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.

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.

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.

Physical performance and technical specific skills of women football players with cerebral palsy.

This study aimed to determine the physical performance profile (ability to change direction, vertical and horizontal jump, sprint ability, and dribbling-specific skills) of the first women football players with cerebral palsy (CP) who participated in an international CP football competition, accounting for their sport classes. We also examined the relationships between the different physical performance variables. Forty-five female players with CP (24.9 ± 7.5 years) were categorised into three sport classes based on their impairment severity: 19 were FT1 (severe impairments); 21 FT2; and 5 FT3 (mild impairments). Various physical performance tests were conducted, including the 505 change of direction test; vertical and horizontal jumps; 10 m sprint test; and the dribbling speed test. Significant correlations were observed between the change of direction ability, sprint (r = 0.89; p < 0.01), and dribbling tests (r = 0.71; p < 0.01), as well as between horizontal jump and sprint time (r = - 0.74; p < 0.01). FT1 players demonstrated poorer performance compared to FT3 in the 505 test and standing broad jump (p < 0.05; dg = -1.79 and 1.22 respectively), but also lower vertical jump heights (p < 0.05; dg = -0.91 to -1.57) and increased time required for sprint (p < 0.05; dg = 0.88 to 1.16) and dribbling tests (p < 0.05; dg = 0.85 to 1.44) compared to both FT2 and FT3 players. These findings offer valuable insights into the physical performance characteristics of female footballers with CP, which can guide training and sport enhancement programs for this unique para-sport population.

Exploring the Impact of Web-Based vs. In-Person Exercise Training on Benefits and Adherence in Substance Use Disorder Interventions: A Pilot Study.

BACKGROUND: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. METHODS: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. RESULTS: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. CONCLUSIONS: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies.

Differences in kinetic characteristics during countermovement jump of football players with cerebral palsy according to impairment profiles.

Objectives: The purpose of this study was 1) to determine and compare kinetic parameters during the realization of a countermovement jump (CMJ) between footballers with cerebral palsy (CP) and non-impaired footballers, and 2) to analyze the differences in this action between different players' impairment profiles and a group of non-impaired footballers. Methods: This study involved 154 participants comprising 121 male footballers with CP from 11 national teams and 33 male non-impaired football players recruited as the control group (CG). The footballers with CP were described according to the different impairment profiles (bilateral spasticity = 10; athetosis or ataxia = 16; unilateral spasticity = 77; minimum impairment = 18). All participants performed three CMJs on a force platform to record kinetic parameters during the test. Results: The group of para-footballers presented significantly lower values than the CG in the jump height (p < 0.01, d = -1.28), peak power (p < 0.01, d = -0.84), and the net concentric impulse (p < 0.01, d = -0.86). Concerning the pairwise comparisons between CP profiles and the CG, significant differences were found for the bilateral spasticity, athetosis or ataxia, and unilateral spasticity subgroups compared to the non-impaired players for jump height (p < 0.01; d = -1.31 to -2.61), power output (p < 0.05; d = -0.77 to -1.66), and concentric impulse of the CMJ (p < 0.01; d = -0.86 to -1.97). When comparing the minimum impairment subgroup with the CG, only significant differences were found for jump height (p = 0.036; d = -0.82). Footballers with minimum impairment presented higher jumping height (p = 0.002; d = -1.32) and concentric impulse (p = 0.029; d = -1.08) compared to those with bilateral spasticity. Also, the unilateral spasticity subgroup reports a higher jump height performance than the bilateral group (p = 0.012; d = -1.12). Conclusion: These results suggest that the variables related to power production during the concentric phase of the jump are crucial for the performance differences between groups with and without impairment. This study provides a more comprehensive understanding of kinetic variables that would differentiate CP and non-impaired footballers. However, more studies are necessary to clarify which parameters better differentiate among different profiles of CP. The findings could help to prescribe effective physical training programs and support the classifier's decision-making for class allocation in this para-sport.

What Is the Relationship between Trunk Control Function and Arm Coordination in Adults with Severe-to-Moderate Quadriplegic Cerebral Palsy?

