Assessing the Match Physical Responses of International Referees for Footballers with Cerebral Palsy: A Tournaments and Halves Comparative Analysis.

Similar to conventional football, the modality dedicated to footballers with cerebral palsy (CP) requires referees who cope with the physical demands imposed during competitive matches to apply the rules of the game. While a significant body of research has explored the physical demands on referees in mainstream football, there is a noticeable lack of data regarding CP football. This study aimed to examine the physical response of international referees participating in different levels of world competitions for footballers with CP. Thirteen international referees, who officiated 49 matches in the men's 2022 World Cup (1st to 15th ranked teams) and 2022 World Championships (16th to 30th ranked teams), participated in this study. A cross-sectional design was used to determine the physical responses and compare the 1st and 2nd halves and the performance in the different tournaments, recording physical variables throughout the matches. Significant higher physical responses were observed in the World Cup in comparison to the World Championship. Overall, high-level tournaments have been shown to elicit more intense physical responses from referees officiating CP football matches compared to lower-level tournaments. For the World Cup, a significantly higher number of accelerations and decelerations were registered in the 1st half compared to the 2nd half. This information may be useful for the strength and conditioning coaches of referees to plan weekly training sessions more specifically and adjust the periodical training load and post-match recovery protocols.

Evaluating the Validity of Tests to Predict Sprint and Change of Direction Speed in Para-Athletes With Brain Impairments.

Maximum running speed is a performance determinant in para-athletics and cerebral palsy football. Sixty international para-athletes with brain impairments completed five activity-limitation tests (standing broad jump, four bounds for distance, split jumps, 10-m speed skip, and running in place) and two criterion tests (40-m sprint and modified agility test). The same three tests (standing broad jump, four bounds for distance, and 10-m speed skip) that correlated with running performance in nondisabled runners (.67 < r < -.82; p < .05; 75% of variance) also correlated in para-athletes with brain impairments (.41 < r < -.62; p < .01; 55% of variance). Standing broad jump, four bounds for distance, split jumps, and running in place also correlated with change-of-direction speed (.43 < r < -.63; p < .01; 58% of variance). Results indicate that methods of classification for para-athletics with nondisabled runners are also valid with para-athletes with brain impairments, and new sport-specific relationships were found for assessing the performance of rapid and short sprints toward different directions, specific of a team para-sport like cerebral palsy football.

Sex differences in change of direction deficit and asymmetries in footballers with cerebral palsy.

The aims of this study were (1) to describe and examine differences in change of direction (COD) performance and the magnitude of asymmetries in para-footballers with cerebral palsy (CP) and controls and (2) to evaluate the association between COD outcomes and linear sprint performance. Twenty-eight international para-footballers with CP and thirty-nine non-impaired football players (control group) participated in this study. All participants completed a 10-m sprint and two attempts of the 505 COD test with the dominant and non-dominant leg. The COD deficit was calculated using the difference between the 505 test and the 10-m sprint time, while the asymmetry index was determined by comparing each leg's completion time and COD deficit. Players across groups showed interlimb asymmetries between the dominant and non-dominant legs in COD outcomes and deficit (p < 0.05, dg = -0.40 to -1.46), although these asymmetries imbalance were not significantly different between the sexes with and without impairment. Males with CP exhibited a faster directional COD speed and a shorter COD deficit than their female counterparts (p < 0.01, dg = -1.68 to -2.53). Similarly, the control group had faster scores than the CP groups of the same sex (p < 0.05, dg = 0.53 to 3.78). Lastly, the female CP group and male control groups showed a significant association between sprint and the COD deficit in the dominant leg (p < 0.05, r = -0.58 to 0.65). Therefore, the use of directional dominance, the COD deficit, and asymmetry outcomes could be helpful for classification purposes to assess the impact of the impairment on sport-specific activity testing according to sex.

Comparison of the Physical Response During Official Matches and Small-Sided Games in International Cerebral Palsy Footballers: Implications for Evidence-Based Classification.

