Sports for the physically challenged child

A Randomized Controlled Cluster Trial of an Obesity Prevention Program for Children with Special Health Care Needs: Methods and Implications

Children with disabilities have higher prevalence estimates of obesity than typically developing children. The Healthy Caregivers-Healthy Children Phase 3 (HC3) project implemented an obesity prevention program adapted for children with special health care needs (CSHCN) that includes dietary intake and physical activity (PA) components. The primary outcome was a change in dietary intake, PA, and the body mass index (BMI) percentile. Ten childcare centers (CCCs) serving low-resource families with ≥30 2- to 5-year-olds attending were randomized to either the intervention (n = 5) or control (n = 5). The HC3 CCCs received (1) snack, beverage, PA, and screen time policies via weekly technical assistance; (2) adapted lesson plans for CSHCN; and (3) parent curricula. The control CCCs received a behavioral health attention curriculum. HC3 was delivered over three school years, with data collected at five different timepoints. It was delivered weekly for six months in year one. To ensure capacity building, the HC3 tasks were scaled back, with quarterly intervention delivery in year 2 and annually in year 3. Adaptations were made to the curriculum to ensure appropriate access for CSHCN. Given that the program was being delivered during the COVID-19 pandemic, special modifications were made to follow CDC safety standards. The primary outcome measures included the Environment and Policy Assessment and Observation (EPAO) tool, standardized dietary intake and PA assessments, and the child BMI percentile. CCCs are an ideal setting for targeting CSHCN for obesity prevention efforts as they provide an opportunity to address modifiable risk factors.

Facilitators and barriers for participation in sports and physical activity for children with lower-limb absence: A systematic review

Sports and recreational activities offer physical and psychological benefits to children with limb absence. Understanding what facilitators and barriers exist for the participation in sports and physical activity is vital to aid stakeholders to continue enabling facilitators and develop means to tackle existing barriers so that all children with lower-limb absence can participate in sport and physical activity as they wish. The aim of this systematic review was to identify facilitators and barriers that children with lower-limb absence experience when wanting to participate in sports and physical activity. Systematic review. Five databases were used to identify the literature relating to facilitators and barriers to sports and physical activity for children with lower-limb absence. These were Medline, Scopus, Cochrane, SPORTDiscus, and CINAHL. Google scholar was used as a secondary source. The review followed the "Preferred Reporting Item for Systematic Reviews and Meta-Analysis" guidelines. The review identified 10 articles for inclusion that met predefined inclusion criteria. The identified peer-review articles date from 1999 to 2021. The number of published articles steadily increases up to 2010 and then increase rapidly from 2016 to 2021. The results show although there are facilitators for sports participation for children with limb absence, there are many barriers which continue to hinder many children from participating in sports and physical activity. Facilitators that exist include advancements in prosthetic design and technology, increased opportunities, and physical and social benefits. Barriers that were reported include prosthesis failure, stigma, and high costs.

Perspectives of Swiss Paediatric Health Care Professionals on Factors Influencing Physical Activity Participation in Children with Disabilities

AIM

Investigation of the perspectives of paediatric health care professionals (PHCPs) in Switzerland regarding factors that influence participation in physical activity programs for children and adolescents with disabilities or chronic conditions (CADCCs). Evaluation of self-reported exercise counselling behavior of those professionals.

METHOD

A cross-sectional survey was used to collect the opinions of 171 PHCPs working with CADCCs using a structured questionnaire. The information obtained was evaluated by performing a combined quantitative and qualitative statistical analysis.

RESULTS

PHCPs in Switzerland think that CADCC do not get enough physical activity and see the underlying reasons in lacking information/knowledge and organizational factors. We found that the level of knowledge about disability sports opportunities among PHCPs has a positive influence on their exercise counselling behaviour.

CONCLUSIONS

We propose three approaches to increase the level of physical activity in CADCC: Establishing personalized exercise counseling, intensifying information about disability sports programmes towards PHCPs, and improving inclusion and integration in PE lessons or regular sports clubs.

Participation in sports of Dutch children with lower limb deficiencies

PURPOSE

The primary aim was to describe sports participation of Dutch children and adolescents with lower limb deficiencies (LLD). The secondary aim was to explore perceived limitations concerning sports participation.

METHODS

A total of 103 children and adolescents with LLD, aged 8-18 years (mean 11.7 years), were asked about their sports participation using a study-specific self-report questionnaire.

RESULTS

Children and adolescents with LLD frequently (78%) participated in sports activities, and most of them (68%) participated in the sport of their preference. Just over half of all children (52%) perceived an inability to participate in specific sports. Physical performance (running) and endurance were mentioned as the most limiting factors in participating in certain sports.

