Paralympic Sports Medicine and Science

Paralympic Sports Medicine and Sports Science—Introduction Stuart E. Willick, MD, Jan Lexell, MD, PhD A primary goal of the rehabilitation disciplines is to maximize the functional capabilities of individuals with various injuries and illnesses. Paralympic sport arguably represents the pinnacle of maximizing the function of individuals with lifelong physical, intellectual, and visual impairments. Paralympic sport is elite, exciting, and inspiring. Transcending sport, the Paralympic movement plays an important role in society and in health care Through sports medicine and sports science, rehabilitation specialists can help individuals with an impairment to achieve extraordinary heights of functional capability. It is therefore our job to assist athletes participating in sport and recreation at all levels to achieve their functional goals. The international group of contributors to this special edition of PM&R on Paralympic Sports Medicine and Science has been at the forefront of these fields for years, and through this journal promote the latest evidence in para-sports medicine and science. It is likely that some individuals with an impairment have participated in some form of sport and recreational activities throughout human history. However, the origin of organized sport for individuals with an impairment is widely attributed to the Stoke Mandeville Hospital in Great Britain. Toward the end of World War II, Dr. Ludwig Guttmann, a German-born, British neurosurgeon and Director of the National Spinal Injuries Center at Stoke Mandeville, integrated recreational and organized sport into the standard rehabilitation therapies of the period. Dr. Guttmann was a firm believer that participation in sports could improve patients’ physical and psychological wellness, as “. sport is the most natural form of remedial exercise, restoring physical fitness, strength, coordination, speed, endurance, and overcoming fatigue” [1]. His observations of patients confirmed this belief, and his patients enthusiastically benefited from the opportunities that Dr. Guttmann provided for sports participation. Building on his clinical successes with sports therapy, Dr. Guttmann organized the first Stoke Mandeville Games for individuals with an impairment on July 28th, 1948, the same day as the Opening Ceremonies of the London 1948 Olympic Games. Just 16 injured British war veterans took part in the first Stoke Mandeville Games. Four years later, athletes from the Netherlands also competed, and the Games became international. Sports competition for athletes with an impairment grew rapidly, and the first Paralympic Games took place in Rome, Italy in 1960. The name “Paralympic Games” was chosen to indicate that the Games take place “parallel to the Olympic Games.” Six hundred athletes from 23 countries competed in those first Summer Paralympic Games, which have been held quadrennially ever since. The first Winter Paralympic Games were held in Sweden in 1976. Since 1988, the Summer and Winter Paralympic Games have been held in the same city and immediately after the Olympic Games. The Paralympic Games have seen enormous growth in participation and popularity over the last 5 decades. Based on the number of athletes participating, the Paralympics are the second largest sporting event in the world, behind only the Olympic Games. A total of 502 athletes from 44 countries competed at the Vancouver 2010 Winter Paralympic Games. The London 2012 Summer Paralympic Games saw 4237 athletes from 164 countries set an incredible 314 Paralympic records. More than 2.7 million spectator tickets were sold, and the Games were broadcast in more than 100 countries. A survey of British citizens after the London Games showed that 81% of British adults thought the Paralympics had a positive impact on the way the British public view people with an impairment. This type of societal influence is perhaps the greatest legacy of the Paralympic Movement. The growth of the PM&R 1934-1482/14/$36.00 Printed in U.S.A.

S.E.W. Division of Physical Medicine and Rehabilitation, University of Utah Orthopaedic Center, Salt Lake City, UT. Address correspondence to: S.W.; e-mail: stuart. [email protected] Disclosures outside this publication: travel/ accommodations/meeting expenses unrelated to activities listed, IPC covered expenses related to travel/accommodations to Sochi for the Paralympics J.L. Department of Rehabilitation Medicine, Lund University, Lund, Sweden Disclosures outside this publication: employment, part-time employment, Swedish Paralympic Committee (money to institution)

ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, S1-S3, August 2014 http://dx.doi.org/10.1016/j.pmrj.2014.05.022