This study aimed to analyze whether there are differences and associations in the physical responses in international-level cerebral palsy footballers between official matches and 2v2 small-sided games (2v2-SSG). One hundred seventy international cerebral palsy footballers participated in this study during three international championships. The physical responses of mean and maximum velocities, total distance, distance covered at different intensities, short-term actions, and player load were collected during 2v2-SSG and the real competition. The mean velocity, total distance, jogging, medium- and high-intensity distances, the number of moderate/high accelerations, decelerations, and player load were relatively higher in the 2v2-SSG than in the official matches. Even though the 2v2-SSG could become an appropriate drill to include during the classification process, due to the differences between a 2v2-SSG and the official competition, it is necessary to deepen the scientific knowledge for developing observation methods during real competition to strengthen the relationships between eligible impairments and activity limitation.

Multi-joint isometric measurement for the evidence-based assessment of upper limb strength impairment in wheelchair athletes with different health conditions: a preliminary study.

The present study presents a novel specific multi-joint isometric test to assess upper limb strength impairment for evidence-based classification in wheelchair sports. Sixteen wheelchair athletes participated in this study and were classified according to their type of physical impairment and health condition as follows: athletes with neurological impairment (ANI, n = 5) and athletes with impaired muscle power (IMP, n = 11). In addition, six non-disabled participants formed a control group (CG, n = 6). All the participants performed the isometric propulsion strength test (IPST), evaluating pushing and pulling actions, and two wheelchair performance tests. Excellent relative intra-session reliability scores were obtained for strength values for the ANI, IMP and CG groups (0.90 < ICC < 0.99) and absolute reproducibility showed acceptable scores of SEM (< 9.52%) for IPST pushing action. The ANI had significantly lower scores in strength and wheelchair performance than the IMP and the CG, while no differences were found between the IMP and the non-disabled participants. In addition, no correlations were found for wheelchair athletes between the isometric upper limb strength measure and wheelchair performance. Our findings suggest that the IPST is a valid test for strength measurement in upper limb impairment wheelchair athletes with different health conditions, which must be used in combination with a performance test to obtain a holistic assessment of this population.

Physical responses by cerebral palsy footballers in matches played at sea level and moderate altitude.

The main objective of this study was to compare the physical response of para-footballers with cerebral palsy (CP) in official international football matches played at moderate altitude and sea level locations. Eighty-seven international CP footballers participated in this study. We divided participants according to the place of the international competition [sea level group (SLG) and moderate altitude group (MAG)], sport classes (i.e., FT1, FT2, and FT3), and match playing time (i.e., <20 min, 20‒40 min, and >40 min). We recorded the physical response using global position system devices during matches. This study showed that MAG described a lower physical response than SLG on total distance, distance covered at different intensities, and the number of accelerations and decelerations. FT2 and FT3 presented a similar pattern, where we found significant differences for total distance, distance covered at lower and high intensities and moderate accelerations, and decelerations. Considering the playing time during altitude matches, the 20‒40 min and >40 min groups obtained more marked differences in the physical response variables. Para-footballers with CP who competed under altitude conditions showed a lower physical response during football matches, suggesting the implementation of specific preparation and training strategies to face the demanding environmental conditions.

Influence of upper-limb muscle strength on the repeated change of direction ability in international-level wheelchair basketball players.

This study aims 1) to compare repeated change of direction ability (rCODA) and bench press (BP) between low (A category, ≤2.5) and high (B category, ≥3.0) sport classes and 2) to analyse the relationships between rCODA and BP performance in a sample of wheelchair basketball (WB) players. Seventeen world-class WB players volunteered participated in this study. All the players undertook two tests: the repeated (x12) Modified Agility T-test (rMAT) to measure the rCODA and the movement velocity in a BP test. No significant differences were observed between categories in the rMAT and BP. For the total sample, BP variables with a mean propulsive velocity of 1 m·s-1 (V1LOAD) largely correlated with all the full rMAT outcomes (r>-0.625; p< 0.05). Having a better BP could be favourable to perform repeated efforts and this seems particularly relevant in fatigue conditions, and especially for the B category players.

Is impaired coordination related to match physical load in footballers with cerebral palsy of different sport classes?

