Disability

What is a disability?

The Disability Discrimination Act of 1995 defines it as ‘physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities.’

Sport and disability evolution

Sport for people with disabilities evolved rapidly over the last century, from an archery tournament at Stoke Mandeville hospital on the opening day of the Olympic Games in London in 1948, to 4000 athletes from over 146 countries competing at the Beijing 2008 Paralympic Games in 20 different sports.

Reasons for increased participation

Increased acceptance of rights of people with disabilities within society, e.g. Disability Discrimination Act 1995.
Increased recognition of sporting capability of people with disabilities:
- High jump >2m by a single leg amputee.
- Wheelchair marathon time below 1h 30min.
Increasing recognition of importance of physical activity for health for all the population, including those with a disability, e.g. reduced healthcare costs for active paraplegics vs. sedentary paraplegics.

Physical activity recommendations

How much activity?

The accumulation of at least 30min of moderate intensity activity on most days of the week and at least five days of the week is equally applicable to someone with a disability.¹
The same principles of training apply, i.e. the graded increase induration, intensity, and frequency of activity.
More thought may be required as to the mode of exercise according to the disability.
The social and psychological benefits of exercise and sport participation.
Major improvements in self-esteem and social integration may occur through an active lifestyle.

Advice on choosing a sport/exercise

It is important to try and marry the potential benefits of exercise participation and enjoyment for maximizing long-term increases in physical activity behaviour, with various aspects of the individual’s disability.

Personal preference of the individual: important for adherence
Characteristics of the sport:
- Physiological demands, e.g. aerobic, anaerobic.
- Collision potential—increased risk of injury, e.g. osteopenic limbs in paraplegia.
- Team or individual—preference of individual, social interaction.
- Co-ordination requirements—e.g. tremor or ataxia would limit performance in some sports.
Potential effects of the medical condition:
- Beneficial aspects—e.g. cardiovascular disease (CVD) risk reduction, improved bone density.
- Detrimental—e.g. excess cardiac risk in high intensity sport where a cardiac defect is present, fracture risk.
Conditions associated with the condition, e.g. syndromic conditions may have physical limitations to sport participation, but may have other associated medical issues that need consideration, e.g. Down’s syndrome, and cardiac anomalies or atlanto-axial instability.
Cognitive ability: impaired cognition may limit participation in certain activities or reduce safety.
Social skills of the person: ability to follow rules and interact with others.
Availability of facilities in the locality.
Availability of appropriate coaching and support staff (e.g. lifting and handling).
Equipment availability and cost.

Barriers to physical activity

Cultural.
Medical or parental over-protection.
Social factors.
Lack of opportunity during education.
Facilities.
Accessibility.

Organization of sport for people with disabilities

Disabilities may be physical, sensory, or intellectual or a combination of each of these. There are consequently a large number of organizations that promote and support sport for people with disabilities.

These organizations may be:

Local.
Regional.
National.
International.
Disability specific.
Multi-disability.
Encouraging participation.
Elite sport.

The International Paralympic Committee (IPC)

The IPC unites these disability-specific organizations globally with the exception of the hearing impaired. The hearing-impaired hold a games termed the ‘deaflympics’ every 4yr and this is held in a non-Olympic Games year. The Paralympic Games involves sport at the elite level and is held just after, and in the same city as, the Olympic Games for the following disability groups:

Spinal cord-related disability.
Amputee.
Visually impaired (VI).
Cerebral palsy (CeP).
Les Autres: other physical disabilities not falling into the other categories, e.g. muscular dystrophy, multiple sclerosis.
Intellectual disability (or learning disability).

Sports

People with disabilities can take part in most sports and activities but the number of sports in summer Paralympic Games is limited to the following: Archery.

Athletics.
Boccia.
Cycling.
Equestrian.
Football 5-a-side.
Football 7-a-side.
Goalball.
Judo.
Powerlifting.
Rowing.
Sailing.
Shooting.
Swimming.
Table Tennis.
Volleyball (sitting).
Wheelchair basketball.
Wheelchair fencing.
Wheelchair rugby.
Wheelchair tennis.

There are also Winter Paralympic Games with Alpine and Nordic events as well as wheelchair curling and sledge hockey—a form of ice hockey using a seated sledge.

The Special Olympics is a separate event that involves people with intellectual disability with less emphasis on elite performance and more on participation.

Technology

Wheelchair design

Initially, people with disabilities took part in sports or activities using a standard wheelchair, but became increasingly frustrated at the lack of performance capability and needs for the specific sport. As a result sport-specific chairs developed. Racing chairs owe much of their design to cycle technology, and are ergonomically designed and individually customized for the user. Wheelchair tennis and basketball chairs have a much larger wheel camber to facilitate rapid turning, and may have a rear wheel to prevent tipping over. Rugby chairs have fenders and guards for attacking and defensive manoeuvres. New technological developments will occur to meet the needs of wheelchair users over time to enhance performance.

Prostheses

People are unable to run using the traditional single-axis prosthetic foot as they cannot push off from the foot flat position. To improve function and reduce fatigue an energy-storing, spring action prosthetic foot can be used to simulate normal gait. As the athlete lands on the prosthetic limb energy is stored and released back on push-off much in the same way as the normal Achilles tendon would. Computer-controlled knees for above knee amputees can produce automatic swing-phase adjustments relevant to their activity level.

Classification

To enable athletes to compete on an equal basis relative to their impairment, athletes are classified into groups for competition. In some sports this is disability-specific groups, e.g. cerebral palsy or spinal injury. In other sports, such as swimming, a functional classification system is used so swimmers with different disabilities compete against each other based upon physical disability and functional performance of the sport. The process is not always straightforward and many medical tests are open to subjective interpretation. Classification for intellectual disability has been particularly problematic, but competition in limited events will be re-introduced in London 2012. There are ‘minimum disability’ criteria within a sport for a person to become eligible to participate in competitive sport.

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