The SPORTS Participation Framework: illuminating the pathway for people with disability to enter into, participate in, and excel at sport.

BACKGROUND: Sports participation for people with disabilities exists at the intersection of health, sport, and education sectors. However, no common framework and language exist to describe the stages of sports participation. OBJECTIVE: To present the background to the SPORTS Participation Framework, and how it can be used to illuminate the path that people with disability may travel to enter into, participate in, and enjoy and excel at all levels of sport. METHOD: The SPORTS Participation Framework includes six stages drawn from mainstream sports pathways and models used to classify barriers to sports participation for people with disabilities: (S) Screening, goal setting and individual preparation, (P) Practitioner led, peer-group sports interventions, (O) Organised junior entry-point sports programs, (R) Recreational sport (non-competitive), (T) Team competition (school/club representation), and (S) State, National, and International competition. RESULTS: For each stage, this paper describes the content of sports activities, the context in which they are performed, key stakeholders, barriers to participation, available evidence, and case studies. CONCLUSIONS: The SPORTS Participation Framework presents a structure to navigate the stages of introducing and promoting lifelong sports participation for people with disabilities. It scaffolds clear communication, governance, and policy across health, sport, and education sectors, and supports clinicians and researchers to address barriers to participation at each stage to improve individual and population-wide participation in sport for people with disabilities.

Exercise testing for children with cystic fibrosis: A systematic review.

BACKGROUND: Exercise testing is routinely used to measure exercise capacity in children with cystic fibrosis (CF). Various tests are available, however the psychometric properties of these measures have not been systematically reviewed for this population. METHOD: A systematic search of electronic databases (PubMed, Web of Science, Medline, CINHAL, Cochrane, and PEDro) was performed to identify papers that: (a) reported original psychometric data, (b) examined a measure of exercise capacity, (c) examined children with CF aged eight to 18 years; and (d) were published in English after 1950. The level of psychometric evidence was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS: Searches identified 1025 papers. Forty-six papers were included, covering 15 tests: incremental cardiopulmonary exercise test using a cycle ergometer (CPET(cycle)) or treadmill (CPET(treadmill)), 6 minute walk test (6MWT), modified shuttle test (MST), 3-minute step test (3MST), 2 minute walk test (2MWT), Bratteby walk test, intermittent sprint test, speed ramp test, incremental step test, forward-backwards jump test (FBJT), astride jump test (AJT), motor quotient test, Munich fitness test, and Glittre ADL test. CONCLUSION: There is a plethora of exercise tests available with varying psychometric robustness. The CPET, 6MWT, and MST have fair to good psychometric properties, but each with their clinical advantages and limitations. Thus, a Selection Guide was developed to assist clinicians and researchers in selecting the most appropriate exercise test for various situations.

CyFiT telehealth: protocol for a randomised controlled trial of an online outpatient physiotherapy service for children with cystic fibrosis.

BACKGROUND: Telehealth and telemonitoring is an emerging area of study in people with cystic fibrosis (CF), with the potential of increasing access to care, and minimising infection control risks to patients without compromising their health outcomes. To date, limited evidence is available to support the use of telehealth in paediatric population with CF in a clinical setting. This study aims to investigate the utility of a multimodal telehealth-based outpatient physiotherapy service and assess its effect on quality of life, functional exercise capacity, hospital admission and intravenous antibiotic requirements, lung function, processes of care, participation in activities of daily living, and health economics associated with operating an innovative service. METHOD: This single centre, prospective, parallel, randomised, controlled, non-inferiority trial aims to recruit 110 children with CF between the ages 8 to 18 years of age. Participants will be randomised to the Usual Outpatient Physiotherapy Service group (Usual OPS) or the telehealth intervention group (CyFiT OPS). Quality of life, participation in activity of daily living, functional exercise capacity and patient perception of care will be examined every six months using the Cystic Fibrosis Questionnaire-Revised (CFQ-R), Children's Assessment of Participation and Enjoyment (CAPE), Preferences for Activities of Children (PAC) questionnaire, Modified Shuttle Test-25 (MST25), and Measure of Process of Care (MPOC-20) questionnaire. Physiological measurements collected during routine clinical visits such as spirometry, body weight and height, information will be retrospectively retrieved via a chart review at the end of the study. DISCUSSION: We anticipate that this multi-modal telehealth service will deliver a comparable service to traditional face-to-face models. An alternative to existing outpatient physiotherapy services may potentially increase patient options for access to care and patient-orientated outcomes such as quality of life. If deemed appropriate, the new model of care can be integrated into clinical practice immediately. TRIAL REGISTRATION: This trial is registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617001035314 ) last updated 17th July 2018.