Impaired coordination is a characteristic feature in cerebral palsy (CP) football players. This study aimed to determine the relationships of three coordination tests with match physical load during competition of para-footballers from different sport classes. Records from 259 para-footballers from 25 national teams were obtained in four international competitions held in 2018 and 2019. The three coordination tests were conducted prior to competition (i.e., rapid heel-toe, side-stepping, and split jumps), and physical match load was recorded by GPS devices during the real game: i.e., maximum/mean, total distance, distance covered at different speed zones, number of accelerations/decelerations at different intensities, and player load. FT1 and FT3 players have the lowest and highest performance in all the coordination tests, respectively, but inconclusive between-groups differences were obtained (p=0.022‒0.238). Split jumps and side-stepping tests are associated with the performance of moderate and high accelerations during competition (r = -0.20‒0.71; p<0.01). Significant correlations (r = 0.36‒0.71; p<0.01) were obtained between all the coordination measures. Coordination tests better discriminate those with more severe impairments and some evidence for the validity of the new CP football sport classes is provided. Further research is necessary to identify the portion of the variance in sports performance that coordination explains.

Time-Motion Characteristics and Physiological Responses of Para-Footballers With Cerebral Palsy in Two Small-Sided Games and a Simulated Game.

This study compared physical performance in a group of international cerebral palsy football players during two formats of small-sided games (SSGs) and performance in a simulated game (SG) according to players' sport classes (FT1, FT2, and FT3). Internal load (heart rate and rating of perceived exertion) and external load (total distance, distance covered at different velocities, maximum speed reached, acceleration, and deceleration) were obtained with global positioning system devices during two formats of SSGs (2-a-side/SSG2 and 4-a-side/SSG4) and an SG (7-a-side). SSG2 demands faster actions compared with SSG4/SG, and significant differences and large effect sizes were found in the distance covered in Speed Zones 5 (16.0-17.9 km/hr) and 6 (>18.0 km/hr; p < .05; .35<ηp2<.50, large). Lower moderate accelerations and decelerations per minute in SSG4/SG compared with SSG2 were also found (p < .01; .77<ηp2<.81, large). In the SSG2 task, the FT3 players reached maximum speeds, covered more distance at the highest intensities, and performed more moderate/high accelerations/decelerations and more sprints compared with FT1 and FT2 players (p < .05; -0.85 < dg < -4.64, large). The SSG2 task could be the best option for discriminating physical demands in important variables for cerebral palsy football performance between classes FT3 versus FT1/FT2.

Activity limitation and match load in para-footballers with cerebral palsy: An approach for evidence-based classification.

Classification is a hot topic in Paralympic sport, making the development of evidence-based and sport-specific classification systems mandatory. However, the development of measurements for exploring the relationships between the athletes' impairment and their activity limitation is a considerable scientific challenge in team Paralympic sport such as 7-side football (ie, CP Football). The aims of this study were 1) to describe the activity limitation and external match load (ML) differences among impairment profiles (FT) in international level footballers with cerebral palsy (CPFP) and 2) to analyze the relationship among the activity limitation and external ML variables. Forty-eight international male CPFP (23 ± 7 y; 174.7 ± 7.2 cm; 69.4 ± 9.2 kg; 22.7 ± 2.6 kg·m-2 ) participated in this study and were divided according to their impairment profile (FT5/6, FT7, and FT8). Significant differences (P < .05) have been observed among FT profiles in the activity limitation tests (ie, static balance, coordination, vertical jump, horizontal jump, acceleration capacity, and change of direction ability). Additionally, significant differences have been observed among FT profiles in certain ML values (ie, Velmax , High Acc and in Mod and High Dec), where generally, FT8 players reported the best performance values. On the other hand, especially in the FT5/6 and in the FT8 profiles, a large-to-very large significant relationship was observed between the CPFP activity limitation and the ML values. In general, the results of the present study show that players with a lower impairment have less activity limitation and better ML. This study concludes that the potential relationships between the impairments of hypertonia, ataxia, or athetosis and performance in this para-sport might be impairment-specific.

Effects of Maximal Strength Training on Perceived-Fatigue and Functional Mobility in Persons with Relapsing-Remitting Multiple Sclerosis.

