Relatively unknown sports for people with impairments, such as synchronized swimming, are given less medical support. As a result, people with impairments may develop a misuse syndrome or secondary condition. In this study, we report the use of synchronized swimming as an intervention for a female with cerebral palsy supported by a physiotherapist. We highlight that it is important for physiotherapists or other supporters of people with impairments to consider the characteristics of the person\u27s physical disability and activities of daily living, and give them appropriate advice before undertaking any sporting activity

Hitomi BUNKI

IKEYA Masae

Japan Synchronized swimming Association for people with an impairment

Michiyo MORITA

Physiotherapist Shiga School of Medical Technology Physical Therapy Course

Relatively unknown sports for people with impairments, such as synchronized swimming, are given less medical support. As a result, people with impairments may develop a misuse syndrome or secondary condition. In this study, we report the use of synchronized swimming as an intervention for a female with cerebral palsy supported by a physiotherapist. We highlight that it is important for physiotherapists or other supporters of people with impairments to consider the characteristics of the person's physical disability and activities of daily living, and give them appropriate advice before undertaking any sporting activity.10KJ00010289099POriginal paperdepartmental bulletin pape

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BUNKI, Hitomi

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MORITA, Michiyo

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Aino University Institutional Repository / 藍野大学学術機関リポジトリ