Adults with tetraparesis cerebral palsy (i.e., wheelchair users) tend to experience more accelerated ageing, resulting in physical deterioration that increases the impact of the disability, leading to a loss of mobility that interferes with people's daily activities and participation in the community. The aim of this work is to study the relationship between trunk control and the function of the less-affected arm in this population. For this purpose, 41 para-athletes were invited to participate in this study, performing five tests to assess upper limb coordination, two tests to assess manual dexterity [i.e., Box and Block Test (BBT) and Box and Ball Test (BBLT)] and three tests to assess intra-limb coordination in different planes. Trunk control was assessed in both static and dynamic sitting conditions. The results show moderate correlations between static postural control and manual dexterity tests in the BBT (r = -0.553; p = 0.002) and BBLT (r = -0.537; p = 0.004). Large correlations were also found between static postural control and intra-limb tasks in horizontal (r = 0.769; p = 0.001) and vertical movements (r = 0.739; p = 0.009). Better static trunk control is related to a better upper limb function in the sagittal plane. Considerations and implications are explained in the manuscript.

Dynamic and static stability in para-athletes with cerebral palsy considering their impairment profile.

BACKGROUND: Balance impairment is a common feature in people with cerebral palsy (CP), affecting the performance of daily-life and physical activities. OBJECTIVES: To (1) explore the absolute and relative intrasession reliability of two balance tests to assess dynamic and static balance in ambulant para-athletes with CP; (2) explore the relationships between the two balance tests to determine potential application in sport classification; (3) assess the differences between CP profiles (ie, spastic diplegia, athetosis/ataxia, and spastic hemiplegia) in comparison to those with a minimum impairment; and (4) compare the outcomes of the static and dynamic balance of ambulant para-athletes with CP regarding controls. METHODS: A group of 129 male well-trained para-footballers with CP, classified as Level I according to the Gross Motor Function Classification System, participated in the present study. Static balance was assessed using the One-Leg Stance test, performed bilaterally on a force platform, and the dynamic balance was assessed in two conditions of the Tandem Walk test (TW): walking heel-toe contact over a 5 -m straight line and performing 10 steps. RESULTS: Moderate-to-excellent intrasession reliability (intraclass correlation coefficient = 0.60-0.98) was obtained for all the measurements and groups. However, only small to moderate correlations were found between the dynamic and the static measurements of balance for the CP group when performing the One-Leg Stance test with the unimpaired or dominant leg (0.23 < r < 0.30; P < .01). The TW performed over 10 steps revealed more sensitivity to discriminate between CP profiles. Those para-athletes with ataxia/athetosis performed worse in all the tests whereas all CP profiles performed worse than the control group (P < .01). CONCLUSIONS: Balance performance and postural control are constrained to a higher extent in those with impaired voluntary control due to ataxia or with involuntary contractions of the muscles due to athetosis.

Memory Modulation by Exercise in Young Adults Is Related to Lactate and Not Affected by Sex or BDNF Polymorphism.

Currently, high-intensity interval exercise (HIIE) is on the rise compared to moderate-intensity exercise (MIE) due to its similar benefits for health and performance with low time requirements. Recent studies show how physical exercise can also influence cognitive function, although the optimal dose and underlying mechanisms remain unknown. Therefore, in our study, we have compared the effects on visuospatial and declarative memory of different exercise intensities (HIIE vs. MIE), including possible implicated factors such as lactate released after each session and the Brain-Derived Neurotrophic Factor (BDNF) genotype. Thirty-six undergraduate students participated in this study. The HIIE session consisted of a 3 min warm-up, four 2 min sets at 90−95% of the maximal aerobic speed (MAS) with 2 min of passive recovery between sets, and a 3 min cooldown, and the MIE session implies the same total duration of continuous exercise at 60% of the MAS. Better improvements were found after HIIE than MIE on the backward condition of the visuospatial memory test (p = 0.014, ηp2 = 0.17) and the 48 h retention of the declarative memory test (p = 0.04; d = 0.34). No differences were observed in the forward condition of the visuospatial memory test and the 7-day retention of the declarative memory test (p > 0.05). Moreover, non-modifiable parameters such as biological sex and BDNF polymorphism (Val/Val, Val/Met, or Met/Met) did not modulate the cognitive response to exercise. Curiously, the correlational analysis showed associations (p < 0.05) between changes in memory (visuospatial and declarative) and lactate release. In this sense, our results suggest an important role for intensity in improving cognitive function with exercise, regardless of genetic factors such as biological sex or BDNF Val66Met polymorphism.

