Adaptive Sports Medicine Arthur Jason De Luigi, DO Program Director, Sports Medicine Fellowship Director, Sports Medicine Director, Interventional Pain National Rehabilitation Hospital Georgetown University Hospital Financial Disclosures • None to report Disclosure • Stuart Willick, MD • United States Ski and Snowboarding Association • United States Olympic Committee • Walter Reed Army Medical Center • Military Advanced Training Center Overview • History • Paralympic Games • Sports Governance • Disability Groups • Classifications • Adaptive Sports • Adaptive Equipment • Medical Care • Research History • Inaugural Event – 1948 • Sir Ludwig Guttmann • World War II veterans with a spinal cord injury • Stoke Mandeville, England. – 1952 • competitors from the Netherlands joined the games • international movement was born. • Inaugural Olympic style games for athletes with a disability – Rome, 1960 – Now called Paralympics. • Toronto, 1976 – other disability groups were added – idea of merging together different disability groups for international sport competitions was born. • Sweden, 1976 – First Paralympic Winter Games History • Paralympic Games – Elite sport events for athletes from 6 different disability groups – Emphasize the participants' athletic achievements rather than their disability • Movement has grown dramatically since its first days • Rome 1960 – 400 athletes from 23 countries • Beijing 2008 – 3,951 athletes from 146 countries History • Paralympic Games – Always been held same year as the Olympics – Seoul 1988 Paralympic Games and the Albertville 1992 Winter Paralympic Games: • Same venues as the Olympics – 2001: • Agreement between the IOC and the IPC securing this practice for the future – From 2012 onwards: • Host city chosen to host the Olympic Games will be obliged to also host the Paralympics History • International Paralympic Committee (IPC) – Global governing body of the Paralympic Movement – Organizes the Summer and Winter Paralympic Games – Founded on 22 September 1989 in Dusseldorf ,Germany • Preceded by the ICC in 1982 • "International Coordination Committee of World Sports Organizations for the Disabled" – IPC ‘s First Paralympic Games • The Winter Paralympics in Lillehammer in 1994 – Organization is rapidly developing • 165 member nations – Growth is best exemplified through the phenomenal rise of the Paralympic Games. • More countries competed at the Beijing 2008 Paralympics (3951 athletes, 146 countries) than in the Munich 1972 Olympic Games. • In Beijing, degree of media coverage was unprecedented. – Growing interest in and acceptance for sport for persons with a disability – Expansion of the Paralympics is most likely to continue in the future History • “Paralympic” • Derives from the Greek • preposition "para" (beside or alongside) and "Olympics" • Paralympics being the parallel Games to the Olympics – Originally a pun combining 'paraplegic' and 'Olympic' • however with the inclusion of other disability groups and the close associations with the Olympic Movement – Now represents 'parallel' and 'Olympic' to illustrate how the two movements exist side by side Paralympic Games Paralympic Games • Sports Governance – 20 Paralympic Summer Games – 5 Paralympic Winter Games – 1 Non Paralympic Sport Sports Governance • International Paralympic Committee (IPC) – Serves as the International Federation for nine (9) sports – Supervises and co-ordinates the World Championships and other competitions • The following sports are governed by the IPC: – Alpine Skiing – Athletics • Track events: Sprint (100m, 200m, 400m), Middle Distance (800m, 1500m), Long Distance (5,000m, 10,000m) and Relay races (4x100m, 4x400m) • Road event: Marathon • Jumping events: High Jump, Long Jump and Triple Jump • Throwing events: Discus, Shot Put, Javelin • Combined events: Pentathlon (track and road events, jumping events and throwing events, classification dependant) – Biathlon – Cross-Country Skiing – Ice Sledge Hockey – Powerlifting – Shooting – Swimming – Wheelchair Dance Sport Sports Governance • International Organization of Sport for the Disabled (IOSD) • IPC currently recognizes six IOSD sports on the Paralympic Program – Governed by the Cerebral Palsy International Sports and Recreation Association (CPISRA) • Boccia • Football 7-a-side – Governed by the International Blind Sports Federation (IBSA) • Football 5-a-side • Goalball • Judo – Governed by the International Wheelchair and Amputee Sports Federation (IWAS) • Wheelchair Fencing Sports Governance • International Federations (IF) – Archery (International Archery Federation) – Cycling (International Cycling Federation) – Equestrian (International Equestrian Federation) – Rowing (International Rowing Federation) – Sailing (International Association for Disabled