effect . from this , it can be understood that , as the severity of the disability of a child with cp 
 increases , the assistance required by the mother will increase , resulting in increased 
 dependency and subsequent physiological stress as well as psychological burden . inclusion of 
 economic difficulty or problematic health condition of the mother would exacerbate the 
 experienced burden . the present study examined social support independently as informal support and formal 
 support . according to research by hong ji - yeon20 , social support provided to the mothers of children with cp is 
 aimed at allowing efficient coping and adaptation to stress , and proficient adjustment of 
 social support would make successful adaptation possible . moreover , research by cohen and 
 wills21 suggests that social support is 
 a significant coping resource , reducing stress and improving personal adaptation levels by 
 reducing pessimistic emotions while promoting optimistic emotions . the present study demonstrated there is a negative correlation ( r=0.260 , p<0.01 ) 
 between social support and the parenting stress of mothers . this result was comparable to 
 those of several previous studies3 , 8 , 16 , 22 , 23 
 that reported a negative correlation between social support and parenting stress , and that 
 increased social support yielded decreased parenting stress . furthermore , in hierarchial 
 multiple regression analysis , social support was independently examined as formal support 
 and informal support , but of parenting stress only informal support was identified as a 
 significant predictor ( = 1.117 , p<0.01 ) . in other words , informal support has a perceptible influence on the parenting stress of 
 mothers of children with disabilities , rather than formal support , indicating that emotional 
 intervention is relatively indispensable for mothers of children with disabilities . in his 
 research , jeon jae - il24 acknowledged the 
 significance of formal support based on an analysis of the most influential support , in 
 affecting the quality of life of mothers of children with disabilities . kim sung - su25 revealed that an increased level of social 
 support positively influenced childhood negligence while increased economic stress 
 contributed to increased childhood negligence of children with developmental disorders , as 
 well as the level of depression of mothers . results of the in - depth survey of the present 
 study disclosed a firm demand for lessening the physical and financial burden of caring for 
 disabled children , indicating the significance of formal support for mothers , and the 
 necessity of organizing a relevant welfare support system . in summary , the present study revealed that the characteristics of children with cp and 
 mothers , as well as social support intercorrelated , and that social support reduces the 
 burden and stress of parenting experienced by mothers . therefore , we must understand and 
 ameliorate the adversity , physiological and psychological afflictions experienced through 
 parenting of children with cp . in addition , the responsibility of parenting for children 
 with disabilities must be administered at a national level and various support programs must 
 be comprehensively provided for mothers to maintain their psychological and physical 
 health . first , there are difficulties in the generalization of the results of the present study . information concerning children with cp who are enrolled in special - education schools or 
 those who live at home , was not been incorporated . therefore , it may be impractical to apply 
 the results to all mothers of children with cp , and an expanded sampling region and a large 
 number of subjects will be essential in future studies . second , research into social support for not only the mother of children with cp , but for 
 the members of the family should be conducted . in particular , the brothers and sisters of 
 children with disabilities should be carefully studied and research on understanding the 
 difficulties and negligence felt by siblings is required . third , during the conduct for the present study , we perceived that there had been 
 inadequate research into the leisure activities of mothers of children with disabilities . various studies of leisure activities , which may improve the quality of life for mothers , 
 must be conducted .
[ purpose ] this study investigated the effect of perceived social support on the 
 parenting stress of mothers who have children with cerebral palsy ( cp ) . 
 [ methods ] this 
 study was conducted using surveys , literature review , and interviews . 
 survey data were 
 collected from 181 mothers of children ( under 18 years of age ) with cp . [ results ] 
 level of 
 disability , mother 's health status and social support were significant predictors of the 
 parenting stress of mothers . 
 [ conclusion ] we have to comprehend and share the 
 psychological and physical affliction of mothers having much difficulty nurturing children 
 with cp . 
 also , the government should take social responsibility for the upbringing of 
 their children , developing back - up programs for mothers and making them comprehensively 
 available to support the psychological and physical health of mothers of children with 
 cp .