The interpretation of study results is additionally challenging with a lack of consensus on what constitutes an injury and when it should be reported. The definitions of injuries reported vary between studies. Without fail, the definition of injury influences both the data collected and the risk assessment of the sports studied. For instance, several retrospective questionnaire studies included minor soft tissue injuries, listed as blisters or abrasions, for which no medical attention was sought. However, other research efforts, which were based on the organizing committee’s medical services at the Paralympic Games, did not include such minor soft tissue injuries.

The aim of this chapter is to review the current literature on adaptive sports epidemiology, ultimately in a quest to provide the best care for Paralympic athletes. Source material for this review were primarily published articles and reports from a literature search of PubMed and SPORTDiscus. Information was also collected and evaluated from Congressional proceedings as well as both published and unpublished articles known to the authors but not identified through these database sources. Articles published in English were used primarily, but some German texts were incorporated when translation was available. Search terms involved permutations and combinations of Paralympic, sport, disability, injury, cerebral palsy, visually impaired, and wheelchair.

The unique grouping of sports by disability in Paralympic sport is complex and makes obtaining a clear picture of injury risk difficult. There are currently 30 Paralympic sports (Table 4.1) which include 25 summer events planned for Rio 2016 and five winter events planned for PyeongChang 2018. Some sporting events such as Athletics allow participation by athletes with different impairments, including athletes with spinal cord injury, visual impairment, limb deficiency, and cerebral palsy. Other sporting events are unique to a particular disability category. For example, goalball only allows competition by athletes with visual impairment, whereas wheelchair rugby has sole participation by athletes with impairment in all four limbs. Clearly this makes investigating the risk of injury related to a particular sport for the upcoming 2016–2018 Games quite challenging. Further, some sports are modified by equipment specific to impairment such as a sledge for ice hockey. Comparatively, alpine skiing features multiple events (downhill, super-G, super combined, giant slalom, slalom, and snowboard), and its participants have options between multiple types of equipment (single ski, sit ski, or orthopedic aids) adapted to the athlete’s impairment. Some sporting events such as basketball require multiple classes of disability to be included on the same team.

Caution is also required when interpreting studies where the investigation is focused on the risks related to a particular class of disability across different sports. For example, an athlete with a lower limb deficiency may compete with a prosthesis for track athletics or cycling, without a prosthesis for swimming or high jump, or in a wheelchair for sports such as basketball and tennis. Athletes with cerebral palsy may be ambulant or wheelchair users depending upon their degree of impairment. Some more recent studies have used a combination of impairment and sport specificity to limit these confounders but so far have relatively few athlete numbers [2–4].

In order to review the literature and better understand possible patterns of injury, this chapter is broken down into three categories: location, type, and rate of injury. For the location of injury, we attempt to identify common anatomic locations prone to injury. In the type of injury, we discuss both the etiology and medical diagnosis of injury and acute versus chronic injury patterns. Whereas for the rate of injury, we review injury incidence rates divided by winter and summer sports.