Evaluating the Effects of Performance-Focused Swimming Training on People with Cerebral Palsy Who Have High Support Needs – A Study Protocol Using Single-Case Experimental Design

Abstract

Background: People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs. Methods: This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases. Discussion: The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.

Study protocol for Running for health (Run4Health CP): a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy

“…Feasibility, tolerability and safety will be measured on a weekly basis in both groups using the Wong-Baker FACES rating scale (pain), 40 Fatigue Severity Scale (fatigue), 41 and for the training group only, training load (Rate of Perceived Exertion (RPE) on the OMNI RPE 42 multiplied by session duration). 43 Monitoring of adverse and unintended events including injuries will be undertaken throughout the study.…”

Does sports-specific training improve measures of impairment developed for para sport classification? A multiple-baseline, single-case experiment

“…The results presented in this study come from the first year of a four-year longitudinal project in which participants are monitored whilst completing four seasons of performancefocused swimming training. The protocol for the first year of the longitudinal project has been previously described (Dutia et al, 2019). A large number of qualitative and quantitative outcomes are collected in this project -including measures of psychosocial and physical function, and swimming biomechanics (Dutia et al, 2019).…”

“…The protocol for the first year of the longitudinal project has been previously described (Dutia et al, 2019). A large number of qualitative and quantitative outcomes are collected in this project -including measures of psychosocial and physical function, and swimming biomechanics (Dutia et al, 2019). This article presents swimming performance, isometric strength, range of movement and coordination data collected in the first swimming season.…”

“…not consistently meeting global recommendations for physical activity and health (World Health Organisation, 2010)) -and not participating in any organized sports or exercise training; were medically fit to participate in a performance-focused swimming programme and cognitively able to follow the instructions required to safely engage in supervised exercise and exercise testing protocols. A detailed description of the inclusion and exclusion criteria used for this study has been previously published (Dutia et al, 2019), and is also presented in the Supplementary Materials -Appendix 1. Participant characteristics are described in (Table 1).…”

“…The assessment was conducted in a 25 m pool, heated to 29 . The assessment method has been described previously (Dutia et al, 2019). Participants were asked to swim freestyle, covering as much distance as possible.…”