Effect of acute exercise intensity on cognitive inhibition and well-being: Role of lactate and BDNF polymorphism in the dose-response relationship.

Introduction: There is evidence in the literature that acute exercise can modify cognitive function after the effort. However, there is still some controversy concerning the most effective exercise modality to improve cognitive function in acute interventions. Regarding these different exercise modalities, the dose-response relationship between exercise intensity and cognitive response is one of the most challenging questions in exercise and cognition research. Methods: In this study, we tested the impact of moderate-intensity (MICT), high-intensity (HIIT) exercise sessions, or control situation (CTRL) on cognitive inhibition (measured with the Stroop Test). Thirty-six young college students participated in this study, where a within-subject repeated measure design was used. Results: ANOVA 2×3 demonstrated that HIIT improved the acute cognitive response to a higher degree when compared to MICT or CTRL (p < 0.05). The cognitive improvements correlated with lactate release, providing a plausible molecular explanation for the cognitive enhancement (r < -0.2 and p < 0.05 for all the Stroop conditions). Moreover, a positive trend in wellbeing was observed after both exercise protocols (HIIT and MICT) but not in the CTRL situation. Genetic BDNF single nucleotide polymorphism did not influence any interactions (p < 0.05). Discussion: In this sense, our results suggest that exercise intensity could be a key factor in improved cognitive function following exercise in young college students, with no additional impact of BDNF polymorphism. Moreover, our results also provide evidence that exercise could be a useful tool in improving psychological wellbeing.

Different Exercise Types Produce the Same Acute Inhibitory Control Improvements When the Subjective Intensity Is Equal.

Twenty-eight active older people (67.19 ± 4.91 years) who engaged in physical exercise activity twice a week were recruited to participate in a counterbalanced experimental protocol. The participants performed three different exercise sessions on three different days, one based on aerobic activities, one based on strength exercises with elastic bands, and one based on stationary balance games. During all three sessions, they were encouraged to maintain a moderate subjective intensity (5-6 on the RPE10 scale), and their heart rate was recorded. In addition, all of the participants took a digital version of the Stroop test before and after each session. The study aimed to compare the acute cognitive impacts of different types of exercise sessions in older adults. The participants' heart rate differed between the exercise sessions, but they maintained the RPE intensity. There was a significant improvement in inhibitory control (Stroop test) after all sessions, with no differences between exercise sessions. Moreover, some participants agreed to be genotyped to record the single nucleotide polymorphism of BDNF rs6265. There were no differences between Val/Val and Met carriers at the beginning or end of the exercise sessions. The present study showed similar cognitive improvements with different exercise type sessions when the subjective intensity was maintained.

Are Self-Efficacy Gains of University Students in Adapted Physical Activity Influenced by Online Teaching Derived From the COVID-19 Pandemic?

Due to the lockdown caused by the COVID-19 pandemic, e-learning suddenly spread to different levels of education, including university. In Spain, students of sports sciences are prepared during a 4-year study program to work in different areas (including physical education) and with different populations (including people with disabilities). The aims of this study were (1) to assess the effect of pandemic-driven online teaching on self-efficacy (SE) for the inclusion of people with disabilities in a group of university students enrolled in a compulsory course on adapted physical activity (APA); (2) compare the gains from SE before and after the APA course with a sample of students who followed the same course before the pandemic; and (3) explore the influence on SE scores according to three demographic variables: gender, previous SE training, and previous experience with people with disabilities. The study involved a sample of 124 university students (22.1 ± 2.6 years), distributed into two groups: prepandemic (n = 86) and pandemic (n = 38). They voluntarily completed the Spanish version of the Scale of Self-Efficacy of Physical Education Teachers of Physical Education toward Children with Disabilities, obtaining pre- and postcourse measurements. Due to the sudden lockdown, two-thirds of the pandemic course was taught online, and changes in the teaching strategies and tasks had to be made. Similar gains were obtained in both groups for the three subscales of the SE scale (p < 0.001, large effect sizes): intellectual, physical, and visual disability. No significant differences were found for comparisons between groups and the interaction effect of the course taught, nor for the three demographic co-variables. This study shows that teaching strategies that encourage student participation and reflections on learning increase student SE, regardless of the teaching format (i.e., face-to-face vs. online teaching). Moreover, the gains in SE are invariable to demographic co-variables.

