This page intentionally left blank Handbook of Sports Medicine and Science The Paralympic Athlete Dedicated to the memory of Trevor Williams who inspired the editors in 1997 to write this book. Handbook of Sports Medicine and Science The Paralympic Athlete
AN IOC MEDICAL COMMISSION PUBLICATION
EDITED BY Yves C. Vanlandewijck PhD, PT
Full professor at the Katholieke Universiteit Leuven Faculty of Kinesiology and Rehabilitation Sciences Department of Rehabilitation Sciences Leuven, Belgium
Walter R. Thompson PhD
Regents Professor Kinesiology and Health (College of Education) Nutrition (College of Health and Human Sciences) Georgia State University Atlanta, GA USA This edition fi rst published 2011 © 2011 International Olympic Committee Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientifi c, Technical and Medical business to form Wiley-Blackwell. Registered offi ce: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identifi ed as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientifi c research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specifi c method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifi cally disclaim all warranties, including without limitation any implied warranties of fi tness for a particular purpose. In view of ongoing research, equipment modifi cations, changes in governmental regulations, and the constant fl ow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data The Paralympic athlete : handbook of sports medicine and science / edited by Yves C. Vanlandewijck, Walter R. Thompson. p. ; cm. “An IOC Medical Commission publication.” Includes bibliographical references. ISBN 978-1-4443-3404-3 1. Athletes with disabilities. 2. Athletes with disabilities—Health and hygiene. 3. Paralympics. 4. Sports for people with disabilities. I. Vanlandewijck, Yves. II. Thompson, Walter R. III. IOC Medical Commission. [DNLM: 1. Disabled Persons. 2. Sports. 3. Athletes. 4. Sports Medicine. QT 260 P222 2011] GV183.5.P37 2011 796.087—dc22 2010023430 A catalogue record for this book is available from the British Library. This book is published in the following electronic formats: ePDF 9781444328363; Wiley Online Library 9781444328356 Set in 8.75/12pt Stone Serif by MPS Limited, a Macmillan Company, Chennai, India
1 2011 Contents
List of Contributors vii 9 Strength training 156 Foreword by Dr Jacques Rogge xi Marco Cardinale and Lee Romer Foreword by Sir Philip Craven xiii 10 Nutrition, body composition Preface xv and pharmacology 172 Peter Van de Vliet, Elizabeth Broad Part 1 Introduction and Matthias Strupler 11 Mental preparation 198 1 Introduction to the Paralympic Movement 3 Dietmar Martin Samulski, Franco Noce Sean Tweedy and P. David Howe and Varley Teoldo da Costa
Part 2 Paralympic Sport Science Part 4 Best Practices
2 Biomechanics 33 12 Preparation for the Paralympic Summer Ian Rice, Florentina J. Hettinga, Justin Laferrier, Games: heat, humidity, pollution 217 Michelle L. Sporner, Christine M. Heiner, Brendan Marco Túlio de Mello, Burkett and Rory A. Cooper Sílvio de Araújo Fernandes Jr, 3 Physiology 51 Andressa da Silva, Luiz Oswaldo Carneiro Yagesh Bhambhani Rodrigues, Emilson Colantonio, 4 Medicine 74 Marcos Gonçalves de Santana and Stuart Willick and Nick Webborn Sergio Tufi k 5 Philosophy 89 13 Preparation for the Paralympic Winter Steven D. Edwards and Mike J. McNamee Games: cold, altitude 231 Marco Bernardi and Federico Schena 6 Sociology 102 P. David Howe 14 Contribution of sport science to performance—wheelchair rugby 249 7 Psychology 116 Laurie A. Malone, Natalia Jeffrey J. Martin and Garry Wheeler Morgulec-Adamowicz and Kevin Orr 15 Contribution of sport science to Exercise Testing Part 3 performance—swimming 264 and Prescription Brendan Burkett
8 Aerobic and anaerobic power 137 Index 283 Yeshayahu “Shayke” Hutzler, Yoav Meckel and Judith Berzen
v This page intentionally left blank List of Contributors
Marco Bernardi MD Rory A. Cooper PhD School of Specialization in Sports Medicine, Human Engineering Research Laboratories, Department of Physiology and Pharmacology Department of Veterans Affairs, Rehabilitation “V. Erspamer”, “Sapienza”, Università di Roma, Rome, Research and Development Service, and the Italy and Italian Paralympic Committee Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA Judith Berzen MSc Israel Sport Center for the Disabled, Ramat-Gan, Israel Varley Teoldo da Costa MS Department of Physical Education, Yagesh Bhambhani PhD University of Belo Horizonte, Belo Horizonte, Faculty of Rehabilitation Medicine, University of Minas Gerais, Brazil Alberta, Edmonton, AB, Canada Steven D. Edwards PhD Elizabeth Broad PhD Department of Philosophy, History and Law in Clinical Services, AIS Sports Nutrition, Australian Healthcare, School of Human and Health Sciences, Institute of Sport, Canberra, ACT, Australia Swansea University, Swansea, UK
Brendan Burkett PhD Sílvio de Araújo Fernandes Jr, PT School of Health and Sport Sciences, University Departamento de Psicobiologia, Universidade Federal of the Sunshine Coast, Maroochydore DC, QLD, de Sao Paulo, São Paulo, Brazil Australia Marcos Gonçalves de Santana PhD Marco Cardinale PhD Campus Jataí, Universidade Federal de Goiás, British Olympic Medical Institute, Institute of Sport, Jataí, Brazil Exercise and Health, University College London, London, UK and University of Aberdeen, School of Christine M. Heiner BA Medical Sciences, Aberdeen, UK Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Emilson Colantonio PhD Research and Development Service, and Departamento de Biociências, Universidade Federal de Department of Physical Medicine and Rehabilitation, Sao Paulo, Santos, Brazil University of Pittsburgh, Pittsburgh, PA, USA
vii viii List of Contributors
Florentina J. Hettinga PhD Franco Noce PhD Center of Human Movement Sciences, University of Department of Physical Education, Groningen/University Medical Center, Groningen, University of Belo Horizonte, Belo Horizonte, The Netherlands Minas Gerais, Brazil
P. David Howe PhD Kevin Orr BS School of Sport, Exercise and Health Sciences, Canadian Wheelchair Sports Association, Loughborough University, Loughborough, Ottawa, ON, Canada Leicestershire, UK Ian Rice MS, OTR Yeshayahu “Shayke” Hutzler PhD Human Engineering Research Laboratories, Zinman College of Physical Education and Sport Department of Veterans Affairs, Rehabilitation Science, Netanya and Israel Sport Center for the Research and Development Service, and the Disabled, Ramat-Gan, Israel Department of Rehabilitation Science & Technology, Justin Laferrier MSPT University of Pittsburgh, Pittsburgh, PA, USA Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Luiz Oswaldo Carneiro Rodrigues PhD Research and Development Service, Departamento de Educação Física, Universidade and the Department of Rehabilitation Federal de Minas Gerais, Belo Horizonte, Brazil Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA Lee Romer PhD Centre for Sports Medicine and Human Performance, Laurie A. Malone PhD Brunel University, London, UK Department of Research & Education, Lakeshore Foundation, Birmingham, AL, USA Dietmar Martin Samulski PhD Department of Physical Education, Federal University Jeffrey J. Martin PhD of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil Department of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI, USA Federico Schena MD, PhD Department of Neuroscience & Faculty of Exercise Mike J. McNamee PhD and Sport Science, University of Verona, and Center of Department of Philosophy, History and Law in Bioengineering and Sport Science, Verona, Italy Healthcare, School of Human and Health Sciences, Swansea University, Swansea, UK Andressa da Silva Msc Departamento de Psicobiologia, Universidade Federal Yoav Meckel PhD de Sao Paulo, São Paulo, Brazil Zinman College of Physical Education and Sport Science, Netanya, Israel Michelle L. Sporner MS Department of Rehabilitation Science & Technology, Marco Túlio de Mello PhD University of Pittsburgh, Pittsburgh, PA, USA Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Matthias Strupler MD São Paulo, Brazil Institute of Sports Medicine, Swiss Paraplegic Center, Nottwil, Switzerland Natalia Morgulec-Adamowicz PhD Department of Adapted Physical Activity, Sergio Tufi k PhD The Józef Piłsudski University of Physical Education, Departamento de Psicobiologia, Universidade Federal Warsaw, Poland de Sao Paulo, São Paulo, Brazil List of Contributors ix
Sean Tweedy PhD Stuart Willick MD The University of Queensland, School of Human Division of Physical Medicine and Rehabilitation Movement Studies, Brisbane, QLD, Australia University of Utah Orthopaedic Center, Salt Lake City, UT, USA Peter Van de Vliet PhD International Paralympic Committee, Bonn, Garry Wheeler PhD Germany and Health, Leisure and Human Performance Vice President Edmonton Chapter and Alberta Research Institute, Faculty of Kinesiology and Recreation Division, MS Society of Canada, Psychologist, Management, University of Manitoba, MB, Canada Glenrose Rehabilitation Hospital, and Faculty of Physical Education and Recreation, Nick Webborn MBBS University of Alberta, Edmonton, AB, Chelsea School Research Centre, University Canada of Brighton, East Sussex, UK This page intentionally left blank Foreword By Dr Jacques Rogge
The physiology, biomechanics, and medical care of A major section of the handbook is devoted to athletes must be studied and interpreted with spe- all aspects of the science of disability sport: biome- cial relationships to age, gender, and genetic poten- chanics, physiology, medicine, and the social sci- tial. Each athlete must base programs of nutrition, ences of philosophy, sociology, and psychology. physiological and psychological conditioning, and A second major emphasis of the handbook is allo- skill development on a base of what has been inher- cated to exercise testing and exercise prescription ited from the parents. The special features brought for Paralympic Sports. This includes aerobic and to the competitive venues by athletes with a wide anaerobic power, strength, nutrition, mental prepa- variety of disabilities must be carefully reviewed ration, and preparation for different meteorological and understood in order to better serve their health, environments. safety, and performance needs. The collaborative efforts of the International As levels of both interest and participation in Olympic Committee and the International Para- sports by disabled athletes have grown markedly lympic Committee to produce this handbook have in recent years, so has the amount and sophistica- resulted in a major contribution to the health and tion of related research by sports medical personnel welfare of many thousands of athletes. and sport scientists. Profs. Vanlandewijck and Thompson and their contributing authors have produced a handbook in which the research has not only been synthesized and summarized but also presented with practical applications of great use to sports medicine doctors, sports scientists, coaches and trainers, and the athletes themselves.
xi This page intentionally left blank Foreword By Sir Philip Craven
Since its founding in 1989, the International Para- college and university courses are dedicated to the lympic Committee (IPC) has experienced expo- understanding of the Paralympic athlete. nential growth in the number of sports but more Prof. Dr. Yves Vanlandewijck of Katholieke importantly, the number of athletes competing Universiteit (Leuven, Belgium) and Prof. Dr. Walt against each other with the Paralympic Gold Medal Thompson of Georgia State University (Atlanta, as the ultimate prize. While much has been learned GA, USA), both members of the IPC Sports about the Paralympic athlete in these past two Science Committee, have successfully recruited decades, there is still much more to be discovered. the world’s best and most respected scientists to Scientists all over the world are now actively engaged write exemplary chapters and then amalgamated in the study of Paralympic athletes. Much of the this handbook into the most comprehensive book credit for the increased interest has to be attributed on the subject of the Paralympic athlete. The IPC to the IPC Sports Science Committee. Governing Board, Paralympic Sports, coaches and This book, The Paralympic Athlete, introduces for athletes, member nations, and the Paralympic the fi rst time a comprehensive evaluation of the Movement are indebted to all who contributed to athlete from several different perspectives: basic this book. science, applied science, social science, nutrition, and performance enhancement in both cold and hot environments. This book will be used to stimulate more research but can also be utilized by the coach and the athlete as a guide to improving athletic performance. The book can be a source of valuable Sir Philip Craven, MBE information for coaches and athletes and will also President be important in the classroom where now entire International Paralympic Committee
xiii This page intentionally left blank Preface
The idea for this book was raised for the fi rst time (IPC SSC), originated in 1994 under the leadership in a hotel room in Chateau Frontenac in Quebec, of Prof. Dr. Gudrun Doll-Tepper as the IPC Sport Canada in 1997 by Dr. Trevor Williams, a true pio- Science, Research and Education Committee. Trevor neer in research on the Paralympic Movement. was a member of the committee from its inception Trevor’s aim was two fold: he wanted to review the until his untimely death in 1998. The mission of knowledge available within the main sport scien- the IPC SSC is to seek interaction with the scientifi c tifi c disciplines addressing questions relevant to the community, formulating actual research questions Movement; and he wanted to apply this available relevant to the Movement, hand the questions over knowledge to the current training and coaching to the academic community, and activate strate- strategies of Paralympic athletes. The fi rst outline gies to come to solutions. In its efforts, the Com- of the book conceived by us respected this double mittee collaborates with the leading associations aim, reviewing – after a historical review of the in sport science such as the International Council Paralympic Movement and a comprehensive expla- of Sport Science and Physical Education (ICSSPE), nation of the role of classifi cation in Paralympic the Medical and Scientifi c Working Group of the Sports in chapter 1 – Biomechanics, Physiology, International Olympic Committee (IOC), the Medicine, Philosophy, Sociology, and Psychology American College of Sports Medicine (ACSM) and of Sport research in chapters 2 to 7, and providing the International Federation of Sports Medicine coaching information on how to train and prepare (FIMS). It is the hope of the Editors that this book the Paralympic athlete for competition in chapters will also fi nd its way to the shelf of the members 8 to 15. When all the pieces started to take form in of these associations, amalgamating the strength of this book, the line between science and its appli- researchers from both sport for the able-bodied and cation to the Paralympic athlete became very thin, athletes with a disability. mainly because of the high involvement of all the The Paralympic Movement is very young but contributing authors in the Movement. We fi rst evolving extremely fast. At the time that Trevor thought that researchers would be interested in initiated this idea, one book could perhaps have the fi rst part of the book while coaches and ath- encompassed all of the research questions and letes would be more interested in the second half. answers of the time. Today, however, to address in However, we now believe that all who are interested detail all the issues important for the Paralympic in the Paralympic Movement will read this book athlete to perform at the most optimal level in the cover-to-cover. most health protective conditions, each Paralympic This book was initiated through the International sport and each academic discipline addressing the Paralympic Committee Sport Science Committee Paralympic athlete has enough substance for a
xv xvi Preface separate book. The IPC SSC will therefore initiate encouraging us to complete this project so that a series of Sport-specifi c and Discipline-specifi c others could see the work of research within the monographs in the future to address research Paralympic Movement. We would like to thank relevant to the Paralympic Movement and all its Lieven Coudenys for greatly enhancing the book stakeholders. by including his incredible photographs. He has The editors would like to thank all of the authors always been a good friend to the Movement, and who spent countless hours writing manuscripts for for that we especially thank him for lending us his this book and who put up with the seemingly end- talent. We also thank our publisher, Wiley-Black- less questions and comments from the editors. We well and especially Cathryn Gates and Geetha Wil- would also like to thank the International Olym- liams for their guidance and for their patience. pic Committee, and especially Prof. Dr. Howard Finally, we thank all of the athletes who have dem- Knuttgen and Dr. Jacques Rogge, for this extraor- onstrated to us that no physical impairment can dinary opportunity to once again partner for the keep anyone from excelling in sport and for allow- betterment of all athletes. The editors would like ing us to be fans as well as scientists. to thank the International Paralympic Committee, Yves C. Vanlandewijck and especially Dr. Peter Van de Vliet, Mr. Xavier Walter R. Thompson Gonzales and Sir Philip Craven who always were PART 1 INTRODUCTION This page intentionally left blank Chapter 1 Introduction to the Paralympic Movement Sean Tweedy1 and P. David Howe2 1The University of Queensland, School of Human Movement Studies, Brisbane, QLD, Australia 2School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
Part 1 of this book provides the reader with a the development of the movement is divided into comprehensive overview of the Paralympic Move- six key periods: 1944–1952; 1952–1959; 1960–1964; ment, describing the principle events and ideas 1964–1987; 1987–present; and the future. For each that have shaped the movement to date, and con- period an overview is provided and in some instances sidering the key issues for the future. It comprises key events are identifi ed and expanded upon. two sections—History of the Paralympic Move- Throughout the history of the movement it is clear ment and Classifi cation in Paralympic sport. This that Paralympic sport has grown and developed for structure provides the reader with an historical three main reasons: account which fl ows logically and is not broken 1. Sport is an effective means of augmenting up by detailed consideration of the evolution of rehabilitation outcomes for people with disabilities. Paralympic classifi cation, an area that is so impor- 2. People with disabilities have a right to partici- tant and complex that it warrants stand-alone pate in sport and should have the same opportuni- treatment. The fi rst section, History of the Para- ties as others. lympic Movement, was co-authored by Drs. Sean 3. Paralympic sport is elite, exciting, and inspiring Tweedy and David Howe and the second section, (Figure 1.1). Classifi cation in Paralympic Sport, was authored These factors have rarely operated in isolation, and by Dr. Tweedy. at most points in the history of the movement, a
History of the Paralympic Movement
Introduction
History of the Paralympic Movement commences with background information for the reader— antecedents of the Paralympic Movement, the life and achievements of Sir Ludwig Guttman, and ety- mology of the term “Paralympic”. Following that,
The Paralympic Athlete, 1st edition. Edited by Yves C. Vanlandewijck and Walter R. Thompson. Published 2011 by Figure 1.1 Paralympic sport is elite, exciting, and Blackwell Publishing Ltd. inspiring.