A touchy topic: tactile assessment among pediatric therapists.

PURPOSE: Tactile impairments affect over 77% of children with unilateral cerebral palsy (CP). This study aimed to examine the current practices of pediatric therapists in relation to tactile assessment and the barriers to carrying out tactile assessment in children with CP. METHOD: The study was in two parts. In part one, pediatric therapists (n = 35) completed a questionnaire detailing their current knowledge and the use of tactile assessments in children. In part two, therapists (n = 12) completed a questionnaire based on the Theoretical Domains Framework examining the barriers and facilitators to completing tactile assessments in clinical practice. RESULTS: Most therapists (over 90%) carry out tactile assessments in the minority (less than 25%) of children with CP that they treat. Therapists reported the need for improved knowledge/skills (n = 24) and confidence (n = 19) in carrying out tactile assessments, alongside the provision of necessary equipment (n = 17). Qualitative reports also suggested that organizational assessment guidelines and templates may facilitate the implementation of tactile assessment. CONCLUSIONS: A multi-faceted knowledge translation strategy to address the barriers to tactile assessment among pediatric therapists needs to be developed. Implications for rehabilitation Pediatric occupational therapists and physiotherapists may not be completing tactile assessments according to current evidence-based recommendations. Therapists identified five main barriers, including a lack of knowledge, skills, belief in their capabilities (confidence), behavioral regulation (organizational procedures), and environmental context (e.g., equipment). Therapists recommended several potential facilitators, including access to necessary equipment, procedures, record sheets, training in tactile assessments, and research supporting related interventions. Service providers are encouraged to develop multi-faceted knowledge translation strategies that address these barriers and maximize facilitators.

Reproducibility of Muscle Strength Testing for Children with Spina Bifida.

AIMS: Examine the inter-rater reliability of the Daniels and Worthingham (D&W) manual muscle test (MMT) protocol for children with spina bifida between experienced and novice physiotherapists. METHODS: Thirteen children with spina bifida (two males) aged 6 to 18 years were recruited from a spina bifida service in a state-wide tertiary children's hospital. Each child had the muscle strength of 19, and lower limb muscles were measured bilaterally by one experienced and one novice physiotherapist using the D&W MMT protocol. Examiner and limb order were counterbalanced. Standard training and recording sheets were used. Agreement between raters was examined with quadratic weighted kappa (κw2), percentage exact agreement (%EA), and the Bland-Altmann Limits of Agreement (LoA). Minimal detectable change (MDC) was calculated. RESULTS: Inter-rater agreement between the experienced and novice raters was excellent (κw2 = 0.95; 95% confidence interval: 0.94-0.96); %EA was good (72.3%); and clinically appropriate LoA levels were -1.30-1.40. The MDC was 1.11 points on a six-point MMT scale. CONCLUSIONS: The D&W MMT protocol, when used after standard training and with standard recording sheets, was reproducible for children with spina bifida, aged 6-18 years.

Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for Children With Cerebral Palsy.