Using Decision Trees to Support Classifiers' Decision-Making about Activity Limitation of Cerebral Palsy Footballers.

This study aimed (1) to determine the appropriateness of using decision trees as a classification tool for determining the allocation of sport classes of para-footballers with "moderate vs. mild" cerebral palsy (CP) profiles of spastic diplegia/hemiplegia and ataxia/athetosis based on observational outcomes by international classifiers, and (2) to identify what key observational features were relevant to discriminating among different impairment levels. A sample of 16 experienced international classifiers from five world regions participated in this study, observing activity limitation of a final sample of 21 international CP footballers when performing 16 gross-motor and sports-specific tests for balance (n = 3), coordination (n = 5), running, accelerations and decelerations (n = 3), jumping (n = 4), and change of direction ability (n = 1). For the overall sample (336 observations), the model included eight decision nodes and 24 branches with 17 leaves, including side-step, side-stepping, and triple hop as the tests with the best sensitivity (precision = 67.0%). For those with spastic diplegia (64 observations: Two nodes, six branches with five leaves), the range of motion in the side-step test and the balance in the tandem walk tests correctly classified 89.1% of the observations. In those with athetosis and ataxia (96 observations), the model included five nodes, 15 branches, and 11 leaves (176 observations, precision = 86.5%). For those with spastic hemiplegia, a model containing two nodes, six branches, and five leaves had 90.9% accuracy, including observational features of balance in the side-step test and symmetry in the side-stepping test. The observational tool used in this study, based on the impact of specific impairment measurements of hypertonia, athetosis, and ataxia, can be used to determine which assessments are more appropriate for discriminating between functional profiles in para-footballers with CP.

Change-of-Direction Ability of Para-Footballers With Cerebral Palsy Under a New Evidence-Based and Sport-Specific Classification System.

PURPOSE: This study aimed (1) to explore the validity and reliability of a new and specific change-of-direction (COD) test that requires dribbling skills to classify international footballers with cerebral palsy (CP) and compare it with another valid and reliable COD test without ball dribbling and (2) to probe whether both tests can discriminate between the new CP football classes (ie, FT1, FT2, and FT3) established worldwide in 2018. METHODS: This study involved 180 international para-footballers with CP from 23 national teams at the 3 regional competitions held in 2018. They performed 2 COD tests, the modified agility test (no dribbling skills) and the dribbling speed test (DST). RESULTS: Reliability was excellent for both the modified agility test (intraclass correlation coefficient [ICC]2,1 = .91, SEM = 5.75%) and the DST (ICC2,1 = .92, SEM = 4.66%). The modified agility test and DST results were highly to very highly correlated to one another for the whole group and considering the sport classes (r = .60-.80; P < .001). A 1-way analysis of variance showed significant differences between sport classes in both tests (P < .001). However, among classes, there were significant differences between FT1 and FT2 and FT3 (P < .01, effect size = large) and low to moderate effect sizes between FT2 and FT3 for either test. CONCLUSION: The DST appears to be valid and reliable to classify CP football players within the new classification system. Regression analysis revealed that 18.2% of the variance in the new sport classes could be explained by the 2 examined tests.

To What Degree Does Limb Spasticity Affect Motor Performance in Para-Footballers With Cerebral Palsy?

