Abstract
Spasticity is considered a contributor to hypertonia, frequently presented in people with cerebral palsy (CP), affecting muscle function and motor activities. In CP football, the classification system determines that this impairment is eligible for competitive para-sports due to the impact on activity limitation and sports performance. However, the relationship between this feature (i.e., spastic hypertonia) and performance determinants has not been explored yet. This study aimed to assess the association of clinical spasticity measurements with the performance of sport-specific tests used for classification purposes. Sixty-nine international footballers with CP voluntarily participated in this study. The Australian Spasticity Assessment Scale was used to measure spasticity in lower limbs muscle groups and activity limitation tests were conducted considering dynamic balance, coordination, vertical and horizontal jumps, acceleration, and change of direction ability. Low-to-moderate negative significant associations were found between the hip spasticity and measures of dynamic balance and dominant unipedal horizontal jump capacity. Additionally, moderate associations were reported between the knee spasticity and the non-dominant unipedal horizontal jump capacity and the change of direction actions with the ball. The ankle spasticity score reported small to moderate associations with the change of direction assessment without the ball and bipedal and dominant unipedal horizontal jump capability. Finally, the total spasticity score only presented a significant association with horizontal jump performance. This is a novel study that provides evidence of the associations between an eligible neural impairment and relevant specific measures of activity limitation tests. These results suggest that the amount of spasticity according to each evaluated joint muscle group of the lower limbs presents a low-to-moderate significant relationship with determined measures of dynamic balance, coordination, horizontal jump, acceleration, and change of direction ability with and without the ball in international-level CP footballers. Further studies are necessary to elucidate the real contribution of neural and non-neural impairments related to hypertonia on fundamental sport-specific motor skills of para-footballers with CP.
Highlights
In para-sport, evidence-based grading is mandatory to develop a competition system that ensures that outcomes are based on a causal relationship between eligibility and the impact of the eligible impairment on sports performance (Tweedy and Vanlandewijck, 2011)
The most recent research corpus on evidence-based classification in cerebral palsy (CP) football has explored the relationship between match performance parameters and coordination impairments (Reina et al, 2021b), and with a battery of activity limitation tests (Reina et al, 2020b). These results have shown a complex interaction between these factors, confirming the need to clarify the impairmentspecific associations for classification in para-sport
This study suggests that the amount of spasticity according to each evaluated joint muscle group of the lower limbs presents a low-to-moderate significant relationship with determined measures of dynamic balance, coordination, horizontal jump, acceleration, and change of direction ability with and without the ball in international-level CP footballers
Summary
In para-sport, evidence-based grading is mandatory to develop a competition system that ensures that outcomes are based on a causal relationship between eligibility and the impact of the eligible impairment on sports performance (Tweedy and Vanlandewijck, 2011). The development of evidence-based classification research for para-athletes with eligible impairments of hypertonia, athetosis or ataxia (i.e., those with cerebral palsy [CP] and other related neurological conditions) is still a challenge in para-sports (Tweedy and Vanlandewijck, 2011; Tweedy et al, 2014, 2016, 2018). Para-athletes with CP are usually eligible due to the presence of a minimum impairment criteria concerning hypertonia, ataxia, or athetosis, which is evaluated with clinical measures to determine the severity of the involvement and its impact when performing sports-specific skills (Connick et al, 2018). Among the three eligible impairments, hypertonia, or related impairments (i.e., spastic syndromes) are the most common type of CP, resulting from the injury of the upper motor neurons and possibly the loss of descending inhibitory input, thereby altering muscle tone, which intensifies with movement velocity (Odding et al, 2006; Graham et al, 2016). Nonneural origins are referred to the altered muscle properties such as tissue viscoelastic and stiffness which are often altered in cerebral palsy (Bar-On et al, 2015)
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