3 4 Chapter 1
combination of these factors has driven develop- that drove development at that time. The reader is ment. Equally, however, each of these factors has pre- also referred to Table 1.1 which presents a chronologi- dominated at certain periods and each of the fi ve key cal summary of the key events in the history of the periods includes consideration of the principal factors movement.
Table 1.1 Chronological summary of key events in the history of Paralympic sport.
Event Year [Signifi cance of the event in square brackets and italicized]
1922 • Establishment of Comité International des Sports des Sourds/International Committee for Deaf Sports (CISS) [Signifi cance—fi rst international sports organization for people with disabilities] • Establishment of the Disabled Drivers Motor Club (UK) [Signifi cance—one of the earliest sports organization for people with physical disabilities (Brittain, 2010)]
1924 • First International Games for the Deaf [Signifi cance—fi rst international sports event for people with disabilities]
1932 • Establishment of British Society of One-armed Golfers [Signifi cance—one of the earliest organizations to emphasize sports of physical prowess for people with physical disabilities]
1939 • Start of World War II [Signifi cance—theatres of war lead to a large increase in the number of fi t, young soldiers and civilians sustaining permanent physical impairments, including SCI ]
1944 • Dr. Ludwig Guttmann begins tenure as inaugural Director of the National Spinal Injuries Unit in Stoke Mandeville, UK [Signifi cance—Guttmann had free reign to develop and implement his quite radical approach to management of SCI. The inclusion of competitive sports activity was a key component of this approach and it became increasingly important over the years]
1945 • Finish of World War II
1948 • First Stoke Mandeville Games, an archery competition between patients from Stoke Mandeville and those from the Star and Garter Home in Richmond, Surrey (Bailey, 2009; Brittain, 2010) [Signifi cance—occurred the same day as the opening ceremony of the London Olympic Games being held just 35 miles away, an important, though possibly coincidental initial link with the Olympic Movement (Bailey, 2009; Brittain, 2010)]
1949 • Second Stoke Mandeville Games, known at the time as the Grand Festival of Paraplegic Sport—Brittain, 2010 [Signifi cance—the Games became an established annual event and grew substantially, from 16 competitors and two hospitals in the previous year, to 37 competitors from six hospitals—(Brittain, 2010); Guttmann gives a speech in which he declares his hope that the Games would become international and achieve “world fame as the disabled men and women’s equivalent of the Olympic Games (Bailey, 2007; Goodman, 1986).] • First Winter Games for the Deaf
1950 • Ski School for amputees established in Salzberg, Austria [Signifi cance—fi rst winter sports organization for persons with a disability (Jahnke, 2006).]
1952 • First International Stoke Mandeville Games, known at the time as the First International Inter-Spinal Unit Sports Festival (Bailey, 2009) with an offi cial team from the Netherlands competing in a program of fi ve sports (Gold 2007; Brittain 2010; Bailey, 2009) [Signifi cance—Recognized as the fi rst ISMGs; First International Games for Athletes with a Physical Disability; second Stoke Mandeville Games to be held in the same year as the Olympic Games.]
1953 First media record of the term “Paralympic”, in the Bucks Advertiser and Aylesbury News (Brittain, 2010)
1956 • Fifth International Stoke Mandeville Games [Signifi cance—third Stoke Mandeville Games to be held in the same year as the Olympic Games.] • Guttmann awarded the Fearnley cup by the IOC for “outstanding achievement in the service of Olympic ideals” [Signifi cance—fi rst offi cial engagement with the Olympic Movement.] Introduction to the Paralympic Movement 5
Event Year [Signifi cance of the event in square brackets and italicized]
1957 The term “Paralympic” in common colloquial use to describe the Stoke Mandeville Games (Gold, 2007)
1959 Establishment of International Stoke Mandeville Games Committee (ISMGC) (Bailey, 2009)
1960 • First Paralympic Games held in Rome (also offi cially known as the Ninth International Stoke Mandeville Games); Competitors were SCI athletes only [Signifi cance—fi rst ISMGs held outside Stoke Mandeville; fi rst time the Olympic Games and Stoke Mandeville Games were held in the same city, venue, and year, strengthening links between the movements; recognized by IPC as fi rst Paralympic Games.] • Formal decision by International Stoke Mandeville Games Committee to align the International Stoke Mandeville Games with the Olympic cycle, so that in the year of an Olympic Games the Committee would endeavor to hold the annual Games in the same city (or country) as the Olympic Games
1964 • Second Paralympic Games held in Tokyo, also offi cially known as the Thirteenth International Stoke Mandeville Games; competitors were SCI athletes only [Signifi cance—ISMGC achieves goal of linking the Games with the Olympics, which they set in 1960; Paralympic athletes share accommodation and sporting facilities used by Olympic athletes.] • Establishment of International Sports Organization for the Disabled (ISOD), a multi-disability sports organization that aimed to provide sports opportunities for people with disabilities other than SCI
1966 • Ludwig Guttmann knighted for services to the disabled and becomes President of ISOD • World Games for the Deaf replace International Games for the Deaf (est’d 1924) • First International Sports Competition for Amputees, held at Stoke Mandeville and hosted by the British Limbless Ex-Serviceman’s Association (Brittain, 2010)
1967 • ISOD transfers headquarters to Stoke Mandeville • ISOD begins development of rules of sports and classifi cation for amputee athletes
1968 • Third Paralympic Games held in Tel Aviv, Israel, also offi cially known as Seventeenth International Stoke Mandeville Games; competitors were SCI athletes only [Signifi cance—despite promising early negotiations with Instituto Mexicano de Rehabilitación, ISMGC failed for the fi rst time to secure a host for the Games in Mexico, the 1968 Olympic City; credible alternative bids from Israel and United States indicated the growing international stature of the Games.] • Establishment of Sports and Leisure Group by International Cerebral Palsy Society
1972 • Fourth Paralympic Games held in Heidleburg, Germany, also offi cially known as the Twenty-fi rst International Stoke Mandeville Games; competitors were SCI athletes only • ISMGC changes name to International Stoke Mandeville Games Federation (ISMGF) (Bailey, 2007)
1975 • United Nations (UN) General Assembly adopts The Declaration on the rights of Disabled Persons (Resolution 3447), article 9 of which states that “Disabled persons have the right to . . . participate in all social, creative or recreational activities.”
1976 • Fifth Paralympic Games held in Toronto, Canada (also offi cially known at the time as the Toronto Olympiad for the Physically Disabled, or Torontolympiad); competitors were SCI athletes and, for the fi rst time, amputee and vision impaired (VI) athletes [Signifi cance—fi rst Paralympic Games not auspiced by the ISMGC alone, but in cooperation with ISOD; fi rst games which included athletes other than those with SCI—viz. amputee and les autres.] • First Winter Paralympic Games held in Örnsköldvik, Sweden (also offi cially known at the time as the Winter Olympic Games for the Disabled (Jahnke, 2006)); competitors were amputee and VI athletes • United Nations adopted resolution 31/123, declaring 1981 the International Year of Disabled Persons
1977 • ISOD creates Les Autres Classifi cation system, a single classifi cation system for athletes not eligible to compete in competitions for people with SCI, CP, amputation, VI, or hearing impairment (Bailey, 2009)
1978 Establishment of Cerebral Palsy-International Sports and Recreation Association (CP-ISRA), replacing Sports and Leisure Group of the International Cerebral Palsy Society (est’d 1968) (Brittain, 2010)
(continued ) 6 Chapter 1
Table 1.1 (Continued )
Event Year [Signifi cance of the event in square brackets and italicized]
1980 • Sixth Paralympic Games in Arnhem, the Netherlands (also offi cially known at the time as Olympics for the Disabled); competitors were SCI, amputee, VI athletes and, for the fi rst time, athletes with CP. • Establishment of International Blind Sports Association (IBSA) [Signifi cance—fi rst international sports organization for people with VI.] • Second Winter Paralympic Games held in Geilo, Norway (also offi cially known at the time as the Second Winter Olympic Games for the Disabled (Jahnke, 2006)); competitors were amputee and VI athletes and, for the fi rst time, athletes with SCI. • World Health Organization publishes International Classifi cation of Impairment Disability and Handicap (ICIDH). [Signifi cance—this document defi ned and used a standardised language for describing the consequences of disease and injury. It also provided a framework to code information relating to the consequences of disease and injury]
1981 United Nations declares International Year of the Disabled
1982 • Establishment International Coordinating Committee of World Sports Organizations for the Disabled (ICC), comprising representatives from CP-ISRA, IBSA, ISMGF, ISOD (Bailey, 2007; Brittain, 2010) • First Cerebral Palsy World Games, held in Denmark and hosted by CP-ISRA • United Nations adopts Resolution 37/53, proclaiming 1983–1992 the United Nations Decade of Disabled Persons
1983 United Nations declares Decade of Disabled Persons (GA resolution 37/52)
1984 • Seventh Paralympic Games held in two locations: • New York, USA (also offi cially known at the time as the New York International Games for the Disabled); competitors were SCI, amputee, VI, CP, and, for the fi rst time, LA athletes • Aylesbury, UK (also offi cially known at the time as International Stoke Mandeville Games); competitors were SCI athletes only • Third Winter Paralympic Games, held in Innsbruck, Austria (also offi cially known at the time as the III World Winter Games for the Disabled (Jahnke, 2006)); competitors were SCI, amputee, VI, CP, and, for the fi rst time, LA athletes
1985 Establishment of International Association for Sport for Persons with Mental Handicap (INAS-FMH)
1986 CISS and INAS-FMH join ICC
1988 • Eighth Paralympic Games, held in Seoul Korea [Signifi cance—fi rst Games since 1964 held in the same city as the Olympic Games, sharing venues and facilities]; competitors were SCI, amputee, VI, CP, LA athletes, and, for the fi rst time dwarves were included under the banner of LA • Fourth Winter Paralympic Games, held in Innsbruck, Austria (also offi cially known at the time by two names—the IV World Winter Games for the Disabled—Winter Paralympics 1988 and IV World Winter Games for Physically Disabled Innsbruck 1988 (Jahnke, 2006)); competitors were SCI, amputee, VI, CP, and LA athletes
1989 • Establishment of International Paralympic Committee (IPC)
1990 ISMGF changes name to International Stoke Mandeville Wheelchair Sports Federation (ISMWSF)
1992 • Ninth Paralympic Games, held in Barcelona, Spain; competitors were SCI, amputee, VI, CP, and LA athletes • First Paralympic Games for athletes with ID, held in Madrid, Spain • Fifth Winter Paralympic Games held in Tignes-Albertville, France • Conclusion of United Nations Decade of Disabled Persons • United Nations declares December 3 the annual International Day of Disabled Persons (GA resolution 47/3)
1993 • First World Dwarf Games, Chicago, USA • Establishment of the International Dwarf Athletic Federation (IDAF)
1994 • Sixth Winter Paralympic Games held in Lillehammer, Norway; competitors were SCI, amputee, VI, CP, and LA athletes.
1995 • CISS withdraws from Paralympic Family, having joined in 1986
1996 • Tenth Paralympic Games, held in Atlanta, USA; competitors were SCI, amputee, VI, CP and LA athletes, and, for the fi rst time at the same venue, ID athletes Introduction to the Paralympic Movement 7
Event Year [Signifi cance of the event in square brackets and italicized ]
1998 • Seventh Winter Paralympic Games held in Nagano, Japan; competitors were SCI, amputee, VI, CP and LA athletes, and, for the fi rst time, ID athletes
1999 INAS-FMH changes name to International Association for Sport for Persons with Intellectual Disability (INAS-FID)
2000 • Eleventh Paralympic Games held in Sydney, Australia; competitors were SCI, amputee, VI, CP, LA, and ID athletes
2001 • INAS-FID suspended from the Paralympic Movement by the IPC at the 2001 General Assembly following revelations that 69% of athletes who had won medals in the intellectually disabled events at the Sydney Paralympic Games did not have a necessary verifi cation of an ID • Deafl ympics replace World Games for the Deaf (est’d 1966)
2002 • Eighth Winter Paralympic Games held in Salt Lake, USA; competitors were SCI, amputee, VI, CP, and LA athletes
2004 • Twelfth Paralympic Games held in Athens, Greece • ISMWSF and ISOD merge to form the International Wheelchair and Amputee Sports Federation (IWAS)
2006 • Ninth Winter Paralympic Games, held in Torino, Italy
2007 • IPC endorses the IPC Classifi cation Code [Signifi cance—details policies and procedures that should be common to classifi cation in all sports; sets principles to be applied by all sports within the Paralympic Movement, including mandating development of evidence-based systems of classifi cation.]
