Breaking Barriers: Performance-Focused Sport Can Reduce Motor Decline in Young People with Cerebral Palsy

Cerebral palsy (CP) is the most common motor disorder in children and, for the most part, young people with CPHSN (Cerebral Palsy with High Support Needs) typically experience worsening motor function over time. Limited physical activity is often associated with this downward trajectory, reinforcing the narrative that the decline in function is inevitable. However, our recently published study, which was led by Dr Iain Dutia and linked here, challenges this narrative, demonstrating that performance-focused swimming training can not only prevent decline in motor function but may perhaps actively improve it.

A Paradigm Shift: Performance-Focused Sport

We conducted a 46-month study involving three adolescents with CPHSN in structured swimming exercise where periods of training were followed by periods of no training. All three participants were previously untrained and were not achieving physical activity levels recommended by the World Health Organisation (WHO) at the start of the study. The swimming program they engaged in was designed to be performance-driven - the goal was to enhance sports performance by focusing on swimming skills and increased training load. During the study, participants increased training load to levels consistent with WHO physical activity guidelines and the results were marked:

• Motor function, as measured by the Gross Motor Function Measure (GMFM-66), improved across each training phase. This was opposite to the decline expected to occur based on previous population-based studies.
• Participants improved their swimming performance, significantly increasing average swimming velocity.
• Periods of training withdrawal led to measurable declines in motor function, reinforcing the effect of the training program.

Why Goals in Sport Matter

Setting and pursuing clear goals is an important part of achieving athletic success in athletes with and without disabilities. The competitive nature of sport and the drive to excel fosters discipline, motivation, and personal growth which may ultimately provide:

• A sense of achievement: Rather than focusing on limitations, athletes work toward milestones in speed, endurance, and skill.
• A structured environment: Regular training with coaches and therapists ensures consistency which is important to long-term progress.
• Social engagement: Team settings are important to foster friendships and community connections.

Removing Barriers to Participation

Our article describes the concept of “Para Sport as Medicine” which suggests that intensive, performance-focused sports training can bring about significant functional benefits. However, despite these benefits, performance-focused sport remains inaccessible to many people with high support needs. The study highlights some of the key obstacles that ought to be addressed:

1. Lack of specialized training programs. Few initiatives cater specifically to high-support-needs athletes.
2. Cost and accessibility. Transportation and coaching fees can be prohibitive.
3. Limited representation. Research and mainstream sports programming rarely include non-ambulant individuals, leading to fewer tailored opportunities. To increase participation, we must prioritize investment in adaptive sports programs, increase funding for multiprofessional coaching teams, and create inclusive pathways for athletes of all abilities.

Looking Ahead

While some of the barriers are listed above, there is an important need for further research into barriers to participation including the role that geographical location plays. Accessibility issues may differ greatly between city and remote communities, with transportation, facility availability, and coaching expertise often limited. Understanding and addressing these differences may be crucial to ensuring opportunities for aspiring athletes at grassroots and elite levels. By breaking down barriers, redefining possibilities and building infrastructure, we can increase the likelihood that individuals with disabilities who wish to participate in similar sports programs to the one described here can do so regardless of their location, activity of interest and level of support needs.