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Purpose: The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings., Methods: Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors., Results: Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD., Conclusion: Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.

Children with cerebral palsy (CP) are often mainstreamed into the general education system, but are likely to be excluded from physical education (PE) classes. A questionnaire was constructed and utilized to measure PE teachers' self-efficacy (SE) toward inclusion of students with CP in each of three mobility categories (independent, using assistive devices, using wheelchair mobility) and the impact of experience and training on teachers' SE. Participants in the study were 121 PE teachers from different parts of Israel (mean age: 41.02±9.33 years; range: 25.00-59.00 years). Exploratory factor analysis was used to determine the structure of the sub-scales' factors' structure and Cronbach's Alpha reliability was satisfactory (range 0.872-0.941). Independent t-tests were calculated in order to compare the SE of teachers with and without adapted PE experience. Repeated Analysis of Variance was performed to measure within-group differences in SE. Results revealed that the PE teachers' SE in teaching students who use mobility assistive devices or wheelchairs was significantly lower compared to teaching those who walk and run unaided (F=19.11; p<0.001). The teachers' SE towards including CP children who independently ambulate was influenced (p<0.05; d=0.94) by the teacher's experience (elementary school practicum). SE in the mobility with assistive device group was also significantly influenced (p<0.05; d=0.1) by teaching experience (previous experience and having a specialization in adapted PE). Finally, SE when teaching the wheelchair mobility group was influenced by having an adapted PE specialization (p<0.05; d=0.82). Specialized training in this particular area should be enhanced to increase teachers' SE and enable greater participation of children with CP in general physical education classes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The management goal of cerebral palsy (CP) is improving functionality, locomotion and independence. Treatment programs commonly encompass adapted physical activity (APA). This review summarizes the knowledge regarding the effects and recommendations for APA in persons with CP. In addition, barriers to APA in this population are reviewed. The available literature on benefits of APA to persons with CP has focused mainly on youth. The components of the APA programs generally consist of strength, aerobic and flexibility training. There is no empirical evidence that strength-training increases spasticity in people with CP. Furthermore, strength-training may increase strength and the ability to perform daily activities. Aerobic-training is especially important as persons with CP typically have low cardiorespiratory fitness and high prevalence of cardiac disease. However, limited published evidence exists on aerobic-training effects in this population. Nonetheless, the evidence suggests that aerobic-training in persons with CP can improve physiological outcomes, yet the influence of these changes on participation has not been investigated sufficiently. Stretching exercise is a common treatment for spasticity. Surprisingly, there is inconclusive evidence for the effectiveness of stretching exercise for persons with CP. Despite the importance attributed to APA for people with CP, low levels of physical activity have been reported in this population. However, when caregivers perceive greater benefits of exercise, individuals with CP are more likely to be active. In contrast, barriers to APA include costs of APA programs, limited means of transportation to APA facilities, lack of information regarding APA facilities and limited appropriate exercising equipment in the APA facilities.

The purpose of the current study was to establish measurement reliability in adults with Cerebral Palsy (CP), and to examine the feasibility and outcomes of an upper extremity strength training program (three times per week for 90 min each time). A control group design mixed with a prospective time series design for the intervention group was completed, including a pre-test, a post-test after a 12-week intervention period, and a follow-up in the intervention group after an additional 10-week period. Seventeen adults with CP with severe motor impairment took part in the study (10 in the intervention and seven in the control group). The test battery was comprised of wrist and hand dynamometry; dominant hand upper-extremity function measures (Jebsen Hand Function Test=JHFT, Minnesota Manual Dexterity Test=MMDT, and the Nine Hole Peg Test=NHPT); and activity of daily living with the Barthel Index. The results indicated that in both the control and the intervention groups, the strength tests exhibited good-to-excellent reliability during pre-test and post-test. The group comparison revealed that while in the pre-test no between-group differences existed, in the post-test the strength training group demonstrated significantly higher values in five out of eight strength measures, as well as in the MMDT. Discontinuing the program for eight weeks reversed the effects almost to baseline. In conclusion, the outcomes demonstrated the reliability of the assessments utilized in this study, as well as the feasibility of the strength training program, in adults with severe motor impairment due to CP., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: To describe Re-Step™, a novel mechatronic shoe system that measures center of pressure (COP) gait parameters and complexity of COP dispersion while walking, and to demonstrate these measurements in healthy controls and individuals with hemiparesis and cerebral palsy (CP) before and after perturbation training., Method: The Re-Step™ was used to induce programmed chaotic perturbations to the feet while walking for 30 min for 36 sessions over 12-weeks of training in two subjects with hemiparesis and two with CP., Results: Baseline measurements of complexity indices (fractal dimension and approximate entropy) tended to be higher in controls than in those with disabilities, while COP variability, mean and variability of step time and COP dispersion were lower. After training the disabled subjects these measurement values tended toward those of the controls, along with a decrease in step time, 10 m walk time, average step time, percentage of double support and increased Berg balance score., Conclusions: This pilot trial reveals the feasibility and applicability of this unique measurement and perturbation system for evaluating functional disabilities and changes with interventions to improve walking. Implication for Rehabilitation Walking, of individuals with cerebral palsy and hemiparesis following stroke, can be viewed in terms of a rigid motor behavior that prevents adaptation to changing environmental conditions. Re-Step system (a) measures and records linear and non-linear gait parameters during free walking to provide a detailed evaluation of walking disabilities, (b) is an intervention training modality that applies unexpected perturbations during walking. This perturbation intervention may improve gait and motor functions of individuals with hemiparesis and cerebral plasy.

