Physical Activity in Children with Physical Disabilities: Factors Influencing Participation and Functional Outcomes of Participation.

The benefits of physical activity participation are greater for children with physical disabilities compared with able-bodied children because these children have the potential to gain not only the same health benefits of participation as their able-bodied peers but also specific benefits related to their condition. Research in this area is particularly limited, however theoretically physical activity participation may intervene in a cycle of disuse which often leads to de-conditioning, secondary health complications and further decreases in physical function for children with physical disabilities. Despite these potential benefits, children with physical disabilities have low levels of physical activity participation and perform less physical activity than their able-bodied peers. To improve these participation levels the factors that influence participation need to be understood. Study Number 1 in this thesis investigated the factors that influence the physical activity participation of children with physical disabilities. A pilot study determined that the best method for gathering the data was through the use of semi-structured interviews. Therefore, 14 children (ranging in age from 8 to 16 years of age) with physical disabilities, including spina bifida, cerebral palsy and acquired brain injury, were interviewed to examine factors influencing physical activity participation, from the childs perspective. The interviews were tape recorded, later transcribed verbatim and analysed by identifying core themes which recurred frequently in the data and linked the data together. This qualitative analysis resulted in the identification of nine factors. The most noteworthy of these factors were: availability of skilled and knowledgeable leaders; school practices that influence physical activity participation; peer acceptance or rejection, and; desire to be physically active and/or attitude towards physical activity. It was concluded that the identified factors could positively inform the development of future strategies or interventions to increase the physical activity participation of children with physical disabilities. Study Number 2 in this thesis, used the results of Study Number 1 as a guide for developing an effective short-term intervention program for a specific group of children with physical disabilities. As mentioned earlier, research in the area of the outcomes of physical activity participation for children with physical disabilities is limited. Therefore, the provision of evidence for the benefits of physical activity participation for this group coupled with the results of Study Number 1 may enable appropriate bodies to act upon the need to increase physical activity participation for children with physical disabilities. Consequently, the aim of Study Number 2 was to determine a disability-specific benefit of physical activity participation, improved physical functional ability, for children with physical disabilities. Study Number 2 was a prospective nonrandomised control study where the intervention was an 8 week progressive resistance training program instructed by an Exercise Physiologist. Subjects (manual wheelchair users with spina bifida, aged from 10 to 17 years of age) chose to be either in the Intervention Group (IG; n = 8, who participated in the twice weekly individualised program) or in the Usual Care Group (UCG; n = 9). Parameters of upper body muscular strength and physical functional ability (measured by three wheelchair propulsion tests and the mobility domain of the Pediatric Evaluation of Disability Inventory {PEDI}) were measured prior to the commencement of the intervention period and following the completion of the intervention period. The changes in the measurement parameters pre-test and post-test, within and between groups were calculated, and paired t-tests were performed, to determine the outcome of the intervention. Significant increases in upper body strength of up to 75.6% (p < 0.00005) for the IG compared with the UCG following the intervention were found. However, the results of the physical functional tests were not as conclusive. There was no change in the mobility domain of the PEDI following the intervention however, a significant improvement in the time to complete one of the wheelchair propulsion tests by the IG was found. It was concluded that further research into the strain of wheelchair propulsion during various activities of daily living and other aspects of physical function of children with physical disabilities following a physical activity intervention is needed. In summary, this thesis established a list of factors that influence physical activity participation of children with physical disabilities that can inform future intervention strategies to improve physical activity participation levels of this group. Additionally, this thesis confirmed previous evidence for increasing the strength of children with physical disabilities through participation in a progressive resistance training program. And finally, this thesis demonstrated a clear trend for improving physical functional ability by participation in resistance training and provided new methodological ideas for the application of a future successful intervention to clearly define the ability of progressive resistance training to increase physical functional ability in children with physical disabilities