Abstract

Objective: This study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine whether the motor decline typical of adolescents with CPHSN occurred in these swimmers.

Methods: A Multiple-Baseline, Single-Case Experimental Design (MB-SCED) study comprising five phases and a 30-month follow-up was conducted. Participants were two males and one female, all aged 15 years, untrained and with CPHSN. The intervention was a 46-month swimming training programme, focused exclusively on improving performance. Outcomes were swim performance (velocity); training load (rating of perceived exertion min/week; swim distance/week) and Gross Motor Function Measure-66-Item Set (GMFM-66). MB-SCED data were analysed using interrupted time-series simulation analysis. Motor function over 46 months was modelled (generalised additive model) using GMFM-66 scores and compared with a model of predicted motor decline.

Results: Improvements in GMFM-66 scores in response to training were significant (p<0.001), and two periods of training withdrawal each resulted in significant motor decline (p≤0.001). Participant motor function remained above baseline levels for the study duration, and, importantly, participants did not experience the motor decline typical of other adolescents with CPHSN. Weekly training volumes were also commensurate with WHO recommended physical activity levels.

Conclusions: Results suggest that adolescents with CPHSN who meet physical activity guidelines through participation in competitive swimming may prevent motor decline. However, this population is clinically complex, and in order to permit safe, effective participation in competitive sport, priority should be placed on the development of programmes delivered by skilled multiprofessional teams.

Effectiveness of postural interventions in cerebral palsy: umbrella systematic review.

Monica Toohey , Remy Blatch-Williams , Kristian Budini , Astrid Ferreira , Alexandra Griffin , Ashleigh Hines , Michelle Jackman , Karin Lind , Jill Massey , Maria Mc Namara , Jenna Mitchell , Catherine Morgan , Esther Norfolk , Madison CB. Paton , Daniel Polyblank , Sarah Reedman , Iona Novak


Discussion

The objective of this umbrella systematic review was to summarize and evaluate the evidence for postural management interventions in cerebral palsy published since Gough's 2009 paper. We have expanded the scope of the review from passive continuous postural management to include active postural control interventions. Many interventions show positive effects on postural outcomes including range of motion, spasticity, pain, hip migration, gross motor function, hand function, gait parameters,

Conclusion

In conclusion, our umbrella systematic review evaluated the evidence for postural control and postural management interventions in CP, since Gough's seminal 2009 paper. Despite numerous interventions showing positive effects on various postural outcomes, such as range of motion, spasticity, and gross motor function, the overall quality of evidence remains low to very low, limiting the certainty of conclusions and recommendations. The lack of certainty and population heterogeneity poses

https://www.sciencedirect.com/science/article/abs/pii/S1751722224000805

Ewan is the director of Malaria Risk Stratification at the Kids Research Institute Australia.

With over a decade of international research experience spanning the fields of astronomy, statistics, machine learning and epidemiology, Dr Ewan Cameron returned to Australia in February 2020 as an Associate Professor at Curtin University and Honorary Research Associate at The Kids Research Institute Australia.

Within the Malaria Atlas Project, he leads a team responsible for the innovation of novel approaches to probabilistic disease mapping, with a focus on bespoke model development for sub-national risk stratification.

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