Background and objectives: Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods: 26 participants with MS were balanced according to their pre-intervention fatigue scores and distributed into an MST group (n = 13) and a control group (CG; n = 13). The MST group completed eight weeks using high loads, evaluating detraining after ten weeks. Quadriceps and hamstring isokinetic (QPTIK; HPTIK) and isometric (QPTIM; HPTIM) peak torques were assessed using an isokinetic dynamometer. Effect size differences were estimated with the Hedges' g index (dg ). Fatigue was evaluated through the Fatigue Severity Scale (FSS), while functional mobility was assessed via the Timed Up and Go Test (TUG). Results: The MST significantly improved all the strength measurements after the intervention (Δ6.43-29.55%; p < 0.05) compared to the control group. FSS showed a significant reduction (59.97%, dg = 5.41, large). The MST group also reduced the TUG time (19.69%; dg = 0.93, large) compared to the control group. Improvements caused by the intervention did not remain after a 10-week follow-up, with decreases in strength performance from 4.40% to 13.86% (dg = 0.24-0.56, small to moderate), 112.08% in the FSS (dg = -3.88, large), and 16.93% in TUG (dg = -1.07, large). Conclusions: MST (up to 90% 1RM) seems to be a feasible and useful way to obtain clinically relevant improvements in the perceived-fatigue symptoms and functional mobility. Still, symptom improvements decrease after a 10-week detraining period.

A mathematical model for decision-making in the classification of para-footballers with different severity of coordination impairments.

Classification is a defining feature of Para-sport, and sports-specific classification systems determined through multidisciplinary scientific research are required, i.e., evidence-based and focused on the relationship between the impairment and the key performance determinants. Data envelopment analysis (DEA) was applied as a classification tool using a directional distance function (DDF) model. The aim of the study was to test the DEA as a possible classification tool in cerebral palsy football. We analyse the performance of 56 international para-footballers with hypertonia, ataxia or athetosis, who completed a 20-test battery with DEA models. Five of the tests are included in the model (change of direction: Illinois agility test; jumping: standing broad jump, four bounds for distance, and triple hop with the non-dominant leg; 10-m sprint/acceleration; and ball dribbling, both in a straight line and following a trajectory), showing that players with less impairment exhibit the highest efficiency. This outcome suggests that DEA models might be feasible for detecting and discriminating the performance and magnitude of impairment in cerebral palsy football, with an objective ranking of the athletes in relation to different physical performance tests. This study also provides reference scores for decision-making during classification and guidance for further research in team Paralympic sports.

Evaluation of the Official Match External Load in Soccer Players With Cerebral Palsy.

Yanci, J, Castillo, D, Iturricastillo, A, and Reina, R. Evaluation of the official match external load in soccer players with cerebral palsy. J Strength Cond Res 33(3): 866-873, 2019-The aims of this study were to analyze the official match external loads (i.e., total distance, distance covered at different speeds, accelerations, decelerations, player load [PL], peak metabolic power, and changes of direction [CODs]) of football players with cerebral palsy (CP) and to determine the external loads according to playing time (i.e., <20, 20-40, and >40 minutes). The external load of 31 international football players with CP (23.0 ± 6.6 years; 69.1 ± 9.0 kg; 174.8 ± 7.3 cm) was analyzed during a World Championship Qualification Tournament (n = 8 matches, 58 individual observations). Results showed that the football players with CP covered less distance at high-intensity running and sprinting, performing a smaller number of moderate and high-intensity accelerations and decelerations, had a lower PL, and performed fewer CODs in official matches compared with conventional football players as reported in other studies. The number of minutes played by the players (i.e., <20, 20-40, and >40 minutes) could significantly influence the players' match external load (effect size = 0.3-5.5, small to extremely large). The impairments presented by football players with CP affect players' match external loads, especially in short-term high-intensity neuromuscular actions.

Student Attitudes Toward Inclusion in Physical Education: The Impact of Ability Beliefs, Gender, and Previous Experiences.

