Definitions

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  Physically challenged: combines all groups of athletes competing in international competitions such as Paralympics; such athletes have an impairment that limits their ability to participate in athletic arenas within a manner considered “normal” for defined sport

  
  
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  Impairment: any loss or abnormality of psychological, physical, or anatomic structure or function

  
  
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  Disability: any restriction imposed from an impairment that limits an individual’s ability to perform an activity within a manner considered “normal” for an able-bodied individual

  
  
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  Handicap (as defined by World Health Organization): a disadvantage, resulting from impairment or disability that interferes with a person’s efforts to fulfill a role that is normal for that person; handicap is a social concept, representing social and environmental consequences of a person’s impairments or disabilities

Statistics

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  Over 56.7 million disabled people in the United States (US); many nonambulatory

  
  
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  “Disabled” classification broad; includes nonathletic population

  
  
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  Over 200,000 people in the US with spinal cord injury (SCI)

  
  
  
  
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    Includes traumatic and nontraumatic

    
    
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    11,000 new injuries per year; average age at injury is 32 years

    
    
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    55% tetraplegia, 45% paraplegia

  
  
  
  
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  Over 1,540,000 million people in the US with limb loss

  
  
  
  
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    Incidence of congenital limb deficiency is 60 per 100,000 live births.

    
    
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    People older than 65 years account for 19.4 per 1000 of those with limb loss.

    
    
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    Comorbidities: diabetes, vascular, and malignancy

    
    
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    Incidence:

    
    
    
    
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      Lower extremity amputation (LEA), diabetes, and younger than 30 years: 7.2%

      
      
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      LEA, diabetes, and older than 30 years: 9.9%

      
      
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      Dysvascular disease: 46.2 per 100,000 with limb loss

      
      
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      Trauma: over 5.86 per 100,000 with limb loss (war increases this rate)

      
      
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      Malignancy: 0.35 per 100,000 with limb loss

    
    

  
  
  
  
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  Multiple sclerosis: 400,000 cases diagnosed in the US each year

  
  
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  Muscular dystrophies: new cases estimated at 250,000 each year in the US; Duchenne muscular dystrophy is 1 of the 9 types of muscular dystrophy

History

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  First sports event, physically challenged: 1888, Sport Club for the Deaf; Berlin, Germany

  
  
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  First international competition for the disabled: International Silent Games, 1924

  
  
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  First international sports competition for people with various physical impairments: Stoke Mandeville Games for the Paralyzed, 1948

  
  
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  Youth divisions, in addition to adult, for athletes with physical impairment: 1980s

  
  
  
  
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    Adaptive physical education, hippotherapy (a form of therapy using the characteristic movements of a horse to provide carefully graded motor and sensory inputs), and aquatic therapy: 1980s

  
  

Competition

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  Interscholastic, collegiate, professional sports: physical impairment cannot require changes in rules of a sport, lowering of standards for achievement, or modification of a defined sport to accommodate athletes

  
  
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  Neither adaptive equipment nor physical impairment can impart danger or an advantage to athletes or others competing in that sport.

  
  
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  Wrestling

  
  
  
  
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    Those with hearing loss have successfully competed with normal hearing athletes; if hearing loss is >55 decibels in the better ear, qualifies for physically challenged

    
    
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    Limb loss: must weigh in with prosthesis, if used

  
  
  
  
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  Jim Abbott, professional major league baseball. Congenitally absent right hand

  
  
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  Archery

  
  
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  Below-knee amputations (BKAs)

  
  
  
  
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    Allowed in high school football after restrictions removed in 1978; check local competition rules

    
    
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    National Federation of State High School Associations’ rules concerning contact sports:

    
    
    
    
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      Restricted to BKA; no upper extremity or above-knee prosthesis

      
      
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      Metal hinges restricted to lateral and medial; require covering

      
      
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      No metal in front of knee unless appropriately padded

      
      
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      Prosthesis wrapped with minimum of half-inch foam rubber or appropriate polyurethane

      
      
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      Approval of physician associated with amputee care recommended

    
    

  
  
  
  
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  Paralympics

  
  
  
  
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    International competition following Olympics

    
    
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    Traditionally includes athletes with limb deficiency, cerebral palsy (CP), visual impairment, SCI, “les autres” (those not fitting into other groups), and intellectual disability

    
    
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    Currently, intellectual disability is not a participant group in the International Paralympic Committee (IPC)-sanctioned events. The IPC has asked the International Sports Federation for Persons with an Intellectual Disability (INAS-FID) to develop eligibility and verification processes that are commensurate with other IPC divisions to ensure fair competition.

  
  

Classification Systems

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  System used to equalize athletes in competition using objective methods:

  
  
  
  
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    Medical diagnosis only: e.g., CP, limb deficiency, and muscular dystrophy

    
    
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    Functional measurement only: e.g., wheelchair mobility level, above-knee amputation (AKA), and BKA

    
    
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    Hybrid: use functional measurements and medical diagnosis; multiple sclerosis with full trunk control and wheelchair mobility

  
  
  
  
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  May be sports-specific for alpine skiing or cycling

  
  
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  Classification systems may differ at international and local competitions.

  
  
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  1996 Paralympics: Of 3500 athletes, the most common impairment was limb deficiency.

Physiologic Changes in Exercise

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  Altered venous return, consequent decreased ability to respond to exercise stress

  
  
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  Depending on level of SCI, possible blunting of heart rate response to exercise

  
  
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  Vagal withdrawal, not sympathetic drive

  
  
  
  
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    Decreases reflexive regulation of blood flow

    
    
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    Decreased total peripheral resistance (increased vasodilation)

    
    
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    Increased peripheral pooling

    
    
    
    
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      Treatment to minimize: compression garments or abdominal binder

    
    
    
    
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    Decreased oxygenated blood to exercising muscle

    
    
    
    
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      Fatigue, limited aerobic endurance

    
    

  
  
  
  
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  Cardiac repolarization abnormalities

  
  
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  Decreased lactate threshold

  
  
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  Limited pulmonary capacity, generally restrictive type (due to respiratory muscle weakness)

  
  
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  Kinetic chain disruption

  
  
  
  
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    Loss of ground reactive force from lower extremity

    
    
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    Stabilizing muscles become prime movers.

  
  
  
  
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  Greater muscular strength improves aerobic power and endurance.

  
  
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  Paraplegics and people with high-level SCI can increase VO ₂ max with exercise.

  
  
  
  
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    Dependent on intensity, frequency, and duration

  
  

Medical Concerns in Athletes

Physical Conditions to Consider