Nora Shields 

We often sort of focus on the child, particularly when we're working in health. But of course, there's so many other levels outside of that at an organisational level, at community levels, at policy levels, which we sort of think are a little bit more kind of outside the realm of our, you know, immediate clinical practice. But actually all of those things can make a big impact as to whether somebody participates or not.

Leanne Johnston

Hello and welcome to this podcast by the PRF on Disability and sport and recreation for physiotherapy. First of all, I'd like to acknowledge the Turrbal and Jagera peoples of the Meanjin land as the original owners and custodians of the lands on which we meet and work and learn today. We pay our respects to the elders, past, present and emerging.

Hello, my name is Associate Professor Leanne Johnstone from the University of Queensland and I'm really pleased today to have with me Professor Nora Shields and Dr. Georgina Clutterbuck. So let's do some introductions first. Nora, would you like to tell us a little bit about yourself?

Nora 

Hi, Liane. Hi everyone. I'm Nora Shields. I am, and I'm research director at the Olga Tennison Autism Research Centre at La Trobe University in Melbourne.

Leanne 

Thanks, Nora, and hi Georgina. Would you like to tell us a little bit about yourself?

Georgina Clutterbuck

Yeah, absolutely. So I'm Georgina Clutterbuck and I'm a lecturer at the University of Queensland and my research is in the area of sports participation for kids with disabilities.

Leanne 

Thanks, Georgina. So today we're going to be talking together about the topic of disability and how we can better facilitate the participation and engagement of children, young people and adults with disability in sport and recreation.

So Nora, do you want to tell us a little bit, first of all, about what recreation and what sport are and what's the difference between then and then? We'll ask Georgina a little bit about the sports participation framework. So thanks, Nora. Do you want to talk about that first?

Nora 

Sure. Well, Leanne, it all really comes under this idea, or concept of physical activity, which we know is really just movement. Any movement that people do and then all these other things are kind of subsets of, of that. So with physical recreation and sport, often the activities can be the same, or they can both involve movement, but perhaps where they differ is, is why people do those or what the intent of those activities are.

So with physical recreation, people are sort of voluntarily participating in an activity, you know, because it makes them, you know, feel good or for leisure or to relax or things like that. Compared with sports, which often has the same amount of intensity or vigour around the activity. But there are rules and regulations and sort of codes. It's much more structured often, so yeah, that's kind of a basic overview.

Leanne 

And I hear, Georgina, that one of the key differences between recreation and sport is that competitive aspect that enables, as Nora says, the ability to use the same skills and ability, but in a structured way that has a competitive intent where you might have teams play together. And I believe you've put together a lovely sports participation framework that helps to explain that.

And then the pathways that people with disabilities can take. Could you talk us through that a little bit further?

Georgina 

Absolutely. So the sports participation framework is a really useful tool to help understand where children are currently participate, to help them set goals for where they'd like to be participating and to help there team around them to work out what's the best intervention to help them reach their goals.

So it starts out where we as physiotherapist spend a lot of our time in that screening, goal setting and individual preparation phase. And so this is where you might be working with a child who's maybe interested in participating in sport, who needs help with their leg strength to be able to kick a ball or their balance and all things like that.

What we see a lot of the time is kids get stuck here and they don't move on to then participate in community sports options. So practitioner led sports groups can help as a transition phase to get kids in the community. Still working with a practitioner like a physiotherapist and help them to then make that jump to community sport.

So junior entry point programs such as Net set, go, Auskick, Mini Roos into cricket, any of those where typically developing children often have their first experiences in sport. The practitioner led sports group helps kids with disabilities to feel confident and capable and have really positive first experiences in sport. After the junior entry point stage, children will sometimes head to recreational sport as the next stage, or they might go straight into team competition, either at the school or the club level.

And then of course, it goes all the way up to state, national and international competition. And the pathway can be either for mainstream sport or para sport. The sports framework rings true for all pathways, and so that can just help to conceptualise that pathway from individual physiotherapy with the kids you're seeing all the way to the Paralympic podium.

Leanne 

That's amazing and I love the way that you’ve used sports, S P O R T S to help people to understand the stages of that progression that young people can take. The sky's really the limit, isn't it? And when we think about Brisbane 2032 coming up shortly, we certainly are looking at young people with disabilities reaching towards the goal of Paralympic competition.

But at the same time there's a whole population, isn't there, of children and young people who are looking for recreation and sports options. So if I go back to you then, Nora, when we're trying to think about how we can best facilitate the progression and engagement of young people and adults in sports, what do you think is some of the key challenges in the recreational space?

