Focused Review Sports and Disability Pamela E. Wilson, MD, Gerald H. Clayton, PhD Abstract: Participation in recreational and competitive sports at an early age has long been touted as a positive influence on growth and development, and for fostering lifelong healthy lifestyles. The benefits of an active lifestyle include not only fitness, but the promotion of a sense of inclusion and improved self-esteem. These benefits are well documented in all populations, and their importance has been summarized in the recent Healthy People 2010 guidelines. The American Academy of Pediatrics has recently produced a summary state- ment on the benefits of activity for disabled children. They note that children with disabilities tend to have an overall lower level of fitness and an increased level of obesity. For this population, developing a lifelong desire to be active can be a simple means for limiting illness and much of the morbidity associated with sedentary lifestyles often associated with disability. For disabled youth, participation in disabled sports programs available nationally and internationally can be an effective means to promote such precepts. The goal of this focused review is to improve the learner’s knowledge of the positive impact that active lifestyles can have on overall health in the disabled youth population and, as a result, modify their practice by incorporating recreational and competitive sport activities as part of improving overall patient care. PM R 2010;2:S46-S54 INTRODUCTION In examining the impact that sports and recreation can have on habilitation and rehabilita- tion, consider a very talented young athlete who woke up one morning unable to move her lower extremities. She was diagnosed with transverse myelitis and was devastated by the impact this diagnosis would have on her life. During the day she was upbeat, but at night the reality of her situation was apparent. Her body and spirit were devastated, and hope for her previous life was stripped away. Interestingly, however, during the rehabilitation process, she was able to recapture part of her old self. One of the crucial elements in this rebirth was her reintroduction to sports and recreational activity. It gave her the strength and courage to move forward with a new image. Clinicians need to understand the power that sports and recreation can have on those with disabilities. This is extremely important for adults who have been injured and perhaps even more so to children born with a disability [1, 2]. Sports, recreation, and play activities are what ground young athletes and expose them to a different aspect of their lives. THE ROOT OF DISABLED SPORTS Before the 20th century, individuals with disabilities often were viewed as nonproductive members of society and often left to fend for themselves. The concept of survival of the fittest P.E.W. Department of Physical Medicine & was used to justify infanticide and neglect. The large numbers of survivors of regional and Rehabilitation, B-285, The Children’s Hospi- tal, Aurora, CO worldwide conflict appear to be a major impetus for the social reform necessary to foster the Disclosure: nothing to disclose. creation of organized disabled sports as a concept. Formal programs for those with G.H.C. Department of Physical Medicine & disabilities can be traced back to 1888, when the first sports programs for the deaf were Rehabilitation, B-285, The Children’s Hospital, started in Berlin. The actual deaf Olympics were formed in 1922. Sports for those with 13123 E. 16th Avenue, Aurora, CO 80045. Ad- dress correspondence to G.H.C.; e-mail: Clayton. physical disabilities were introduced during World War II by Dr. Ludwig Guttman in [email protected] England, a neurosurgeon and director of a spinal cord injury program at Stoke Mandeville Disclosure: nothing to disclose Hospital. The clinicians in this program used physical activity as part of the recovery Submitted for publication May 12, 2009; process, which evolved into competition among those in their rehabilitation programs [3]. accepted February 9, 2010. PM&R © 2010 by the American Academy of Physical Medicine and Rehabilitation S46 1934-1482/10/$36.00 Suppl. 1, S46-S54, March 2010 Printed in U.S.A. DOI: 10.1016/j.pmrj.2010.02.002 PM&R Vol. 2, Iss. 3, Supplement 1, 2010 S47 By 1948, as the Olympics were opening in London, Dr. palsy (CP), visual impairments, and les autre (a mixture of Guttman introduced the first Stoke Mandeville Games. The other disabilities). Athletes are not only classified by disabil- games developed an international flavor when the Dutch sent ity but also by age. Opportunities for disabled children/ a team to compete in 1952 and, thus, the birth of the adolescents to compete in sports have grown as several sport International Stoke Mandeville games. These games are still governing bodies around the world have developed youth held today. In recognition of the need for an international programs. Basketball now has youth as well as college-level competitive venue for disabled athletes, the Olympic-style tournaments. events