Increasing long-term participation in sports based activities in children and young people with acquired brain injury.


Participation in sports can play a key role in a child’s quality of life, development and learning (Willis, 2018). Children and young people (CYP) with acquired brain injury (ABI) face significant barriers in accessing sporting and leisure activities.  This reduces the likelihood of participation in regular sporting and leisure activities (Anaby,2018),  both in the recovery period and the later stages (Willis, 2018).

This is a quality improvement project that explores the implementation of a sports based group in a neurorehabilitation centre for CYP with ABI.


Plan-Do-Study-Act (PDSA) cycles (Hayes, 2014) were used to structure the project. 

A weekly football group was planned by the multi-disciplinary team, with consideration of how each child could maximally participate and overcome barriers.


Cycle 1:

Operational Plan

  • Set up, facilitation and involvement of the multidisciplinary team in the group with external football coaches to run the group.

Communication Plan

  • Regular multidisciplinary meetings to review groups, and to adapt groups in line with feedback.
  • Goal setting, consider how each child is working towards their rehabilitation goals within the group.

Risk Management

  • Each sub-team to risk assess environment for sports based group and for the child to participate in the activity.

Measurement Plan (completed at 1 month)

  • Audit: The number of participants, age and ability level of the CYPs.
  • Survey Questionnaire: The attitudes and beliefs of staff and the CYP towards the group.
  • To be designed in conjunction with a psychologist. To use an advocate to ask the CYPs questions to prevent bias and be set with in line with the children’s language skills.


The outlined plan was adhered to, completed and outcomes measures were recorded and analysed. Agreed suggestions and considerations were discussed. A new plan was structured and trialled in cycle 2 (6 months).



  • CYP accessing neurorehabilitation at the centre were given the option to attend.
  • All CYP (n=9) that accessed the group expressed that they enjoyed the group and wanted to continue to participate.
  • CYP varied in abilities (GMFM I to IV) and age (7-17).
  • Staff (n=11) felt the groups were beneficial for the CYP, allowing the CYP to work towards their goals and replicating a school based PE lesson.
  • Themes of suggested improvement from both CYP and staff: communication, rotation of activities, staff allocation and planning.


Use of a PDSA cycle has allowed the implementation of successful sports based groups for CYP with ABI in a rehabilitation setting, and overcome specific barriers. Future follow up studies should be undertaken to see if participation in sports groups within a neurorehabilitation setting translates to improved long-term participation in sports groups within the community.

Cost and savings

This quality improvement project was managed within current resources.  The focus was implementation of a new group.  Future PDSA cycles will evaluate the productivity and efficiency of offering this type of intervention within a rehabilitation setting.


  • Age and ability appropriate sports groups for CYP with ABI are both enjoyable and beneficial.
  • Multi-disciplinary communication and planning is required to ensure that groups are appropriate for all CYP with differing needs and goals.
  • PDSA cycles will allow ongoing development of the groups, and monitor their effects on long term participation.

Top three learning points

  1. How to apply PDSA cycles to service development, which will continue to impact how we continue to deliver and introduce further sports group’s successfully.
  2. How to set up a challenging, motivating, participation focused sports groups that replicate a school based PE session.
  3. How to use multi-disciplinary communication and planning to ensure that groups are appropriate for all CYP with differing needs and goals.

Funding acknowledgements


Additional notes

This work was presented at Physiotherapy UK 2019

Please see the attached Innovations poster below.

For further information about this work please contact Natasha Watson.



Anaby, D.R., Law, M., Feldman, D., Majnemer, A. and Avery, L., 2018. The effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention: improving participation of adolescents with physical disabilities. Developmental Medicine & Child Neurology60(5), pp.513-519.

Hayes, J., 2018. The theory and practice of change management. Palgrave. Macmillan

Willis, C., Nyquist, A., Jahnsen, R., Elliott, C. and Ullenhag, A., 2018. Enabling physical activity participation for children and youth with disabilities following a goal-directed, family-centred