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Sport Wheelchair Falls During the Rio 2016 Summer Paralympic Games: a Video-­Based Cross-Sectional­ Observational Study

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Sport Wheelchair Falls During the Rio 2016 Summer Paralympic Games: a Video-­Based Cross-Sectional­ Observational Study Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-033088 on 8 March 2020. Downloaded from Analysis of team- sport wheelchair falls during the Rio 2016 Summer Paralympic Games: a video- based cross-sectional observational study Junpei Sasadai , Noriaki Maeda, Reia Shimizu, Takumi Kobayashi, Shogo Sakai, Makoto Komiya, Yukio Urabe To cite: Sasadai J, Maeda N, ABSTRACT Strengths and limitations of this study Shimizu R, et al. Analysis Objectives To present the fall characteristics of athletes of team- sport wheelchair playing wheelchair rugby (WR) and wheelchair basketball ► This is the first study to describe the fall character- falls during the Rio 2016 (WB) using official videos from the Rio 2016 Paralympic Summer Paralympic Games: istics of wheelchair athletes during popular wheel- Games and compare the key fall characteristics among the a video- based cross- sectional chair team sports at the Paralympic Games. team wheelchair sports event. observational study. BMJ Open ► We analysed the official videos of the Paralympic Methods Eighteen WR and 10 WB game videos for men 2020;10:e033088. doi:10.1136/ Games, which are publicly available on the Internet, (MWB) and women (WWB), including 8 teams per sport, bmjopen-2019-033088 focussing on the falls of wheelchair athletes during were obtained from the official International Paralympic wheelchair rugby and wheelchair basketball ► Prepublication history for Committee of the Rio 2016 Paralympic Games. The videos this paper is available online. matches. were analysed to assess the number of falls, playing time To view these files, please visit ► We cannot confirm that all wheelchair falls during of fall, playing phase, contact with other athletes, the the journal online (http:// dx. doi. the 2016 Paralympic Games were captured or direction of the fall and the body part first in contact with org/ 10. 1136/ bmjopen- 2019- analysed. 033088). the floor during the fall. ► We could not confirm that any injuries were sus- Results In total, 359 falls (96 for WR, 172 for MWB tained from the wheelchair falls captured on the Received 19 July 2019 and 91 for WWB) occurred with a mean of 5.3, 17.2 and videos. Revised 17 February 2020 9.1 falls per match, respectively (p<0.05). Significant ► To clarify the relationship between falls and injuries, Accepted 20 February 2020 differences among the three sports were detected in the it is necessary to combine the results of video analy- http://bmjopen.bmj.com/ playing time (p=0.011), presence of contact (p=0.037), sis with injury survey data and compare them. direction (p<0.001) and body part first in contact with the floor (p<0.001). For WR, the falls were primarily lateral and caused by contact, occurring in the second half of the competitors. Wheelchair sports are those that match. WB falls tended to be in the first half for women have been modified according to the abilities and the second half for men. Most falls were contact falls of athletes with lower limb and trunk impair- in the forward direction. Conclusion By observing the situational details, we ments. The competitions are diverse, ranging described that a number of falls due to contact occurred from non- contact sports such as wheelchair on September 28, 2021 by guest. Protected copyright. during these team sports events, especially MWB. In tennis to contact sports like wheelchair rugby addition, each sport exhibited characteristics attributable (WR) and wheelchair basketball (WB), and to differences in gender, degree of impairment and game combat sports like wheelchair fencing. It was rules. The directions of the falls and characteristics of the announced recently that over 10 wheelchair affected body parts indicate differences in impairments sports have been added to the official list of depending on the sport. A fall to the side or back may competitions for the Paralympic Games.3 indicate a risk of injury. With increasing competition levels, an © Author(s) (or their increase in sports injuries may follow. Previous employer(s)) 2020. Re- use surveys on sports injuries of impaired athletes permitted under CC BY-NC. No INTRODUCTION showed that 510 injuries were incurred by 441 commercial re- use. See rights and permissions. Published by The Paralympic Games is the third- largest athletes during the 14 day games event. These BMJ. sporting event in the world after the Olympic injury cases included 61 athletes who had 1 Department of Sports Games and FIFA World Cup. The Tokyo participated in WR and WB and incurred 14.9 Rehabilitation, Hiroshima 2020 Paralympic Games will feature 540 and 12.8 injuries per 1000 athlete days at the University, Hiroshima, Japan medal events of 22 sports, in which and 4400 Rio 2016 Paralympic Games.4 Additionally, a 2 Correspondence to athletes