Modified sports interventions for children and adolescents with disabilities: A scoping review.

AIM: To establish the scope of the literature on modified sports interventions for children and adolescents with disabilities. METHOD: For this scoping review, articles were screened and the characteristics of studies were extracted. The modified sports interventions were described in terms of their structure, using the items of the Template for Intervention Description and Replication. Components of intervention treatment were described by using the language of the Rehabilitation Treatment Specification System. Results were analysed and validated by a group of professionals, using the Public and Patient Involvement strategy. RESULTS: Twelve studies were eligible for inclusion, investigating interventions for children with autism spectrum disorder, cerebral palsy, and other conditions. Most studies presented a moderate level of evidence. Active ingredients were repeated sports-related motor training and introduction to the sport through a 'learning by action' mechanism. The intervention target was gross motor skills performance, and intervention aims (indirect outcomes) were physical activity participation and different body functions. INTERPRETATION: The inclusion of stakeholders in this review helped to validate our findings about the characteristics and structure of modified sports interventions, to identify research gaps, and to provide a step process for clinical implementation. Future investigations are warranted of the effectiveness of modified sports investigations with better quality studies, including participation outcomes and studies with non-ambulant children.

Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo.

Resumo gráfico: Intervenções de esportes modificados para crianças e adolescentes com deficiência: Uma revisão de escopo.

OBJETIVO: Estabelecer o escopo da literatura sobre intervenção de esportes modificados para crianças e adolescentes com deficiência. MÉTODOS: Para esta revisão de escopo, os artigos foram selecionados e as características dos estudos foram extraídas. As intervenções de esportes modificados foram descritas quanto à sua estrutura, utilizando os itens do Template for Intervention Description and Replication (TIDieR). Os componentes do tratamento foram descritos usando a linguagem do Sistema de Especificação de Tratamento de Reabilitação. Os resultados foram analisados e validados por um grupo de profissionais, utilizando a estratégia de Envolvimento do Público e do Paciente. RESULTADOS: Doze estudos foram elegíveis para inclusão, investigando intervenções para crianças com transtorno do espectro do autismo, paralisia cerebral e outras condições. A maioria dos estudos apresentou nível de evidência moderado. Os ingredientes ativos foram o treino motor repetido relacionado com o esporte e a introdução à prática esportiva através do mecanismo de "aprendizagem pela ação". O alvo da intervenção foi a capacidade de execução das habilidades motoras grossas, e os objetivos da intervenção (resultados indiretos) foram a participação em atividades físicas e diferentes funções corporais. INTERPRETAÇÃO: As principais características e estrutura da intervenção, lacunas de pesquisa e um passo­a­passo para implementação clínica foram apresentados para melhorar sua compreensão. São necessárias investigações futuras sobre a eficácia das intervenções de esportes modificados com estudos de melhor qualidade, incluindo resultados de participação, e estudos com crianças não deambulantes.

Parents' perceptions of a modified sports intervention for children with cerebral palsy.

AIM: To explore the perceptions of parents of children with cerebral palsy (CP) participating in a modified sports intervention, Sports Stars Brazil. METHOD: Parents of children with CP (n = 15, 6-12 years old, nine males, six females), classified in Gross Motor Function Classification System levels I and II, who participated in the Sports Stars Brazil intervention, were recruited for this descriptive qualitative study. Children received the 8-week (1 hour per week) modified sports intervention. After the intervention, parents participated in a focus group. The F-word (fitness, family, fun, functioning, friends, and future) interpretation of the International Classification of Functioning, Disability and Health was used to guide the discussion. Participants were invited to report their experience of participating in the intervention using the F-words for a childhood disability model. Transcripts were coded using content analysis. RESULTS: Parents reported positive experiences of the Sports Stars Brazil intervention, including a decrease in sedentarism (fitness), improvement of motor skills (functioning), greater connection between child and family (family), better socialization (friends), increased participation in pleasurable activities (fun), and awareness of the importance of physical activity (future). All positive experiences were interconnected. INTERPRETATION: This study presents the ability of the Sports Stars Brazil intervention to integrate all aspects of functioning and supports its role as an engaging and promising intervention option for ambulant children with CP.

Effectiveness of Modified Sports for Children and Adolescents With Cerebral Palsy: A Pragmatic Study Protocol.