Nora 

There's so many levels at which to sort of think about this stuff. So when we when we look at the literature, we've done a number of systematic reviews that have tried to answer this particular question. What we find is, is that we're really good at identifying all of the barriers, not so good at identifying all of the facilitators.

And I think the other sort of thing about this, this literature is, is that this multiple levels at which those barriers and facilitators operate. So it can be really helpful to think about the socio ecological model in this regard. We often sort of focus on the child, particularly when we're working in health. Our focus is always on the child and perhaps maybe on the family.

But of course there's so many other levels outside of that which, you know, at an organisational level, at community levels, at policy levels, which we sort of think are a little bit more kind of outside the realm of our, you know, immediate clinical practice. But actually all of those things can make a big impact as to whether somebody participates or not.

So you could have, for example, as Georgina mentioned, you know, you can have somebody who has has impairments or difficulties in some motor skills that perhaps we can intervene at the child level or at the family level. So we know that active kids often have active parents or in fact, the other way around. Active parents often have active kids.

So we sometimes need to think about intervening at the family level because what happens in that context can actually impact the child. And then at an organisational level, we can things about how that organisational works and operates can actually either facilitate or hinder. I often give the example of my own children's school, you know, where there's a big sign in the courtyard that says Do not run.

And I laugh every time I see it because I understand why it's there. It's there to prevent the kids from, you know, clashing heads, you know, running into each other and all the rest of it. But it's it's a really good example of where our sort of best intentions actually limit what children naturally do. We actually really want kids to be running around.

 And then if you think at the community level, well, if there aren’t the choices and the opportunities and activities that are actually designed for you, well, that's going to limit whether you engage with something or not. So with all of these challenges, I think it's really important that we as physiotherapist, we sort of think beyond that immediate, you know, the child and the family think more broadly.

Leanne 

It's great to think of active families, active communities and active schools, isn't it, as some of the strategies that can come in for young people? And Georgina, I know you've been publishing a lot recently on something called Sport Stars, which is a great way to help overcome some of these barriers that might be in the sports space by a practitioner led program. Can you tell us more about sport stars and who can be involved?

Georgina 

Yeah, so Sport Stars is, as Lianne said, a practitioner led sports group. So it is a short term transition program. Usually we run at about eight weeks long, one hour a week after school, and it's held in community areas. So it really works to bridge that gap between individual physiotherapy and community sports participation.

We originally designed sports stars or research sports stars in the area of cerebral palsy, so ambulant children with cerebral palsy. But we've gone on to research this group in another number of other populations. So over in Brazil, we've adapted it to include popular Brazilian sports and looked at it for children and adolescents with both cerebral palsy and autism.

We've looked at it in rural Australia with groups of kids with mixed disabilities, and we've currently got a PRF grant to investigate the feasibility of doing it for kids with juvenile idiopathic arthritis and and looking at the impact of pain and feelings about pain in participating in sport moving forward. So it's a really adaptable program that can be changed based on the context of the community and what sports are available in the community and adapted based on the population that is wanting to participate in sport.

So I think that's why Sport Stars has been really popular with families and with practitioners because it has a lot of applications and I think sports stars has shown improvements in physical skills. But what the families have reported to be far more important than that, are the improvements that children have in their self-efficacy, in their confidence, in their motivation to participate in sport, in their knowledge that they can participate in sport and enjoy participating in sport.

It's those benefits that have led to children. Three years after participating in the group reporting that sport starts, was the spark that helped them to try different sports and is why they're continuing to participate in sports now even after COVID lockdowns and all sorts of bumps in their road, they feel like they can still get out there and give something new a try.

Leanne 

Well, that's amazing. How exciting to hear that sports stars Australia has gone sports stars. Bush and sport stars, international sports stars, Brazil. Well, that's a huge credit to your work. And you mentioned there that it's very adaptable to different types of sports. Can you tell me about the types of sports that are engaged in sport stars in Australia and how you came to choose those particular sports?

Georgina 

Yes. So the original Sports Starts CP program included soccer, netball t-ball and cricket, and those are the four most popular in terms of population numbers, teams sports for children in Australia. And so with the Queensland wide trial that we ran, we chose those so that it was most appropriate over the most number of levels when we adapted it for sport stars.