will be competing. Wheelchair survey on the winter competitions reports 142 Dr Junpei Sasadai; athletes who participate in wheelchair sports injuries with an injury rate of 20.9 injuries per jumpei. sasadai@ jpnsport. go. jp events comprise a majority of the Paralympic 1000 athlete days.5 Furthermore, the number Sasadai J, et al. BMJ Open 2020;10:e033088. doi:10.1136/bmjopen-2019-033088 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-033088 on 8 March 2020. Downloaded from of acute injuries during contact team sports such as WR assigned classifications from 1.0 (least physical function) and WB is higher than fencing and tennis (61%, 65%, to 4.5 (most physical function).14 and 42%, 37%, respectively).6 It is common for many falls Since WR and WB are team sports, collisions between to occur in these two wheelchair team sports, however, no wheelchairs and falls from wheelchairs occur frequently study has characterised the falls in each sport. Moreover, during the games. Moreover, these two sports had a the relationship between the sports injury characteristics combined high incidence rate of acute injuries, that of team wheelchair sports and the occurrence of wheel- accounted for 70% of the total injuries in the Paralympic chair falls has not been presented yet. Furthermore, there Games.6 Wheelchair users with traumatic spinal cord are recent reports showing a lack of measures to prevent injuries are most prone to falls while playing wheel- injuries to competitors, including wheelchair athletes chair sports, with injuries occurring once every four during the Paralympic Games.7 In the case of wheelchair times.15 Hollander et al reported that 9 out of 100 inju- sports, a fall may cause a head impact and may result in ries, which occurred during the WB World Champion- concussion or other medical emergencies. Therefore, ships 2018 were traumatic injuries due to falls.16 In this careful attention would be needed to understand the previous study, gender differences were compared, and causes of falls. One method to analyse the occurrence of falls caused the 8 out of 42 injuries reported in women. wheelchair associated sports injuries is to view the video Therefore, there can be different characteristics of falls records of the competition. for men and women in the same sport. Moreover, falling With sports becoming popular among impaired athletes can cause contusions, fractures and concussions in wheel- and the demand for the Paralympic Games increasing, chair athletes, which reaffirms the need for effective fall research on sports injuries of impaired athletes gained prevention methods. Falls can be caused by contact with research attention. The International Paralympic others, losing one’s balance, shock-relieving or they could Committee (IPC) published epidemiological studies on be completely unexpected. Not all may cause injuries, but sports injuries occurring during the recent Paralympic they can occur differently during each sport and their Games events.4 8 The IPC report shows that acute inju- characteristics may differ according to those of the sports. ries during the Para Alpine ski were decreased to less However, so far, no study has analysed the characteristics than half in the5 PyeongChang 2018 Paralympic Winter of wheelchair falls or compared them according to each Games compared with that in the Sochi 2014 Paralympic sport. Winter Games.9 However, these studies did not describe This study aimed to characterise falls of team-sports the causes of sports injuries or their prevention methods wheelchair athletes during the Rio 2016 Summer available. Paralympic Games and compare key fall characteristics Games videos is an effective method to characterise between three main wheelchair team-sport events (WR, sports injuries, and it was applied to interpret the occur- men’s WB and women’s WB). http://bmjopen.bmj.com/ rence of injuries in able- bodied athletes.10 11 Even anterior cruciate ligament injuries were analysed to understand the changing dynamic alignments, which can aid in plan- METHODS ning prevention methods.10 For the video- based cross- sectional analysis, we acquired WR and WB, two popular competitive team wheelchair the official game videos of the selected wheelchair team sports, are part of the competitions in the Paralympic sports—WR and WB from the official website of the IPC. Games.12 These indoor wheelchair team sports both We analysed the match videos of all eight teams partici- require intense movements and are performed on pating in WR, and the eight MWB and WWB teams that on September 28, 2021 by guest. Protected copyright. wooden floor surfaces. Since the official WR rules permit entered the quarterfinals of the 4 Rio 2016 Paralympic contact between wheelchairs, wheelchairs are designed Games. A total of 18 WR and 10 WB game videos for men’s to be strong and heavy, whereas, the WB rules prohibit (MWB) and women’s (WWB) including eight teams per charging and holding. Therefore, wheelchairs for WB are sport, were obtained from the official IPC website of the light and mobile.
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