Esportes modificados para crianças com paralisia cerebral: componentes da intervenção, efetividade e percepções dos pais e cuidadores

Abstract

Participating in leisure-time physical activities involves engaging in sports or physical recreation. Sports-focused interventions prepare children with disabilities for these community activities by developing physical literacy. However, little is known about the true effectiveness of these interventions in the participation of children with cerebral palsy (CP) in leisure activities, as well as their treatment components. Among the available interventions, modified sports interventions stand out. The Sports Stars Brazil project is one intervention, implemented at the Universidade Federal de Minas Gerais, Brazil. This thesis, composed of five studies, had the following objectives: 1) To investigate the effectiveness of sports-centered interventions of children and adolescents with CP in participation in leisure time physical activities; 2) To examine the components of modified sports interventions; 3) To evaluate the effectiveness of Sports Stars Brazil for children with CP who walk independently; and 4) To explore the experiences of the families of children who participated in the intervention. In a systematic review in Study 1, we found positive results regarding effectiveness in promoting participation in leisure time physical activities through participation-based therapy, modified sports interventions, or group fitness training. In Study 2, a scoping review, we concluded that the main treatment components of modified sports interventions are sport-related motor training and sport introduction through modified games, with "learning by doing" as the primary mechanism of action. These interventions aim to improve gross motor function, indirectly impacting body functions, executive functions, and participation in leisure time physical activities. Studies 3 and 4 demonstrated, through a randomized controlled trial, that Sports Stars Brazil was effective in promoting participation in leisure physical activities among ambulatory children with CP, increasing both attendance and involvement. The intervention also improved motor performance in fundamental skills, with results comparable to usual physical therapy. However, there was no improvement in general physical activity levels, physical literacy, or participation in other areas. Finally, Study 5, a qualitative study, revealed that parents and caregivers of children participating in Sports Stars Brazil reported positive experiences, such as reduced sedentary behavior ("Fitness"), improved motor skills ("Functioning"), stronger family connections ("Family"), better socialization ("Friends"), increased participation in enjoyable activities ("Fun"), and greater awareness of the importance of physical activity ("Future"). These positive experiences were interconnected, integrating various aspects of functionality. The results of this thesis support modified sports interventions like Sports Stars Brazil as a promising intervention for ambulatory children with CP, specially in the context of middle income country as in Brazil.