Acquired brain injury (ABI) from both vascular and traumatic causes is a major global public health problem that increases each year. ABI refers to an affectation generated on the mature brain, regardless of its severity and duration, resulting from different aetiologies such as stroke, traumatic brain injury, tumours or infectious diseases.1,2 People with ABI learn to predominantly use the non-affected upper or lower limb and ignore the most affected limb (mostly the upper one), which leads to non-use and abnormal postural patterns affecting their performance of daily activities. They will subsequently develop poor perception of quality of life, decreased cognitive and functional ability and their active participation in physical activity and sport community is altered.3,4,5
The International Classification of Functioning, Disability and Health (ICF) is the main bio-psycho-social framework to design and implement rehabilitation programs for people with disability.6,7 Precisely, people with ABI frequently exhibit physical function challenges, regarding the ‘body structure and function’ ICF domain (e.g. spasticity, muscle weakness or poor motor control). In addition, these impairments can restrict the ‘activity’ domain (e.g. poor fine motor function) and limits the ‘participation’ domain (e.g. difficulty in engaging physical activities and sports) as well.8 Hence, evidence suggests that rehabilitation interventions for people with ABI should consider improving all of the aforementioned dimensions to be more effective.9,10,11,12
Some systematic reviews point to the effectiveness of exercise therapy intervention programs, and favourable results of physical activity programs in people with ABI, leading to activation of supplementary motor areas, and augment more consistent motor recovery than only standard care.13,14,15,16,17 Multidisciplinary approaches oriented to exercise therapy and social leisure activities seem to be fundamental to elicit neuroplastic adaptations to enhance physical recovery, 16,18,19,20 and to improve the cognitive and behavioural sequels after ABI. 21,22 Considering the principles of motor learning, the dynamic interaction between systems including the demanding task of a real sport, allowing neuro-plastic adaptations and underlying behavioural improvement for the patients and achieving a motivating functional context. 23,24 On one hand, participation in group-based therapy programs centered on physical exercise showed a positive influence on quality of life, self-esteem levels and social inclusion in patients with ABI. 25,26,27,28 Moreover, a small group-based exercise program has been shown to achieve notable functional improvements in the rehabilitation process by maximizing engagement, motivation and participation.29 On the other hand, some studies have proposed programs that combine exercise and adapted physical activity based on different sports. 30,31 Precisely, a program based on racket sports is an accessible tool with a high social component that allows to integrate different body synergies and complex motor strategies that promote functional performance on both lower and upper limbs. 32,33,34 Several studies point out the lack of description of the structure and specific contents of this type of interventions, thus limiting their reproducibility and the development of standardised clinical practice guidelines. 35,36 Additionally, to date, there are some gaps in terms of exercise programs towards people with ABI which provide answers and encompass all the aforementioned CIF dimensions. Finally, it should be noted that there is no study yet on the effects of a program using a multi-component racket sports-based intervention. Therefore, the objective of this study is to design and determine the effectiveness of an exercise therapy program based on racket sports towards ambulant adults with ABI. We hypothesise that an exercise therapy program based on racket sports in ambulant people with acquired brain injury will enhance upper limb motor function and participation, as well as increase the levels of functional capacity, mobility, balance and quality of life.