Bush We talked to all the different people. We talked to the parents, the children, the referring clinicians and coaches in the community to work out what sports would be best in that specific location. And so in the different areas, we had different sports. So we had rugby, AFL, athletics, soccer, basketball, cricket and it all depended on what was available in the local community.

Leanne 

That's amazing. And I'm sure you had a few other different sports than in in Brazil doing it over there. It's a great way to approach it, isn't it, to be able to be flexible and diverse depending on the location that the children and families are in? And Nora, I know that you've put together another award winning program called Fit Skills that is more in the recreation space. Can you tell us a little bit about that, how you came to develop it and who can participate in fit skills?

Nora 

The central idea and fit skills is that a young person with a disability is matched with a student mentor from a health discipline, and they meet at the gym and they exercise together at the gym twice a week for 12 weeks. And it really grew out of really the inspiration was what young adults with disability and their families and their support workers told us.

We asked what would help you to to be physically active and they said somebody to exercise with. So we sort of took this idea and at the same time I was coordinating the PEADs curriculum at the university and in the annual feedback reviews that graduates were giving kind of one year after they they'd finished their courses, the students kept saying, Oh, well, you know, we didn't get enough experience working with young people.

We'd like to do a lot more of that. So really what happened was, is I had one group of people who were saying, we need somebody to exercise with, and I had another group of young people who were saying, well, we want to work with young people. And so we put those two groups together. And that was kind of really how the the program was or the idea for the program was born.

I think, though, Georgina, you mentioned something there about sports stars, which I think is really pertinent to linking in is that sports stars and fit skills, really what they provide is an opportunity. You know, you talked about the spark and it was this was the spark to kind of go on and do other things. And that's exactly what we found in fit skills.

So really having those opportunities for young people to participate in the community, often that's the thing that provides them with the confidence and the motivation and the know how to then go on and participate in other physical activity. So that's that's really important.

Leanne 

And I think that's an excellent point, isn't it? It really brings together Maxwell's five areas. When we think about the environment, when my thinking about the availability of opportunities, the accessibility of those opportunities, whether they can be adapted, whether it's acceptable to people, it really needs to be considered in a very important way when we're setting up programs, doesn't it?

Nora 

Absolutely.

Leanne 

So you've made a lot of progress, both of you, in your areas, and there's a lot of overlap, isn't there? And it's really amazing to see where the PRF has been able to support progress in this space of physiotherapy. So Georgina, you mentioned the PRF grant for children with juvenile idiopathic arthritis being able to participate in sport stars and I believe that's happening from this month.

Georgina 

It is. So we're doing our final pre assessments today actually, and we'll start our first intervention sessions next week.

Leanne 

How exciting. And I know you've got a lovely partnership there with Queensland Health and Children coming through the medical programs there. So really a strategy to help them transition into community based physical activity and sport. And Nora, I think some of your colleagues in your team have had some PRF funding to support this work as well.

Nora 

Hot off the press. Leanne as so Stacy Cleary, who's one of the postdocs working with this on the C.P Achieve centre of research excellent done at MCRI in Melbourne has just been successful with a PRF grant and that project is is a little bit more broader. It is, it is in the area of participation, but it is a little bit more broader than just physical activity into, you know, kind of all of life areas that are important for young adults with cerebral palsy. So really excited.

Leanne 

Well, what exciting news on both of those fronts. And it absolutely does, doesn't it? It comes into the whole of life experience for a young person or an adult with a disability. So if we're thinking about clinicians now who are listening to this podcast and we're thinking about what they can do as physiotherapist, Georgina what would be your tip to a physiotherapist in terms of how they could incorporate sport into some of the services that they're providing to clients?

Georgina 

Yeah, I think it's something that first of all needs to be goal focussed, so it needs to be a conversation that we have with our clients, whether they're interested in participating in sport, whether they might be more interested in a physical recreation space because the interventions aren't going to change the person and what they want. So we need to be providing these interventions to the people who are most going to benefit from them.

Then I would say that you shouldn't be afraid of looking at providing sports focussed interventions to children just because you're not an expert in sport. As physiotherapist. We're experts in movement. We've got a lot of knowledge around how to support children with disabilities in movement, and sport is a type of movement. They're going to go on and participate in other sports focussed activities where people do have the sports expertise to teach them the specific throws and catches and techniques and tactics.

So allow yourself to get stuck in and go on that journey together with the children and the families. Learn about what they're interested in and provide them the opportunity to build their confidence and to build their expertise so that they do have that opportunity to then move into community sport spaces.