CONCLUSION

Children and adolescents with LLD in the Netherlands participate in a variety of sports. Despite dependency on lower limb prostheses in most cases, children and adolescents with LLD have a high potentiality of participating in sports.

Parasport: Effects on Musculoskeletal Function and Injury Patterns

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Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation.

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Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity.

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Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment.

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Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.

Surgical Fixation Using Screw-Rod Construct Instrumentation for Upper Cervical Instability in Pediatric Down Syndrome Patients

STUDY DESIGN

Retrospective case series.

OBJECTIVES

To describe the indications and outcomes of cervical fixation using modern instrumentation in a case series of pediatric Down syndrome (DS) patients.

SUMMARY OF BACKGROUND DATA

Cervical instability is the major cervical spine concern in children with DS. Although fixation techniques have advanced over the past quarter-century, the outcome of fixation with modern instrumentation for upper cervical instability in DS patients has not been thoroughly investigated.

METHODS

We searched the orthopedic database at our institution for patients with a diagnosis of DS who had undergone a cervical spine fusion between 2006 and 2017. Patient demographics, diagnoses, surgical indications, surgical details, and complications were recorded. Preoperative imaging was reviewed to determine atlanto-dens intervals and spinal cord signal changes. Postoperative radiographs or CT scans were reviewed to determine union.

RESULTS

Twelve DS patients met our inclusion criteria. The mean age at surgery was 9.3 years (range 3.8-18.8 years). Patients with secondary causes of instability included 7 patients with os odontoideum and 1 patient with a pars fracture. Three patients (25%) were identified on asymptomatic screening, with none of these having cord signal changes on magnetic resonance imaging (MRI). Modern implants (screws, plates, cages) were used in every patient in our series. The mean number of levels fused was 1.9 (range 1-5). The overall complication rate was 41.7% (5/12). Four patients required repeat surgery for nonunion. All patients with adequate radiographic follow-up demonstrated union (11/11, 100%). One patient was lost to follow-up.

CONCLUSIONS

Fixation for cervical instability is a critical component of the management of DS. A minority of patients receiving surgery were identified through asymptomatic screening. There was a high complication risk associated with surgery in our study; however, the addition of rigid fixation has lessened the complication rate compared with previous studies.

LEVEL OF EVIDENCE

Level IV.

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.

Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review

PURPOSE

Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP).

METHOD

A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters.

RESULTS

Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II).

INTERPRETATION

Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.

Wrestlers with Limb Deficiencies: A Descriptive Study

OBJECTIVE

The objective of this study was to determine if wrestling is a safe, positive athletic option for limb-deficient individuals.

DESIGN

This descriptive study consisted of an opportunity sample of limb-deficient wrestlers, aged 5 yrs and older with at least 1 yr of experience. Participants completed a questionnaire regarding health, satisfaction, and achievements. Descriptive statistics were used for analysis.

RESULTS

Sixteen male wrestlers reported nine below-the-knee, five above-the-knee, and three below-the-elbow limb deficiencies. There were nine congenital deficiencies and seven amputations acquired during childhood. Two individuals won National Collegiate Athletic Association championships, and seven competed collegiately. All reported a positive impact on quality-of-life, 87% reported no difficulty finding acceptance with the team, and 50% experienced wrestling-related residual limb complications. Associations between (1) residual limb complications before and during wrestling and (2) skin breakdown before and during wrestling did not demonstrate statistical significance (P = 0.30 and 0.1189, respectively).

CONCLUSIONS

This study suggests that wrestling is a safe, positive sport for limb-deficient individuals, that it fosters competitive equality between impaired and nonimpaired participants, and that it has a positive impact on health and quality-of-life. The incidence of residual limb complications warrants monitoring.

Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis

PURPOSE

The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation.

MATERIALS AND METHODS

All patients with longitudinal deficiencies and traumatic amputations of upper extremity with a level of amputation of proximal third forearm and above were included. A total of 49 patients with unilateral upper extremity amputations that had used the prosthetic for a minimum of 2 years were included in the protocol. The Disability arm shoulder hand (DASH) scale was used to determine a good result with a cut-off of less than 40%. The independent variables were the level of amputation, the etiology for its use, initial age of use and number of hours/day using the prosthesis.

RESULTS

It was found that patients with a congenital etiology and those that started using the prosthetic before 6 years of age had better functional results.

DISCUSSION

It was found that when adapting a patient with an upper extremity prosthetic, which has a high rejection rate of up to 49%, better functional outcomes are found in those who started using it before 6 years of age, and preferably because of a congenital etiology. It was also found that the number of hours/day strongly correlates with a favorable functional outcome.

Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions

Physical activity has established mental and physical health benefits, but related adverse events have not received attention. The purpose of this paper was to review the documented adverse events occurring from physical activity participation among individuals with psychological or cognitive conditions. Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published paper examining the effect of changes on physical activity behaviour, included a diagnosed population with a cognitive or psychological disorder, and reported on the presence or absence of adverse events. Quality of included studies was assessed, and the analyses examined the overall evidence by available subcategories. Forty trials passed the eligibility criteria; these were grouped (not mutually exclusively) by dementia (n = 5), depression (n = 10), anxiety disorders (n = 12), eating disorders (n = 4), psychotic disorders (n = 4), and intellectual disability (n = 15). All studies displayed a possible risk of bias, ranging from moderate to high. The results showed a relatively low prevalence of adverse events. Populations with dementia, psychological disorders, or intellectual disability do not report considerable or consequential adverse events from physical activity independent of associated comorbidities. The one exception to these findings may be Down syndrome populations with atlantoaxial instability; in these cases, additional caution may be required during screening for physical activity. This review, however, highlights the relative paucity of the reported presence or absence of adverse events, and finds that many studies are at high risk of bias toward reporting naturally occurring adverse events.

A Critical Appraisal of How Occupational Therapists Can Enable Participation in Adaptive Physical Activity for Children and Young People

Introduction:

Adaptive physical activity (APA) for people with physical disabilities was researched. Barriers to participation were identified, along with potential solutions. The role of occupational therapists in enabling participation in APA was explored.

Method:

A literature review, using a systematic approach, highlighted a number of barriers to participation. Each article was critically analysed using the Critical Appraisal Skills Programme tool. The information was summarised and analysed, using an iterative approach to identify themes.

Findings:

Eleven key articles were retrieved from the search and two key themes emerged. The first theme encompassed barriers to participation, lack of role models, family attitudes and transportation. The second theme identified potential solutions through integrating APA into health care interventions.

Conclusion:

Participation in APA improves physical, social and psychological skills, which in turn impacts on other occupations. There is a role for occupational therapists to enable participation in APA by using their core skills of assessment, collaboration, engagement, adaptation, education and advocating for children and young people. APA is an occupation for many children and adolescents, but there are barriers to participation for individuals with disabilities who are seeking to start APA. Occupational therapists have the skills and knowledge to enable an individual to participate in APA.

Patient safety in the rehabilitation of children with spinal cord injuries, spina bifida, neuromuscular disorders, and amputations

Pediatric patient safety continues to challenge both pediatricians and pediatric physiatrists. While there is a trend toward developing general patient safety initiatives, there is little research on pediatric patient safety. This article identifies major areas of general safety risk, with a focus on timely diagnosis and care coordination to prevent secondary complications that compromise health, function, and quality of life in pediatric neuromuscular disease, spinal cord disorders, and amputation.

Sport participation by physically and cognitively challenged young athletes

Many physically and cognitively challenged athletes participate in organized and recreational sports. Health benefits of sport participation by athletes with disabilities have been well recognized. A careful preparticipation evaluation and proper classification of athletes ensures safe sports participation by athletes with disabilities. Some conditions in these athletes, such as problems with thermoregulation, autonomic control, neurogenic bladder and bowel, latex allergy, and many associated and secondary complications deserve special consideration. This article reviews common medical issues that relate to sport participation by athletes with physical and cognitive disabilities.

Obesity in disabled children and adolescents: an overlooked group of patients

BACKGROUND

There is an ongoing debate concerning the relationship between disability and obesity in childhood and adolescence.

METHODS

The literature available in Medline was selectively searched for the terms: "(children /OR/ adolescents) /AND/ disability /AND/ (overweight /OR/ obesity)". This search was complemented by inspection of journals in the fields of obesity, pediatrics, and neurology.

RESULTS

A total of 38 relevant articles were identified. All studies agreed that the prevalence of overweight and obesity in children with disabilities was almost twice that in their non-disabled peers. No effective, long-lasting interventions for obesity in disabled children and adolescents have been published.

CONCLUSION

Since a high proportion of disabled children and adolescents are overweight or obese, effective strategies for preventing and managing excess weight need to be developed so as not to further endanger their social participation. Moreover, risk factors for overweight in disabled children and adolescents should be identified and their weight status carefully monitored.

The Benefits of Physical Activity for Youth with Developmental Disabilities: A Systematic Review

Objective.

Analyze evidence of the benefits of physical activity for youth with developmental disabilities.

Data Sources.

Key word searches for “disability,” “physical activity,” “exercise,” “fitness,” and “sport” in major databases. A total of 3263 citations was found.

Study Inclusion/Exclusion Criteria.

Systematic reviews and articles about studies quantitatively examining the effects of physical activity in youth with developmental disabilities ages 0 to 20 years were included. Only articles published in English in peer-reviewed journals were included.

Data Extraction.