PURPOSE: Sports Stars is a modified sports intervention that aims to prepare individuals with cerebral palsy for the transition from usual physical therapy care to community sports participation. This is a pragmatic randomized controlled trial protocol of a Brazilian applicability of this intervention. METHOD: This study will compare the effectiveness of Sports Stars Brazil with standard care. Seventy-six children who walk and adolescents with cerebral palsy will be randomly assigned into an intervention or control group. The intervention group will receive 8 weekly group sessions. Each session will include 1 hour of sports-focused gross motor activity training and teamwork development, centered on popular Brazilian sports. Participation, levels of physical activity and, physical literacy domains will be measured at baseline, postintervention, and at 12-weeks of follow-up. DISCUSSION: The investigation of Sports Stars Brazil will provide high-quality evidence regarding the effectiveness of modified sports intervention to support participation in sports in this population.

High-level motor skills assessment for ambulant children with cerebral palsy: a systematic review and decision tree.

AIM: To examine the psychometric evidence for high-level motor skills assessment tools for ambulant, school-aged children with cerebral palsy (CP). METHOD: We searched five databases for population (children with CP aged 5-18y in Gross Motor Function Classification System levels I and II), assessment focus (high-level motor skills), and psychometric evidence. We evaluated evidence strength using the number of studies, quality, and conduct according to COnsensus-based Standards for the selection of health status Measurement INstruments checklists. RESULTS: Eleven assessments (39 studies) met the criteria. Seven high-level motor skills assessment items (Muscle Power Sprint Test, 10m Shuttle Run Test, 10×5m Sprint Test, vertical jump, standing broad jump, seated throw, and Timed Up and Down Stairs) had strong validity and responsiveness evidence. Jumping items and seated throw lacked reliability data. Four high-level motor skills assessment batteries (Functional Strength Measure in CP, Gross Motor Function Measure-Challenge, Peabody Developmental Motor Scale, and Test of Gross Motor Development, Second Edition) had moderate-to-strong validity and/or reliability evidence. Responsiveness data were only available for the Gross Motor Function Measure-Challenge battery. The decision tree was developed with five levels: clinical feasibility, relevance, tool design, clinical utility, and psychometric properties. INTERPRETATION: High-level motor skills assessment tools have strong psychometric evidence for ambulant, school-aged children with CP. The decision tree can assist clinicians and researchers in identifying appropriate tools to measure high-level motor skills. WHAT THIS PAPER ADDS: An evidence-based decision tree guides the selection of appropriate high-level motor skills assessment tools. Seven high-level motor skills assessment items have strong psychometric evidence and clinical utility for ambulant children with cerebral palsy. Four high-level motor skills assessment batteries with recreation and mobility items have emerging psychometric evidence in this population.

Percepções dos pais sobre uma intervenção de esportes modificados para crianças com paralisia cerebral.

OBJETIVO: Explorar as percepções dos pais de crianças com paralisia cerebral (PC) sobre uma intervenção de esportes modificados, intitulada Sports Stars Brasil. MÉTODOS: Pais de crianças (n = 15, com idades de 6 a 12 anos) com PC, classificadas nos níveis I e II do GMFCS, que participaram do Sports Stars Brasil, foram recrutados para este estudo qualitativo descritivo. As crianças receberam uma intervenção de esportes modificados de oito semanas (1 hora por semana). Após a intervenção, os pais participaram de um grupo focal. A interpretação das "minhas palavras favoritas" (saúde, família, diversão, funcionalidade, amigos e futuro) da Classificação Internacional de Funcionalidade, Incapacidade e Saúde foi usada para orientar a os grupos focais. As transcrições foram codificadas usando a metodologia de análise de conteúdo. RESULTADOS: Os pais relataram experiências positivas com o Sports Stars Brasil, incluindo a redução do sedentarismo ("Saúde"), melhora das habilidades motoras ("Funcionalidade"), maior conexão entre a criança e a família ("Família"), melhor socialização ("Amigos"), aumento na participação em atividades prazerosas ("Diversão") e conscientização sobre a importância da atividade física ("Futuro"). Todas as experiências positivas estavam interconectadas. INTERPRETAÇÃO: A capacidade do Sports Stars de integrar todos os aspectos do funcionalidade apoia seu papel como uma opção de intervenção promissora para crianças com PC deambulantes.

SPORTS STARS study protocol: a randomised, controlled trial of the effectiveness of a physiotherapist-led modified sport intervention for ambulant school-aged children with cerebral palsy.

