More than 50 million Americans have some type of disability, and this number is increasing. Musculoskeletal diseases comprise a significant cause of disability worldwide. Regular exercise in the disabled population is just as important, if not more so, than in the able-bodied population. Those with disabilities are more likely to be sedentary and 4 times more likely to suffer from cardiovascular disease. Persons with disabilities should be encouraged to participate in regular athletic activity, and the physician should be aware of additional obstacles they face, as well as tools to overcome these obstacles. When performing a preparticipation physical examination on a disabled athlete, it is important to identify unique abnormalities that may increase their risk of injury. These include skin protection, impaired thermoregulation, and risk of autonomic dysreflexia in the spinal cord population; atlantoaxial instability in the Down syndrome population; increased cardiac demand in limb-deficient individuals; and the increased reliance on their upper extremities and implications of overuse injury in wheelchair-bound individuals. There are many social, mental, and physical health benefits from athletic activity, and a disability should not preclude an individual from obtaining these benefits.
A disability, as defined by the World Health Organization (WHO), is a condition (either mental or physical) that limits the ability of a person to perform an activity in the range considered normal for a human being.
An impairment, as defined by the WHO, is “any loss or abnormality of psychological, physiological or anatomical structure or function” and is used by the International Paralympic Committee to create their competition classification system.
Nearly 60 million Americans have some type of disability according to 2010 U.S. Census Bureau data—an increase of 2.2 million since 2005.
Musculoskeletal diseases are some of the major causes of disability in the United States and the world.
The benefits of a regular exercise program can be obtained by those with disabilities, but 54% of people with disabilities engage in no leisure-time physical activity compared with just 32% of their peers without disabilities and are 4 times more likely to suffer from cardiovascular disease among adults ages 18 to 44 years.
Physicians who have disabled patients must encourage physical activity while being mindful of both the limitations of the disability and common injury patterns either unique to the disability or the result of the activity type.
Physicians must also be aware of societal and environmental factors that hinder the activities of disabled persons and provide tools to eliminate obstacles as necessary.
A disabled sports program was started for wheelchair athletes in the 1950s, borne from a need to rehabilitate war veterans
The first Paralympic Games were held in Rome in 1960. The Paralympics were games established for athletes with either a physical disability or visual impairment.
The Special Olympics began in 1960 and has since grown to involve more than 5.7 million athletes in 172 different countries. The games are for those athletes with mental retardation regardless of physical ability.
The International Paralympic Committee was established in 1989 to act as the representative body of adaptive sports.
The Rehabilitation Act of 1973 aided in bringing physical activity programs to most disabled people regardless of participation in competitive sports.
Currently, there are a myriad of programs promoting physical activity for the disabled, including the Special Olympics, the United States Association of Blind Athletes, the National Wheelchair Athlete Association, the National Association of Sports for Cerebral Palsy, and Adaptive Sports USA.
In addition, the Centers for Disease Control and Prevention sponsor several programs, such as Healthy People, aimed at improving physical fitness and promoting healthy lifestyles for disabled persons.
Several different types of disabilities exist ( Box 6.1 ).
Spinal cord injuries
Traumatic brain injury
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