2008 • Thirteenth Paralympic Games, held in Beijing, China
2009 • INAS-FID reinstated to the Paralympic Movement at the IPC General Assembly • Publication of International Paralympic Committee Position Stand – Background and scientifi c principles of Classifi cation in Paralympic Sport [Signifi cance—provides a scientifi c background for classifi cation in Paralympic sport; defi nes evidence-based classifi cation; and provides guidelines for how evidence-based classifi cation may be achieved ]
2010 Tenth Winter Paralympic Games, held in Vancouver, Canada
2012 • Thirteenth Paralympic Games, to be held in London, UK; competitors will be SCI, amputee, VI, CP, LA, and ID athletes
2014 • Eleventh Winter Paralympic Games, to be held in Sochi, Russia; competitors will be SCI, amputee, VI, CP, LA, and ID athletes
2016 • Fourteenth Paralympic Games, to be held in Rio, Brazil
Background to the Paralympic Games were held in the year of the Olympic Games Movement and in the same city: the 1924 Paris Games and the 1928 Amsterdam Games (http://www.deafl ympics. com/games/). However, since 1935 the Interna- Antecedents of the Paralympic tional Games for the Deaf have been held in the year Movement immediately following the staging of the Olympic It is commonly accepted that the Paralympic Move- Games. In 1966, the Games were renamed the World ment began in England in the 1940s. However Games for the Deaf and the current offi cial name— the concept of providing sports opportunities Deafl ympics—was adopted in 2000. Winter Games specifi cally for people with disabilities was pio- for the Deaf have been held since 1949 and are held neered much earlier. The fi rst Sports Club for the in the year following the Winter Olympics (http:// Deaf was founded in Berlin in 1888 (Gold & Gold, www.deafl ympics.com/games/). 2007). An international sports federation for the Among the earliest sports organizations for people deaf—Comité International des Sports des Sourds with physical disabilities were the Disabled Drivers (CISS)—was founded in 1922 (Bailey, 2007; Gold & Motor Club (1922) and the British Society of One- Gold, 2007). The fi rst two International Silent Armed Golfers (1932) (Brittain, 2010). 8 Chapter 1
Sir Ludwig Guttmann—Founding Father of the Paralympic Games “Dr Guttmann, you are the de Coubertin of the paralysed!” (His Holiness Pope John XXIII, 1960)
Sir Ludwig Guttmann (1899–1980) was born into a Jewish family in Germany on July 3, 1899. He quali- fi ed as a medical doctor in 1924 (MD, Frieburg) and, as a new graduate, began his lifelong specialization in neurology and neurosurgery under the tutelage of Prof. Otfrid Foerster (Whitteridge, 2004). In 1933, the National Socialists came to power and, because he was Jewish, Guttmann was forced to leave his Figure 1.2 Sir Ludwig Guttmann, the founding father of post and become a neurologist and neurosurgeon in the Paralympic Movement (photographer unknown). the Jewish hospital in Breslau. In 1937, Guttmann became medical director of that hospital. In 1939, Guttmann and his family were granted visas to visit named in his honor (Whitteridge, 2004). Guttmann England. On that visit he made contact with the Soci- became Sir Ludwig Guttmann in 1966 when he ety for the Protection of Science and Learning and, was knighted by Queen Elizabeth II for services through this connection, was invited to interview to the disabled. He died on March 18, 1980, prior to at Oxford University where he secured a research the Olympics for the Disabled in the Netherlands position (Whitteridge, 2004). He worked at Oxford later that year. until 1943 when, frustrated by the lack of clinical There is little doubt that, just as Baron Pierre de work in the University environment, he accepted an Coubertin is considered the founder of the modern offer to become inaugural Director of the National Olympic Games, Sir Ludwig Guttmann deserves to Spinal Injuries Unit at the Ministry of Pensions Hos- be considered founding father of the Paralympic pital, Stoke Mandeville, Aylesbury. He became a Movement (Figure 1.2). naturalized Briton in 1945 (Whitteridge, 2004). It was at Stoke Mandeville that Guttmann began a number of highly innovative methods of reha- The term “Paralympic” bilitation for people with spinal cord injury (SCI). Chief among these was the inclusion of sport as an integral part of physical rehabilitation, an initia- Originally, the term “Paralympic” was considered tive which ultimately led to the establishment of a pun combining “paraplegic” and “Olympic” the Paralympic Games. Guttmann’s considerable although its origins are unclear. The term was fi rst contribution in this area is covered in more detail used in the media in 1953 in the Bucks Advertiser and in the remainder of this section. As instrumental as Aylesbury News and until 1960 the term was used Guttmann was in the establishment of the Games, as an alternative or colloquial means of referring to he made other contributions that were similarly the annual International Stoke Mandeville Games impressive—he founded the scientifi c journal Para- (ISMGs) (Brittain, 2010). Although Guttmann was a plegia (currently published as Spinal Cord) as well determined promoter of the link between the Olym- as the International Medical Society for Paraplegia pic and Paralympic Movements, the record shows (now the International Spinal Cord Society) and wrote that he preferred the “International Stoke Mandev- a Textbook of Sport for the Disabled (1976). He also ille Games” to be used offi cially and did not promote trained medical staff from many countries at Stoke use of the term Paralympic. The term remained col- Mandeville and, in recognition of the outstanding loquial following the 1960 Rome Games although, education he provided, medical training centers from that time, Paralympic tended to be used in in Spain, West Germany, and Israel have been the press only when referring to the ISMGs that Introduction to the Paralympic Movement 9 occurred in the same year as the Olympics (Brittain, 1944–1952: sport as rehabilitation 2010; Gold & Gold, 2007). The fi rst attempt to use the term offi cially was by the self-titled “1984 Paralympics Steering Com- Dr. Ludwig Guttmann’s tenure as inaugural Direc- mittee”, which was preparing to host games for the tor of the National Spinal Injuries Unit in Stoke spinal cord injured in Chicago. The United States Mandeville began on March 1, 1944. His patients Olympic Committee (USOC) registered its disap- were principally ex-servicemen who had sustained proval of the term at that time, indicating that it felt war-related SCIs, although there were an appre- that the term was too closely aligned with “Olym- ciable number of civilian injuries admitted as well pic”, but the Games in Chicago did not eventuate (Howe, 2008). It was believed that a unit specializ- and so use of the term at that point was not tested ing in management of spinal injuries would ensure (Brittain, 2010). Subsequently, the International that patients would receive better treatment than Olympic Committee (IOC) approved the use of the could be given in general medical, surgical, ortho- term Paralympic in connection with the 1988 Seoul pedic, or neurosurgical wards (Scrutton, 1998). Games and following these Games the term was Guttmann’s early work was infl uenced by incorporated into the name of the new governing Dr. D. Munro, a neurosurgeon from Boston, USA, body for the Games, the International Paralympic who had developed methods of management that Committee (IPC). The term Paralympic has been reduced the incidence and recovery time from the correct term of reference for the Games and decubitus ulcers, and who also achieved some suc- the movement ever since (Figure 1.3) (http://www. cess in the treatment of urinary tract infections. paralympic.org/Media_Centre/). Guttmann began by implementing Munro’s mea- Offi cially the IPC has retrospectively recog- sures, but soon made important advances himself. nized the 1960 Rome Games as the fi rst Summer For example, he showed that antiseptics retarded Paralympics and the 1976 Örnsköldvik Games as the healing of bedsores, which were best managed the fi rst Winter Paralympics. The meaning of the by excision of necrotic tissues, skin grafting, and the term has also been defi ned to indicate its mean- training of patients to self-monitor on a regular basis ing in the current context—the English prefi x (Whitteridge, 2004). A hallmark of rehabilitation “para” (i.e., a bound morpheme derived from the at Stoke Mandeville was that patients were always Greek) meaning alongside and the stem “Olympic” encouraged to extend themselves physically— referring to the Games, with the term Paralympic whether sitting up in bed during early rehabilitation indicating that the Olympic and Paralympic move- or using calipers in the later stages. Upon discharge ments exist side by side (http://www.paralympic. from the Unit, patients were expected to have high org/Media_Centre/). levels of physical independence (Scrutton, 1998). Inspiration for incorporating sport into the Stoke Mandeville rehabilitation methods came from the patients themselves. While doing his rounds, Gutt- mann saw a group of patients frantically moving in their wheelchairs outside the dormitory blocks using a puck and an upside down walking stick, a game subsequently dubbed wheelchair polo. Attrac- tive as this game was for the patients, the use of the stick at the same time as propelling the wheelchair made the game unacceptably dangerous, and it was soon replaced by a variety of other sports, including archery, netball, javelin, and snooker. In the context of postwar spinal rehabilitation, Figure 1.3 Modern Paralympic athlete competing in a the notion that sport could be used to enhance recent Paralympic Games. Reproduced courtesy of Lieven outcomes was entirely novel. It is arguable that, Coudenys. unless Guttmann had helped establish sport as a 10 Chapter 1
legitimate feature of comprehensive rehabilitation, became international. Known at the time as the the growth of the Paralympic Movement could First International Inter-Spinal Unit Sports Festi- have been delayed by 40 years. Guttmann pro- val, a team from a spinal unit for war veterans at moted sport as “the most natural form of remedial Aardenburg in the Netherlands traveled to Stoke exercise, restoring physical fi tness, strength, Mandeville to compete in the Games (Bailey, 2007; coordination, speed, endurance and overcom- Gold & Gold, 2007). Over the next 7 years, the ing fatigue” (Guttmann, 1976). He also held that Games became offi cially known as the ISMGs and sport “. . . had a psychological impact of restoring were held annually at the Hospital. The number pleasure in life and contributing to social reinte- of international teams grew markedly, and at the gration”. In essence, Guttmann believed that sport 1959 Games, 360 competitors from 20 countries was a vital means of achieving what he regarded (principally from the industrialized nations) took as the ultimate aims of rehabilitation—to make part (Brittain, 2010). the spinally injured person “. . . as independent as possible and to restore him to his rightful place in social life” (Guttmann, 1976). 1952–1959: leaving the hospital On July 29, 1948, Guttmann offi cially extended the reach of his sports program beyond the patient population at Stoke Mandeville, inviting During this period of internationalization (1952– a team of patients from the Star and Garter Home 1959), rehabilitation remained an important driver in Richmond, Surry, to compete against his own for development of Paralympic sport. Specifi cally, patients in an archery competition at the Hos- medical specialists and staff from rehabilitation pital. This was the fi rst Stoke Mandeville Games units were a crucial engine for growth of the Games. and it occurred on the same day as the opening Staff who visited the hospital to train, and Stoke ceremony of the 1948 London Olympic Games. Mandeville staff who moved on to positions in other With the benefi t of hindsight, this co-occurrence countries, spread knowledge of and enthusiasm for appears highly symbolic, although Guttmann the Hospital’s approach to paraplegic care and the himself did not claim that he had selected the role of sport in rehabilitation (Gold & Gold, 2007). date for that reason (Brittain, 2010). Guttmann himself also spread the word though The The second Stoke Mandeville Games were held Cord—a newsletter published from Stoke Mandev- exactly one year later and grew substantially in that ille which Guttmann contributed to regularly and short space of time—at the 1948 Games, 16 patients which often devoted space to sports reports from from two hospitals had competed; in the 1949 the Hospital—and through international confer- Games, 37 patients from six hospitals competed. It ence presentations, at which he frequently chal- was at these Games that Guttmann made his Para- lenged key delegates to bring teams to the Games lympic pretensions explicit. In a remarkably prescient (Brittain, 2010; Gold & Gold, 2007). speech, Guttmann foreshadowed the possibility that During the same period, however, Paralympic the movement would eventually mature into one sport grew beyond rehabilitation. This occurred which would fully embrace the ethos of elite sport, principally through continued participation in the speaking of the day when the Games would become Games by patients who had completed their reha- truly international and when it would be “the dis- bilitation and been discharged into the community. abled men and women’s equivalent of the Olympic This increasingly large group of people was no lon- Games” (Bailey, 2007; Goodman, 1986). In the ensu- ger comprised of patients completing an externally ing years, the growth of the Games continued apace imposed rehabilitation regime in order to achieve and at the 1951 Games, 126 patients from 11 hospi- augmented rehabilitation outcomes—rehabilitation tals throughout the United Kingdom competed in was over. These people—community- dwelling four sports—archery, netball, javelin, and snooker. people with SCI who continued to compete at ISMGs The year of the Helsinki Olympic Games (1952), following discharge—can therefore rightly be iden- was the fi rst year that the Stoke Mandeville Games tifi ed as the fi rst Paralympic athletes who were NOT Introduction to the Paralympic Movement 11 doing sport as rehabilitation. Instead, people in sul Lavoro—INAIL—and the Ostia Spinal Unit, this group competed in sport for the same reasons Rome). as other people in the community are known to, The Rome Games were the fi rst to be conducted including enjoyment, social interaction, recreation, under the auspices of the ISMG Committee (ISMGC), competition, and enhanced health and well being which was formed in 1959. Inspired by the great suc- (Vallerand & Rousseau, 2001). In 1952, athletes cess of the Rome Games, the ISMGC made a formal were selected to represent their countries, rather decision to align the ISMGs with the Olympic cycle, than their rehabilitation hospital, another change so that in the year of an Olympic Games the Com- that aligned Paralympic sport with nondisabled mittee would endeavor to hold the annual Games sport, and which served to de-emphasize sport as in the same city (or country) as the Olympic Games rehabilitation. (Bailey, 2007; Brittain, 2010). This highly ambitious An important antecedent of elite Paralympic aim was achieved in 1964, when the ISMG were held sport also appeared during this period, with the fi rst in Tokyo. The 1964 Tokyo Games were similar to the offi cial link between the Paralympic and Olympic Rome Games in a number of ways—they were held in movements. The Olympic Movement is synony- the same city and year as the Olympic Games, Olym- mous with elite sport; and in 1956, one of the guests pic facilities were used by ISMG competitors and these invited to the ISMGs was Sir Artur Porritt, a surgeon arrangements were facilitated by very strong links and a British member of the IOC. Porritt was appar- between Stoke Mandeville and the medical rehabilita- ently so impressed by the Games that he nominated tion community in the host country—in this case with the Games for the Fearnley Cup, an IOC award for Dr. Nakamura a doctor of rehabilitation from Beppu “outstanding achievement in the service of the (Brittain, 2010). At this point in time, the factors help- Olympic ideals” (Guttmann, 1976). At this point ing to drive the development of Paralympic sport were the symbol of the International Stoke Mandev- derived from each of the three themes identifi ed in ille Games Federation (ISMGF) was three entwin- the introduction to this section: sport for rehabilita- ing wheels that represented friendship, unity, and tion, promoting participation, and elite sport. sportsmanship, a clear echo of the symbolism of the Unfortunately, despite the best efforts of people fi ve Olympic rings. within the movement, it was not until 24 years later, at the 1988 Games in Seoul, that the Olympic and Paralympic Games were once again held in the same city re-establishing the close alignment that charac- 1960–1964: a material link to the terized the Rome and Tokyo Games. Olympic Games