The purpose of this study was to describe running economy, soccer specific endurance, and selected kinematic running criteria in soccer players with cerebral palsy (SPCP) and to compare them with values of position-matched players without CP. Fourteen international, male soccer players with cerebral palsy completed the "Yo-Yo" intermittent recovery run level 1 (IRL-1) test to assess soccer-specific endurance and a submaximal running test on a treadmill to determine running economy. The mean IRL-1 distance covered by the SPCP of the Irish CP team was found to be 43-50% below the mean distance attained by position-matched soccer players without disability, while running economy was found to be within the range of that reported for able-bodied athletes. No relationship could be found between the level of CP-ISRA classification and soccer-specific endurance or running economy in this group of elite level SPCP. Though small in number, these data support a further examination of the relationship between CP classification and sport-specific performance.

Evidence-based practice (EBP) is a growing movement in the health and educational disciplines that recommends emphasis on research outcomes during decision making in practice. EBP is made possible through evidence based research (EBR), which attempts to synthesize the volume and scientific rigor of intervention effectiveness. With the purpose of assessing the impact of this movement on adapted physical activity, this article (a) describes EBP/EBR and outlines its methodological development, (b) provides an historical perspective of EBP/EBR in APA, (c) examines EBR quality indicators in the review literature published in "Adapted Physical Activity Quarterly", (d) identifies and synthesizes thematic domains appearing in these review articles, and (e) discusses practical examples of professional issues in APA arising from a lack of EBR. (Contains 3 tables and 3 figures.)

