Pilot study of parent and child perspectives evaluating the effect of a 14 week swim programme on quality of life, self esteem and independence in children with cerebral palsy

Abstract

Pilot study of parent and child perspectives evaluating the effect of a 14 week swim programme on quality of life, self esteem and independence in children with cerebral palsy

Background The properties of water are known to create a supportive environment for physical activity, by reducing joint-loading force, allowing for reduced pain during movement, and providing resistance for strengthening. For those with cerebral palsy (CP), previous literature indicates that aquatic based activity can improve physical endurance, strength, and motor control. Greater freedom of movement experienced in water has been indicated as providing an environment that promotes social interactions and improved self-concept for children with CP. Research is yet to investigate the specific effect of a 14 week, structured learn-to-swim programme on the quality of life, independence, and self esteem in children with CP.

Method Design: This mixed-method pilot study consisted of a single-group design involving eight families with a child with CP; with pre- and post-intervention measurements of the Quality of Life Questionnaire for Children with Cerebral Palsy (CPQOL-Child) and post-intervention semi-structured interviews. The CPQOL-Child included a parent-proxy (children 4-12 years old) and child self-report (9-12 years) version; three of the children in this present study were aged 9-12 and eligible to complete the self-report. The pre-intervention measure was followed by a 14 week water-skill focused swim programme carried out by experienced swim instructors, once per week for 30 minutes, with participants in either small groups or one-on-one sessions, depending on the participant’s individual abilities. Sample: Eight children aged 5-11 with CP, and Gross Motor Function Classification System (GMFCS) levels of motor impairment I to III and their parents. The participant sample included five children with hemiplegia, two with diplegia and one with ataxic CP. Data analysis: Changes in the CPQOL-Child from pre- to post-intervention were analysed using the Chi-square analysis and the post-intervention interview transcripts were analysed for theme development through a descriptive, exploratory approach.

Results The mean improvement in CPQOL-Child for all participants was 3.12% ± 2.97 (mean percentage ± SD), with Chi square analysis demonstrating no significant change (P=0.23), and no significant change was shown in the individual seven domains of quality of life within the CPQOL-Child. Thematic analysis demonstrated incidence of improvement as follows: all eight parents reported improvement in the physical domain of quality of life and in the swim programme; seven parents in the quality of life domains of emotional and cognitive, as well as in independence and self esteem. The lowest incidence was in the social domain of quality of life, where six parents reported improvement.

Conclusion There is a discrepancy between the quantitative and qualitative results in the present research, with the perceived change from parent perspectives demonstrating higher levels of improvement compared to the CPQOL-Child. This difference may be due to the limited sample size in the research and/or a lack of sensitivity of the CPQOL-Child. A controlled experimental design with a larger sample would provide more information regarding the discrepancy, and would also provide more generalisable results for the effect of the swim programme in children with CP.