Leanne 

That's great advice and I love the point that you're making about it's all about movement and sport is one of those vehicles that we can use to increase the ability to do more movement and to improve our movement and to build our strength and do other things.

And that collaboration space with other disciplines and Nora from the recreation space, then what advice would you have to physiotherapy practitioners about how to incorporate this into their practice?

Nora 

Yeah, well I'm going to build a little bit on what you've just said there about, you know, all movement being important. And I'm going to suggest something because usually as physios we like the what's the pragmatic, what's the thing that I can do in the clinic? But I'm going to suggest you just think about changing the way you think about it or your mindset on it, because I think quite often lots of physiotherapists are, you know, if we think about the ICF, we're still very much focussed on body structure and function and we kind of think, well, if we solve all of those things at the impairment level, that activity and participation will naturally flow.

Whereas actually maybe we should be thinking about it from the other way if we think, well, if we can talk to people about their goals as Georgina suggests, and then actually just get people participating in that movement and what they're doing and all of that opportunity and experience that they get by doing that and doing that on a continual basis.

I suspect we might also actually impact the activity at at the impairment level. So so just maybe suggesting to everybody there are other ways to think and perhaps we need to just take a different perspective and think about participation as the first thing rather than as the last thing.

Leanne 

It's really interesting, isn't it? I heard a podcast the other day with Kate and Bronte, some of our Olympic swimmers, and when they were talking about their program of training, it is very much across the ICF. So as well as doing their participation focussed swimming training, they're also in the gym, doing strength, doing range of motion, doing all of those types of things.

They're also accessing, you know, mental health and social supports in order to help work on their mindset for that type of performance as well. And I think the working across the ICF at all times definitely applies here. We don't need to be bottom up or top down do we, looking at all areas as a profile for that person.

Nora 

Wise advice, Leanne.

Leanne 

So if we were thinking, then I'm a new practitioner, I'm trying to learn the skills that I need to do this in my practice. Georgina could you recommend any avenues of education or training that people could take to improve their knowledge or skills in sports related interventions?

Georgina 

Yeah, so I would say it's such a exciting area of research at the moment. There's a lot of stuff happening. I mean, this APA conference in particular, we've we've had workshops on sports participation. I know we at the Children's Motor Control Research Collaboration in Queensland, we run masterclasses each year as well. And then I would say that another really great resource is linking into the organised junior entry point program resources online. So if you search up the national organisations for each sport, they include coaching materials for entry point activities that you can then use your physiotherapy knowledge to adapt backwards and simplify to, to help make those connections, because I think that that intersectoral and interdisciplinary approach is so important in this area.

Leanne 

Fantastic Georgina they’re great resources. And Nora, just to round out our session, have you got some suggestions for education and training for physical activity? I believe there is a physiotherapy special interest group that people could join the physios for physical activity.

Nora 

Yes, so there's a group of physiotherapy, primarily researchers, but not limited to that. We've got quite a few clinicians in our ranks as well. They cover physical activity across the lifespan and also across all of the various specialities and that can be really helpful because often if we're just thinking about paeds or we're just thinking about neuro, we can miss out on things that are happening in the musc or the cardio space that actually are really applicable.

So I think that's really important. One other sort of final piece of advice would be just to get out into your communities and just to give something a go, look up what organisations are out there. Lots of those sports and rec organisations are often looking for volunteers. There is a disability sport and recreation association in every state in Australia and they do terrific work. So even just linking in with that group in your own state would be fantastic.

Leanne 

Oh, that's amazing. So there's there's lots of opportunities for people, isn't there? And just to wrap up, if people are wanting to find out more about what you're doing or to connect with you in any way to ask about research or running programs, where would they go to talk to you? Georgina how’s the best way to connect with you.

Georgina 

Yeah, you can email me G dot Clutterbuck at UQ dot edu dot au or head over to Twitter or X as we now know it at Georgina peads pt or if you Google Clutterbuck, you're pretty much going to get onto me that way as well.

Leanne 

And Nora, how would people get in contact with you?

Nora 

Yeah, same same avenues, really. So and N Dot Shiels at La Trobe Edu dot au or On X. I'm at Dr. Nora Shields.

Leanne 

Well thank you both. It's been an amazing opportunity to talk to you and to hear about all the fantastic work that you are doing to help improve the lives of people with disability through the very, very fun avenue of recreation and sport. I hope people do link in with you through the information that you've provided and the networks that you've let us know about today. Thank you so much, ladies.

Nora and Georgina
Thanks again.