termed the Paralympics were first held in Rome in A move toward disabled athlete inclusion in all age groups 1960 [4]. Four hundred athletes with paralysis, from 23 has been adopted by several sports organizations. Today, countries, were present and competed in 8 sports. sports such as fencing, archery, shooting, and table tennis all The need to include multiple groups with disabilities include disabled groups/categories within their competitions became apparent and the International Sports Organization so that able-bodied and disabled athlete alike can be a part of for the Disabled was formed in 1964 to include not only the event. Practical considerations, however, may limit the athletes with spinal cord injuries (SCIs), but athletes who adoption of this philosophy because of time and facility were blind, who were amputees, and those with movement considerations when large numbers of athletes compete disorders. The Olympic games in 1976 were the first official across many classifications. games that merged multiple disabilities into a single compet- As one reviews the history of sports for those with disabil- itive event. This is also the year during which the first winter ities, it is interesting to reflect on individuals who had dis- Paralympic events were held in Sweden. abilities and participated and succeeded in sports against The Paralympics have always been held in the same city as non-disabled athletes. Table 1 lists a few key individuals who the Olympics, but not until Seoul 1988 and Albertville 1992 have crossed these barriers. were they included in the same venues. During the last several decades, the Paralympics have evolved into an elite level of competition. In the most recent games in Beijing ORGANIZATIONAL STRUCTURE OF (2008), 4000 athletes from 147 countries participated [5]. During the 12 days of competition, 279 world records were DISABLED SPORTS set by these highly trained athletes. The next Paralympic There have been many changes to the governing bodies of events will be held in London, and a large group of partici- disabled sports during the years. The current organization of pants are expected to come from those young adults injured grassroots and elite sports is under the doctrine of the Inter- in recent years in military actions. national Paralympic Committee, which develops policy and Before 1984, junior-age athletes could only compete in supervises the conduct of summer and winter events. Groups adult venues, which often placed them at a significant disad- who impact decision-making policy include the national vantage. During this same year, however, the first US junior Paralympic committees, international sports federations, and wheelchair sports meet was held in Delaware as a means to the 4 disability groups under the direction of International provide young disabled athletes a venue at which they could Sports Organization for the Disabled: truly compete with their peers. The event has since been held yearly, and to meet the needs of all disabilities, it has evolved into a multidisabled event analogous to the Paralympic ● Cerebral Palsy International Sports and Recreation Associ- movement. Disability groups include not only wheelchair ation; athletes, but children/adolescents with amputations, cerebral ● International Blind Sports Federation; Table 1. Prominent individuals with disabilities breaking barriers in sports Athlete Sport Disability George Eyser Gymnastics: Olympics 1904 and won 6 medals Amputee competed with a prosthesis Peter Gray Baseball: St. Louis Browns 1945 Upper extremity amputee Liz Hartel Dressage: Olympics 1952, silver medal winner in a Polio combined male female division Wilma Rudolf Track: Olympics 1956 and 1960, 3 gold medals, 1 bronze Polio Eddie Gadeal Baseball (St. Louis): 1959 he played one game Short stature (3 feet, 7 inches) Tom Dempsey Football: field goal kicker set record 63 yard which stood Partial foot amputee from 1970-2007 until it was equaled by Elam Neroli Fairhall Archery: Olympics 1984, first paraplegic in the Olympics Spinal cord injury Marla Runyon Track: Olympics 2000 1500 meters Visually impaired John Curtis Pride Baseball: LA outfielder 2008 Hearing impaired Natalie du Toit Swimmer: Olympics 2008 10,000 meters open Amputee S48 Wilson and Clayton SPORTS AND DISABILITY ● International Federation for Sport for Persons with an track athletes could compete as ambulatory runners, but Intellectual Disability; and because of issues with their stump/prostheses, opt to com- ● International Wheelchair and Amputee Federation pete in the wheelchair division (ie, crossover to another competitive division). Their functional abilities would be reevaluated as appropriate to their wheelchair class. The CLASSIFICATION FOR DISABLED SPORTS crossover athlete would then be competing against individu- Classification is a method to place individuals with similar als with different disabilities (eg, SCI) but overall with similar disabilities in a group that will provide for equitable compe- functional limitations. There is no perfect classification sys- tition.