How much trunk control is affected in adults with moderate-to-severe cerebral palsy?

Trunk control (TC) impairment is a typical feature in individuals with cerebral palsy (CP), but there are lack of methods that allow to quantify the extent to which static and dynamic TC is impaired in adults with moderate-to-severe CP. Thus, the aims of this study were to analyze the reliability of a posturography protocol to assess TC in adults with CP, and quantify their degree of TC impairment compared to a control sample of adults without CP. Forty-seven adults with moderate-to-severe CP and nineteen control participants were assessed via a protocol of static and dynamic seated trunk tasks, performed on a stable and an unstable surface placed on a force-plate. The mean radial error was the primary variable measured. A large percentage of CP participants successfully completed the static and dynamic conditions on the stable surface (static: 93.6%; dynamic: 91.5-72.3%); however, this percentage decreased considerably on the unstable surface (51.1-34.0%). The posturography protocol displayed good reliability in adults with CP (0.89 ≤ ICC ≤ 0.95; 15.2% ≤ SEM ≤ 20.7%). Adults with CP displayed significantly decreased TC in 4/5 tasks on the stable seat, particularly in dynamic conditions (1.71 ≤ dg ≤ 1.91). Our results confirmed that TC is significantly affected in CP adults compared with controls without CP of similar age, but they present more difficulties to perform dynamic tasks. Thus, it would be recommend including dynamic in addition to static conditions to obtain a comprehensive assessment of TC impairment in adults with moderate-to-severe CP. Additional, these results encourage practitioners to design dynamic activities that challenge trunk control for rehabilitations/training programs.

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.

Vertical and Horizontal Jump Capacity in International Cerebral Palsy Football Players.

PURPOSE: To evaluate the reliability and validity of vertical and horizontal jump tests in football players with cerebral palsy (FPCP) and to analyze the jump performance differences between current International Federation for Cerebral Palsy Football functional classes (ie, FT5-FT8). METHODS: A total of 132 international parafootballers (25.8 [6.7] y; 70.0 [9.1] kg; 175.7 [7.3] cm; 22.8 [2.8] kg·m-2; and 10.7 [7.5] y training experience) participated in the study. The participants were classified according to the International Federation for Cerebral Palsy Football classification rules, and a group of 39 players without cerebral palsy was included in the study as a control group. Football players' vertical and horizontal jump performance was assessed. RESULTS: All the tests showed good to excellent relative intrasession reliability scores, both in FPCP and in the control group (intraclass correlation = .78-.97, SEM < 10.5%). Significant between-groups differences (P < .001) were obtained in the countermovement jump, standing broad jump, 4 bounds for distance, and triple hop for distance dominant leg and nondominant leg. The control group performed higher/farther jumps with regard to all the FPCP classes, obtaining significant differences and moderate to large effect sizes (ESs) (.85 < ES < 5.54, P < .01). Players in FT8 class (less severe impairments) had significantly higher scores in all the jump tests than players in the lower classes (ES = moderate to large, P < .01). CONCLUSIONS: The vertical and horizontal jump tests performed in this study could be applied to the classification procedures and protocols for FPCP.

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.

Change of Direction Ability Performance in Cerebral Palsy Football Players According to Functional Profiles.

The aims of the present study were to evaluate the validity and reliability of the two different change of direction ability (CODA) tests in elite football players with cerebral palsy (CP) and to analyse the differences in performance of this ability between current functional classes (FT) and controls. The sample consisted of 96 international cerebral palsy football players (FPCP) and 37 football players. Participants were divided into four different groups according to the International Federation of Cerebral Palsy Football (IFCPF) classes and a control group (CG): FT5 (n = 8); FT6 (n = 12); FT7 (n = 62); FT8 (n = 14); and CG (n = 37). The reproducibility of Modified Agility Test (MAT) and Illinois Agility Test (IAT) (ICC = 0.82-0.95, SEM = 2.5-5.8%) showed excellent to good values. In two CODA tests, CG performed faster scores compared with FPCP classes (p < 0.01, d = 1.76-3.26). In IAT, FT8 class comparisons regarding the other classes were: FT5 (p = 0.047, d = 1.05), FT6 (p = 0.055, d = 1.19), and FT7 (p = 0.396, d = 0.56). With regard to MAT, FT8 class was also compared with FT5 (p = 0.006, d = 1.30), FT6 (p = 0.061, d = 0.93), and FT7 (p = 0.033, d = 1.01). No significant differences have been found between FT5, FT6, and FT7 classes. According to these results, IAT and MAT could be useful and reliable and valid tests to analyse CODA in FPCP. Each test (IAT and MAT) could be applied considering the cut point that classifiers need to make a decision about the FT8 class and the other FT classes (FT5, FT6, and FT7).