The 1960 ISMGs were tremendously signifi cant 1964–1987: defi ning the scope of the in the development of the Paralympic Movement movement and the beginnings of a and are offi cially recognized by the IPC as the unifi ed voice for Paralympic sport fi rst Paralympic Games (http://www.paralympic. org/Media_Centre/). They were the fi rst ISMGs ever held outside the Hospital grounds, and they were In 1964, only athletes with SCI participated in Para- conducted in the same city as the Olympic Games lympic sport and only Summer Games were held. had been. The association with the Olympic Games By 1987, the scope of the movement had expanded was strengthened by the fact that competitors at dramatically to include all the groups that are cur- the ISMG competed at Olympic venues. The capac- rently eligible to compete in Paralympic sport; the ity to conduct the Games was due largely to strong Winter Paralympic Games had been established; working links between Guttmann and the unit at and the fi rst international umbrella organization Stoke Mandeville on one hand, and key rehabilita- for Paralympic sport—the International Coordinat- tion institutions in Italy on the other (namely Insti- ing Committee of World Sports Organizations for tuto Nazionale per l’Assicurazione contro Infortuni the Disabled (ICC)—had been formed. 12 Chapter 1
Expansion of the disability groups 1984 and fi rst competed at the Seoul Paralympics in comprising the movement 1988 (http://www. paralympic.org/Media_Centre/). In 1986, toward the end of this period of expan- Initially it was intended that a single organization— sion, the International Association for Sports for the International Sports Organization for the Dis- Persons with a Mental Handicap (INAS-FMH) was abled (ISOD), established in 1964—would develop established and was later renamed the International opportunities for people who were not eligible to Association for Sports for Persons-Federation for the compete under ISMGC rules (i.e., the spinal cord Intellectually Disabled (INAS-FID). Athletes with an injured). In 1966, Guttmann became President of intellectual disability (ID) competed in their fi rst ISOD and the Headquarters shifted from Paris to Paralympic Games in 1992, although a decision by Stoke Mandeville. ISOD commissioned writing of the local organizing committee meant that they sports rules and a classifi cation system for ampu- were not permitted to compete in Barcelona. Instead tees and other forms of limb defi ciency in 1967 INAS-FID organized separate games in Madrid, after (Bailey, 2007). By 1976, ISOD had also developed the Barcelona Games which, although separate, sport rules and classifi cation systems for people were offi cially recognized as part of the Paralympic with vision impairment (VI) and cerebral palsy Games (Brittain, 2010). (CP), however, establishment of independent sports organizations for athletes with CP in 1976 The Winter Games (the Cerebral Palsy-International Sport and Recre- ation Association— CP-ISRA) and those with VI in Winter sports for persons with a disability began in 1980 (the International Blind Sports Association— Europe in the late 1940s and, in contrast to the sum- IBSA) meant that the systems developed by ISOD mer sports which began with sports for people with were never widely implemented (Brittain, 2010). SCI, the fi rst sports organization for people with a Amputee and VI athletes fi rst competed at the disability was a ski school for amputees ( Jahnke, Summer Paralympic Games in Toronto in 1976 2006). The school was established in Salzburg, Aus- and CP athletes competed at the Arnhem Games tria in 1950 and during the 1960s organizations 4 years later. for people with VI also began. The concept of an ISOD also developed sports rules and a classifi ca- International Winter Games for persons with a dis- tion system for Les Autres (LA), a French term which ability was proposed by Sweden at an ISOD meeting literally means “the others”. As the name suggests, in 1974, and in 1976 the fi rst Winter Paralympic the system served as a catch-all, catering for people Games—also offi cially known at the time as the with movement-related impairments who were Winter Olympic Games for the Disabled—were hosted not eligible to compete under the rules of other by ISOD in Örnsköldvik, Sweden (Jahnke, 2006). sports organizations for the disabled at that time Competitors at the games were amputees and ath- (i.e., ISMGF, CP-ISRA, ISOD [rules for Amputees], or letes with VI. The second Games were held in Geilo, IBSA). More specifi cally LA athletes were those with Norway in 1980 and athletes with SCI competed for “locomotor disabilities1 regardless of diagnosis”, but the fi rst time. LA athletes and those with CP fi rst specifi cally excluding those with “severely reduced competed at the third Winter Paralympic Games in mental capacity . . . heart, chest, abdominal, skin, 1984 at Innsbruck, Austria. ear and eye diseases without locomotor disability” Examination of historical accounts of this phase (ISOD, 1993). It included athletes affected by condi- of Paralympic sports development does not indi- tions such as multiple sclerosis, arthrogryposis, mus- cate that provision of sport as rehabilitation drove cular dystrophy, as well as those with injuries that growth in the variety of groups participating permanently affected muscles, nerves, or bones and and provision of opportunities in winter sports. caused permanent weakness and/or loss of range More specifi cally the strong involvement of the of movement. LA athletes fi rst competed at the medical fraternity that was evident in the early Summer Paralympic Games in 1984 in New York. development and expansion of the ISMGs were Dwarves were included under the LA banner after not as evident in these new sports organizations. Introduction to the Paralympic Movement 13
Rather, it appears that this signifi cant period of meeting of what was later named the ICC. In 1986, broadening was related to growing international CISS and INAS-FMH were admitted as members of acceptance of the view that people with disabili- the ICC (Brittain, 2010). ties had a right to participate in the full spectrum The explicit aim of the ICC was to become the of activities that comprised community life, and organizing body for the Paralympic Games and that sport and recreation were an integral part of it gave the Paralympic Movement its fi rst united this spectrum. For example, in 1975 the United voice, permitting improved lines of communica- Nations (UN) General Assembly adopted The Dec- tion with the IOC and relevant Olympic Games laration on the rights of Disabled Persons (Resolution organizing committees. The advantages conferred 3447), article 9 of which states that “Disabled per- by a unifi ed voice undoubtedly facilitated arrange- sons have the right to . . . participate in all social, ments that permitted the 1988 Summer Olympic creative or recreational activities.” In 1976, the and Paralympic Games to be held in the same city United Nations adopted resolution 31/123, declar- and in close cooperation for the fi rst time since ing 1981 the International Year of Disabled Per- 1964. Following on from this, the 1992 Win- sons and in 1982 (Resolution 37/53) proclaimed ter Olympic and Winter Paralympic Games also the period 1983–1992 the United Nations Decade engaged in a similar shared organization for the of Disabled Persons. While these UN initiatives fi rst time ever. are not explicitly linked to the broadening of the During the period 1964–1987, recognition that Paralympic Movement, they certainly indicate Paralympic sport was elite and inspiring did not that the international conditions were right for an make a major contribution to the growth of Para- expansion of the types of sporting opportunities lympic sport. This was due principally to the fact available to people with disabilities, as well as an that for the majority of this period the movement extension of the number of people with disabilities had been too fractured and disparate to develop served by Paralympic sport. The offi cial philosophy effective working relations with the IOC, relations of INAS-FID, one of several international sports that later proved pivotal in developing the image organizations for people with disabilities that was of Paralympic sport as elite. However, there were established during this period, supports this view, two developments that helped develop the image stating that “ . . . persons with intellectual disability of Paralympic sport as elite. are members of society entitled to the same rights, The fi rst was the inclusion of wheelchair racing opportunities, and duties as everyone else. They (men’s 1500 m and women’s 800 m) as demonstra- are not special, but have specifi c needs, just as the tion events for the fi rst time at the 1984 Olympic old, the young, the blind, and physically impaired Games (Brittain, 2010). This raised the profi le of have specifi c needs.” Paralympic sport enormously and, because of the status of the Olympic Games as an elite sports event, made a clear statement that Paralympic sport Development of a unifi ed voice is elite sport. The other notable trend toward elitism By 1981, four international organizations of sport from within the movement was the tailoring of the for the disabled existed—ISMWSF (representing Paralympic events program so that it became more athletes with SCI), ISOD (representing amputee closely aligned with the Olympic sports program. and LA athletes), CP-ISRA (representing CP ath- Table 1.2 presents sports and events that were culled letes), and IBSA (representing VI athletes)—and no from the Paralympic program during this period, single organization existed that had the authority clearly demonstrating a tendency to remove events to speak or act on behalf of this collective. This that might be perceived as novelty events, reha- made dealings with the Paralympic Movement bilitation events or recreational events. Whether very complicated and fractious, concerns that culling such events was necessary in order to proj- had been expressed on a number of occasions by ect an image of elite Paralympic sport is debatable, the IOC (Bailey, 2007). In March 1982, the four however, there is little doubt that elitism motivated international organizations held the founding the trend. 14 Chapter 1
Table 1.2 Sports and events culled from the Paralympic program 1960–1987.
Sport/event Year in Last year on program
Dartchery* 1960 1980 Snooker 1960 1976 Precision javelin 1960 1976 Wheelchair slalom 1964 1988 Kick ball 1988 1988 Lawn bowls 1968 1996
*Dartchery: a sport in which competitors score points by shooting arrows onto a target that is confi gured in the same way as a dart board.
Figure 1.4 Athletes competing in the 2008 Beijing Paralympic Games. Reproduced courtesy of Lieven 1988–present: Paralympic sport Coudenys. comes of age of 1988 and 1992. On the whole these four Games were considered outstanding successes, bearing This period began with the 1988 Seoul Paralympic testimony to the effectiveness of the organization Games, the Games that heralded the arrival of Para- and the advantage of having a single representa- lympic sport as an elite international sporting event. tive organization for Paralympic sport (Brittain, At the conclusion of the games, the fi rst President of 2010). the IPC, Dr. Bob Steadward commented: “the 1988 The IPC was formed in 1989 and replaced the Seoul Paralympics dramatically demonstrated the ICC as the lead agency for organization of the Sum- effects of proper organisation and the shift from mer and Winter Games in 1992. Organizationally sport as rehabilitation to sport as recreation to elite the principal difference between the ICC and the sport . . . The winning athlete was the elite athlete, IPC was that while the ICC membership comprised one at the peak of training and conditioning. Thus only the six International Sports Organizations for these Games are considered the fi rst Games of the the Disabled (IOSDs2)—ISMWGF, CP-ISRA, IBSA, modern Paralympic era” (Bailey, 2007). Indeed, ISOD, INAS-FMH, and CISS—IPC membership also with 3951 athletes competing at the Beijing Games included 41 member nations, each of whom had in 2008 (Figure 1.4), the Paralympics are now the voting rights. This structure was more democratic second largest international sports gathering of and ensured that a greater diversity of voices could any type after the Summer Olympics (Gold & Gold, be heard. CISS withdrew from the IPC in 1995, 2007). resuming the independent position that had been During this period, the predominant factor that characteristic of the organization since its inception has driven development of the movement has been in 1922 (Bailey, 2007). recognition that Paralympic sport is elite, exciting, Currently, the IPC is the global governing body and inspiring. Specifi cally, factors that have contrib- of the Paralympic Movement, as well as the orga- uted to this recognition have included an evolution nizer of the Summer and Winter Paralympic Games. from the ICC to the IPC and closer, more functional There are 20 Summer Paralympic sports, and four ties between the IPC and the IOC. Winter Paralympic sports and these are presented in Table 1.3, together with Wheelchair Dance Sport Evolution from the ICC to the IPC which is not contested at the Paralympic Games but which is governed by the IPC. The ICC was established in 1982 and achieved As indicated in Table 1.3, the IPC acts as interna- its intended purpose, coordinating the staging of tional federation for eight sports (seven Paralympic both the Summer and Winter Paralympic Games and one non-Paralympic), whereas the remaining Introduction to the Paralympic Movement 15
Table 1.3 Sports governed by the IPC and its member federations as of January 2009.
Sports governed by IPC Sports governed by IPC Member Federations
IOSDs International Federation Sports
Sport Organization Sport Organization
Alpine Skiing (W) Boccia CP-ISRA Archery Fédération International de Tir à l’Arc Athletics Football 5-a-Side IBSA Cycling Union Cycliste International
Ice Sledge Hockey (W) Football 7-a-Side CP-ISRA Equestrian International Equestrian Federation Nordic Skiing (Biathlon & Goalball IBSA Rowing International Rowing Cross Country Skiing) (W) Federation Powerlifting Judo IBSA Sailing International Foundation for Disabled Sailing Shooting Wheelchair Fencing IWAS Table Tennis International Table Tennis Federation Swimming Volleyball (Sitting) World Organization for Volleyball for Disabled Wheelchair Dance Sport Wheelchair Basketball International Wheelchair Basketball Federation Wheelchair Tennis International Tennis Federation Wheelchair Curling (W) World Curling Federation Wheelchair Rugby International Wheelchair Rugby Federation
Acronym key: IOSD, International Organizations of Sport for the Disabled; CP-ISRA, Cerebral Palsy-International Sport and Recreation Asso- ciation; IBSA, International Blind Sport Association; IWAS, International Wheelchair and Amputee Sports Federation; W, Winter sport.