This study addresses the associations between students' ability beliefs and attitudes toward inclusion in physical education, as well as the impact of gender and previous contact/participation with children with disability on these variables. A cross-sectional study was conducted with 976 students (491 girls and 485 boys; age 11-16 years), who responded to ability beliefs and attitudes questionnaires. Ability beliefs (entity and incremental) and the 3 sociodemographic variables predicted 20.4% and 9% of the behavioral and cognitive subscales of attitudes, respectively. Students with higher scores for entity beliefs of ability had a less favorable attitude toward inclusion. Girls reported more favorable attitudes toward inclusion than boys. Students who indicated previous participation in physical activities with children with disabilities showed attitudes that were more favorable in both the behavioral and cognitive subscales, while those who reported previous contact had more favorable attitudes in the behavioral subscale and lower entity beliefs. However, the 3 sociodemographic variables had a lower contribution to the explained variance of attitudes.

Monitoring Heart Rate Variability Before and After a Marathon in an Elite Wheelchair Athlete: A Case Study.

The purpose of this study was to analyze heart rate variability (HRV) oscillations before and after a marathon which involved trans-meridian air travel and substantial time zone differences in a professional wheelchair athlete with Charcot-Marie-Tooth (CMT) disease. The natural logarithm of the root mean square difference between adjacent normal R-R intervals (Ln rMSSD) was measured daily on the days before, including and following the race. Relative to baseline, small (-3.8 - -4.6%) reductions in LnRMSSD were observed following relocation and on race-day, indicating only minor effects of travel on cardiac-autonomic activity. On the morning following the marathon, a 23.1% reduction in Ln rMSSD was observed, which returned to baseline by 48 h. The race time set by the athlete was the world-leading time in his class. This case study showed that Ln rMSSD responses to marathon in an elite wheelchair athlete with CMT was similar to those previously reported among unrestricted endurance athletes.

Role of vision in sighted and blind soccer players in adapting to an unstable balance task.

This study tested whether a compensatory hypothesis exists on postural control during standing unstable balance tasks comparing blind soccer players (n = 7) to sighted soccer players (n = 15) and sighted sedentary individuals (n = 6). All subjects performed a pre-test, a training of ten practice trials on a single day, and a post-test balance test. All tests were performed on an unstable surface placed on a force platform and under closed-eyes conditions, and a final test was performed with open eyes. Balance performance was assessed by resultant distance (RD) and the magnitude of mean velocity (MV) of the centre of pressure (CoP) displacement, and EMG signals from the gastrocnemius lateralis, tibialis anterior, rectus femoris, and peroneus longus were measured with surface electromyography. Principal component analysis (PCA) on EMG muscular activation was used to assess EMG pattern differences during the balance tasks. All groups improved their performance, obtaining low scores for the closed-eyes condition balance task after the training period in RD, VM, and aids received to keep balance in the novel task, and no differences were found between groups or in interaction effects. Sighted individuals and the control group showed significantly lower RD and VM scores under open-eyes conditions than blind participants. As regards neuromuscular behaviour, three principal patterns explained 84.15% of the variability in the measured data. The theoretical improvement of the other senses caused by visual deprivation does not allow blind individuals to obtain better balance than sighted individuals under closed-eyes conditions, thereby reinforcing the prominent role of vision in integrating and processing the other sensory inputs. In addition, blind individuals seem to increase their muscular co-activation as a safety strategy, but this behaviour is not different to that shown by sighted people under closed-eyes conditions.

Study of reaction time to visual stimuli in athletes with and without a hearing impairment.

This study analyzes the differences in manual reaction time (RT) to visual stimuli in two samples of physically active persons: a group of athletes without hearing impairment (n = 79; M age = 22.6 yr., SD = 3.7) and a group of athletes with hearing impairment (n = 44, M age = 25.6 yr., SD = 5.0). Reaction time (RT) was measured and then differences between both groups were assessed by sex, type of sport (individual vs team sports), and competition level. RT to visual stimuli was significantly shorter for athletes with hearing impairment than for those without hearing impairment, with a significant sex difference (shorter RT for males), but no differences regarding type of sport or competition level. Suggestions for further research and sport applications are provided.

Effects of different contextual interference training programs on straight sprinting and agility performance of primary school students.