A Measurement Tool to Assess Reviews criteria were used for systematic reviews; Grading of Recommendations, Assessment, Development, Evaluation criteria were used for observational studies; and Population, Intervention, Comparison, Outcome criteria were used for all studies.

Data Synthesis.

Data, shown in table format, were synthesized in relation to five research questions.

Results.

Three systematic reviews and 14 studies were reviewed. Strong evidence indicated that children and adolescents with developmental disabilities derive health benefits from participation in group exercise programs, treadmill training, or therapeutic riding/hippotherapy. Lesser levels of evidence indicated that health benefits might be present for adapted skiing or aquatic programs. Documented benefits of physical activity include improvements in aerobic capacity, improved gross motor function, and high levels of participant/parent satisfaction.

Conclusions.

Evidence exists that physical activity is beneficial for youth with developmental disabilities. Further research studies are needed that are of greater scientific rigor including larger sample sizes, control groups, and stringent, replicable methodology.

Promoting the participation of children with disabilities in sports, recreation, and physical activities

The benefits of physical activity are universal for all children, including those with disabilities. The participation of children with disabilities in sports and recreational activities promotes inclusion, minimizes deconditioning, optimizes physical functioning, and enhances overall well-being. Despite these benefits, children with disabilities are more restricted in their participation, have lower levels of fitness, and have higher levels of obesity than their peers without disabilities. Pediatricians and parents may overestimate the risks or overlook the benefits of physical activity in children with disabilities. Well-informed decisions regarding each child's participation must consider overall health status, individual activity preferences, safety precautions, and availability of appropriate programs and equipment. Health supervision visits afford pediatricians, children with disabilities, and parents opportunities to collaboratively generate goal-directed activity "prescriptions." Child, family, financial, and societal barriers to participation need to be directly identified and addressed in the context of local, state, and federal laws. The goal is inclusion for all children with disabilities in appropriate activities. This clinical report discusses the importance of physical activity, recreation, and sports participation for children with disabilities and offers practical suggestions to pediatric health care professionals for the promotion of participation.

Recreational terminal devices for children with upper extremity amputations

Children with upper extremity amputations are particularly challenged in sports and other recreational activities. Many find that a prosthesis is of no benefit in their routine daily activities. Although a number of recreational terminal devices are available for prosthetic modification, it is unclear how effective they are at improving a child's performance in sports or hobbies.

METHODS

We evaluated the usefulness of 15 recreational terminal devices for upper extremity prostheses in 11 children by chart review and patient survey. All patients had functional elbows, and all but one was a unilateral amputee. All patients were instructed in their use by a prosthetist, and 3 patients received occupational therapy.

RESULTS

Nine of 15 recreational terminal devices prescribed improved performance. However, they primarily were the adaptations for weight lifting and violin bows, where their use was obligatory for participation. The wholesale costs for the terminal devices ranged from $120 to $957, and many patients also required the construction of a prosthesis just for the activity. Only 4 of the 9 successful recreational terminal devices were still in use at average follow-up of 3.9 years because patients had lost interest in the activity or had designed something that worked better.

CONCLUSIONS

Recreational terminal devices available for weight lifting and violin bows uniformly improved the child's ability to pursue those activities. These prosthetic adaptations are expensive and must be weighed individually by the family in light of children's fleeting interest in individual hobbies.

LEVELS OF EVIDENCE

Level IV.

Quality of life, depressed mood, and self-esteem in adolescents with heart disease

OBJECTIVE

To assess health-related quality of life (HRQoL), depressed mood, and self-esteem in adolescents with heart disease and compare them with age-matched healthy adolescents (control group).

METHODS

Ninety adolescents (aged 12 to 18 years with congenital or acquired heart disease) and 87 controls completed the HRQoL (TAAQOL-CHD), Center for Epidemiologic Studies Depression scale, and Rosenberg self-esteem questionnaires. Relevant medical details were collected. The patients and their parents were asked to rate their perceived severity of heart disease.

RESULTS

Adolescents with severe heart disease reported higher levels of depressed mood and lower self-esteem than did adolescents with moderate and mild heart disease and age-matched healthy controls. Adolescents with severe heart disease also reported worse HRQoL than those with moderate and mild disease. According to the multiple regression analysis, 44% of variance of HRQoL was explained by the study variables. Disease severity alone explained 11% of the variance, but when entered with the other study variables, depressed mood, self-esteem, and adolescents' perceived severity of disease were the only significant contributors to the explained variance of HRQoL. An exploratory mediation analysis, using the Sobel test, was therefore applied, and it showed that depressed mood and perceived disease severity, but not self-esteem, mediated the relationship between disease severity and HRQoL.

CONCLUSIONS

Lower HRQoL was found in adolescents with severe heart disease. Psychosocial factors have a significant effect on the psychological state of adolescents, and they should be addressed and treated.