17 Paralympic sports are governed by international as elite and entertaining. Figure 1.5 presents the federations that are structurally independent, but current IPC organizational structure. which have been admitted to the membership of the IPC. These international federations comprise Closer and more functional ties International Organizations of Sport for the Dis- between IPC and IOC abled (IOSDs) which provide sports opportunities for people with specifi c disabilities (e.g., CP or VI); Between the 1964 Tokyo Games and the 1988 Seoul and International Sport-Specifi c Federations (e.g., Games relations between the IOC and the Paralym- Union Cycliste Internationale or International pic Movement were not strong. This was due in part Wheelchair Basketball Federation). to the absence of a functioning umbrella organiza- The IPC celebrated its 30th anniversary in 2009 tion that could legitimately speak on behalf of the and in this time it has had only two Presidents— Paralympic Movement. However, during this period Dr. Robert Steadward (1989–2001) and Sir Philip the IOSDs did demonstrate an ability to resolve dif- Craven (2001–present). It has unprecedented ferences and work together for mutual benefi t. The resources that, in a relatively stable organizational fi rst meeting between the newly established ICC environment, have permitted development of and then IOC President Juan Antonio Samaranch a corporate culture and systems that have aided took place in 1983 and was called to resolve a dispute the advancement of the movement, including over naming of the third Winter Paralympic Games. cultivation and projection of Paralympic sport Outcomes from the meeting were: the originally 16 Chapter 1
IPC GENERAL STRUCTURE Sarajevo Winter Olympics and the Los Angeles Olympics (Brittain, 2010). General Assembly In the lead-up to the 1988 Games the IOC agreed International National International Regional to the term “Paralympic” being used for the Seoul Sports Paralympic Organizations Organizations Federations Committees of Sport for the (ROs) Games and all games from then onward. With the (IFs) (NPCs) Disabled naming issue fi nally settled, tensions arose over the IOSD Sports* (IOSDs) IPC Regions* logo selected for the Korean Paralympic Games—5 IPC Sports* Tae geuks—which the IOC considered was too simi- *Speaking and Voting Rights lar to the Olympic rings (Figure 1.6). Sanctions were threatened and the IPC agreed to change the logo to
Councils Standing Committees 3 Tae-geuks in 1992 (Figure 1.7), though the original Governing Board logo remained in limited use until the 1994 Winter Games (Bailey, 2007; Brittain, 2010). In 2003, the Athletes’ Management Anti-Doping Council Team Committee
Athletes with High IOSDs’ Sport Technical Support Needs Council Committees Committee
Regions’ Audit and Finance Council Committee
Sports’ Classification Council Committee
Development Committee
Education Committee
Legal and Ethics Figure 1.6 Five Tae-geuks, the logo developed for the Committee 1988 Summer Games (Seoul) and used at the 1992 Summer Games (Barcelona) and the 1994 Winter Games Medical Committee (Lillihammer). It was also the original logo for the IPC but, at the urging of the IOC, was changed in 1992—see Paralympic Games Figure 1.7 (http://www.paralympic.org/IPC/Paralympic_ Committee Symbol_Motto.html).
Sports Science Committee
Women in Sport Committee
Figure 1.5 IPC organizational structure.
named “Third Winter Olympic Games for the Dis- Figure 1.7 Three Tae-geuks, symbolizing “Mind, Body abled” would remove the word “Olympic” from Spirit”. This logo was adopted by the IPC in 1992 and was used until 2003, when it was replaced by the the name, becoming the “World Winter Games for current logo (see Figure 1.8). From 2003 it remained in the Disabled”; IOC would provide patronage and limited used until the 2004 Athens Paralympic games fi nancial support to the ICC; and demonstration of (http://www.paralympic.org/IPC/Paralympic_Symbol_ Paralympic events would be included at the 1984 Motto.html). Introduction to the Paralympic Movement 17 current logo—3 agitos symbolizing spirit in motion and Paralympic Games would be contractually was adopted (Figure 1.8). linked and new levels of fi nancial support for the In 2001, relations between the IPC and IOC IPC. In 2003, this agreement was amended to trans- reached an unprecedented level of formality with fer “broadcasting and marketing responsibilities the signing of a detailed cooperative agreement of the 2008, 2010, and 2012 Paralympic Games to which stipulated, inter alia, bids for the Olympic the Organizing Committee of these Olympic and Paralympic Games”. Currently the Olympic and Paralympic Move- ments have become so closely aligned that it is rea- sonable to posit that Guttmann’s 1948 vision—that the Paralympic Games would become the “dis- abled men and women’s equivalent of the Olym- pic Games”—has been realized. Closer ties between the IPC and IOC have been the hallmark of the IPC stewardship to date, and this relationship has been instrumental in transforming Paralympic sport into the high performance spectacle that it currently is, as
Figure 1.8 Current offi cial logo for the IPC, adopted in well as facilitating unprecedented growth in terms 2003. It comprises three Agitos, symbolizing “Spirit in of athlete numbers (Figure 1.9a and b) and number motion”. of countries competing (Figure 1.10a and b).
4
3.5
3
2.5
2
1.5
1
Number of competitors (thousands) 0.5
0 (a) 1960 1964 1968 1972 1976 1980 1984 1988 1992 1996 2000 2004 2008
6
5
4
3
(hundreds) 2 Figure 1.9 Number of 1 competitors at (a) the Summer Number of Competitors Paralympic Games 1960–2008 and 0 (b) the Winter Paralympic Games (b) 1976 1980 1984 1988 1992 1994 1998 2002 2006 2010 1976–2010. 18 Chapter 1
160 140 120 100 80 60 40 Number of countries 20 0 (a) 1960 1968 1976 1984 1992 2000 2008
50 45 40 35 30 25 20 Figure 1.10 Number of countries 15 competing at (a) the Summer 10 Number of Countries Paralympic Games 1960–2008 5 and (b) the Winter Paralympic 0 Games 1976–2010. (b) 1976 1980 1984 1988 1992 1994 1998 2002 2006 2010
The Sydney 2000 classifi cation Athletes with an ID were re-admitted to the fi asco Paralympic Movement in November 2009. The timing and extent of readmission depends on At the 2000 Paralympic Games in Sydney, the the progress of international research being con- Spanish team defeated Russia in the gold medal ducted in order to determine the relative strength play-off in the basketball competition for ath- of association between different measures of letes with an ID. Following the Games, Carlos intellectual impairment and performance in four Ribagorda, a member of the winning team and a sports— athletics, swimming, table tennis, and journalist with the magazine Capital published rowing. an article in which he revealed that, inter alia, 10 of the 12 members of the Spanish gold-medal- winning team in Sydney were not intellectually The future disabled (Brittain, 2010). Subsequent investiga- tion by the IPC revealed that, “Of the possible medals awarded for ID events at the Sydney 2000 This historical account posits that the Paralympic Paralympic Games, 69% were awarded to athletes Movement has grown for three main reasons: from various countries whose INAS-FID registra- 1. Sport is an effective means of augmenting reha- tion forms did not meet the proper requirements bilitation outcomes for people with disabilities. of the eligibility verifi cation process” (Interna- 2. People with disabilities have a right to partici- tional Paralympic Committee, 2006). As a result, pate in sport and should have the same opportuni- INAS-FID was suspended from the Paralympic ties as others. Movement by the IPC General Assembly in 2001. 3. Paralympic sport is elite, exciting, and inspiring. Introduction to the Paralympic Movement 19
Each of these reasons has been predominant at Paralympic sport which is elite, different periods during the growth of the Paralym- exciting, and inspiring pic Movement. The future health of the Paralympic Movement depends on recognition and cultivation of all three of these historically important areas of This is an area in which the IPC has excelled growth. recently—a dedicated media department, the advent of ParalympicSport.tv and an increasingly Sport as rehabilitation professional website provide outstanding access to a product that is highly attractive. However, The long-term prospects of the movement will be efforts to promote Paralympic sport as elite must improved by active engagement with the reha- be clear about what elite performance is in the bilitation sector. Just as Stoke Mandeville served Paralympic context. Specifi cally, elite should not as a hot-house for Paralympic sport in the 1940s, be a descriptor reserved for performances that are rehabilitation centers that include sport as a com- comparable with nondisabled performances—an ponent of comprehensive management methods athlete in a severely disabled class that breaks a provide a vital avenue for recruiting participants. world record should receive similar attention Rehabilitation units that provide modern exem- and kudos within the Paralympic family as Oscar plars of practice in this area include the Swiss Pistorius, another Paralympic record holder who Paraplegic Center and Association at Nottwil, performs in a class in which records are, quite the Beitostølen Healthsports Center in Norway understandably, reasonably close to those of and the Zahal Disabled Veteran’s Organization nondisabled athletes. Failure to discharge this in Israel. Innovative programs in developing duty toward the more severely disabled in the countries are also important (Carvalho & Farkas, movement threatens the authenticity of the IPC, 2005), as is publication of the results of sports including its role as legitimate representative of and lifestyle interventions in scientifi c journals all Paralympic athletes. and conference proceedings (Carvalho & Farkas, Finally, the single issue that is likely to have the 2005; Røe, 2008). greatest bearing on the future of the Paralympic Movement is that of classifi cation which is addressed Sport as a right for people with in the second section of this Introduction. disabilities
Away from rehabilitation centers in community Classifi cation in Paralympic sport settings, effective methods for promoting sports participation must be studied and implemented. Within the IPC’s current structure the IOSDs— Classifi cation is a critical aspect of Paralympic sport IWAS, CP-ISRA, IBSA, and INAS-FID—have a for two key reasons. central role in developing and growing opportu- 1. Classifi cation determines who is and who is not nities for participation among the populations eligible to compete in Paralympic sport. As the stat- within their remit. Although evidence regarding ure of Paralympic sport increases—increased public participation rates among people with disabilities awareness, increased media attention—there is a in sport is limited, available evidence indicates proportional increase in the importance of decisions that rates are particularly low—in Australia, in which determine eligibility for Paralympic sport. 2003, 24.0% of adults with disabilities partici- 2. Classifi cation is the sole means by which success pated in organized sport, compared with 62.4% in Paralympic sport is legitimized. If stakeholders in of nondisabled adults (Australian Bureau of Paralympic sport—athletes, coaches, administrators, Statistics, 2006). The IPC has an obligation to pro- the media, or the public—suspect that the athletes vide opportunities, pathways, and incentives for who succeed in Paralympic sport are simply those sports participation. who have disabilities that are less severe than their 20 Chapter 1 competitors, then the value of success in Paralympic From a sociological perspective, classifi cation in sport becomes questionable. sport encourages and fosters participation. This is because, as the previous example illustrates, classifi - cation increases the prospects of close competition What is classifi cation? and empirical evidence indicates that close compe- tition is one of the key factors that motivate people to participate in sport (Vallerand & Rousseau, 2001). Classifi cation is a process in which a single group If children were not classifi ed according to age and of entities (or units) are ordered into a number of 6-year-old boys competed against 13-year-old boys smaller groups (or classes) on the basis of observable at the school carnival, the prospects of close com- properties that they have in common (Bailey, 1994; petition would be low and the 6-year-olds would Fleishman & Quaintance, 1984). have little motivation to participate. Classifi cation Taxonomy is the science of how to classify, its according to age minimizes the impact of age on principles, procedures, and rules (Fleishman & competition outcome, and this encourages younger Quaintance, 1984). It is applied in most scientifi c children to participate. fi elds to develop systems of naming and ordering that facilitate communication, understanding, and identifi cation of interrelationships. Classifi cation in Paralympic sport
Classifi cation in sport The fi rst sports competitions for the hearing impaired were held in the late 19th century. From a sports classifi cation perspective these competitions As a science in its own right, taxonomy is made were signifi cant because it was the fi rst time that meaningful through its application in other fi elds impairment had been used as a unit of classifi cation of science, such as pathology, botany, and zoology in a sporting context. Later, in the 1940s, Dr. Ludwig for classifi cation of diseases, plants, and animals, Guttmann’s decision to incorporate sport as an ele- respectively. Classifi cation is also a feature of most ment of comprehensive spinal injury rehabilitation modern sports. The units of classifi cation most lead to the development of the impairment-based commonly used in sport are age, sex, and body systems of classifi cation that are now the basis of mass. The effect of these forms of classifi cation is to Paralympic sport. minimize the impact of the unit/s of classifi cation Originally, probably because Paralympic sport on the outcome of competition. originated as an extension of the rehabilitation pro- To illustrate, if all the boys at a school athletics cess, early systems of classifi cation were medically carnival competed together, the age of each child based. The organizational structure of medically would have a huge impact on where each child fi n- based classifi cation systems refl ected the structure ished in the fi eld—the top-placed children would of a rehabilitation hospital, with separate classes for likely be older, and the youngest would be among people with SCIs, amputations, brain impairments, the last-placed children. This is because age is closely and those with other neurological or orthopedic related to physical maturation and, for a range of conditions. Athletes received a single class based reasons, the more physically mature children are, on their medical diagnosis, and competed in that the faster they are able to run. However, if the chil- class for all sports—athletics, swimming, archery, dren at the carnival were classifi ed according to and any other sports offered. An athlete with a com- how old they were, then the impact of maturation plete L2 SCI—resulting in lower limb paresis but on the order of fi nishing would be minimized. As normal arm and trunk power—would compete in a a consequence, the relative importance of other separate wheelchair race from a double above-knee attributes—amount of training, psychology, physi- amputee because their medical diagnosis was differ- ology, and anthropometry—would be increased. ent. The fact that the impairments resulting from Introduction to the Paralympic Movement 21 their medical condition caused roughly the same the majority share some key features—for exam- activity limitation in wheelchair propulsion was ple, class should refl ect how much an impairment not considered in the classifi cation process because impacts performance in a specifi c sport—there is classifi cation was based on medical diagnosis. considerable variability on a range of fundamen- As the Paralympic Movement matured, sport tal issues, including defi nition of key terms, the ceased to be a mere extension of rehabilitation and stated purpose of each of the systems, and the basis became important in its own right. The focus on for determining minimum impairment criteria. sport, rather than rehabilitation, drove the develop- These differences have arisen partly for historical ment of functional classifi cation systems. In func- reasons—most Paralympic sports predate unifi ca- tional systems, the main factors that determine class tion under the IPC by many years and therefore, are not diagnosis and medical evaluation, but how naturally, developed quite independently—but also much the impairment of a person impacts upon because, until recently, the domain of