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Approximately 4400 athletes from 184 nations competed in 22 sports at the 2024 Paris Paralympic Games. However, it is recognised that athletes with more severe disabilities and high support needs are under-represented in sport, and strategies to increase representation are required. Focusing on individuals with cerebral palsy (CP), we present evidence that people with high support needs are also under-represented in Para sport and exercise medicine (P-SEM) research. We outline why single case experimental designs (SCEDs) are a rigorous and effective means of addressing under-representation in P-SEM research.
Cerebral palsy
CP is an eligible underlying health condition for 17 of the 22 Paralympic sports. It results from a non-progressive brain lesion and is defined as a heterogeneous group of permanent disorders affecting movement and posture.1 CP heterogeneity is multidimensional and can be classified based on:
Neurological subtype: Spastic CP (quadriplegia/diplegia/hemiplegia); dyskinetic; ataxic; and mixed.2 Subtypes vary in severity and anatomical distribution.
Functional effects: The Gross Motor Function Classification System (GMFCS) is the most common and has five levels: GMFCS level I (least severe) and II are able to walk independently; GMFCS IV/V use wheeled mobility and typically have high support needs (CP-HSN).
Additionally 95% of people with CP have >1 comorbidity2 but CP-HSN have a greater prevalence of serious comorbidity including cortical blindness, deafness, gavage feeding and seizure disorders.3
Exercise training research in people with CP
At least three major reviews have analysed randomised controlled trials (RCTs) that evaluate exercise training in people with CP and all report that CP-HSN participants are under-represented.4–6 CP-HSN constitutes approximately 30% of the CP population7 but …
Footnotes
Contributors ST is the guarantor of this work. All authors made substantial contributions to conception of the work, provided critical revisions, approved the final version and agreed to be accountable for the accuracy and integrity of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests ST, JC and EB work for The University of Queensland, the Official Higher Education Partner for Paralympics Australia. EB is on secondment as Head of Parasport with the Queensland Academy of Sport and Paralympics Australia. ST is a member of the International Paralympic Committee’s Classification Compliance and Oversight Committee and a member of World Para Athletics Classification Advisory Group.
Provenance and peer review Not commissioned; externally peer reviewed.