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Games continues, with the Sochi 2014 Winter Paralympic Games seeing a record 545 athletes from 45 nations competing. The growth in size of the Paralympic Games has been accompanied by a dramatic rise in the level of sports competition. Athletes are training more intensely than ever before. Qualifying for the Games has become progressively more difficult and the competition ever more challenging. Competition during the Games routinely occurs in front of packed crowds of fans, enthusiastically cheering for their heroes. Beyond the sports competition itself, the Paralympic Movement has advanced many related fields within sports medicine and sports science, some of which are highlighted in this journal supplement. Perhaps the most important among these has been the efforts to use sport as a platform from which to promote health, wellness, and self-worth among all people with an impairment, and to increase societal awareness about these individuals’ capabilities. These efforts are outlined in the lead article titled “Policy and Advocacy Initiatives to Promote the Benefits of Sports Participation for Individuals with an Impairment,” co-authored by Paralympic star and sports physiatrist Cheri Blauwet, MD, and Lisa Iezzoni, MD, both of Harvard University. Sean Tweedy, PhD, and his colleagues at the University of Brisbane have contributed the article on classification, the process whereby athletes with an impairment are grouped into different competition groups based on their functional status. Classification is critical to Paralympic sport and is the sole means by which success is legitimized. This area of Paralympic sport has undergone considerable development with the production of the IPC Classification Code and the Position Stand on Scientific Principles of Classification. Dr. Tweedy is the former Chair of the IPC Classification Committee, and has published and lectured widely on the topic. In this article, Professor Tweedy advocates for an evidencebased approach to classification that is grounded in sports science research. Another key area of sports medicine and sports science to arise from the Paralympic Movement is the area of adaptive sports injury and illness epidemiology, presented in articles 4 and 5 of this supplement. The Paralympic Injury and Illness Surveillance Study has been enhancing our understanding and medical care of both the sports injuries and medical problems seen in athletes with an impairment. The article on Paralympic injuries is authored by Carolyn Emory, PT, PhD, of the University of Calgary and Nick Webborn, MBBS, of the University of Brighton, both of whom have made substantial contributions to this field. Dr. Webborn is credited with initiating this important project at the Salt Lake City 2002 Winter Paralympic Games, and working tirelessly to ensure its longitudinal success. The article on illnesses seen in Paralympic athletes is presented by Wayne Derman, MD, Martin Schwellnus, MD, and Esme Jordaan, PhD, of the University of Cape Town. The collective experience of these experts, all of whom have published widely in the sports

PARALYMPIC SPORTS MEDICINE AND SPORTS SCIENCE

epidemiology literature, is considerable. The knowledge gained from their research not only improves the medical care of elite athletes, but the trickle-down effect also improves medical care of all individuals with an impairment. Furthermore, this research is leading to the implementation of injury prevention strategies in para-sports. The next 2 articles in this supplement, numbers 6 and 7, authored by Arthur Jason De Luigi, DO, of the National Rehabilitation Hospital and Georgetown University along with Rory Cooper, PhD, of the University of Pittsburgh, describe the latest technological advances in sports prosthetics and sports wheelchairs. These advances have allowed athletes to realize amazing athletic achievements. More importantly, many of the design improvements that are engineered for elite athletes eventually become incorporated into the design of prosthetic devices and wheelchairs for everyday users, thus improving the function of many individuals with an impairment. From sports biomechanics and technology, this journal supplement turns its attention to Paralympic sports physiology. One of the world’s leading experts on exercise physiology in athletes with spinal cord injury, Andrei Krassioukov, MD, PhD, from the University of British Columbia and his colleague Christopher West, PhD, contribute an article on: “The Role of Autonomic Function on Sports Performance in Athletes with Spinal Cord Injury.” This article includes a discussion of the highly controversial practice of boosting. Boosting is the intentional induction of autonomic dysreflexia for the sole purpose of enhancing sports performance. Boosting is a prohibited method of “doping” and has been banned by the International Paralympic Committee (IPC) for more than a decade. There are many ways for athletes to enhance sports performance. There are well-accepted and approved methods such as improved nutrition and proper training techniques. There are banned methods such as boosting and the use of performance-enhancing drugs. Then there are some gray areas of performance enhancement, such as certain elective medical and surgical treatments that are sometimes done for the sole purpose of improving sports performance. In this issue’s PointeCounter Point debate, 2 of the world’s leading sports ethicists, Mike McNamee, PhD, of Swansea University and Julian Savulescu, PhD, of Oxford University, tackle the very challenging question, “When Are Elective Treatments Allowable to Improve Sports Performance?” This special edition concludes with an article entitled “Stories from Sochi: Sun, Sea, Snow and Salt.” In this article, the authors recount some of their lasting impressions from the Winter Paralympic Games held in Sochi, Russia in March 2014. Paralympic sports and Paralympic athletes are inspiring. Paralympic competition is exciting and fun to watch. More importantly, however, the Paralympic Movement has generated substantial research and other initiatives that will improve the lives of all individuals with an impairment. It is

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clear that para-sports have developed, and will continue to develop, because they are an effective means of augmenting quality of life for people with an impairment. Equally important, people with an impairment have the right to participate in sports and to have the same opportunities as others. We hope that you find this special supplement of PM&R interesting and thought provoking. We expect that you will find clinical applications in the material presented. Most of all, we hope that this supplement will inspire you to get involved in the Paralympic Movement. Volunteer at a local

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adaptive sports event. Become a classifier. Become a team physician. Get involved in adaptive sports science research. The athletes, both elite and recreational, need all of us to help them achieve their maximal functional goals.

REFERENCE 1. Tweedy S, Howe PD. Introduction to the paralympic movement. In: Vanlandewijck YC, Thompson WR, eds. The Paralympic Athlete. Oxford, UK: Wiley-Blackwell; 2011, 10.

Paralympic sports medicine and sports science--introduction.

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