Adaptive sailing has been part of the Paralympic Games since 1996 [3]. The first occurrence consisted of one event with a mixed crew boat. It was initially contested as a demonstration event and not an official part of the games, although medals were awarded to the first Paralympic sailors. In 2000, adaptive sailing became an official part of the Summer Paralympic Games with two events being represented in Sydney. The first was a one-person keelboat using the 2.4mR and a three-person keelboat using the Sonar. The SKUD 18 class of sailing debuted in Qingdao, China, in 2008 during the Paralympic Games with 11 nations competing on the two-person keelboat [4].

Athletes with disabilities due to spinal cord injury, brain injury, stroke, amputations, cerebral palsy, visual impairment, hearing impairment, and intellectual disability may all participate in sailing with different levels of adaptation. However, adaptive sailing itself is a multi-disability sport in which athletes with differing types of impairments can compete together on the same vessels or against one another. At the Paralympic level, three sailing classes exist: the 2.4mR, SKUD 18, and Sonar [3, 4]. These classes of adaptive sailboats are raced with 1, 2, and 3 sailors aboard, respectively. A further detail regarding the type of boats raced in each class is listed below in Table 21.5. Paralympic sailing classification is based on three factors including stability, hand function, and mobility [3]. Athletes are ranked according to a point system awarded based on severity of disability with the lower points corresponding to severely impaired and the higher points for the less disabled. The awarded points range from 1 to 7, with 1 corresponding to the lowest level of function to 7 being the highest. Furthermore, each individual boat uses its own point system to make up a team. Athletes in a single-person boat have to meet a minimum criterion of a classification ranking 1–7. The two-person boats require one of the two sailors having a number of 1 or 2 with the other crew member having any classification from 1 to 7. Furthermore, of the 2 crew members must be female. In the three-person boat, each team of sailors is allowed a maximum of 14 points to allow for equal competition [3]. Athletes with visual impairments have a separate classification procedure for adaptive sailing. They are placed into 1 of 3 competition rating classes based on visual acuity and field of vision [3]. Depending on the athlete’s visual capabilities, they are placed in a sport class of 3, 5, or 7. In this system 7 indicates the highest eligible visual ability. Table 21.3 describes the classification system for the visually impaired athletes.

Adaptations may include use of transfer systems, adaptive seating and support systems, communication systems, and alterations to the sailing vessel itself that may alter how the sails and/or the steering fin (rudder) are manipulated. Additional methods of increasing safety during transfers may also be employed. In addition to any access ramps, lifts, stability mats, or other equipment that will enable a disabled sailor to reach a vessel, measures should be taken to maximize safety during transfers [5]. For instance, when a disabled sailor is boarding a vessel from a dock, it is important to remove bumpers in order to allow the boats body (hull) to be as close to the dock as possible, therefore decreasing the space a sailor must traverse to board the boat. Also, it is important remove any stray ropes (lines) from the boarding area that may present a safety hazard or otherwise interfere with transfer.

The major adaptations seen within sailing correlate with boating vessels themselves. There are a number of sailing vessels that are used in adaptive sailing, and the most commonly used vessels are included in Table 21.4.

Once aboard, a disabled sailor may utilize a number of adaptations to the cockpit environment. In terms of safety, special seating, harnesses, and/or stability straps may be used. Additional nonskid surfaces and added handles and grips may be added to the deck and cockpit surfaces to further add to sailor stability. For vessel operation, a number of adaptations may be made to equipment. For sailors with unilateral upper extremity impairments, alteration to cleats may be made for improved ability to operate one handed. Tillers, long steering bars which attach to a steering “fin” below the water known as the rudder, can be modified by alteration length or addition of rings or handles to assist a captain in steering the vessel. For those sailors with more advanced impairment of the upper extremities, joystick controls combined with electric winches and/or servo-assisted tillers may allow for both sail and rudder manipulation [5]. In cases where sailors have very limited or absent upper extremity function, sip and puff systems similar to those used with power wheelchairs may be used to both trim (pull in/out) sails and steer the tiller [5]. Ropes, loops, and grips are equipment that are commonly added to the vessels and employed to aid the sailors in holding on for stability.

Adaptive swimming is one of the most popular sports among disabled athletes with one of the highest participation rates. Since the first Paralympic Games in Rome, Italy, in 1960, it has remained a staple in the games drawing some of the greatest interest from participants to spectators. The 2012 Paralympic Games in London, England, saw one of the most impressive number of participants, including 148 medal events with 600 athletes, 340 of which were men and the remaining 260 being women [6]. Competitions are held in 50-m pools and swimmers are not allowed to don prostheses or assistive devices during competitive events per Paralympics guidelines. Events are open to both male and female athletes with physical disabilities including dwarfism, amputation/limb loss, blindness/visual impairment, spinal cord injury, and other wheelchair-bound ailments, cerebral palsy, brain injury, stroke, other cognitive impairments, and Les Autres [6]

Adaptive swimming, like many other adaptive aquatic sports, helps to develop both strength and flexibility. Much of the stress that would be placed on athletes during participation in contact sports is reduced, producing an activity that allows for both cardiovascular and musculoskeletal conditioning without the added degradation and worsening of already present physical impairments, including no impact forces through residual limbs in athletes with amputations. Furthermore, the water’s buoyancy properties produce for an environment in which disabled swimmers are afforded the support of their body weight, without the added consequence of falling, often times helping to even the playing field among varying impairments.

The majority of the same rules apply for Paralympic swimming that apply to non-disabled competitions. Similar to non-disabled races, swimmers may begin races by standing on a platform and diving into the pool. Other athletes however may start in the water if their impairment limits them from standing and/or diving. Some strict rules do apply to adaptive swimmers who present with certain impairments. One such rule is no butterfly stroke or diving at the start of the race for persons with atlantoaxial instability. Similar to this, no diving is allowed for athletes if they have any sort of shunt in place. Furthermore, athletes who present with open wounds must be excluded from all competition as the risk for infection and further bodily harm is too great.

An adaptive swimmer classification may vary for different swimming strokes as their physical impairments may alter the way in which they are able to perform the certain strokes. However, unlike any other Paralympic sport, swimming is the only sport that combines varying impairments, including conditions of limb loss, cerebral palsy, spinal cord injury, Dwarfism, and other disabilities, across classes. The classification system allows for swimmers with certain impairments to compete against those with similar levels of function. Those with physical disabilities are placed in categories between 1 and 10, with 1 representing the most severely disabled. Blind and visually impaired swimmers are altogether categorized into a separate classification within categories 11, 12, or 13. Category 11 is relegated for athletes who are totally blind, while those in category 13 have severe visual impairment but are not completely blind. Swimmers with intellectual disabilities fall into class or category 14. In the adaptive swimming classification system, the prefix S denotes the class for freestyle, backstroke, and butterfly, while SB denotes the class for breaststroke, and SM represents the class for individual medley [6, 7]. Table 21.5 outlines the different classifications among disabled swimmers.