Spasticity is considered a contributor to hypertonia, frequently presented in people with cerebral palsy (CP), affecting muscle function and motor activities. In CP football, the classification system determines that this impairment is eligible for competitive para-sports due to the impact on activity limitation and sports performance. However, the relationship between this feature (i.e., spastic hypertonia) and performance determinants has not been explored yet. This study aimed to assess the association of clinical spasticity measurements with the performance of sport-specific tests used for classification purposes. Sixty-nine international footballers with CP voluntarily participated in this study. The Australian Spasticity Assessment Scale was used to measure spasticity in lower limbs muscle groups and activity limitation tests were conducted considering dynamic balance, coordination, vertical and horizontal jumps, acceleration, and change of direction ability. Low-to-moderate negative significant associations were found between the hip spasticity and measures of dynamic balance and dominant unipedal horizontal jump capacity. Additionally, moderate associations were reported between the knee spasticity and the non-dominant unipedal horizontal jump capacity and the change of direction actions with the ball. The ankle spasticity score reported small to moderate associations with the change of direction assessment without the ball and bipedal and dominant unipedal horizontal jump capability. Finally, the total spasticity score only presented a significant association with horizontal jump performance. This is a novel study that provides evidence of the associations between an eligible neural impairment and relevant specific measures of activity limitation tests. These results suggest that the amount of spasticity according to each evaluated joint muscle group of the lower limbs presents a low-to-moderate significant relationship with determined measures of dynamic balance, coordination, horizontal jump, acceleration, and change of direction ability with and without the ball in international-level CP footballers. Further studies are necessary to elucidate the real contribution of neural and non-neural impairments related to hypertonia on fundamental sport-specific motor skills of para-footballers with CP.

Physical Performance Differences Between Spanish Selected and Nonselected Para-Footballers With Cerebral Palsy for the National Team.

In regular football, the players' selection process involves an objective assessment based on their anthropometric and physical performance. However, available literature focused on players' selection process in cerebral palsy (CP) football is scarce. PURPOSE: To describe the anthropometrical and physical performance profiles of the International Spanish CP footballers and to compare them with the remaining CP football players from the national competition. METHOD: A total of 75 CP football players from the Spanish CP Football National Competition (classified into the 3 existing classes: football class [FT] 1 = 38; FT2 = 29; FT3 = 8) participated in the study. Participants were divided into 2 groups: selected players (n = 15) and nonselected players (n = 60) for the national team. Anthropometrical data and physical performance (countermovement jump, 20-m sprint, modified agility T-test [MAT], and dribbling test) were collected. RESULTS: There were significant differences in the 20-m sprint, MAT, and dribbling for the total sample and in MAT and dribbling for FT2 and FT3 classes between selected players and nonselected players (P < .05), but there were no differences for FT1. The MAT and dribbling showed a positive correlation and a high percentage of player selection prediction. CONCLUSION: Change-of-direction ability (ie, MAT) and dribbling skills are important when performing the selection process, as they allow the evaluation of important aspects of the game, but they may also provide the technical staff with an idea of the functionality and the physical performance of the players in each sport class.

Performance Analysis in Football-Specific Tests by Para-Footballers With Cerebral Palsy: Implications for Evidence-Based Classification.

PURPOSE: The objectives of this study were to analyze whether there were differences among para-footballers with different types and degrees of brain impairment (ie, bilateral spasticity, athetosis/ataxia, unilateral spasticity, minimum impairment criteria, or no impairment) in performing 3 football-specific tests requiring ball dribbling, to analyze whether there was an association among the results obtained in the 3 tests, and to determine whether the performance in the tests was associated with competitive level, level of training, or years' experience in para-footballers with cerebral palsy (CP). METHODS: A total of 123 footballers took part in the study, 87 of whom were footballers with CP and 36 who were without impairment. Both groups were assessed in 3 football-specific tests (Stop and Go, Turning and Dribbling, and the Illinois Agility Test). RESULTS: The results showed that the footballers without impairment recorded a better performance in all tests (P < .01) in comparison with the CP players. No significant differences in test performance were observed among the CP players from different competitive levels. However, significant differences (P < .01) were observed between players with diplegia or athetosis/ataxia compared with players with hemiplegia or minimum impairment level. Performance in the tests did not correlate with years of football experience, weekly strength training sessions, or specific football training in the footballers with CP (P = .12-.95). CONCLUSIONS: These findings suggest the possible inclusion of these tests in the classification process for footballers with CP because they discriminate among functional classes and are resistant to training and competitive level.