Paralym- sports performance. For example, in Paralympic Ath- pic classifi cation was almost entirely atheoretical letics, an athlete with a complete L2 SCI now com- (Sherrill, 1999; Tweedy, 2002). However, classifi ca- petes in the same wheelchair racing class as a double tion is of such fundamental importance to Paralym- above-knee amputee (class T54). This is because pic sport that in order for the movement to advance these impairments have an impact on wheelchair requires greater unity in this domain. The issue of propulsion that is approximately the same. minimum impairment criteria illustrates why unity In contrast to the medical classifi cation approach, is required. in which athletes competed in the same class for all In order for Paralympic sport to exist requires sport, functional systems of classifi cation are nec- methods for classifying prospective athletes as eli- essarily sports-specifi c. This is because any given gible or not eligible, commonly known as mini- impairment may have a signifi cant impact in one mum impairment criteria. But what should be sport and a relatively minor impact in another. For the principle that determines what the minimum example, the impact that bilateral below elbow impairment criteria should be? Is the presence amputation has on swimming is relatively large of a clinically verifi able impairment suffi cient? compared with the impact on distance running. Or should the impairment not only be clinically Consequently, in sport-specifi c functional classifi - detectable, but also have an impact on sport (i.e., cation systems, an athlete with such impairment have different criteria from sport to sport)? What would compete in a class that had relatively severe if the impairment does not impact on a particu- activity limitation in swimming and a class that lar sport, but impacts on a person’s ability to train had relatively minor activity limitation in track for the sport—should these people be eligible? Or athletics. Currently, most Paralympic sports use should the criteria be that the impairment causes systems of classifi cation that are described as func- a disadvantage compared to nondisabled athletes? tional, a notable exception being the classifi cation This is not an exhaustive list of the possibilities, yet system used by the IBSA which remains medically each of these approaches leads to eligibility criteria based. that differ vastly from each other. Each approach also makes a fundamental statement about what Paralympic sport stands for and the values of the movement. Moreover, in order for science to make The IPC Classifi cation Code and a contribution to the development of criteria, the Position Stand on scientifi c principles principle should remain consistent. Therefore, in of classifi cation order for Paralympic sport to advance, a unifi ed, coherent position on such issues is required across In general terms, the preceding account of the Paralympic sports. historical evolution of classifi cation in Paralym- Recently, the IPC has endorsed two documents pic sport is accurate. However, there are currently that have aimed to bring cohesion to a range of clas- 25 Paralympic systems of classifi cation and while sifi cation issues—the IPC Classifi cation Code and 22 Chapter 1
International Standards (International Paralympic Evidence-based Committee, 2007), approved by the IPC General In Paralympic sport, an evidence-based system Assembly in November 2007; and the IPC Posi- of classifi cation is one that has the following two tion Stand—Background and Scientifi c Principles features. of Classifi cation in Paralympic Sport (Tweedy & 1. The system has a clearly stated purpose: To Vanlandewijck, 2009), passed by the IPC Sports date, one of the most signifi cant barriers to the Science Committee, Classifi cation Committee and development of evidence-based systems of classifi - Governing Board in June 2009. At the time of writ- cation is that many systems of classifi cation either ing, the IPC were overseeing a self-audit process in do not have a stated purpose or have a statement which each of the sports was determining where of purpose that is ambiguous. For example, many their respective systems were in accord with the code classifi cation systems simply state that the purpose and where they were not. Until all systems align is to provide “fair and equitable competition”. This with the code it will remain very diffi cult to make statement is ambiguous because fair and equitable accurate, general statements about Paralympic clas- sports competition can be achieved in ways that are sifi cation. Therefore, the remainder of this part of not consistent with the aims of Paralympic classi- the Introduction summarizes the main resolutions fi cation. For example, grouping athletes who have to come from these two documents, highlighting similar levels of performance—such as the handi- areas where major discrepancies still exist, and chal- cap system used in golf or the belt system used in lenges for the future. The fi ve areas of resolution are martial arts—is recognized as fair and equitable that all Paralympic systems of classifi cation must: within those sports. However, this form of fair and • be consistent with the International Classifi ca- equitable is not an acceptable basis for Paralympic tion of Functioning Disability and Health (ICF); classifi cation. • be based on scientifi c evidence; To facilitate development of evidence-based • defi ne eligible types of impairments; systems of classifi cation, all Paralympic systems • defi ne minimum impairment criteria; of classifi cation should indicate that the pur- • classify impairments according to the extent of pose of the system is to promote participation in activity limitation caused. sport by people with disabilities by minimizing the impact of eligible types of impairment on the outcome Consistency with ICF of competition. From a taxonomic perspective the The ICF (World Health Organization, 2001) is cur- proposed statement of purpose is critical because rently the most widely accepted classifi cation of “impairment” is explicitly identifi ed as the unit health and functioning. It is a broad, multipurpose of classifi cation. When impairment is the unit of classifi cation that provides a standardized language classifi cation then the relative impact of other per- and structure that may be applied to describing and formance determinants—for example, volume and understanding health-related functioning in a wide quality of training and psychological profi le—is variety of contexts and sectors. Further information, increased and the athletes who succeed will do so including copies of the ICF, is available at: http:// because they are stronger in these areas, rather than www.who.int/classifi cations/icf/en/. The Position Stand because they have an impairment that causes less on Classifi cation indicates that Paralympic systems activity limitation. of classifi cation should be consistent with the ICF 2. Empirical evidence indicates that the meth- language and structure in order to reduce the consid- ods used for assigning class will achieve the stated erable barriers to international communication that purpose: Most current systems of classifi cation currently exist, and to help to promote research by have little scientifi c evidence to support them. In ensuring the language used to describe classifi cation some instances, this is not problematic because is unambiguous and uniform across sports. This intro- decisions make innate sense—for example, as duction uses terms as defi ned by the ICF, the most previously described, an athlete with L2 SCI com- important of which are presented in the Glossary. petes in the same class as a double above-knee Introduction to the Paralympic Movement 23
amputee because the impairments have a com- and color vision in athletes with visual impair- parable impact on wheelchair propulsion. How- ment; or ever, there are many instances when decisions • testing of general and sport intelligence (generic become more diffi cult. For example, in the sport name for component of intellectual functioning of athletics a wheelchair racing athlete with a or cognition that relate to performance, such as SCI, who has paralyzed legs, but unimpaired arms response process, manner and content; executive and trunk muscles, will compete in the T54 class. functioning; and attention/concentration) for However, if the athlete also has a permanently athletes with intellectual impairment. injured elbow which he/she cannot straighten, 2. Novel activities—these are activities or move- the classifi cation decision is more diffi cult. If the ments that are new to the athlete and which are elbow restriction is small and is deemed to have unlikely to have been practiced by them in the usual little impact on wheelchair propulsion, the ath- course of training for their sport. Performance on lete would stay in the T54 class. But if the restric- these tests is likely to be quite consistent with fi nd- tion is severe enough to signifi cantly hinder the ings from the impairment tests. Examples of novel athlete’s ability to push a wheelchair they would tests include: compete in the T53 class, which is for athletes • foot tapping tasks, hand rubbing, isolated fi n- who have normal arm muscle power but no ger fl exion/extension, static balance exercises in muscle power in their trunk muscles or in their athletes with physical impairment; legs. Classifi ers assessing such an athlete must ask • general orientation and object-discrimination themselves an important question: “How much tasks in athletes with visual impairment; or elbow restriction will cause the same amount of dif- • memory, visualization, choice reaction time, fi culty as the complete loss of trunk muscle function?” spatial orientation tasks in athletes with intellec- Unfortunately there is no research or evidence tual impairment. which can help to answer this question. This sort 3. Practiced activities—these are activities which of decision-making is the basis of all functional incorporate elements of strength, range of move- Paralympic classifi cation systems. Because there ment, coordination, intellectual functioning, and/ is no research, currently these decisions are nec- or any other sport-specifi c demands which are essarily based on the experience and judgment highly likely to have been practiced by the athlete of the classifi ers who write and administer the in the course of training for their sport. Perfor- classifi cation systems. However, the IPC is com- mance on these tests is likely to be quite different mitted to scientifi c studies that will develop from the novel tests for well-trained athletes, while evidence to support decision-making in classifi - for untrained athletes performance is not likely to cation. An overview of the methods required for differ markedly. Examples of practiced activities developing such an evidence base is provided in include: the Position Stand. • assessment of wheelchair rugby players would In the absence of research evidence, the current include dynamic warm-up routines, ball catch best practice for estimating the extent of activ- and throw drills, wheelchair maneuverability, ity limitation resulting from impairment requires and exercises; assessment of four key areas: • assessment of goalball players would include 1. Impairment(s)—tests of impairment include, audio-spatial orientation; but are not limited to: • assessment of intellectual impaired table ten- • manual muscle test scores for individual move- nis players would include items such as service ments (e.g., elbow fl exion, elbow extension), return, return to target skills, player positioning assessment of hypertonia at different joints, with respect to the table. residual limb length, and range of movement for 4. Training history and other personal and envi- athletes with physical impairment; ronmental factors affecting how well the athlete • assessment of static and dynamic visual acuity, will do the activity—this will include ques- visual fi eld, motion detection, contrast sensitivity, tions about frequency, intensity and duration 24 Chapter 1 of training, periodization of training, coaching of impairment (e.g., botox to reduce hypertonia; standard (e.g., coach qualifi cations), use of sports tendon releases; Harrington rods; corrective eye medicine/sports science services. Other factors surgery), classification systems should have a such as athlete age and gender may also be rel- Notifiable Interventions policy which requires evant. Intelligent, cogent questioning of athletes the athlete to notify the Head of Classification regarding training habits will provide insight into or Chief Classifier and make them aware of the how well the athletes are trained—even athletes intervention and to make arrangements for of low intellect who are well trained will be likely reclassification. A sound Notifiable Interven- to answer questions about their training that indi- tions policy also positions Paralympic sports to cates the frequency, duration, and intensity of manage future scientific advances, for example, training they do. in the fields of neural regeneration, neural plas- These four sources of information need to be evalu- ticity, and gene therapy. ated by the classifi cation team and considered on The requirement that impairments should be per- balance in order to determine how much of the manent is based, at least in part, on the premise that activity limitation experienced by an athlete is eligible impairment types do not alter signifi cantly attributable to impairment. in response to physical training—that athletes cannot “train away” spastic hypertonia, atheto- Defi ning eligible types of impairment sis, or neurological paresis. However, in the recent past there have been instances of athletes claim- Sports should clearly identify which impairment ing that, through sheer hard work and training types are eligible and defi ne them according to the intensity, impairments such as hypertonia which ICF codes. To date only 10 types of impairment have had previously been clearly clinically evident—to been eligible for Paralympic sport, these being VI, the extent that they had been deemed eligible by impaired strength, impaired range of movement, classifi cation panels—had become clinically unde- limb defi ciency, leg length difference, hypertonia, tectable. The current state of research does not per- ataxia, athetosis, short stature, and intellectual mit such claims to be dismissed out of hand nor impairment. Table 1.4 presents eligible impairment accepted at face value. Decision-making in this area types. Impairments are not to be confused with would benefi t greatly from research investigating health conditions—SCI, CP, spina bifi da, retinitis the responsiveness of impairments to sustained pigmentosa—which are useful for identifying the high level training, particularly the responsiveness disease processes which lead to eligible impair- of minimal impairments. ment types, but which should not be the basis for It is important to note that many health con- determining eligibility. ditions that cause eligible impairment types affect Section 5 of the Code states that the type of multiple body structures and functions. For exam- impairment must be permanent (IPC, 2007; ple, in addition to impaired strength, SCI may also Tweedy & Vanlandewijck, 2009) indicating that result in impaired sensation (tactile sensation, pro- it should not resolve in the foreseeable future prioception, or pain), impaired thermoregulatory regardless of physical training rehabilitation or function and impaired cardiac function. While other therapeutic interventions. The motiva- some of these associated impairment types— tion for requiring permanence is clear—a per- notably impaired cardiac function—may have a son should not be eligible for Paralympic sport signifi cant impact on sports performance, they are if they, for example, rupture a cruciate ligament currently not eligible impairment types and there- and, as a result of casting or disuse during the fore should not impact classifi cation. Whether the acute phase, muscle strength, and/or joint range types of eligible impairments should be expanded become temporarily impaired. To account for is a matter for debate. However, a decision to instances when a classified athlete receives an expand should not be taken lightly—expansion intervention that will materially alter measures of the types of impairment that are classifi ed Introduction to the Paralympic Movement 25
Table 1.4 The 10 impairment types that are eligible for various Paralympic sports: In order to compete in Paralympic sports, a person must be affected by at least one of the impairments listed in fi rst column of this table. Note that the impairments presented must result directly from a health condition (e.g., trauma, disease, or dysgenesis), examples of which are presented in column 2. Impaired muscle power resulting from disuse (e.g., due to pain, hysterical conversion) is not eligible.