People with severe physical disabilities may experience psychosocial problems. Boccia is one sport that athletes with severe disability can engage in, but no information on the effects of Boccia on psychosocial outcomes for participants with severe disability is available. Therefore, we analyzed the effects of Boccia on psychosocial outcomes in persons with severe disabilities. The study included two competitive Boccia groups: independent competitive (IC) (n = 9) and nonindependent competitive (NIC) (n = 7), as well as a recreational Boccia group (n = 14) and control subjects (n = 13) (mean age for all participants = 46.46 +/- 10.75 yr). All participants underwent a rehabilitation program. Between-group differences in change scores were assessed using analysis of variance/multivariate analysis of variance. Within-group differences were compared using t-tests and effect sizes (ESs). Change in psychosocial parameters was not significantly influenced by study group (p > 0.05). All groups presented moderate-to-large ESs in physical and psychological quality of life (ES > 0.51). In comparison to the control group, who presented small-to-trivial ESs in General Health Questionnaire-28 (GHQ-28), StateTrait Anxiety Inventory, and Profile of Mood States-Tension, the IC and recreational group presented moderate ESs in GHQ-28, whereas the NIC group presented moderate ESs in anxiety and tension. In conclusion, the rehabilitation program had a general positive effect on the psychosocial status of individuals with severe physical disabilities. However, the competitive Boccia groups demonstrated a greater number of favorable changes, suggesting an added value of participation in Boccia. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the effects of aquatic (AQ) compared to a land-based (LB) intervention programs on metabolic cost of walking (MCW), gross motor function and locomotor performance in children with cerebral palsy (CP). Methods. Eleven children with spastic diplegic CP completed this study, six in the AQ (5.2 ± 1.45 yrs) and five in the LB group (4.1 ± 1.33 yrs).MCWderived from Oxygen uptake (VO2) measured with a Cosmed K4 device and walking speed at steady state. Additional measures included the 10-m test, Gross Motor Function Measure (GMFM), and Pediatric Evaluation Developmental Inventory (PEDI). Non-parametric statistics were used to analyze change in each group. Results. The AQ group significantly decreased MCW (Z = -2.2; P < .05) and increased steady state walking speed (Z = -2.2; P < .05). Both groups significantly increased 10-m walking speed (Z = -2.2; P < .03, and Z = -2.02; P < .05, resp.). The LB group exhibited moderate to large effect sizes in 10-m self-selected and fast walking speeds (Cohen's d = 1.07 and 0.73, resp.). Conclusion. Our findings suggest that Both AQ and LB programs were effective in improving 10-m speed, while the AQ training also improved theMCWof walking at steady state in children with spastic diplegic CP. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the effects of aquatic intervention with those of land-based intervention on social function, perceived competence, and social acceptance in children with cerebral palsy (CP). Twenty-two children (F, 17; M, 5) with spastic diplegia CP participated in the study: 12 in the aquatic intervention group (5.4 yrs ± 0.95); and 10 in the exercise intervention group (4.9 yrs ± 0.99). Social function was measured by the Paediatric evaluation of disability inventory (PEDI) social function domain. Perceived competence and social acceptance were measured by the Pictorial scale of perceived competence and social acceptance for children with cerebral palsy. Paired t-tests were used to evaluate differences between groups. To reveal relationships across all measures Pearson correlations were carried out. Because of small group sizes, effect sizes were calculated across measures for each dependent variable. Results were calculated for each dependent variable before and after a four-month intervention period. No significant changes were found between groups in perceived physical competence. Significant differences (t = 2.26, p < 0.035) were found between groups in perceived social acceptance in favour of the aquatic group. No significant differences were found between groups in the PEDI social function. Significant differences were found between pre-test to post-test scores in the PEDI caregivers social function domain (t = -3.78, p < 0.003) in the aquatic intervention group but not in the exercise group (t = -2.11, p < 0.065). Aquatic intervention appears to have a positive effect on perceived social acceptance and social function as reported by caregivers. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of aquatic interventions in children with neuromotor impairments. Design: A search of electronic databases that included MEDLINE, PubMed, ERIC, PsychLit, PEDro, Sport Discus, CINAHL and Cochrane between 1966 and January 2005 was conducted using the following keywords: 'hydrotherapy', 'aquatic therapy', 'water exercise', 'aquatics', 'adapted aquatics', 'aquatic exercise' and 'swimming'. An additional resource, the Aquatic Therapy Research Bibliography until 1999, was explored manually. Titles and abstracts were assessed manually according to the following inclusion criteria: (1) population (children with neuromotor or neuromuscular impairments), (2) intervention (aquatic programme). Articles were reviewed according to merit of design, population participants and outcome measures with respect to International Classification of Function and Disability terminology (changes in body function, activity level and participation). Results: Eleven of the 173 articles that were retrieved met the inclusion criteria: one randomized control trial, two quasi-experimental studies, one cohort study, two case control studies and five case reports. Seven articles reported improvement in body functions, and seven articles reported improvement in activity level. Two of the four articles that investigated outcome measures regarding participation described positive effects while the findings of the other two revealed no change. None of the articles reported negative effects due to aquatic interventions. Conclusion: According to this review, there is a substantial lack of evidence-based research evaluating the specific effects of aquatic interventions in this population. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study aimed to compare between the motor outcomes of a Halliwick-based training program (HT) and a strength and skill-based program organized according to the principles of interval training (IT) and to compare the outcomes of children with mild CP (Gross Motor Function Classification System [GMFCS] 1-2) to those with moderate and severe CP (GMFCS 3-5). Method: Sixteen children aged 3-6 years completed this study. Seven children were in the IT and nine in the HT groups. Regarding the severity distribution, nine were classified as mild, and seven as moderate and severe CP. Prior to and after an intervention period lasting four months with two weekly 30-min sessions children participated in a series of land-based motor tests: the Berg Balance Scale (BBS), the 10-meter test for fast (10-MF) and convenient (10-MC) speed, the Timed Up and Go (TUG) test, and the Energy Expenditure Index (EEI). An aquatic skill test (WOTA) was also performed. Results: A significant improvement with a large effect size (ES: Cohen's d >0.8) was observed in the EEI only in the IT group. TUG performance time and WOTA scores significantly improved with large ES in both training groups. The improvement in EEI and TUG was inversely related to pretest scores and was larger in GMFCS 3-5. Conclusions: IT appears to be more effective for increasing efficiency while walking. Participants in both training protocols similarly improved in walking agility and balance and in aquatic skill. Both interventions seem to be more effective for participants with lower performance scores. [ABSTRACT FROM AUTHOR]