 AINO  JOURNAL,  Vol.  14, 2015, pp.  39-43Original paperApproaches used by a physiotherapist in synchronized swimming             for an adult with cerebral palsyMasae IKEYAHitomi  BUNKI Michiyo  MORITAPhysiotherapist Shiga School  of  Medical Technology Physical Therapy Course Physiotherapist Shiga School  of  Medical Technology Physical Therapy  Course     President, Japan Synchronized swimming Association for people     with an impairmentAbstract Relatively unknown sports for people with impairments, such as synchronized swimming, are given less medical support. As a result, people with impairments may develop a misuse syndrome or secondary condition. In this study, we report the use of synchronized swimming as an intervention for a female with cerebral palsy supported by a physiotherapist. We highlight that it is important for physiotherapists or other supporters of people with impairments to consider the characteristics of the person's physical disability and activities of daily living, and give them appropriate advice before undertaking any sporting activity. Key words : Sports for people with impairments, cerebral palsy, support by           physiotherapistsIntroduction The history of sports undertaken by people with impairments differs depending on the disability, e. g., deafness, physical impairment, and mental disability. The first Paralympic Games was held in 1960 in London due to the efforts of Dr. Ludwig Guttmann, who proposed that "It's ability, not disability, that  counts". Today, the Paralym-pic Games remain a major international sporting event, which attracts mass media attention. On the other hand, a large number of sports for people with impairments are not included in the Paralympic Games, including recreational sports, such as aquatics programs, which are generally popular among children and adults with impair-ments. Although many studies on swimming for spinal cord injury victims exist, only a few have been published on swimming and patients with cerebral palsy (CP). Indeed, aquatic exercises have been demonstrated to be effective for reducing muscle tone or improving the cardio-pulmonary function and gross motor function inpatients with CP. Moreover, a study on children and adolescents with CP reported that perform-ing motor skills in the water can potentially increase confidence and lead to less resistance when attempting difficult tasks. However, despite these positive results, few studies have been conducted on synchronized swimming and patients with CP or other impairments.  While synchronized swimming is a sport undertaken by people with impairments, it is not generally recognized by the medical profession. Therefore, few reports to date have investigated synchronized swimming for people with impair-ments. In this study, we report the approaches and advice, according to movement and risk management, provided by a physiotherapist for a female with athetoid cerebral palsy participating in synchronized swimming.<What is synchronized swimming for people with  impairments  ?>  Synchronized swimming for people with impairments was initiated in Kyoto, Japan in 1983.39AINO JOURNAL, Vol. 14,Synchronized swimming involves synchronization with water, music, and people (Morita, 2011). Similar to the competition events of synchronized swimming, several types of performances exist for people with impairments, including solo, duet, trio, and team performances. The most promi-nent feature of synchronized swimming, which no other sport for people with impairments has, is equality. That is, regardless of the age, sex, and presence or absence of disability, the same performance is given by all participants.  Both people with and without impairments enjoy synchronized swimming as a sport. Even if a person has a severe disability, they can still swim utilizing the properties of water, or if it is difficult to swim by oneself, they can be paired with a healthy team member. These healthy team members are usually elderly people or members of their family. Relatively few people with impairments currently pair with physio-therapists. Moreover, both people with and without impairments can start synchronized swimming even if they cannot currently swim. While practicing synchronized swimming, they will learn to swim and gain freedom in the water. Synchronized swimming requires various motions to swim, maintain balance, and add unique technical movements (figures), such as rotation, spin, or float. In addition, a successful perfor-mance can build confidence, and practicing the performances helps swimmers to maintain or improve their physical functions.  An annual synchronized swimming festival is held in Kyoto for people with impairments as an opportunity to present their progress and achievement. This annual event celebrates its  25th anniversary next year. The number of parti-cipants has increased year by year. Currently, over thirty groups compete in the solo, duet, and team events in the festival (Fig. 1). Five judges give criticism after each performance, and three winners are selected. An annual solo competition is also held, in which participants perform in each classification of impairments, and their scores are ranked. This competition is only in its third year, and while it currently has only a small number of participants, more are joining each year.Subject and Methods We explained the purpose and methods of this study orally to the subject and obtained approval.History  The subject was a 34-year-old female diagnosed2015Fig. 1 Team performancewith athetoid cerebral palsy. She developed cervical spondylosis as a secondary condition. The subject's height was 156 cm, her weight was 68 kg and her Gross Motor Function Classification Score (GMFCS) was 4. As for her activities of daily living (ADL), the subject uses an electric wheelchair outdoors and moves on all fours when indoors. It is possible for the subject to stand up when grasping some support. She has toileting independence. Regarding the function of her upper limbs, she can eat using a spoon  ; however, she needs help changing her clothes because of her hypertonia.  With respect to her motor function, her muscle tone shows high spasticity while active both in water and on land, particularly her upper limbs move involuntarily. She mainly uses her left arm with left neck rotation because of the asym-metrical tonic neck reflex. During movement in the water, her right upper limb shows flexion, while her lower limbs show an extension pattern. While floating on her back, the spasticity of her upper limbs relaxes  ; however, the lower limbs still show hypertonia.  The subject started synchronized swimming at the age of 13 years. At the age of 26 years, she paired with a physiotherapist and participated as a duet in an annual synchronized swimming festival held in Kyoto. The team practice took place in 1-h sessions, two or four times each month. At the baseline, she could swim breast and back stroke without support, but only slowly. She could perform the following technical move-ments (figures) : scouring (scour with arms while floating on one's back) and floating and tab (flex both legs while floating on the back) (Fig. 2). However, the spin and rotation movements were difficult to independently perform. She practiced spinal rotation for 6 months with her physio-40IKEYA et al. Approaches used by a physiotherapist in synchronized swimming for an adult with cerebral palsyFig. 2 Practice for duet performance Fig. 3 Repeat the isolated movement in a relaxed position.therapist. As a result, she could voluntarily rotate her body backward in 2014.   