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

Abstract

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 paraathletes 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 heeltoe 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.

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

“…This is a very effi-cient model since scores of 1 or 2 in the root node (i.e., the observed impaired balance of the non-dominant or more affected leg in the side-step test) correctly classify 128.4 instances (93.1%) as moderate spastic hemiplegia. Recent research describes similar difficulties for maintaining balance stability, indicating differences in control postural strategies in para-footballers with CP during a one-leg stance position with the dominant [59] and when comparing both body sides [32]. Our findings are in line with Reina et al [14], who demonstrated that the mean velocity of the centre of pressures when performing a one-leg stance is the best predictor for discriminating between different levels of spastic hemiplegia.…”

“…Para-footballers with eligible impairments of ataxia/athetosis exhibit a higher coefficient of variance when performing agility, sprint, and acceleration/deceleration skills, with and without ball dribbling, when compared to the other two CP football profiles of spasticity [18]. Moreover, recent research with this population evidence that this subgroup has greater limitations for both static and dynamic balance, and this fact would influence the performance of basic and specific motor skills differently [32]. Therefore, it is plausible to think that this variability affects the efficiency of the model for this CP subgroup, but also the overall model.…”

“…In addition, this decision tree model included the impaired balance in the tandem walk test in a second node. Poor balance is a common symptom (i.e., activity limitation) involved in all CP profiles [32] and is deeply studied because of its association with postural control [56]. A zero score on the balance observed in the tandem walk correctly classifies 20.3% of the observations as C8 (i.e., a mild form of the impairment), demonstrating that better balance levels have been related to higher motor function in people with CP [57].…”

“…The total distance covered in meters is standardized by using the leg length (distance between the anterior superior iliac spine and the medial malleolus). The player walks barefoot heel to toe along a 5 m line as fast as possible and with the best accuracy, with both arms crossed in front of the chest [32]. Participants stood on a marked area (force platform) and, in their own time, jumped as high as they could, landing on both feet.…”

“…The test was ended when the footballer did any of the following: 1. Uncrossed or used arms to maintain balance; 2. touched the floor with the raised foot; 3. moved the weight-bearing foot; 4. exceeded maximum duration of 20 s[32].…”