Examples of health conditions likely to cause Impairment as described Relevant ICF Impairment Working descriptor such impairments in the ICF* Codes
Hypertonia (e.g., CP, stroke, acquired brain High muscle tone b735 hemiplegia, diplegia/ injury, multiple sclerosis Inclusions: hypertonia/high quadriplegia, monoplegia) muscle tone Exclusions: low muscle tone
Ataxia Ataxia resulting from CP, Control of voluntary movement b760 brain injury, Friedreich’s Inclusions: ataxia only ataxia, multiple sclerosis, Exclusions: problems of control spinocerebellar ataxia of voluntary movement that do not fi t description of ataxia
Athetosis Chorea, athetosis Involuntary contractions of muscles b7650 (e.g., from CP) Inclusions: athetosis, chorea Exclusions: sleep-related movement disorders
Limb defi ciency Amputation resulting from Total or partial absence of the s720, s730, s740, s750 trauma or congenital limb bones or joints of the shoulder Note: These Codes would have defi ciency (dysmelia) region, upper extremities, pelvic the extension 0.81 or 0.82 to region or lower extremities indicate total or partial absence of the structure, respectively
Impaired Passive Range Arthrogryposis, ankylosis, Joint mobility b7100–b7102 of Movement (PROM) scoliosis Exclusions: hypermobility of joints
Impaired muscle power SCI, muscular dystrophy, Muscle power b730 brachial plexus injury, Erb palsy, polio, spina bifi da, Guillain-Barré syndrome
Leg length difference Congenital or traumatic Aberrant dimensions of bones s75000, s75010, s75020 causes of bone shortening of right lower limb OR left lower limb Note: For coding purposes in one leg Inclusions: shortening of bones aberrant dimensions of bones of one lower limb of right lower limb is indicated Exclusions: shortening of bones by addition of the qualifying of both lower limbs; any increase code 0.841 and in the left lower in dimensions limb, 0.842
Short stature Achondroplasia or other Aberrant dimensions of bones s730.343, s750.343, s760.349 of upper and lower limbs or trunk which will reduce standing height
Vision impairment Trauma, retinitis Vision acuity functions b2100 pigmentosa, glaucoma Visual fi eld functions b2101
Intellectual impairment Down syndrome Psychomotor control (quality) b1471 Higher-level cognitive functions b1640, b1643, b1645, 1646 (abstraction, cognitive fl exibility, judgment problem solving)
*For further information on ICF codes, including how to obtain a copy of the ICF, visit the website at http://www.who.int/classifi cations/icf/site/ icftemplate.cfm. 26 Chapter 1 in Paralympic sport has the potential to have makes sense as a minimum impairment criterion a signifi cant impact on the culture and fabric of for amputees for any sport they wanted to compete Paralympic sport. in—running, throwing, swimming, etc. Legitimacy Finally, it should be noted that while it is theoreti- of the criteria derives from the fact that the aim of cally possible to develop systems of classifi cation in the sports organization was to provide sports oppor- which people with all 10 types of impairment com- tunities for amputees. Moreover, when an organiza- pete together, this approach is not favored by the tion only provides sports opportunities for a single IPC. Sports are encouraged to group impairments in disability group, then the organization is not chal- a way that promotes face validity—when a spectator lenged to develop criteria for different impairment looks at an event, it should make sense. As Tweedy groups that are equitable. has previously proposed (2003), there are sound However, when IPC took charge of the gov- taxonomic reasons for treating the ten eligible ernance of the movement in 1989, the focus of impairment types as at least three distinct groups: Paralympic sport became considerably more elite (a) neuromusculoskeletal (or biomechanical impair- and, because the IPC mandate covered a range of ments), comprising the eight neuromusculoskeletal impairment groups, it became more important to impairments—impaired strength, impaired range of develop minimum impairment criteria which were movement, limb defi ciency, leg length difference, equitable across impairment groups. In these cir- hypertonia, ataxia, athetosis, and short stature; cumstances, equity is required and the most logi- (b) visual impairments; and (c) intellectual impair- cal standard is that all eligible impairments should ments. In fact there are cogent arguments in favor impact on sports performance. In the elite sporting of breaking down neuromusculoskeletal impair- milieu, the legitimacy of minimum impairment ments into smaller “fundamental competitive criteria is not derived from a charitable stand- units”: can a spectator be expected to understand point in which the objective is to provide sports how the effects of dwarfi sm and SCI can be readily opportunities to everyone with a particular impair- equated in the sporting context? Those responsible ment type—rather, legitimacy is derived from the for developments in classifi cation should give this fact that the sports people that deserve a “parallel matter appropriate consideration. Olympic Games” are those who have an impair- ment which materially and directly impacts sports performance. Defi ne minimum impairment criteria To ensure that only impairments which impact Section 5 of the Code indicates that in order to on the sport are eligible, each Paralympic sport be eligible, an impairment must impact on sports should develop minimum impairment criteria performance (IPC, 2007). The origin of the notion (IPC, 2007; Tweedy & Vanlandewijck, 2009). that impairments should impact on sports perfor- More specifi cally, each Paralympic sport should mance in order to be eligible can be traced back to identify those activities that are fundamental to the establishment of the IPC. Prior to that time, performance in that sport, and then operation- international sport for people with disabilities was ally describe criteria for each eligible impairment organized along diagnostic lines—CP-ISRA for peo- type that will impact on the execution of those ple with CP, ISMGF for people with SCI, etc. The fundamental activities. For example, determi- mission of such organizations was based around nation of minimum impairment criteria for VI provision of sports opportunities for people with in alpine skiing should be set by analyzing the those conditions and consequently the most logical vision requirements for optimum downhill per- inclusion criteria was diagnostic—a person with a formance—visual acuity, visual fi eld, contrast SCI should be catered for within ISMGF. The pur- sensitivity, etc.—and then, once they have been pose of minimum impairment criteria was to ensure identifi ed, developing an operational description impairment was not trivial—fi nger or toe amputees of the minimum VIs that will suffi ciently com- were not eligible for amputee sport. Under this promise those requirements to be considered organizational structure, through wrist amputation eligible. Introduction to the Paralympic Movement 27
There are two important consequences arising from in sprinting (e.g., the snatch and the power clean), accurately described minimum impairment criteria. the impairment will cause negligible activity limita- 1. It will be possible for an athlete to have an tion in the sprint events themselves and therefore eligible type of impairment but to be ruled ineligible such an impairment is not eligible in IPC sprint because the impairment does not meet the relevant events (Tweedy & Bourke, 2009). minimum impairment criterion. For example, while To some extent determining how much activ- a person who has had a single toe amputated is tech- ity limitation will be suffi cient is affected by sports nically an amputee (an eligible type of impairment), culture and more than one view may sometimes the impairment does not cause suffi cient activity be considered valid. Consequently, determination limitation in running and therefore does not meet of minimum impairment criteria should draw on the minimum impairment criteria for IPC Athletics empirical evidence when it is available, but also (Tweedy & Bourke, 2009). ensure that it refl ects the views of key stakehold- 2. Minimum impairment criteria will be specifi c ers in the sport—athletes, coaches, sports scientists, to each sport. Consequently, it will be possible and classifi ers. for a person to have an impairment that is eligible in one sport, but not in another. Classifying impairments according to Note that minimum impairment criteria should extent of activity limitation caused describe impairments that directly cause activity limitation in the sport and should exclude impair- Impairments which meet the eligibility criteria ments that may cause activity limitation in train- should be divided into classes according to how ing but do not directly impact on activities that are much activity limitation they cause. To date a fundamental to a sport (Tweedy & Vanlandewijck, number of other phrases have been used to describe 2009). For example, although the loss of the fi ngers the conceptual basis of classifi cation in Paralym- on one hand will cause activity limitation in certain pic sports. Table 1.5 identifi es two of the main resistance training exercises considered important ones and illustrates why each is not suitable. Note
Table 1.5 Previously proposed statements regarding the conceptual basis of Paralympic classifi cation and why they are unsuitable.
Conceptual basis Problem with this conceptual basis
Place athletes into classes according to Although function is affected by impairment, a range of other factors also affect how well a their degree of function person functions. These factors include age, fi tness, and motivation. A person who is old, unfi t, and unmotivated will not function as well as when they were young, fi t, and motivated. Moreover, we know that training affects function—if it did not, then athletes would not train. If athletes was placed into classes according to function, then an athlete who was young, motivated, and well trained would be placed in a more functional class than someone who was older, unmotivated, and poorly trained. Paralympic systems of classifi cation should ensure that young, well-trained athletes should gain a competitive advantage, and therefore classifying athletes according to their degree of function is not a suitable conceptual basis for classifi cation in Paralympic sport.
Place athletes into classes according to The performance potential or innate potential of an athlete is determined by an array of natural their degree of performance potential or attributes including, but not limited to, impairment. For example, in discus, performance potential innate potential or innate potential is obviously negatively infl uenced by impaired strength. However, performance potential is enhanced by increased standing height, arm span and increased proportion of type II (fast twitch) muscle fi bers. If athletes were classifi ed according to such constructs, then tall athletes with long arms and an ideal muscle fi ber composition would compete in higher classes than short, endurance-type athletes. Paralympic classifi cation systems should ensure that athletes with the best combination of natural attributes have a competitive advantage over others, therefore classifying athletes according to their performance potential is not a suitable conceptual basis for classifi cation in Paralympic sport. 28 Chapter 1 that while it is common to refer to “classifying • Scientifi c challenges include: athletes”, the IPC has recently reinforced that the • Developing research designs which evalu- unit of classifi cation in Paralympic systems should ate the relative strength of association between be impairments, not athletes. This distinction is eligible types of impairment—intellectual, important because it emphasizes the fact that each strength, range of movement, coordination, athlete is a unique, sentient human being whose etc.—and sports performance. diversity and individuality cannot be captured by • Recruiting samples of suffi cient size to ensure assigning a label or a class (Tweedy, 2002; Tweedy & credible results. Vanlandewijck, 2009). To conclude this section on classifi cation, an out- line of the administrative and scientifi c challenges facing the movement is provided. Acknowledgments • Administrative challenges include: • Capacity building: The research questions that Sean Tweedy’s work was supported by the Motor must be addressed in order to develop evidence- Accident Insurance Commission, Australia. This based classifi cation methods are both conceptu- research was supported by the Australian Research ally and methodologically challenging. While Council (grant LP0882187), the International Para- the IPC maintains strong links in the medical lympic Committee, the Australian Sports Commis- fraternity, it does not have a strong scientifi c sion, and the Australian Paralympic Committee. culture— particularly in classifi cation—or broad engagement with the scientifi c community. Efforts to build scientifi c capacity are therefore required. Glossary • Realistic time frames: As important as changes are in this area, the IPC must be realistic about the Activity An activity is the execution of a task or time frames for developing and funding research action by an individual. The term activity encom- projects, conducting them and implementing passes all sports-specifi c movement, including results. Years, not months, is the most appropri- running, jumping, throwing, wheelchair pushing, ate metric. shooting, and kicking. • Informed media management: Until evi- Activity limitations Activity limitations are dif- dence-based systems are in place, the informa- fi culties an individual may have in executing an tion provided by the IPC to the media regarding activity. In Paralympic sport, activity limitations classifi cation, particularly the information pro- refer to diffi culty executing the sports-specifi c vided when classifi cation controversies inevi- movements required for a particular sport. Running tably arise, must be accurate and consistent. is a core activity in the sport of athletics and a per- Moreover, the message must strike a balance son who has diffi culty running is said to have an between explaining that classifi cation is a “work activity limitation in running. in progress”, and causing the media to call into question the legitimacy of the Paralympic Body functions The body functions are the physi- Movement. ological functions of body systems (e.g., cardiovas- • Stakeholder involvement: The Paralympic cular functions and sensory functions). The body Movement has been doing many things well for functions of central concern in Paralympic sport a long time, and the pressing need for reform are neuromusculoskeletal function, visual function, in this area may not be immediately obvious and intellectual function. to all. The movement must be careful to ensure Body structures The body structures are anatomi- that accurate, lay-language materials, and open cal parts of the body such as organs and limbs and forums explaining the urgency of the reforms are their components. The body structures of central readily available. concern in Paralympic sport are those related to Introduction to the Paralympic Movement 29 movement and include the motor centers of the 2. Note: IOSD is not the name of an organization, but brain and spinal cord, as well as the upper and lower the collective acronym used to refer to international limbs. sports organizations that provide sports opportuni- ties for people from different disability groups (e.g., Function and disability In the ICF the terms CP-ISRA). The term should not be confused with “function” and “disability” are nonspecifi c umbrella ISOD, the umbrella organization founded in 1964 terms that refer to several components of the ICF. and which, in 2004 merged with ISMWSF to form the For example, function can refer to neurological func- International Wheelchair and Amputee Sports Fed- tion (e.g., nerve conduction velocity), the ability to eration (IWAS). perform an activity (e.g., ability to run or jump) or functioning of a person in the community (e.g., to conduct fi nancial affairs or access health services). References To minimize ambiguity, the terms functioning and disability should be avoided when describing the purpose and conceptual bases of Paralympic Australian Bureau of Statistics. (2006). Sport and Recreation: a statistical overview, Australia, Canberra: classifi cation. Author. Handicap The term “handicap” is not used in the ICF Bailey, K.D. (1994). Typologies and Taxonomies: An because of its pejorative connotations in English. Introduction to Classifi cation Techniques. Sage Publications, Inc., Thousand Oaks, CA. Health conditions Health conditions are diseases, Bailey, S. (2007). Athlete First: A History of the Paralympic disorders and injuries and are classifi ed in the Movement. John Wiley and Sons Inc., Hoboken. ICD-10: International Statistical Classifi cation Brittain, I. (2010). The Paralympic Games Explained. of Diseases and Related Health Problems (World Routledge, Abingdon. Health Organization, 1992–1994), not the ICF. CP, Carvalho, J. & Farkas, A. (2005). Essay: Rehabilitation spina bifi da, and multiple sclerosis are examples of through sport—pilot project with amputees in Angola. health conditions. Lancet, 366, S5–S6. Fleishman, E.A. & Quaintance, M.K. (1984). Taxonomies Impairments Impairments are problems with of Human Performance. Harcourt Brace Jovanovich, body functions or body structures. A person with Orlando. a contracture at the right elbow would be described Gold, J.R. & Gold, M.M. (2007). Access for all: the rise of as having impaired range of movement. Paralym- the Paralympic Games. The Journal of the Royal Society pic classifi cation systems should specify eligibility for the Promotion of Health, 127, 133–141. Goodman, S. (1986). Spirit of Stoke Mandeville: the story of in terms of ICF impairment types (e.g., in the sport Ludwig Guttmann. London: Collins. Judo, the classifi cation system should specify that Guttmann, L. (1976). Textbook of Sport for the Disabled. only VIs are classifi ed). St. Lucia, Australia: University of Queensland Press. The ICF The ICF is the acronym for the Interna- Howe, P.D. (2008). The Cultural Politics of the Paralympic tional Classifi cation of Functioning, Disability and Movement. Abingdon: Routledge. International Sports Organisation for the Disabled. Health (ICF), published in 2001 by the World Health (1993). Handbook. International Sports Organisation for Organization. The ICF is an international standard the Disabled, Newmarket, ON. for describing the functioning and disability associ- International Paralympic Committee. (2007). ated with health. IPC Classifi cation Code and International Standards. Bonn, Germany. International Paralympic Committee. (2006). Position Statement Regarding the Participation of Athletes with an Notes Intellectual Disability at IPC Sanctioned events. Bonn, Germany. Jahnke, B.S. (2006). 30th Anniversary Paralympic Winter 1. The term locomotor here is inaccurate—it included Games 1976–2006. RLC, Paris, France. people with upper limb weakness or loss of range of Røe, C., Dalen, H., Lein, M. & Bautz-Holter, E. (2008). movement, impairments with minimal impact on Comprehensive rehabilitation at Beitostølen locomotion. Healthsports Centre: infl uence on mental and physical 30 Chapter 1
functioning. Journal of Rehabilitation Medicine, 40(6), World Health Organization. (2001). International 410–417. Classifi cation of Functioning, Disability, and Health. Scruton, J. (1998). Stoke Mandeville: Road to the Geneva, Switzerland. Paralympics. Aylesbury: The Peterhouse Press. Sherrill, C. (1999). “Disability sport and classifi cation theory: a new era.” Adapted Physical Education Quarterly 16(3), 206–215. Tweedy, S.M. (2002). Taxonomic theory and the Recommended readings ICF: foundations for a unifi ed disability athletics classifi cation. Adapted Physical Activity Quarterly, History of the Paralympic Movement 19(2), 220–237. Tweedy, S.M. (2003). Biomechanical consequences Bailey, S. (2007). Athlete First: A History of the Paralympic of impairment: a taxonomically valid basis for Movement. John Wiley and Sons Inc., Hoboken. classifi cation in a unifi ed disability athletics system. Guttmann, L. (1976). Textbook of Sport for the Disabled. Research Quarterly for Exercise and Sport, 74(1), 9–16. University of Queensland Press, St. Lucia, Australia. Tweedy, S.M. & Bourke, J. (2009). IPC Athletics Howe, P.D. (2008). The Cultural Politics of the Paralympic Classifi cation Project for Physical Impairments: Final Movement. Routledge, Abingdon. Report—Stage 1. IPC Athletics, Bonn, 104. Jahnke, B.S. (2006). 30th Anniversary Paralympic Winter Tweedy, S.M. & Vanlandewijck, Y.C. (2009). Games 1976–2006. RLC, Paris, France. International Paralympic Committee Position Stand—background and scientifi c rationale for classifi cation in Paralympic sport. British Journal of Paralympic Classifi cation Sports Medicine. Published online 22 Oct 2009. Vallerand, R.J. & Rousseau, F.L. (2001). Intrinsic and International Paralympic Committee. (2007). IPC extrinsic motivation in sport and exercise. In: R.N. Classifi cation Code and International Standards. Bonn, Singer, H.A. Hausenblaus, C.M. Janelle (eds.) Handbook Germany. of Sport Psychology, 2nd ed. John Wiley & Sons, Inc., Tweedy, S.M. & Vanlandewijck, Y.C. (2009). International New York. Paralympic Committee Position Stand—background Whitteridge, D. (2004). Guttmann, Sir Ludwig (1899–1980). and scientifi c rationale for classifi cation in Paralympic In: Oxford Dictionary of National Biography, online ed. sport. British Journal of Sports Medicine, published online Oxford University Press, Oxford. 22 Oct 2009. PART 2 PARALYMPIC SPORT SCIENCE This page intentionally left blank Chapter 2 Biomechanics Ian Rice1,2, Florentina J. Hettinga 3, Justin Laferrier1,2, Michelle L. Sporner2, Christine M. Heiner1,4, Brendan Burkett 5 and Rory A. Cooper1,2 1 Human Engineering Research Laboratories, Department of Veterans Affairs, Rehabilitation Research and Development Service, Pittsburgh, PA, USA 2Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA 3 Center of Human Movement Sciences, University of Groningen/University Medical Center, Groningen, The Netherlands 4Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA 5School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
Knowledge of user interfaces and the study of Introduction: sports for athletes wheelchair propulsion biomechanics have shaped with lower-limb disabilities equipment design and improved athletic perfor- mance. Impact on wheelchair racing, basketball, The wheelchair athlete and his/her wheelchair rugby, and handcycling will be discussed in the fi rst are inseparable and must seamlessly interface as part of the chapter. Then, athletes with major limb a complete unit. After injury or trauma result- loss will be discussed separately in the fi nal sec- ing in some degree of lower body paralysis, work tion, as their equipment needs are distinct from the once done by the legs is taken over by the arms. wheelchair athletes. Arm work is less efficient and more strenuous compared to leg work, and can lead to lower physical capacity. Risks of mechanical over- Wheelchair–user interface use are higher and because of overuse injuries, mobility can decrease. Nevertheless, high-level The question of how to minimize injury and maxi- sports performance is possible with subsequent mize performance is vital to the long-term success increases in physical fi tness, health, and mobility. of any wheelchair athlete. Numerous performance- Not only wheelchair athletes, but also individu- determining factors relate to one’s potential for als with lower-limb loss compete at high levels achievement in everyday propulsion as well as in in Paralympic running events with prosthetic sports. It has been suggested that the wheelchair– devices. At the elite level, runners with artificial user interface may be the most critical, yet least limbs/lower-limb prostheses have even been understood performance-determining factor. An suggested to have the potential to outperform optimized user interface should maximize the user’s able-bodied runners, which is an ongoing topic functional abilities without restricting them in any of debate. way. The user’s goals and abilities must be consid- ered while aligning critical chair dimensions to the athlete’s anthropometrics. Subsequently, the equip- ment and user should be thought of as one unit and The Paralympic Athlete, 1st edition. Edited by Yves C. Vanlandewijck and Walter R. Thompson. Published 2011 by the chair as an extension of the body. Many of the Blackwell Publishing Ltd. principles for fi tting a sports wheelchair are similar
33 34 Chapter 2 to those for fi tting a prosthetic limb. For instance, wheelchair technology has led to task-specifi c devices individually adjusted to the user, further leading to enhanced mobility and effi ciency. For example, handcycling has become increasingly pop- ular for long-distance everyday travel, recreation, and elite sport. Handcycling was added as an offi cial event to the Paralympics in 2004. Particularly for elite sports performance, high-tech wheelchairs and handcycling (Figure 2.1) options are available and are commonly customized and tuned to individual characteristics (Figures 2.2–2.4).