OBJECTIVE: To identify whether consensus can be achieved in how clinicians and researchers define, describe, assess, and treat postural control dysfunction in children with cerebral palsy (CP). DESIGN: Delphi study with 3 iterative rounds. SETTING: Electronic survey. PARTICIPANTS: Researchers and/or clinicians (N=43) from 7 countries with a mean ± SD of 20±11 years of experience working with children with CP participated. Participants included authors of published works on postural control in CP (identified from a recent systematic review), members of the Australasian Academy of CP and Developmental Medicine, and 2 major Australian rehabilitation providers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Delphi study consisted of 3 iterative rounds of surveys. In Round 1, respondents answered open-ended questions regarding their views on (1) definition items for postural control, (2) theoretical frameworks, (3) methods for assessment, and (4) interventions for postural control dysfunction in children with CP. Rounds 2 and 3 were made up of items generated by participants in Round 1 and combined with items identified from the literature. Participants indicated their level of agreement for each item on a 7-point Likert scale. Threshold for consensus was ≥85% agreement. RESULTS: Of 306 items generated, 174 reached consensus by Round 3. Most postural control definition items (90%) achieved consensus. Two theoretical frameworks (14%) reached consensus. Less than half (42%) of assessment items reached consensus. More individual assessment items (89%) reached consensus than multi-item tools (4%). Just over half (61%) of the items generated for interventions reached consensus. CONCLUSION: Consensus was achieved for a postural control definition. However, substantial research is needed to establish a comprehensive, postural control-specific framework and suite of assessments. These would provide a foundation to improve intervention selection and dosage.

Exercise interventions improve postural control in children with cerebral palsy: a systematic review.

AIM: The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). METHOD: A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct. RESULTS: Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence. INTERPRETATION: The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.

"Strong and steady": a community-based strength and balance exercise group for children with cerebral palsy.

PURPOSE: This study investigated the effect of an eight-week community-based strength and balance exercise group for children with cerebral palsy (CP). METHOD: Ten children with CP participated in the study (8-15 years; six male; GMFCS I = 6, II = 4; five diplegia; five hemiplegia). Muscle strength was assessed using dynamometry and functional strength tests (seated throw, distance jump, vertical jump). Balance was assessed using the Bruninks-Oseretsky Test of Motor Proficiency, the Movement Assessment Battery for Children (MABC), lateral and forward reach tests and the Timed-up and Go. RESULTS: Muscle strength improved in dominant side elbow flexors, hip abductors, ankle dorsiflexors and ankle plantarflexors (p = 0.018-0.042). Functional strength improved in seated throw (t = 2.7; p = 0.024), distance jump (t = -2.8; p = 0.025) and lateral step-up (p < 0.05). Balance improved on the MABC (t = 2.4; p = 0.040), lateral (p < 0.05) and forward reach (p < 0.05). CONCLUSION: This feasibility study translated research into sustainable practice, showing that a community-based, low dose, group exercise program can improve the balance and strength of children with CP within current funding capacity. Implications for Rehabilitation It has been known that strength and balance training in the clinical research setting with specialized equipment is effective for children with CP, but this study demonstrates the translation of research into clinical practice in a low-cost, low-dose group program. Significant gains in both muscle strength and balance can be achieved in an eight-week community-based gym group using simple equipment.

Reproducibility of tactile assessments for children with unilateral cerebral palsy.

A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were Semmes-Weinstein monofilaments: 75% (90%); single-point localization: 69% (97%); static two-point discrimination: 93% (97%); and moving two-point discrimination: 87% (97%). Test-retest reliability for registration and unilateral spatial tactile perception tests was high in children with CP (intraclass correlation coefficient [ICC] = 0.79-0.96). Two tests demonstrated a learning effect for children with CP, double simultaneous and tactile texture perception. Stereognosis had a ceiling effect for TDC (ICC = 0) and variability for children with CP (% exact agreement = 47%-50%). The Semmes-Weinstein monofilaments, single-point localization, and both static and moving two-point discrimination are recommended for use in practice and research. Although recommended to provide a comprehensive assessment, the measures of double simultaneous, stereognosis, and tactile texture perception may not be responsive to change over time in children with unilateral CP.

Tactile function in children with unilateral cerebral palsy compared to typically developing children.