As for rehabilitation, the subject underwent sessions during childhood, but discontinued them after high school. At the age of 26 years, she attended physiotherapy sessions again (once every month in a hospital) because she became aware of a decrease in her motor function. At the age of 32 years, she also started home occupa-tional therapy once a week. Approaches for synchronized swimming  The subject's hopes were to : (1) relax her body in the water and (2) increase the possible synchronized swimming techniques she could perform. The aims of the physiotherapist were to reduce the subject's spasticity, to teach the subject the difference between voluntary and involuntary pattern movements, to facilitate the subject's use of trunk muscles, and to increase the subject's atisfaction or confidence via synchroniz-ed swimming. Regarding ADL, the physio-therapist's Main aims were to reduce the body weight by exercising and maintain her ability to perform daily activies.  Specific approaches were as  follows  :(1) Approaches in the  water  ..  To achieve relaxation in the water, while the subject was floating on her back, the physio-therapist would move the subject's trunk (pas-sively swing left and right) to reduce spasticity. To increase the possible synchronized swimming techniques, the subject would repeat the isolated movement consciously (Fig. 3), and the phy-siotherapist would give advice on abdominal muscle facilitation exercise because the lower tone of the abdominal muscles can cause hyper-tonia of the legs.(2) Exercises on  land  ..  The physiotherapist suggested facilitation exer-cise for abdominal muscles and neck stabilization exercise for cervical spondylosis. (3)  Support  for  daily  life  The symptoms of cervical spondylosis and obesity had become more severe as the subject aged. Simultaneously, her complaints increased regarding her difficulty in movement and frequency of falling while performing indoor activities. The subject was given the following advice from the physiotherapist : to use a wheel-chair indoors for safety and to exercise to prevent muscle weakness.Results and DiscussionMotor function  Overall, the subject has not shown acute deterioration and has maintained her motor function for 7 years. A physiotherapist in a hospi-tal evaluated the motion of the subject as slow when she did not undertake synchronized swim-ming practice for a while. The physiotherapist who paired with this subject for synchronized swimming confirmed this evaluation. That is, the subject moves smoothly and shows better performance when she practices synchronized swimming every week. With even a single absence, the spasticity increases and movement is slowed. The flexion pattern of the right arm is also marked and difficult to relax.Recent problems  The subject has used an electric wheelchair since her late teens. Her body weight started increasing in her early twenties. In her late twenties, she complained of symptoms of cervical spondylosis, which has recently worsened. 41AINO JOURNAL, Vol. 14, 2015Regarding the cervical spondylosis, an attending physician suggested an operation and did not recommend synchronized swimming. The reason for not recommending this sport is because swimming has some risks, such as slipping on a wet floor and changing clothes without help. However, the doctor allowed the subject to continue synchronized swimming practice under certain conditions, whereby the physiotherapist managed the risk and provided the intervention.  A large number of people with CP show a decline in motor function over the age of 30, and cervical spondylosis tends to appear at a young age (Sekiya et al., 1992). This subject is over the age of 30 years, and thus, her motor function had declined, resulting in obesity, and inactivity. Therefore, to maintain and increase physical health an exercise program is the key. Exercise on land has an inherent risk of falling ; indeed, the subject has fallen down several times recently. However, in the water, the subject will never fall, and buoyancy can reduce the effects of gravity and increase postural support. Moreover, aquatic exercise eliminates the body mass load, which reduces the muscle tone, and thus, is more appropriate than on land. Despite this, it is impossible to relax the muscle tone when swimming ; rather it forces more spasticity and fatigue. On the other hand, during synchronized swimming, there are many chances for people to float and relax ; therefore, it is possible to exercise and relax at the same time. In addition, syn-chronized swimming can provide marked satis-faction when completed or if the patient achieves success during a performance.  A large number of volunteers are required at centers that offer sports for people with impair-ments. Unfortunately, relatively unknown or unrecognized sports have few volunteers are insufficiently considered by physiotherapists and other health care workers. For this reason, people with impairments may develop a misuse syndrome. If the disability is severe, people with impairments may try to adjust to the sporting environment offered to healthy people, which in turn, increases their risk of injury or secondary conditions. Therefore, if supporters can under-stand the characteristics of their disability or motor function accurately and give appropriate advice, people with impairments will be able to enjoy sports for a long period.  Other than the Paralympic Games, physio-therapists can give appropriate advice for people with impairments for participating in recreational sports. This advice should reflect the person'sADL. Indeed, Okuda (2005) reported that phy-siotherapists should engage in risk management or conditioning for people with impairments and should prepare the environment in which they can perform the sports safely. These remain key challenges for physiotherapists in the future. At the same time, physiotherapists hould positively participate in the competition or recreational activity for ongoing management. Even as a volunteer in these sporting centres, physio-therapists are specialists on motor function and are responsible for maintaining current know-ledge and skills. To prevent unnecessary risks to people with impairments, physiotherapists should make an effort to keep their skills up-to-date.Conclusion In this study, we reported the intervention for a female with cerebral palsy via synchronized swimming supported by a physiotherapist. We observed that the task of the physiotherapist was to perform risk management to prevent second-ary conditions and provide interventions ref-lecting the ADL. We propose that in the future, physiotherapists should play a key role in all sports played by persons with impairments, including synchronized swimming.            Acknowledgments  I would like tothank the subject and everyone involved for cooperating with this study.                    References Fragala-Pinkham MA, Dumas  HM, Barlow CA : An aquatic      physical therapy program at a pediatric rehabilitation       hospital : A case series. Pediatric Physical Therapy      21-1, 68-78 2009 Gorter JW, Currie SJ : Aquatic exercise programs for children       and adolescents with cerebral palsy : What do we       know and Where do we go ? International Journalof      Pediatrics 2011, 1-7, 2011 Hatsuyama Y : Sports for persons with disability. General      Rehabilitation 25(9) : 817-822, 1997 Hutzler Y, Chacham A, Bergman U, Szeinberg A : Effects of a       movement and swimming program on vital capacity      and water orientation skills of children with cerebral      palsy. Developmental Medicine & Child Neurology  40  : 176-181, 1998 Kanno  S, Kanno N, Yoshida M, Tajima F : Brief overview of      disabled spots. General Rehabilitation 36(9) : 827-830,     2008 Kelly M, Darrah J : Aquatic exercise for children with cerebral      palsy. Developmental Medicine & Child Neurology      47 : 838-842, 2005 Kondo S : How the Physically Handicapped effectively acquire       their balancing abilities  —through swimmingand       synchronized swimming by the handicapped—      Rehabilitation sports 23(1) : 13-18, 200442

Approaches used by a physiotherapist in synchronized swimming for an adult with cerebral palsy

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Approaches used by a physiotherapist in synchronized swimming for an adult with cerebral palsy

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