BACKGROUND: Modified sport interventions run by physiotherapists have shown potential as cost-effective, engaging, and effective interventions to improve gross motor skills and support transition to real-world sports participation for children with cerebral palsy. At present, this population demonstrates decreased participation in physical activities and sport compared to peers due to barriers ranging from body function to accessibility challenges. Sport provides culturally relevant opportunities for social integration, community participation and physical activity and has been shown to improve the fitness, self-esteem, confidence and quality of life of children with disabilities. The Sports Stars physiotherapy group has been designed to support the development of a range of fundamental movement and sports skills through activity skill practice and participation in modified popular Australian sports. METHODS: This randomised, waitlist controlled, assessor blinded, superiority trial with two parallel groups will aim to compare the effectiveness of Sports Stars to standard care across all ICF domains. Children in the Sports Stars group are expected to demonstrate greater improvement in their individually-selected, sports related goals measured by the Canadian Occupational Performance Measure. This study will aim to assess sixty ambulant children aged six to 12 years with a diagnosis of cerebral palsy. Children will be excluded if they have had recent Botox or neurological/orthopaedic surgery. The Sports Stars intervention includes eight, one-hour, weekly physiotherapy group sessions with four to six participants and one lead physiotherapist. Outcome measures will be collected pre, post and 12 weeks post the immediate Sports Stars group to assess change immediately after, and at follow up time points. DISCUSSION: This will be the first study of its kind to investigate a culturally relevant sports-focussed fundamental movement skills physiotherapy group for ambulant children with cerebral palsy. The findings will add to a growing pool of evidence supporting group physiotherapy for children with cerebral palsy and the Sports Stars group will provide an avenue for children to transition from individual physiotherapy to mainstream and modified recreational and competitive sports. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617000313336 Registered 28, February 2017. WHO Universal Trial Number: U1111-1189-3355 Registered 1, November 2016.

Measuring psychological, cognitive, and social domains of physical literacy in school-aged children with neurodevelopmental disabilities: a systematic review and decision tree.

PURPOSE: To identify and assess the clinimetric properties of psychological, cognitive, and social competence assessment tools relevant to physical activity for school-aged children (5-17 years) with neurodevelopmental disabilities. METHODS: Seven electronic databases were searched. Study findings and methodologies were evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Psychometric strength of assessment tools was determined using Grading of Recommendations Assessment, Development and Evaluation principles (GRADE) (Trial registration: CRD42020180616). RESULTS: Study criteria were met by eight subscales from the BRIEF2, DMQ17, QI-Disability, SAID, and SDQ. Most subscales examined psychological competence (n = 5), with fewer addressing social competence (n = 2), or cognitive competence (n = 1). Validity was moderate to high strength for most subscales. Reliability was of moderate and unclear strength for two subscales. A five-level decision tree was devised to summarise: (1) physical literacy domains/elements, (2) populations, (3) assessment focus, (4) required resources, and (5) psychometric evidence. CONCLUSIONS: Subscales are available to assess psychological, cognitive, or social competence. For school-aged children with neurodevelopmental disabilities, these have moderate to high strength psychometric support. A decision tree will assist practitioners in subscale selection. Future studies are needed to establish gold standard assessment of physical literacy for this population.IMPLICATIONS FOR REHABILITATIONPsychological Activity Competence can be measured for children with neurodevelopmental disabilities, subscales from The Behaviour Rating Inventory of Executive Function, Second Edition (BRIEF2; The Dimensions of Mastery Questionnaire 17.0 (DMQ17); and The Quality of Life Inventory-Disability (QI-Disability).Cognitive Activity Competence can be measured using a subscale from The Scale of Attention in Intellectual Disability (SAID).Social Activity Competence can be measured using subscales from the BRIEF2, and The Strengths and Difficulties Questionnaire (SDQ).Clinicians can use the Physical Literacy decision tree to guide selection of these tools.

Moving together is better: a systematic review with meta-analysis of sports-focused interventions aiming to improve physical activity participation in children and adolescents with cerebral palsy.