An Observational Tool to Assess Activity Limitation in Ambulatory People with Cerebral Palsy When Performing Motor Skills.

Ratios of physical activity and sports participation in people with cerebral palsy (CP) are still low compared with people without a disability. For an adequate and useful practice, physical activity professionals should understand how different types of CP profiles constrain the performance of motor skills that are required during sports practice. This study aims to develop an observation-based assessment tool to evaluate activity limitations in individuals with a moderate level of CP when performing skills requiring jumping, sprinting, change of direction, coordination, and balance. Nineteen observers with different backgrounds from five world regions were recruited for this study, with accredited experience classifying/observing para-athletes with CP. All observers watched videos of 20 international para-athletes with different CP profiles (bilateral spasticity, athetosis/ataxia, unilateral spasticity; all Gross Motor Function Classification System level I) performing 16 motor tasks, and their observations were recorded throughout an ad-hoc data collection instrument. A total of 6080 units of qualitative information were recorded for data analysis. An observation-based tool with qualitative descriptors is derived from data analyses, describing how coordination and balance affected mainly in those with dyskinesia/ataxia, range of movement in those with diplegia, and asymmetries in those with hemiplegia. This tool would help sports practitioners and physical educators to better understand how different CP profiles constrain the performance of motor skills.

Inter-Rater Reliability, Concurrent Validity and Sensitivity of Current Methods to Assess Trunk Function in Boccia Player with Cerebral Palsy.

Trunk function is a core factor to allocate Boccia players with cerebral palsy in BC1 and BC2 sport classes, according to the Boccia International Sports Federation (BISFed). However, the appropriateness of the current test to assess trunk function has never been studied to determine its reliability, validity and sensitivity to discriminate between different levels of impairment. Thirty-six players (BC1 = 13 and BC2 = 23) took part in this study. Trunk control was assessed through the BISFed trunk function scale (TFS) and a posturographic test battery consisting of two static and three dynamic tasks. The inter-rater reliability for the BISFed TFS was set at 94.44% of agreement. Moderate-to-high correlations were obtained between posturographic tasks (0.39 < r < 0.96; p < 0.05-0.01), while the BISFed TFS only correlated with two of the dynamic tasks and the overall dynamic score (-0.38 < r < -0.51; p < 0.05). The BISFed TFS was not able to discriminate between sport classes, whereas the static posturographic task did so (p = 0.004). Even though the current BISFed TFS presented good inter-rater reliability, it does not seem to have enough sensitivity to discriminate between BC1 and BC2. Although the static posturographic tasks were able to discriminate between sports classes, it seems necessary to develop new field tests assessing participants' trunk stabilization abilities.

Evaluation of the bilateral function in para-athletes with spastic hemiplegia: A model-based clustering approach.

OBJECTIVES: Spastic hemiplegia is one of the most common forms of cerebral palsy, in which one side of the body is affected to a greater extent than the other one. Hemiplegia severity (i.e. moderate vs mild forms) is currently used in some Para sports for classification purposes. This study evaluates the sensitivity of several tests of stability (e.g. one-legged stance test), dynamic balance (side-step test), coordination (rapid heel-toe placements), range of movement (backward stepping lunge), and lower limb power (the triple hop distance and the isometric peak force of the knee extensors) to discriminate between the impaired and unimpaired lower extremities' function in para-athletes with spastic hemiplegia. METHODS: A sample of 87 international para-athletes with cerebral palsy took part in the study, and their bilateral performance was measured for the abovementioned tests. The tests' sensitivity to discriminate between impaired vs unimpaired legs was assessed using Boruta's method. RESULTS: The triple hop distance, the magnitude of the mean velocity in the one-legged stance test and the time to perform the rapid heel-toe placement test are the most sensitive variables when performing random forest classifiers. In addition, the study confirms two optimal clusters by Gaussian finite mixture models to represent the athletes' performance. CONCLUSIONS: Reference scores for the clusters are provided, demonstrating that coordination, balance, and power of the lower limbs are relevant variables for classifying para-athletes with spastic hemiplegia.