PURPOSE: Tactile deficits have been understudied in children with unilateral cerebral palsy (UCP) using a limited range of tactile assessments. This study aims to characterize performance across a comprehensive battery of tactile registration and perception assessments in children with UCP and typically developing children (TDC). METHODS: Fifty-two children with UCP (Gross Motor Function Classification System I = 34, II = 18; Manual Ability Classification System I = 36, II = 16) and 34 TDC were assessed using Semmes Weinstein Monofilaments (tactile registration), and single-point localization, double simultaneous, static and moving two-point discrimination, stereognosis, and texture perception (tactile perception). RESULTS: Children with UCP performed consistently worse with their impaired hand than their unimpaired hand (Z = 2.77-5.61; p < 0.005). Both hands of children with UCP performed worse than either hand of TDC (Z = -2.08 to 5.23; p = 0.037-< 0.001). Forty percent of children with UCP had tactile registration and perception deficits, 37% had perception deficits only and 23% had no tactile deficit. The larger the tactile registration deficit, the poorer the performance on all tactile perceptual tests (r = 0.568-0.670; p < 0.001). CONCLUSIONS: Most children with UCP demonstrate poor tactile perception and over one-third also demonstrate poor tactile registration. We contend that tactile dysfunction may contribute to functional impairment and is a possible target for intervention. [ IMPLICATIONS FOR REHABILITATION: • Cerebral palsy (CP) is the most prevalent physical disability in childhood, with an incidence of approximately 2 cases per 1000 live births; about 35% of children with CP have unilateral cerebral palsy (UCP).• Assessment and treatment has been focused on the motor impairment; however, it is known that children with UCP are also likely to have sensory impairment.• Understanding the nature and severity of sensory, specifically tactile, impairment in children with UCP will assist therapists to direct treatment accordingly and possibly impact the motor impairment.]

Functional performance in young Australian children with achondroplasia.

AIM: The aim of this study was to determine population-specific developmental milestones for independence in self-care, mobility, and social cognitive skills in children with achondroplasia, the most common skeletal dysplasia. METHODS: Population-based recruitment from October 2008 to October 2010 identified 44 Australian children with achondroplasia aged 3 to 7 years. Consenting parents of 35 children (16 males, 19 females 14 aged 3y; 12 aged 5y; nine aged 7y) reported their child's self-care, mobility, and social cognition function using the Functional Independence Measure for Children (WeeFIM-II) at the ages of 3 (n=14), 5 (n=12), or 7 (n=9) years. Children were excluded from the study if they had an additional neurological or musculoskeletal condition. RESULTS: Functioning improved in children with achondroplasia between the ages of 3 and 5 years, but not subsequently. Milestones in the achondroplasia group were delayed across all ages and domains compared with normative reference data. Children with achondroplasia required greater caregiver assistance for self-care and mobility skills than typically developing children based on normative data. Social cognition appeared to be an area of relative strength. INTERPRETATION: Children up to 7 years of age with achondroplasia show delayed milestone acquisition and a greater need for caregiver assistance for all domains. As functional delays are likely to be related to common musculoskeletal impairments associated with achondroplasia, access to physiotherapists, occupational therapists, and speech and language pathologists skilled in achondroplasia management may assist children and families to become more independent, particularly around the time of starting school.

Tactile assessment in children with cerebral palsy: a clinimetric review.

This review evaluates the clinimetric properties of tactile assessments for children with cerebral palsy. Assessment of registration was reported using Semmes Weinstein Monofilaments (SWMs) or exteroception. Assessment of two-point discrimination was reported using the Disk-Criminator® or paperclip methods; Single point localization and double simultaneous were reported from the Neurosensory Motor Developmental Assessment (NSMDA); graphaesthesia was reported from the Sensory Integration and Praxis Test (SIPT); and stereognosis was assessed using Manual Form Perception from the SIPT and the Klingels method (Klingels, K. et al. (2010). Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably? Disability and Rehabilitation, 32(5), 409-416) and the Cooper method (Cooper, J., Majnemer, A., Rosenblatt, B., & Birnbaum, R. (1995). The determination of sensory deficits in children with hemiplegic cerebral palsy. Journal of Child Neurology, 10, 300-309). The SIPT and NSMDA demonstrated stronger content validity. Inter-rater reliability was excellent for SIPT (ICC = 0.99) and exteroception (k = 0.88). Test-retest reliability was excellent for exteroception (k = 0.89) and stereognosis (ICC = 0.86; 100%), moderate for SIPT (r = 0.69-0.74) and poor for SWM (k = 0.22). Together these assessments measure tactile registration and spatial perception. Temporal and textural tests are to be developed for comprehensive tactile examination.