PURPOSE: To analyze the effectiveness of sports-focused interventions on the participation of children and adolescents with cerebral palsy (CP). METHODS: Study searches were conducted on EMBASE, PubMed, Scielo, PEDro, CINAHL, SPORTDiscuss in June 2022. We included randomized controlled trials that investigated the effectiveness of sports-focused interventions in children and adolescents with CP in comparison with control. Risk of bias was assessed with PEDro scale and evidence certainty with GRADE approach. Data were pooled in random-effects meta-analyses and results were presented as standardized mean differences. RESULTS: Ten RCTs were selected with different modalities, mostly for ambulant children and adolescents. Significant pooled effects on participation in leisure-time physical activity were seen only in group interventions (modified sports, gross motor training, and fitness training), in comparison with control [SMD(95% CI) = 0.32(0.01-0.73) p = 0.04]. No pooled effects were seen in participation in other life areas in comparison with control (p > 0.05). Current certainty of evidence of all sports-focused interventions included was moderate due to imprecision. CONCLUSION: Positive results on leisure-time participation were seen at short-term follow-up for group interventions. Sports-focused interventions did not improve participation in other life areas, reinforcing the importance of specificity when conducting participation interventions. Studies investigating sports-focused interventions including non-ambulatory individuals are still necessary. IMPLICATIONS FOR REHABILITATIONSports-focused interventions target leisure-time physical activity participation.They present moderate evidence of their effectiveness to improve physical activity participation in individuals with cerebral palsy.Group interventions are effective in improving leisure-time physical activity participation.Sports-focused interventions did not improve participation in other life areas.

Sports Stars Brazil in children with autism spectrum disorder: A feasibility randomized controlled trial protocol.

BACKGROUND: Autism Spectrum Disorder (ASD) children have lower levels of participation in recreational and sporting activities when compared to their peers. Participation has been defined based on the Family of Participation-Related Constructs (fPRC) which defines participation as including both attendance and involvement, with sense of self, preferences and activity competence related to a child's participation. Modified sports interventions such as Sports Stars can act on physical literacy and some of the fPRCs components. This study aims to assess the feasibility of the Sports Stars Brazil intervention for children with ASD. METHODS: This study will be conducted with 36 participants with ASD aged 6 to 12 years old following the CONSORT for pilot and feasibility recommendation. Participants will be randomly allocated into two groups. Intervention group will receive eight, weekly Sports Stars sessions. Each session will include of sports-focused gross motor activity training, confidence building, sports-education and teamwork development. Study assessments will occur at baseline, immediately post-intervention and 20-weeks post-randomization. First, we will assess process feasibility measures: recruitment, assessment completion, adherence, adverse events and satisfaction. Second, we will investigate the scientific feasibility of the intervention by estimating the effect size and variance at the level of achievement sports-related activity and physical activity participation goals (Goal Attainment Scaling), activity competence (Ignite Challenge, Test of Gross Motor Development-second edition, Physical Literacy Profile Questionnaire, Pediatric Disability Assessment Inventory-Computer Adaptive Test-PEDI-CAT-mobility, 10×5 Sprint Test and Muscle Power Sprint Test), sense of self (PEDI-CAT-responsibility), and overall participation at home, school and community, (Participation and Environment Measure for children and young people, PEM-CY). DISCUSSION: The results of this feasibility study will inform which components are critical to planning and preparing a future RCT study, aiming to ensure that the RCT will be feasible, rigorous and justifiable. TRIAL REGISTRATION: The trial was registered with the Brazilian Registry of Clinical Trials database (ID: RBR-9d5kyq4) on June 15, 2022.

SPORTS STARS: a practitioner-led, peer-group sports intervention for ambulant children with cerebral palsy. Activity and participation outcomes of a randomised controlled trial.

PURPOSE: To investigate the effectiveness of a practitioner-led, peer-group sports intervention for children with CP at GMFCS Level I-II. METHOD: Children with CP (GMFCS I-II; 6-12 years) were randomised to Sports Stars or waitlist-control groups. Sports Stars included eight-weeks (eight hours) of physiotherapist-led, sports-specific gross motor activity training, sports education, teamwork development and confidence building. Sports participation was measured using self-identified participation goals (modified Canadian Occupational Performance Measure (mCOPM)). Physical competence was measured with mCOPM activity goals and high-level gross motor batteries (Test of Gross Motor Development (TGMD-2); GMFM-Challenge) and walking (Timed-Up-and-Go), running (Muscle Power Sprint Test; 10x5m Sprint Test), jumping (Standing Broad Jump; Vertical Jump) and throwing (Seated Throw) items. General participation and quality of life were also measured. Outcomes were measured pre, post and 12-weeks post-intervention. Data were analysed using linear mixed models. RESULTS: Fifty-four children were randomised into Sports Stars (n = 29; GMFCS I = 7, II = 22; male = 19; 8.9 ± 2 years) or waitlist-control groups (n = 25; GMFCS I = 10, II = 15; male = 14; 8.6 ± 2 years). The Sports Stars group improved sports participation and activity goals (mCOPM F = 5.49-10.29, p < 0.001) and sports-specific physical competence (TGMD-2, F = 3.45-5.19, p = 0.001-0.009) compared to the waitlist-control. CONCLUSION: Sports Stars is effective for improving sports-specific participation and physical competence for children with CP.Implications for rehabilitationSports Stars improves performance and satisfaction in sports-specific participation and activity goals for ambulant children with CP.Sports Stars improves sports-specific physical activity competence in locomotor and object control skills.Sport-specific interventions should incorporate sport-specific gross motor activity training as well as sports education, confidence building and teamwork.