The aim of this study was to evaluate the effect of a different degree of contextual interference (CI) training program on the change of direction ability (CODA) itself and on the straight sprinting (SSP) performance (5 m and 15 m) in students in the first year of primary school. It also evaluated which CI training program was more effective. Eighty eight students (6.42 ± 0.38 yr) volunteered as participants for the present study. Participants were randomized into 5 different CI training programs (LCI: low contextual interference, MCI: moderate contextual interference, HCI: high contextual interference, VCI: variable contextual interference, and CG: control group) during a 3 week period. Significant CODA improvements (p < 0.05) in pre-post-test were found in MCI (4.39%, ES 0.41) and VCI (9.37%, ES 1. 12) groups. Furthermore, LCI, MCI and HCI groups ameliorated their SSP performance, both in 5 m (5. 92%, ES 0.81; 6.67%, ES 0.90; 8.05%, ES 1.33 respectively) and 15 m SSP (5.86%, ES 0.76; 6.47%, ES 0.80; 2.47% ES 0.41 respectively). These results suggest that training through games of tag (VCI) was the most effective in improving the CODA and training with moderate contextual interference (MCI) was the only type which induced improvements in both capacities (SSP and CODA). Key PointsWe investigated the CODA and SSP performance of students in the first year of primary school and the influence of 5 different training programs on their CODA and SSP ability.Training through games of tag (VCI) was the most effective in improving the CODATraining with moderate contextual interference (MCI) was the only one which induced improvements in both capacities (SSP and CODA).

Somatotype Analysis of International Football Players with Cerebral Palsy: A Comparison with Non-Disabled Football Players.

Football for people with cerebral palsy is a para-sport involving ambulant athletes with impairments, such as hypertonia, ataxia, or athetosis. The objective of the present study was to describe the somatotype of a representative sample of international football players according to different functional profiles of cerebral palsy, including spastic diparesis, athetosis/ataxia, spastic hemiparesis, and minimum impairment criteria, and to compare it with non-disabled football players. A total of 144 international para-footballers and 39 non-disabled footballers participated in the study, and their somatotype was calculated using anthropometric measurements. A Kruskal-Wallis test was used to compare the groups to determine and assess the differences between the different functional profiles, and the analysis of anthropometric variables and body composition showed no differences. Regarding somatotype, a predominance of the mesomorphic component was observed in all subgroups, and differences in somatotype were also found between non-disabled footballers and para-footballers with spastic hemiparesis and minimum impairment criteria. This study suggests that there may be a degree of homogeneity in terms of somatotype among footballers with or without physical impairments, such as hypertonia, athetosis, or ataxia. Furthermore, it provides reference values of international-level para-football players for the different sport classes, which can help coaches and trainers monitor athletes' physical conditions.

Contextual factors and match-physical performance of international-level footballers with cerebral palsy.

This study aimed to explore the match-physical response of international-level footballers with cerebral palsy (CP) according to contextual factors such as team ranking, the quality level of opposition, and match outcome. Eighty-two male outfield footballers with CP from top-ranked teams (n = 26) and bottom-ranked teams (n = 56) took part in this study. The match-player response was recorded using global positioning devices considering the total distance, distance covered at different velocities and number of short-term actions. Players from top-ranked teams covered more distance at low intensities compared to players from bottom-ranked teams (p < 0.05; 0.45 < ES < 0.49). Higher sprint distance, moderate and high accelerations/decelerations were found in players from top-ranked teams playing against teams of similar levels (p < 0.05; 0.73g< 0.86). When players from bottom-ranked teams played against teams of equivalent rank, more physical requirements were presented in total distance, running from medium to sprint intensities, and the number of short-term actions (p < 0.0.05; -0.55S < -0.89). Players from the top-ranking teams presented greater sprint demands in losing matches (p<0.05; dg=-1.01). Considering the bottom-ranking opposition, players presented more running demands in matches with losing results in moderate running, sprinting, and moderate-to-high deceleration (p < 0.05; -0.61 < dg < -0.64). The match-physical response of players with CP varies according to the contextual factors studied. The results provide advice for coaches and classifiers to understand more comprehensively the competing demands in CP football. This knowledge could help practitioners to prepare competition matches and planning training load or post-match recovery strategies, but also for the observation assessments of the classification process in this team para-sport.