The Disabled Athlete

The Disabled Athlete

Kenneth J. Richter

Richard Brickley

Clinicians have a much larger mandate than just diagnosing and treating diseases and their consequences. Patients need care oriented toward their person, not just their disease (1). Nowhere does this apply more than for people with disability. The maximization of life is much more than just the minimization of disease. It is more than just the prevention of secondary, unnecessary disability; it is the reaching for life’s potential and the expansion of one’s options, the effects of which reach far beyond the individual to all of society (2). Recreation and sport are vital and necessary for an individual to accomplish his or her goals.


The history of sports for people with disabilities can be reviewed from two perspectives: the medical and the sports model. Sports activities today exhibit influences from both models. (3). Viewed from the medical standpoint, sports for people with disabilities had its origins in the related activities of gymnastics, and in the concept of exercise being therapeutic and contributing to fitness and health (4). These beginnings are well described by Guttman in Textbook of Sport for the Disabled (5). Later, therapeutic exercises, including group activities, became recognized as a fundamental part of the orthopedic management of fractures (6). The use of sports as a further motivation to enhance the physiologic and anatomic aspects of musculoskeletal healing and strengthening was a later natural development. The step from group gymnastics, sports, and exercises to more integrated rehabilitation sports took place when Guttman incorporated sports activities into the total program of rehabilitation for patients with spinal cord injury (7).

Individuals who learn to play disability sports in rehabilitation centers value this experience and practice enough to become highly skilled, thereby generating opportunities to compete at national and international levels. Separate organizations govern Paralympics, Deaf Sport, and Special Olympics and hold events specific to the disabilities they serve. Paralympics, first offered in 1960, provides competition for elite athletes with spinal paralysis, amputations, cerebral palsy (including stroke and traumatic brain injury) and other locomotor conditions (including dwarfism) called les autres, and blindness. Deaf sport, begun in 1924, primarily serves athletes who use sign language. Special Olympics, begun in 1968, serves only individuals whose primary disability is mental retardation. Since 1996, a few of the best athletes with mental retardation have been integrated into the Paralympics. Paralympics, Deaf Sport, and Special Olympics each are modeled after the Olympic Games, with elaborate opening and closing ceremonies, rules that demand excellence, and scheduling of summer or winter games every two years.

Official competitive sports at the international level vary by disability. Some sports, like track and field, equestrian, sailing, and swimming, are functional for all disabilities. Others are specific to one disability. For example, individuals who are blind compete in goalball, judo, and tandem cycling. Both ambulatory and wheelchair sports are offered for individuals with amputations, les autres conditions, and cerebral palsy. For individuals with C6 spinal paralysis or equivalent function, all competition is in
specially designed manual sport wheelchairs. Individuals so disabled that they must use power wheelchairs (i.e., C5 and above or equivalent function with cerebral palsy or other conditions) typically engage in boccia ball (an outdoor yard game with a premise similar to lawn darts), a specially designed swimming track, or equestrian events (8,9).

Organized Sports—National and International

Guttman’s efforts led directly to the creation of an international sports movement for the spinal cord injured. This movement was identified for many years as the International Stoke Mandeville Games Federation (ISMGF), which sponsored the first international games for people with disabilities in 1952. Its name changed more recently to International Stoke Mandeville Wheelchair Sports Federation (ISMWSF).

Other organizations developed their identity with specific disability groups, such as blind, deaf, cerebral palsy, amputee, and intellectually impaired. Within these organizations, control of the direction, staffing, and goal setting was made by persons who, for the most part, came from the medical or educational systems.

The wheelchair sports movement in the United States was sparked by Ben Lipton, director of the Bulova School of Watchmaking, in New York. He established the U.S. National Wheelchair Association (NWAA) in 1957, which sponsored the annual national wheelchair games. For many years these games were held on the grounds of the Bulova School of Watchmaking in Queens, New York. In 1994 the NWAA was renamed Wheelchair Sports USA, a name it has retained.

There was another quite separate and distinct influence that led to a change in the character and direction of sports for people with disabilities. This was based on the concepts of the value of sports in its own right, and the perceived need to identify the participants as true sportsmen and sportswomen, rather than part of a rehabilitation process. This effort has led to the development of an international governing body, the International Paralympic Committee (IPC), which is associated with the Olympics movement. Through this development, the Paralympic Games have gained stature and have served as the showcase for elite performers in disabled sports. In the 2000 Paralympic Games held in Sydney, Australia, 3,842 competitors (967 women and 2,867 men) from 122 countries participated before crowds that included 340,000 schoolchildren, 1.16 million paid spectators, and 300 million television viewers (10). The 2002 Salt Lake City Winter Paralympics totaled 416 competitors (88 women and 328 men) from 36 countries. This development has led to a close link between national governing bodies for Paralympic sports and the Olympics sports movement. It is estimated that over 500,000 athletes worldwide compete in Paralympic Sports (Table 41.1) (11).

Disability Group Sports Versus Integrated Disability Sports

Sports development at all levels, until recently, has been mostly identified with specific disability groups. Wheelchair sports is primarily for people with spinal cord injuries and bilateral lower extremity amputations, and it developed through an organizational structure at international, national, and local levels, from the Stoke Mandeville organization down to local community groups.

Cerebral palsy sports, both wheelchair and ambulatory, achieved its own American identity in 1978, when a U.S. National Sports organization, the National Association of Sport for Cerebral Palsy, was formed, facilitating regional and national competitions. This in turn led to the creation of a national team, which competed internationally for the first time in 1978. In 1987, cerebral palsy sports were reorganized as the U.S. Cerebral Palsy Athletic Association (USCPAA). More recently, in 2001, this organization broadened its mission to include other disability groups, and has been renamed the National Disability Sports Alliance (NDSA).

Amputee sports developed through several separate pathways. Winter sports offered the opportunity for unilateral amputees to ski, using some simple pole modifications, usually
not using a prosthesis. In more recent years, technical developments led to the participation of bilateral lower limb amputees in sled, and mono-skiing downhill events (12). Summer sports for amputees developed differently in Europe than in the United States. In Europe the emphasis was on the use of prostheses in sports as much as possible in field and track events, whereas in the United States, initially, amputees participating in sports favored the wheelchair route to competition. The development of technically more sophisticated prostheses, such as energy storage foot and ankle systems, has resulted in significantly more amputees participating in sports with their prostheses (e.g., in track events). Bilateral above-knee amputees, who represent a higher degree of impairment, usually continue to compete in wheelchair sports such as track and field and basketball. Disabled Sports USA, formerly National Handicap Sports U.S.A., is the U.S. organization that represents amputees in competitive sports activities.


All-terrain vehicles



Alpine skiing





Sledge hockey


Ice skating



Ice sledding



Ice sledge hockey


Beep baseball

Lawn bowling

Table tennis


Martial arts

Team handball


Nordic skiing









Power soccer

Water skiing


Quad rugby

Weight training



Wheelchair dance sport


Road racing

Wheelchair rugby

Field events

Roller skating

Wilderness experiences




Fitness programs


Floor hockey



Scuba diving



Modified from Sherill C. Adapted physical activity, recreation, and sport, 5th ed. Dubuque, IA: WCB/McGraw-Hill, 1998.

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Aug 27, 2016 | Posted by in ORTHOPEDIC | Comments Off on The Disabled Athlete

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