Athletes with disabilities have been participating in organized sports competition since at least 1948.

A variety of organized athletic events are available for athletes with disabilities. Some involve the use of the wheelchair. Many others are available for patients with disabilities who do not require the use of a wheelchair.

Events and competitions are structured to ensure optimal competition by creating groups of athletes with similar levels of disability. The classification systems vary depending on the event.

Disabled athletes present different medical concerns as compared with able-bodied athletes.

A review of specific medical concerns in various causes of disability is presented in the Chapter 117 (The Disabled Athlete). This chapter will summarize some of the athletic events and competitions available to disabled athletes. In addition, a summary of providing medical care to athletes participating in wheelchair sports will be provided.

In 1948, Sir Ludwig Guttmann organized a sports competition involving World War II veterans with a spinal cord injury in Stoke Mandeville, England. This event is considered the first organized athletic competition for athletes with disabilities.

Four years later, competitors from the Netherlands joined the games, and an international movement was born.

Olympic-style games for athletes with disabilities were organized for the first time in Rome in 1960, now called Paralympics. In Toronto in 1976, additional disability groups were added. The idea of merging together different disability groups for international sport competitions was born. In the same year, the first Paralympic Winter Games took place in Sweden.

The Paralympic Games is currently the world’s elite sporting event for athletes with disabilities. Emphasis is placed on the participants’ athletic achievements rather than their disabilities.

The term “Paralympics” derives from the Greek preposition “para” (beside or alongside) and Olympics. The name was originally intended as a pun combining “paraplegic” and “Olympic.” However, the term is now used as a combination of “parallel” and “Olympic” to illustrate how the two movements exist side by side.

Paralympic athletes are divided into six different groups based on the nature of their disabilities: amputee, cerebral palsy, visual impairment, spinal cord injuries, intellectual disability, and a group that includes all athletes who do not fit into the aforementioned groups (“les autres”).

The Paralympics movement has grown dramatically since its first days. The games originated in Rome in 1960 and included 400 athletes from 23 countries. In Beijing in 2008, 3,951 athletes from 146 countries competed. The fact that more countries competed at the Beijing 2008 Paralympics than in the Munich 1972 Olympic Games speaks to the growing popularity and scope of the Paralympic Games.

Since their founding, the Paralympic Games have been held in the same year as the Olympic Games. Since 1988 (Summer Paralympic Games in Seoul, Korea) and 1992 (Winter Paralympic Games in Albertville, France), the Paralympic Games have used the same venues as the Olympic Games. In 2001, an agreement was reached between the International Olympic Committee (IOC) and the International Paralympic Committee (IPC) securing this practice for the future.

From 2012 onward, the host city chosen to host the Olympic Games will be obliged to also host the Paralympics.

Disabled athletes are grouped in disability categories (http://www.paralympics.org, IPC Classification Code) and compete against athletes with similar disabilities. As previously identified, the groups currently defined by the IPC are amputee, cerebral palsy, visual impairment, spinal injury, intellectual disability, and les autres.

Les autres (French for “the others”) includes all athletes with disabilities who do not fit into any of the other five groups. Examples include dwarfism, multiple sclerosis, congenital limb deformities, and others.

In 2000, the intellectual disability group was suspended by the IPC after allegations of cheating in the intellectual disability basketball competition. It was revealed that several athletes were not disabled. In November 2009, the IPC voted to reinstate the intellectual disability group.

To ensure fairness in competition, athletes within a group are classified based on the extent of their disability. Athlete classification is intended to determine an athlete’s eligibility to compete and to group athletes for competition.