The Effects of an Adapted Community Sports Camp (“GAME ON”) on Functional Mobility,and Fitness in Children and Adolescents With Cerebral Palsy (CP)

Abstract

Date Presented 04/06/19

Our interdisciplinary team has developed a community-based camp "GAME ON" that actively engages children and adolescents with CP in learning new motor skills and improving their functional mobility and fitness. We emphasize the activities used in the camp and the outcome measures to monitor participants' progress. We present the results from a feasibility study that examined the effectiveness of the camp to improve and maintain functional mobility and physical activity in this population.

Primary Author and Speaker: Katherine Dimitropoulou

Additional Authors and Speakers: Genni Hester

Contributing Authors: Adam Blanchard, Amber Newell, Kelly Boscarino, Paul Weiland, Heakyung Kim

Our presentation emphasizes first of principles to design and implement a community-based camp to improve mobility and fitness in children and adolescents with cerebral palsy. We present the guidelines for activity development and outcome measures. Our program creates conditions of high motivation and activity engagement, provides individualized strategies and activity expectations, and emphasizes on critical online outcome measures of fitness (i.e., heart rate) to increase participants' awareness of their fitness goals and have them and their coaches monitor progress. The focus of the camp is on functional mobility and fitness while children and adolescents are actively engaged in sports and interactive games. We then present the results of a feasibility study to examine the effectiveness of the camp program to improve functional mobility (balance and gait), and fitness. We further examine whether the program has the same impact for individuals with baseline high and low physical activity levels. The ultimate goal is to create evidence-based community adapted sports camps and afterschool programs for children and adolescents with CP.

DESIGN: Cross sectional feasibility study.

PARTICIPANTS: A total of 6 boys with unilateral and bilateral CP (age, 11.3±4.7 yr; height, 136.9±27.5 cm; weight, 44.9±26.8 kg) participated in a structured sports camp that provided individualized programs for fitness and motor learning for 3hours/day for 5 consecutive days.

MEASURES: Functional mobility (balance control and gait quality) was measured using the inertial motion sensors (APDM system) before and after the camp. Fitness was measured using the Activity energy expenditure (AEE; J·kg·s-1) and oxygen consumption (VO2; ml·kg·min-1) as assessed by the Actiheart monitor during five, 10meter walks before and after the camp. The Physical Activity Questionnaire assessed baseline PA levels at the beginning of the camp. During the camp participants wore Polar monitors to monitor heart rate as an indicator of rigor. Participants and coaches monitored engagement in the activities to maintain a moderate to high levels of rigor for each participant.

RESULTS: Results were not significant due to the small sample size and the short duration of the program. Medium to large effect sizes were observed in balance and gait parameters such as cadence, stride length, step length, step width and single support (d=0.56 to d=0.82). Medium effect sizes were observed in the reduction of AEE during walking on day at the post test (2.5±0.5 J·kg·s-1) compared to baseline (2.9±0.5 J·kg·s-1; p=0.28, Cohen’s d=-0.66). Similarly, submaximal VO2 was lower on day 5 (8.5±1.9 ml·kg·min-1) compared to baseline (9.3±3.1 ml·kg·min-1; p=0.31, Cohen’s d=-0.31). Regarding to the program’s impact for participants with low and high PA levels, we observed a strong effect size for participants with low PA (n=3) than participants with high PA (n=3) They reduced their VO2 (Δ=1.6±2.3 ml·kg·min-1 versus Δ=0.0±0.9 ml·kg·min-1, respectively; p=0.31; Cohen’s d=0.92) on post test compared to baseline.

DISCUSSION: Children and adolescents actively participated in the camp with high levels of engagement. Although the study had a small sample size, and the camp duration was short, we have seen significant effects on balance control, gait effectiveness and efficiency. We can not generalize the results of the study to the population, but we will conduct a larger scale study with a larger sample size and a longer camp duration (two weeks) to better understand the camp effects and benefits. Our interdisciplinary team comprises of an occupational therapist (PI), an exercise physiologist, a physiatrist, a nurse practitioner and a coach in collaboration with a community organization.

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