For young people with physical or intellectual disabilities, there are often many barriers to sports participation which can often hinder engagement, and therefore limit the positive benefits which structured physical activity provides.
In their narrative review of sport activities in children with cerebral palsy, Italian researchers noted that, ‘children with cerebral palsy of school age are 30% less committed to sports than typically developing children of the same age’.
With males at a significantly greater risk than females of being diagnosed with cerebral palsy, hearing from young people on the challenges and benefits of physical activity is important for how we can better provide support and encouragement.
What is Cerebral Palsy?
Cerebral palsy is defined as ‘the result of a combination of events either before, during or after birth that can lead to an injury in a baby’s developing brain’.
According to peak body Cerebral Palsy Alliance,
- In 13 out of 14 cases of cerebral palsy in Australia, the brain injury leading to cerebral palsy occurs either in the uterus (while the mother is pregnant) or before 1 month of age.
- Stroke is the most common cause in babies who acquire cerebral palsy after 1 month of age. The stroke may occur spontaneously or arise from surgical or heart complications.
Cerebral Palsy & Men
According to research on the prevalence of cerebral palsy according to sex, cerebral palsy ‘affects approximately twice as many males as females’.
Although the exact cause or causes are unknown, it has been theorised that the higher rates of male prevalence may be due to higher rates of preterm birth and lower birth weights (than in female births).
According to data from the Australian Cerebral Palsy Register Report 2023, more males (58%) are diagnosed with cerebral palsy than females.
Cerebral Palsy & physical activity study
A study from Israel examined research into the perceived barriers and enablers for adolescents with cerebral palsy to participate in physical and sporting activities, which are described below.
Study participants
A total of 22 young people agreed to participate in this study.
- 11 male and 11 female participants.
- Aged between 13-23 years (mean 18 years old).
- 64% (14) of the participants experienced musculoskeletal pain.
- Ten attended special education schools and generally reported having moderate or severe learning disabilities.
- Twelve were students in mainstream schools and reported having no learning disabilities.
Semi-structured interviews were conducted by the researchers with the participants, with four primary themes emerging which are discussed below. All quotes have been taken verbatim from the original manuscript.
Study results
Theme 1: Pain, body functions & activity limitations
Muscoskeletal pain was reported by 14 (64%) participants. Pain can often influence a more sedentary lifestyle, or for some- provide a wake-up call to increase movement,
“I am mainly a sitter, because it is very difficult for me to move. Really painful. But, if I don’t move my body, my condition deteriorates even more.”
“It’s hard for me to move because I’m not fit right now. But I know that I will slowly get back to be fit. I’ll get better; if not, then soon I will no longer be able to move.”
Theme 2: Factors related to knowledge & life skills
Developing knowledge and physical skillsets impacted physical activity. Awareness of the benefits that increased activity provided (despite the physical pain), empowered some participants,
“I think that an active lifestyle is important …. Because … as if, our body is like a machine. If it does not work, eventually it will break down.”
Changes in life phases for older participants, required a re-prioritization of physical activity,
“Until I started my studies at the university, I had a very active intensive schedule; every morning started with stretching and physiotherapy, it was the main issue. For the last two years, suddenly nothing, nothing… the division of resources is different. You need to focus. Today, my priorities have changed …. “
Theme 3: Factors related to availability
The importance of relationship with coaches or physiotherapists and their availability to provide structured support was viewed as crucial to sports engagement. The knowledge transfer that a skilled coach passes on, was highly valued,
“I would like to go to the fitness club. I went a few times, but there was no one to help me. I think that with a good coach it definitely would be fun.”
“…while working in a group after school hours I used to say: ‘Enough, I have no energy; after a hard day at school, what more do they want from me?’ It was not in my heart to ‘come on, do it.’ I did it because you (the physiotherapist) encouraged me. After you disappeared … I thought I would find the heart to go on… but it did not work like that. I was still looking for my coaches”.
Theme 4: Factors related to social support
These factors included professional, family and peer support. In particular, the role of the physiotherapist could not be underestimated,
“The physiotherapists were there for me. They were determined and motivated for my own good. I got new exercises every time, that’s why I really liked going to physiotherapy”.
Parental advocacy to commence and continue in physical activity was seen as having high value, but participants voiced that they did not want their parents actively involved in their training or physical treatment,
“I would say that parents are a no no. Siblings – depends… like, depends on the dynamics. I think that once you decide on family, you are afraid to disappoint them. It is not a good place to be …”
The fun and enjoyment that friends and peers provided during physical activities were greatly appreciated,
“We had fun in the training group, we met friends, and the coaches were really fun. Even when it was really hard, we suffered together and laughed.”
“Friends can get me out of my chair. A good friend can really help.”
Study conclusions
At the conclusion of this study, the researchers noted that “there is a need for ongoing, accessible, adapted, community-based physical activity programs for young adults with Cerebral Palsy guided by skilled professionals that can provide them with opportunities for enjoyable activities involving social interactions”.
And furthermore, “Healthcare and educational professionals should provide young people with Cerebral Palsy and their families with theoretical and practical knowledge about physical activity and its health benefits, as well as information about exercise options.
Expert Opinion: Chris Pyne – Ex Australian Pararoo
This is a tricky one for me. While I understand that people with a disability and in this case, cerebral palsy, have extra life challenges, I have never used it as an excuse or used it to stop trying to improve myself.
While the availability of sport and physical exercise is a factor, as for some they may find it difficult to access certain physical activities, but the motivation to keep your mobility, your freedom and independence is enough for me. I have seen people use their disability as a crutch, and they lean on it all too often, and it’s to their detriment.
It is my belief that the motivation has to be intrinsic, as is the same for any person no matter their ability. If you are relying on external sources such as physiotherapists to motivate you then you are already on a slippery slope. Yes, we with a disability have to work harder to maintain physical acumen, yes, we have more pain related to our disability, yes its harder to find disability specific activities and sporting opportunities, but they are out there, if you look hard enough.
This may seem a hard line, but this is my experience. I don’t want to be seen as different; I don’t want to be treated differently because I have a disability. Are things harder, yes, but you have to play with the cards you are dealt. As long as you have a strong support network of family who will drive you, support you and believe in what you can achieve, any goal is attainable.
