BEYOND INCREDIBLE: THE PARALYMPIC ROAD TO RIO – AN ETHNOGRAPHIC STUDY A PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN’S UNIVERSITY SCHOOL OF PHYSICAL THERAPY COLLEGE OF HEALTH SCIENCES BY SHERI WALTERS, D.P.T., M.S. DENTON, TX AUGUST 2018 Copyright © 2018 by Sheri Walters DEDICATION To all my athletes, patients, clients, instructors, peers, and family who have taught me so many lessons, I am personally and professionally grateful. ii ACKNOWLEDGEMENTS I would like to gratefully acknowledge the many individuals who have contributed to this dissertation. I would like to thank my committee chair Dr. Mary Thompson for assigning a journal article that stimulated the idea for this topic. I would like to thank my committee members, Dr. Kelli Brizzolara, Dr. Chad Swank, and Dr. Kerri Morgan, for their assistance and support. I am also grateful for the assistance of four entry-level physical therapy students at Texas Woman’s University, Ashley Brandish, Somer Meyers, Paige McMillian, and Mariana Rong who provided assistance with capturing and coding the social media data for this study. I am also very thankful for Cathy Sellers, the U.S. Paralympic Track and Field High Performance Director for approving this project and my access to the team. Erica Wheeler and Teresa Skinner, two coaches for the team, were also instrumental in helping me to get started and for encouraging me to push through. And obviously, this project would never have happened without the support of the team itself. I am thankful for their willingness to trust me with their stories. It is my sincere hope that this project with serve as a catalyst for continued growth of the Paralympic movement. iii ABSTRACT SHERI WALTERS BEYOND INCREDIBLE: THE PARALYMPIC ROAD TO RIO – AN ETHNOGRAPHIC STUDY AUGUST 2018 The primary purpose of this ethnographic study was to understand the culture of the U.S. Paralympic Track and Field team from the 2015 World Championships through the 2016 Rio Paralympic Games. Secondary purposes included examination of the influence of sport in the lives of those involved in elite adaptive sport, greater examination of barriers and facilitators to participation for those involved in elite sport, issues related to and relevant to healthcare providers and coaches, and the psychosocial effects of the International Paralympic Committee Classification System within Paralympic track and field. Subjects were observed and select participants interviewed after being identified through purposeful snowball sampling. Observation notes, transcribed semi-structured interviews, social media posts, and media coverage were analyzed using theoretical frameworks to guide analyses. Feminist theory guided the ethnographic data analysis related to sport socialization. Self-determination theory was used to analyze the data relevant to healthcare providers and coaches in two separate phenomenological studies. Morgan’s practice community was used to theoretically frame the phenomenological iv study of classification. Rigor was established through triangulation, member checking, peer debriefing, and maintenance of a clear audit trail. Through data analysis, common themes related to the power of sport included a variety of health benefits, and increased participation in society. Barriers to participation included lack of awareness, cost, comorbidities, classification, and “doping.” Facilitators included family, sponsorships, others involved in sport, and fun. Negative aspects included injuries, illnesses, and transportation issues. Prominent negative aspects require staff to assist in managing those negative consequences, to educate athletes of the potential risk, and to allow athlete autonomy. Common themes that emerged related to socialization into and via sport included aspects related to shared training environments, traveling experiences, humor, and integration into able-bodied training environments and events. The athletes used sport and humor as a form of resistance against disablism, leading to a sense of empowerment. Themes related to the role of healthcare providers included the introduction of patients to sport, athletes’ perceptions of their healthcare providers as facilitator or barrier, and the roles of a healthcare provider. Providers could play a variety of roles, including serving as a researcher, coach, classifier, or working with athletes as a team medical provider. Providers reported experiences within the Paralympic movement that were personally and professionally rewarding. Prominent themes related to coaching included coaching philosophy, development, and challenges. Another theme was the influence of working with this v population in the coaches’ lives. Paralympic coaches appear to have adopted an autonomy-supportive-style of coaching, thus empowering their athletes. Coaches report difficulty finding quality adaptive sport coaching education and resources, relying on peer mentorship as a primary mode of gaining knowledge and experience. Adaptive sport athletes often have difficulty finding a program or coach, prompting discussion of integrating athletes with disabilities into able-bodied training groups. Coaches find rewards and meaning in their athletes and their work experiences with this population. Classification issues involving ambulatory sprinters and wheelchair racers produced themes related to psychosocial and potential ethical issues, leading to suggestions for improvement. Lack of transparency and inconsistencies by Paralympic officials and classifiers led to mistrust of the classification system. Potential opportunities for improvement include increased athlete involvement, transparent communication of factors involved in policy decisions, and examination of specific impairments and performance enhancing technology. This qualitative study gave a voice to a population that previously had been rarely heard. In giving these participants the opportunity to tell their story, the participants likely felt empowered in being heard, and we learned what factors were associated with these athletes getting and staying involved with Paralympic sport, including some of the challenges and catalysts to achieving and maintaining elite sport status. We also gained insight into the perspective of the team’s coaches, the team’s healthcare providers, and some national and international classifiers. vi TABLE OF CONTENTS Page DEDICATION .................................................................................................................... ii ACKNOWLEDGEMENTS ............................................................................................... iii ABSTRACT ...................................................................................................................... iiv LIST OF TABLES ............................................................................................................ xii LIST OF FIGURES ......................................................................................................... xiii Chapter I. INTRODUCTION ............................................................................................................1 Statement of the Problem ................................................................................................ 4 Purposes of This Study .................................................................................................... 5 Rationale for This Study ................................................................................................. 6 Research Questions ......................................................................................................... 7 Definition of Terms ......................................................................................................... 8 Assumptions .................................................................................................................. 10 Limitations .................................................................................................................... 11 Primary Investigator’s Relationship to the Topic ......................................................... 11 Significance of the Study .............................................................................................. 13 Organization of the Dissertation ................................................................................... 14 II. REVIEW OF LITERATURE........................................................................................16 Introduction to Paralympic Sport .................................................................................. 16 Power of Adaptive Sport ............................................................................................23 Barriers and Facilitators to Participation ....................................................................25 Sport Socialization ........................................................................................................ 26 Socialization Into Sport ..............................................................................................27 Socialization Via Sport ...............................................................................................36 Implications for Healthcare Providers........................................................................... 48 vii Epidemiology and Injury Prevention .........................................................................53 Ethical and Legal