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The power of Para sport: the effect of performance-focused swimming training on motor function in adolescents with cerebral palsy and high support needs (GMFCS IV) – a single-case experimental design with 30-month follow-up
  1. Iain Mayank Dutia1,2,
  2. Mark Connick1,3,
  3. Emma Beckman1,
  4. Leanne Johnston4,
  5. Paula Wilson1,
  6. Angelo Macaro1,
  7. Jennifer O'Sullivan1,
  8. Sean Tweedy1
  1. 1The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, Queensland, Australia
  2. 2School of Allied Health, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
  3. 3School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
  4. 4The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
  1. Correspondence to Dr Iain Mayank Dutia, The University of Queensland School of Human Movement and Nutrition Sciences, Saint Lucia, QLD 4072, Australia; i.dutia{at}uq.edu.au

Abstract

Objective This study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine whether the motor decline typical of adolescents with CPHSN occurred in these swimmers.

Methods A Multiple-Baseline, Single-Case Experimental Design (MB-SCED) study comprising five phases and a 30-month follow-up was conducted. Participants were two males and one female, all aged 15 years, untrained and with CPHSN. The intervention was a 46-month swimming training programme, focused exclusively on improving performance. Outcomes were swim performance (velocity); training load (rating of perceived exertion min/week; swim distance/week) and Gross Motor Function Measure-66-Item Set (GMFM-66). MB-SCED data were analysed using interrupted time-series simulation analysis. Motor function over 46 months was modelled (generalised additive model) using GMFM-66 scores and compared with a model of predicted motor decline.

Results Improvements in GMFM-66 scores in response to training were significant (p<0.001), and two periods of training withdrawal each resulted in significant motor decline (p≤0.001). Participant motor function remained above baseline levels for the study duration, and, importantly, participants did not experience the motor decline typical of other adolescents with CPHSN. Weekly training volumes were also commensurate with WHO recommended physical activity levels.

Conclusions Results suggest that adolescents with CPHSN who meet physical activity guidelines through participation in competitive swimming may prevent motor decline. However, this population is clinically complex, and in order to permit safe, effective participation in competitive sport, priority should be placed on the development of programmes delivered by skilled multiprofessional teams.

Trial registration number ACTRN12616000326493.

  • Para-Athletes
  • Rehabilitation

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Contributors IMD is the overall content guarantor and contributed to project design, data collection, analysis and manuscript preparation. MC contributed to project design. He conducted the analysis of the MB-SCED and longitudinal dataset and contributed to manuscript preparation. EB was a lead researcher on the project and contributed to project design, protocol development and manuscript preparation. LJ was a lead researcher on the project and contributed to project design, recruitment, data analysis and manuscript preparation. PW contributed to project design, data collection and analysis of the MB-SCED and manuscript preparation. AM contributed to project design, data collection and analysis of the MB-SCED and manuscript preparation. JO’S contributed to project design, data collection and analysis of the longitudinal dataset and manuscript preparation. ST was the lead investigator. He oversaw the ParaSTART programme and contributed to all aspects of the project.

  • Funding We gratefully acknowledge the funders of the work reported in this manuscript: (1) Queensland Academy of Sport; (2) Paralympics Australia; (3) Swimming Australia; (4) Sporting Hasbeens; (5) Gregory Terrace: St Joseph’s College; (6) Pat Rafter Cherish the Children. We also gratefully acknowledge the following individuals/groups who contributed to and facilitated the work reported in this manuscript: (1) The participants and their families; (2) Dr Gaj Panagoda—medical doctor; (3) Dr Jacki Walker—dietician; (4) Minnie Ma—physiotherapist; (5) Jean-Michel Lavalliere—swimming coach; (6) Nathan Seefeld —sport psychologist; (7) UQ Swim Club—community organisation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.