Figure 2.1 Female handcycling (kneeling position).
Classification Handbikes
AP AP1 AP2 AP3 1 ATP ATP1 ATP2 ATP3
Arm-Power 2 Arm-Trunk-Power
wheelchair-sit recumbent 60° recumbent 30° recumbent 0° 3 wheelchair-sit car-seat long-seat knee-seat upright reclined reclined reclined 4 forward forward forward forward attach-unit rigid frame rigid frame rigid frame 5 attach-unit rigid frame rigid frame rigid frame
6
100% 62.6% 39.6% 33.3% 7 96.8% 82.8% 60.9% 60.3%
tour tour competition competition 8 tour tour competition competition H1,H2,H3 H1,H2,H3 9 H3 H4
1=class handbike 2=propulsion-type 3=sitting-type 4=trunkposture 5=handbike-type 6=illustration 7=frontal area 8=handbike-use 9=competition-division © Double Performance • Handbike Expertise Centrum
Figure 2.2 Classifi cation of handcycles divided into arm-power and arm–trunk-power models according to Double Performance, a handcycling expertise center in the Netherlands (www.doubleperformance.nl).
100
90
80
70
60
50 Fraction of effective force (%) force of effective Fraction 40
0 0 90 180 270 360 Crank rotation (°)
Figure 2.4 Mean and standard deviation of fraction of Figure 2.3 Instrumented handle bar with 6 degrees of effective force for handbiking at a mean velocity of 1.39 m/s freedom to measure forces and torques in 3D. (0 top; 180 bottom). Biomechanics 35
highly correlated with the weight-normalized peak Wheelchair propulsion biomechanics resultant force. In another study, researchers found an inverse relationship between median nerve Propulsion and injury prevention health and range of motions at the wrist (Boninger et al., 2004). Greater range of motion was associ- Understanding propulsion biomechanics is vital ated with better median nerve function. They later to performance and injury reduction, because the found that greater wrist range of motion was asso- propulsive motion in and of itself has been shown ciated with greater push angles, lower forces, and to be relatively ineffi cient. The gross mechanical cadence. Therefore, researchers determined that by effi ciency (ME) (the ratio between power output taking long strokes, wheelchair users were able to and energy expenditure) of everyday handrim generate greater work without high peak forces. propulsion is between 5% and 11%, which is Additionally, HERL researchers have published lower than arm ergometry (16%), handcycling many peer-reviewed journal publications on magnetic (18–21%), and wheelchair racing (15–23%). Sports resonance imaging (MRI) and X-ray imaging studies equipments’ geometry, design, and user interface on people with paraplegia (Boninger et al., 2001). The combined with an athlete’s conditioning and abil- results of these imaging studies showed a high prev- ity can infl uence ME. alence of osteolysis of the distal clavicle, which can For the past two decades, researchers around be a debilitating type of repetitive strain-type injury. the world have developed methods for analyzing However, this study found a much lower prevalence pushrim forces critical to assessing injury mech- of rotator cuff tears than that reported by Escobedo anisms and propulsion effi ciency. For example, et al. (1997). The main difference between the two researchers at the Department of Veterans Affairs/ studies was the age of the participating populations. University of Pittsburgh Human Engineering The study by Escobedo et al. focused on an older group Research Labs (HERL) have developed instrumenta- with more years since injury. These combined results tion to measure kinetics during wheelchair propul- point to the need for injury prevention, so that the sion through a device known as the SmartWheel younger populations do not develop these problems (Cooper et al., 1997a,b). HERL’s studies have found later in life. stable pushrim force and moment measures that Because of this work, wheelchair users have been change with speed, and are also statistically valid encouraged to use a more forward rear axle position metrics (Boninger et al., 1997). to promote low-frequency, long smooth strokes Researchers at HERL have also found wheelchair (larger contact angle) during the propulsive phase. pushrim forces to be related to nerve conduction Higher stroke frequencies have been shown to cor- variables. Specifi cally, they have used median nerve relate to median nerve injury and lead to increased conduction studies to diagnose carpal tunnel syn- blood lactate, heart rate, and cardiorespiratory drome and found that when controlling for weight, stress. Utilizing a larger contact angle while hold- there were correlations between median nerve ing velocity constant enables a person to do the function, cadence of propulsion, and rate and rise same propulsive work over a longer period of time, of the resultant force (Boninger et al., 1999). As a loading the handrim less rapidly and potentially follow-up to this work, longitudinal analysis was reducing the increase in resultant force. completed. This data showed that risk of injury to the median nerve could be predicted by wheelchair Propulsion effi ciency propulsion biomechanics (Boninger et al., 2005). For example, 100 individuals who used greater A properly fi t manual wheelchair should offer free- force and cadence during their initial lab visit dom and effi ciency during propulsion. However, had greater progression in median nerve damage defi ning what that is mechanically and determin- approximately 3 years later (Boninger et al., 1999). ing the ideal propulsion technique can be complex Peak resultant force was also found to be a predictor (Cooper & Bedi, 1990). Work by de Groot et al. of the progression of nerve conduction abnormali- (2002) has indicated that the most effective pro- ties. The resulting increased force was found to be pulsion technique is not necessarily the most 36 Chapter 2 effi cient propulsion technique from a biological Torque is defi ned as the product of bimanual tan- point of view. For instance, when individuals have gential force applied to the handrim and the radius been trained to apply propulsion forces in a more of the handrim. The measurement of angular dis- effective mechanical direction while generating placement and the torque around the wheel axle the same external power, gross ME decreases. In requires specialized experimental techniques for essence, because of a fi xed arm posture, there is motion analysis and force measurement. In hand- little freedom to optimize force once the hand cycling, energy is transferred from the hands to the has grasped the pushrim. Ultimately, the direc- crank to go forward. Po can thus be calculated by tion of force is likely based on achieving a balance multiplying torque applied to the crank with angu- between energy cost and force effectiveness (de lar velocity. As mentioned earlier, the athlete is the Groot et al., 2002). It has also been suggested that one generating power to propel based on his/her during propulsion, both forces and task repetition physical capacity. Facts such as upper body muscle should be kept to a minimum in order to reduce force and peak power output must be considered the risk of injury (Boninger et al., 1999). when optimizing the wheelchair to meet the per- formance needs of the athlete. Modeling propulsion Modeling can be particularly useful when study- ing the performance of a small subject population, Performance modeling addresses the development which is often the case in wheelchair athletics and application of predictive, reliable, and quanti- research. One specifi c method for the study of cyclic tative models of performance. Human performance human (sports) performance is through the use of modeling considers the human engaged in some a PBM as proposed by Ingen Schenau (1988). This goal-directed behavior, in the context of a designed energy fl ow model has been used in numerous stud- task within a specifi c environment. In order to ies to describe and predict optimal performance in evaluate human performance, it is essential to have different cyclic sports such as speed skating, cycling, an appropriate model. The following section will rowing, swimming, and running (Ingen Schenau & discuss how the power balance model (PBM) and Cavanagh, 1990) and in rehabilitation settings such the cyclic concept of propulsion have been applied as wheelchair propulsion, handcycling, or walking to the study of wheelchair athletics to improve with an impairment (Groen et al., 2010; Hettinga performance. et al., 2010; van der Woude et al., 2001). PBM gives Wheelchair propulsion and handcycling are best insight into performance-determining factors of described as cyclic movements. This means that pro- these different modes of cyclic endurance exercise pulsion is a motion repeated over time at a given fre- and can thus help to explain performance. For quency (f ) to maintain a certain velocity (v). With example, it can be used to predict optimal pacing each push, the rider produces either more or less strategy in middle-distance sports such as cycling equal work (A). The product of push frequency and and speed skating. work yields the average external power output (P ): o Generally speaking, the PBM approach includes Po f A(W) the wheelchair and user as a free body that moves with a given speed and encounters drag forces. The Linking physiological measures (such as energy cost athlete is described in terms of mechanical energy and physical strain) to biomechanical measures resulting in the power balance. While propelling (such as power output, work, force, and torque) can at a constant velocity, the athlete must overcome be a useful approach in studying the cyclic move- drag forces and internal friction (F ). Drag forces ments associated with propulsion. For example, int during propulsion or handcycling are rolling fric- work per push can be calculated as the integral of tion (F ) and air resistance (F ). When going up the momentary torque (M) applied by the hands to rol air or down a slope (α), gravitational effects (m g the handrim over a more or less fi xed angular dis- sin α) also play a role. Accelerations and decelera- placement (Q): tions are represented by changes in kinetic energy Σ Po f M dQ(W) over the race. Biomechanics 37
The power balance for wheelchair racing and 180 handcycling can thus be described as: 160 α Po (Frol Fair Fint m g sin m a) v 140 where Po is the total mechanical power, Frol is the 120 force necessary to overcome rolling resistance, Fair PO (w) is the force necessary to overcome air resistance, 100
Fint is the internal force, m is the body mass, g is the gravitational force, α is the angle of inclination, 80 y 0.20x3 2.90x; R2 0.95 and a is the acceleration of the system. 60 In daily use, rolling resistance is generally the major 6.5 7.0 7.5 8.0 8.5 9.0 9.5 resisting force. Rolling resistance can be determined v (m/s) by a coast-down technique or a drag test, and is depen- dent on fl oor surface and the characteristics of wheels Figure 2.5 The empirically derived relationship between and tires, since the amount of friction is related to the velocity and power output in handbiking. PO, power output. amount of deformation of tire and fl oor surface. However, in wheelchair racing and elite handcy- cling, velocities are higher; up to 80% of the pro- Wheelchair sports duced energy is lost to air friction. Factors such as frontal plane area reduction, adaptation of seat position, and orientation of the segments of the As mentioned earlier, user interfaces and propulsion body and skin suits will infl uence the drag coeffi - biomechanics are vital to performance, injury cient. Energy losses within the wheelchair are very reduction, and the long-term success of the user. It small and are caused by bearing friction around the is also evident that many aspects of everyday wheel- wheel axles and in the wheel suspension of the cas- chair propulsion, confi guration, and user inter- tor wheels, and possibly by the deformation of the face translate to the study of wheelchair sports. In frame in folding wheelchairs during the force exer- the following section, we will examine wheelchair tion in the push phase. racing, basketball, rugby, and handcycling because Performance has been modeled in elite handcy- of their popularity and status in the Paralympic clists using the PBM, which provided indicators of games. Furthermore, the study of biomechanics mechanical constraints (air friction, rolling friction), and interface of the everyday wheelchair are good submaximal as well as peak performance, concomi- starting points in understanding many of the tant metabolic cost, and ME. Realistic values for power elements of wheelchair athletics. These compari- output and power losses were obtained on an indoor sons must be made cautiously, however, because cycling track with all physiological responses occur- inherent differences exist between the two. These ring as well. Mean gross effi ciency was found to be differences are visible in the speeds and inten- 17.9% 1.6%. The empirically derived relationship sity in which activity occur, the tendency toward between velocity and power output, i.e., the PBM, on extreme chair confi gurations, and, of course, in the track was: the conditioning of the athletes.