Sailing) – Table Tennis (International Table Tennis Federation) – Volleyball (Sitting) (World Organization for Volleyball for Disabled) – Wheelchair Basketball (International Wheelchair Basketball Federation) – Wheelchair Curling (World Curling Federation) – Wheelchair Rugby (International Wheelchair Rugby Federation) – Wheelchair Tennis (International Tennis Federation) Disability Groups • Six different disability groups in the Paralympic Movement: – Amputee – Cerebral palsy – Visual impairment – Spinal cord injuries – Intellectual disability – Les Autres • a group which includes all those that do not fit into the aforementioned groups Disability Groups • Amputee: – partial or total loss of at least one limb • UE/LE • Single/multiple limbs Disability Groups • Cerebral Palsy: – Athletes with non- progressive brain damage, • Cerebral Palsy • Traumatic brain injury • Stroke • Similar disabilities affecting muscle control, balance or coordination. Disability Groups • Intellectual Disability: – Athletes with a significant impairment • intellectual functioning • limitations in adaptive behavior. Disability Groups • Spinal Cord Injury (Wheelchair): – spinal cord injuries – other disabilities which require them to compete in a wheelchair Disability Groups • Visually Impaired: – Vision impairment • Partial vision • Legally blind • Total blindness Disability Groups • Les Autres: – Athletes with a physical disability that does not fall strictly under one of the other five categories • Dwarfism • multiple sclerosis • congenital deformities of the limbs • such as that caused by thalidomide – (the name is French for "the others"). Classification • Classification is simply a structure for competition. – Not unlike wrestling, boxing and weightlifting, where athletes are categorized by weight classes – Athletes with disabilities are grouped in classes defined by the degree of function presented by the disability. • Classes – Determined by a variety of processes that include: • physical and technical assessment and observation in and out of competition • Classifiers – Sports certify individuals to conduct the process of classification • Classes are defined by each sport and form part of the sport rules – Ongoing process. • When an athlete starts competing, they are allocated a class that may be reviewed throughout the athlete's career. • Since the 1960's, the development of sport for athletes with a disability has produced the development of classification systems – Continues to evolve to the present day. Classifications • Classes – Determined by a variety of processes that include: • physical and technical assessment and observation in and out of competition • Classifiers – Sports certify individuals to conduct the process of classification • Classes are defined by each sport and form part of the sport rules – Ongoing process. • When an athlete starts competing, they are allocated a class that may be reviewed throughout the athlete's career. • Since the 1960's, the development of sport for athletes with a disability has produced the development of classification systems – Continues to evolve to the present day. Classifications • Code • Classification Strategy – Developed in 2003 by IPC • Overall objective to support and coordinate the ongoing development of classification systems and their implementation: – Accurate – Reliable – Consistent – Credible – Sport focused • The IPC Classification Code is a direct result of these recommendations – Framework for policies and procedures that are common to all sports • Specific enough to achieve complete harmonization on classification issues • General enough in other areas to permit flexibility • The Code is complemented with International Standards that provide the technical and operational requirements for classification Classifications: Alpine Skiing • Visually impaired – B1 - Totally blind participants with vision up to light perception / hand movement – B2 - visual acuity of 2/60 and / or visual field of less than 5 degrees – B3 - visual acuity above 2/60 to 6/60 and / or visual field of more than 5 degrees and less than 20 degrees Classifications: Alpine Skiing • Standing – LW1 double above-knee amputees or similar – LW2 above knee amputee using outriggers and one ski – LW3 double below-knee amputees/ CP5, CP6 – LW4 skiers with below knee amputation using prosthesis, two skis and poles – LW5/7 skiers with both hands / arms amputated unable to use poles (LW5/7-1, LW5/7-2, LW 5/7-3) – LW6/8 skiers with one hand / arm amputated using one pole (LW6/8 -1, LW6/8 -2) – LW9 disability of one arm and one leg (Amputation, CP, Hemiplegic), (LW9/1, LW9/2) Classifications: Alpine Skiing • Sitting – LW10 mono skiers (high level of spinal cord injury), (LW10/1, LW10/2) – LW11 mono skiers (thoracic