The health needs of about 4,500 athletes with severe, fluctuating or progressive disorders, who compete every 4 years in the summer and winter Paralympic Games, present an important and unusual demand on health care resources.
In a series recently published in The Lancet,Nick Webborn MBBS, of the Center of Sport Research at the Chelsea School of Sport at the University of Brighton in Eastbourne, UK, and British Paralympic Association, and Peter Van de Vliet, PhD, of the International Paralympic Committee and the Health, Leisure and Human Performance Research Institute at the University of Manitoba, Winnipeg, Manitoba, Canada, discussed the different medical issues and injuries handled at the Paralympics, as well as what equipment and medical services are implemented to prevent injuries from occurring.
Health care issues
Originally developed for a particular type of impairment, the Paralympics grew in popularity, as did the number of participating athletes. The six main impairment categories in the Paralympics include amputation or limb deficiency, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment and “les autres,” which includes athletes with physical impairments who are not covered by the other groups.
“By definition, the Paralympic athlete has a pre-existing medical disorder, including degenerative disorders, that make activities of daily life challenging and risk of illness a common feature,” Webborn and Van de Vliet wrote. “The presence of some medical conditions might also raise the question for some healthcare and carers as to whether people with some impairments should be participating in some sporting activities because of the inherent risk… Understanding the main medical issues relating to the impairment groups is key.”
Among athletes with amputations, localized or systemic infection can occur due to chafing or impact of the residual limb, and recurrences or metastatic disease can occur in athletes who had an amputation for neoplastic disease.
Convulsive disorders are a concern among athletes with cerebral palsy. Seizures can be induced by fatigue from intense training, becoming overly stressed or dehydration. Although stretching is necessary to maintain adequate range of motion, athletic performance can be impaired from stretching too soon to activity.
Spinal cord-related disabilities challenge the health and well being of athletes because of physical restrictions of loss of movement, as well as effects on the sensory and autonomic systems, which are not immediately obvious. Hyperthermia can occur in athletes with spinal cord-related disabilities since regulation of body temperature is impaired. Restricted heart rate reserve and reduced stroke volume compounded by a loss of catecholamine response to exercise and by the absence of the muscular venous pump in the legs limit aerobic performance and might not be understood by coaches and trainers from an able-bodied sport background who use heart rate as a proxy for training intensity.
Athletes with visual impairment might have problems orienting to the large, new environment of the Paralympic village, and may experience collision injuries or tripping, increasing the risk of impact to the head. Some practical difficulties that can occur include self-monitoring of hydration and impairment of sleep patterns, which can affect recovery from training.
Although athletes with intellectual impairment were excluded from the Paralympics in 2004 and 2008 because of controversy over the classification system, they were included in the 2012 Paralympics after a more rigorous system of classification was identified. Changes in environment and stress-evoking situations need to be considered when assisting athletes with intellectual impairment, in addition to the general aspects of care.
Athletes categorized under les autres are particularly challenging due to their diverse diagnoses, which include rare syndromes with anomalies in different systems. Athletes with Spondyloepiphyseal dysplasia with neurological or respiratory problems or Becker muscular dystrophy with cardiomyopathy or arrhythmia are examples of those included under les autres.
Equipment, medical services
To help the assessment of injuries occurring during the Paralympics, the International Paralympic Committee (IPC) developed the IPC Medical Code, which supports basic rules regarding best medical practices in the domain of sport and the safeguarding of the rights and health of the athletes in all events and competitions that the IPC or any member organizations feels requires it.
Among Paralympic athletes there are often reports of scrapes, cuts, bruises, blisters and floor and wheel burns. Protective clothing or gloves can help against abrasions and lacerations, while strapping themselves into their wheelchairs can help reduce the rate of injuries during falls. Minor injuries should be assessed for bone fractures because bone density is reduced in paralyzed athletes.
According to the researchers, information about common disability-related issues, medical services, facilities, policies and procedures should be explained to medical staff prior to a Paralympic event and prosthetists, orthotists and wheelchair repair specialists should be available. Medical staff and emergency medical teams should have an understanding of adaptive equipments, including prostheses, wheelchairs, seated throwing chairs and adaptive sit skis, and should have an experience in extricating athletes from the equipment.
“An increasing number of opportunities exist for education in Paralympic medicine, including masters programs, international sports medicine conference programs and International Federation of Sports Medicine team doctor courses,” the researchers concluded. “Individuals with impairments are able to achieve extraordinary levels of performance, indicative of the Paralympic values of the IPC — courage, determination, inspiration and equality. Paralympic Sport is an agent for change to break down social barriers of discrimination for individuals with a disability,.”
Disclosure: Webborn and Van de Vliet have no relevant financial disclosures.