SPORTS STARS: a practitioner-led, peer-group sports intervention for ambulant, school-aged children with cerebral palsy. Parent and physiotherapist perspectives.

BACKGROUND: Sports participation is an important goal for children with cerebral palsy classified at GMFCS Level I or II, however there are no studies of parent or physiotherapist perspectives on effectiveness or overall acceptability of transition-to-sports interventions. METHODS: Parent and physiotherapist perspectives of Sports Stars: a novel, practitioner-led, peer-group sports intervention (Trial registration: ACTRN12617000313336) were collected from Sports Stars Session Reports (39 children, 6-12 years, GMFCS I = 11, II = 28, Female = 12), Fidelity Evaluations (28 children), and Perspectives Surveys (Parents = 29, female = 26; Physiotherapists = 8, female = 5). Outcomes were perceived impact on: (1) sports Participation (Attendance, Involvement), (2) sports Activity Competence across Physical, Social, Cognitive and Psychological Physical Literacy domains and (3) overall acceptability. RESULTS: Over 84% of children Attended most sessions. Physiotherapists rated session Involvement as high (median = 3/4). In Session Reports, physiotherapists recorded quantitative improvements in Physical and Cognitive performance and described improvements across all domains. Parents reported improvements across all domains, with comments focusing on Social and Psychological performance. All physiotherapists (8/8) and most parents (26/29) reported a community-based peer-group was the intervention design of choice for sports-focused goals. CONCLUSIONS: Parents and physiotherapists perceived Sports Stars, a practitioner-led, peer-group sports intervention, as effective and acceptable for children with cerebral palsy with sports-focussed goals.IMPLICATIONS FOR REHABILITATIONParents and physiotherapists agree that Sports Stars improved sports Participation and Physical, Social, Psychological and Cognitive Activity Competence for children with cerebral palsy.Children with sports-focused goals should be offered practitioner-led, peer-group sports interventions in community environments.Therapists should design sports interventions with Physical, Cognitive, Social and Psychological content and outcomes.

Performance of school-aged children with cerebral palsy at GMFCS levels I and II on high-level, sports-focussed gross motor assessments.

PURPOSE: To investigate performance of children with cerebral palsy (CP) at GMFCS Levels I-II on sports-focussed gross motor assessments; and concurrent validity of mainstream and CP-specific high-level assessment batteries and field tests. METHODS: Fifty-four children (6-12 years) with CP at GMFCS I-II completed the Test of Gross Motor Development-second edition, Gross Motor Function Measure-Challenge Module, Muscle Power Sprint Test (MPST), 10 × 5 m Sprint Test (10 × 5 mST), Vertical Jump, Broad Jump, and Seated Throw. Correlations between measures, age and mobility level, and group differences between age and mobility level were examined and content analysis performed. RESULTS: Children at GMFCS I demonstrated significantly higher gross motor assessment battery scores than children at GMFCS II (U = 73.5-109.0, p < 0.001). Performance improved with age for children at Level I but not II. Children with higher overall motor scores scored higher on running (MPST, 10 × 5 mST, r = -0.516 to -0.816, p < 0.001), jumping (Vertical Jump, Broad Jump, r = 0.499-0.774, p < 0.001) and throwing (Seated Throw, r = 0.341-0.500, p = 0.012 < 0.001) field tests. CONCLUSIONS: High-level gross motor assessments were achievable and appropriately challenging for children with CP at GMFCS I-II. Scores discriminated between performance and were associated with mobility level. Concurrent validity was established between gross motor assessment batteries, and locomotor field tests.IMPLICATIONS FOR REHABILITATIONFor children with cerebral palsy at GMFCS I-II, sports-focussed assessments should be used to assess high-level gross motor function.The Gross Motor Function Measure-Challenge and Test of Gross Motor Development demonstrate no ceiling for children with cerebral palsy at GMFCS I-II.Single-item running and jumping field tests provide targeted skill assessment and estimate sports skills for children with cerebral palsy.