Athletic Assistive Technology for Persons with Physical Conditions Affecting Mobility David Hill, BS, MS, Donna Moxley Scarborough, BS, MS, PT, Eric Berkson, BA, MA, MD, Hugh Herr, BA, MS, PhD ABSTRACT Recent advances in technology have allowed athletes with physical conditions to perform at increasingly high levels. After the ruling that one such athlete had an advantage over ‘‘able-bodied’’ athletes before the 2008 Olympics, many question whether these technological advances have even augmented athletic abilities. Although much progress has been achieved, technology for ‘‘disabled’’ athletes must be far advanced to allow them to reach and surpass the ability level of able-bodied athletes. Here, we review the current state of assistive devices created to assist athletes with physical conditions affecting their mobility. We form a quantitative comparison between athletes with and without physical conditions, lay out recent ad- vancements in the development of sports-related assistive devices, and discuss the implications of these devices. Using the Paralympics as a guide, this work serves as an overview of the current state of assistive technology for athletes with mobility conditions and a tool for future researchers attempting to bridge the gap between athletes with and without physical conditions. (J Prosthet Orthot. 2014;26:154Y165.) KEY INDEXING TERMS: assistive technology, prosthesis, wheelchair, sports, Paralympics, athletes with physical conditions, athletes with mobility conditions, disability n 2008, the International Association of Athletics Federa- developments, which could contribute to a future wave of aug- tions (IAAF) began a worldwide debate when they established mentative devices. IRule 144.2(e), prohibiting the use of technical devices that offer a competitive advantage.1 Specifically citing springs as ad- CONTRIBUTION vantageous, this rule resulted in the immediate disqualification of Oscar Pistorius, the South African bilateral amputee sprinter Disability is an umbrella term often used to describe a vying to become the first amputee to compete with ‘‘able-bodied’’ physical or mental impairment that substantially limits one or more major life activities and causes participation restrictions runners at the highest level. Extensive trials and investigation 4 resulting from this ruling caused its eventual repeal,2,3 allow- for an individual. However, using any form of this term to ing Oscar Pistorius to make history as the first-ever amputee refer to humans is unacceptable because the ability to perform sprinter to compete in the Olympics. The initial verdict evoked at extraordinary levels can be restored given the right tech- some pivotal research in sports performance enhancement for nology, as evidenced by Oscar Pistorius. The focus of this work athletes with mobility conditions (AMCs), and a rather inter- is athletes with physical conditions, specifically conditions that esting question emerged: affect limb and motor function. We discuss current work on Just how far can assistive technology enhancements take technology that assists these athletes, thus directly address- all athletes in the future? ing activity and participation restrictions and improving the To examine this question, in this article, we explore the cur- athlete’s ability to perform. The goal is to outline current de- rent state of para-athletics, surveying the literature to assess the sign approaches, evaluating their efficacy and potential for present achievements of AMCs, and find recent advances in as- future applications. sistive technology for sports-related applications. This explora- tion provides insight into the current direction of assistive device PREVIOUS WORK Sports for AMCs have made great strides since the inception of the Paralympics approximately a half century ago.5 Within DAVID HILL, BS, MS, and HUGH HERR, BA, MS, PhD, are affiliated the last 2 decades, the Paralympics and the Olympics became with the Biomechatronics Group, Media Lab, Massachusetts Institute more closely tied, resulting in a sudden surge in exposure and of Technology, Cambridge, Massachusetts. popularity, as well as newfound ‘‘disabled’’ star athletes. Since DONNA MOXLEY SCARBOROUGH, BS, MS, PT, and ERIC BERKSON, then, much work has gone into studying sports performance BA, MA, MD, are affiliated with the Mass General Sports Performance of AMCs from a variety of angles. Although many focus on Center, Department of Orthopaedic Surgery, Mass General Hospital, the Paralympics and its history,5Y7 others cover topics rang- Boston, Massachusetts. ing from psychological characteristics of para-athletes to so- Disclosure: The authors declare no conflict of interest. ciopolitical implications of para-athletics. Copyright * 2014 American Academy of Orthotists and Prosthetists One of the major concerns in all sports is injury. Medical Correspondence to: David Hill, BS, MS, Biomechatronics Group, professionals and athletes alike are deeply invested in study- Media Lab, Massachusetts Institute of Technology, 75 Amherst St ing the occurrences, causes, prevention, and diagnosis of in- E14-348U, Cambridge, MA 02139; email: [email protected] juries. In 2009, Miller8 investigated medical issues associated 154 Volume 26 & Number 3 & 2014 Copyright @ 2014 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited. Journal of Prosthetics and Orthotics Athletic Assistive Technology with Paralympians, discussing common injuries and illnesses worldwide sports competition for athletes with conditions that encountered by these athletes. Mason9 furthered this discus- affect athletic ability. It officially began in 1960. Now, it occurs sion in 2012 when he reviewed the history of sports medicine immediately after the Olympics every 4 years and in the same for AMCs, forming one of the most comprehensive assessments city.31 Examining Paralympic events gives clues to which as- of AMC sports medicine to date. Others have examined specific sistive technologies are most advanced and useful for athletic occurrences of injury to uncover where and how AMCs are most activities. Further, comparing the top performances in the Para- vulnerable.10Y14 lympics and the Olympics gives a more quantitative measure Psychological factors affecting AMC sports performance have of the efficacy of these technologies in matching biological been studied extensively as well. Evaluations of self-esteem, hap- performance. piness, and other psychological factors arose as early as the 1980s, The Paralympics features 26 distinct events, ranging from showing that there are mental benefits of sports participation for aquatics to wheelchair tennis. Of these, 23 coincide with Olym- persons with physical conditions.15 More recently, Martin16 found pic events (see Table 1). Observing the absence of certain Olympic that sport experience positively affected motivation for youth with sports in the Paralympics offers some obvious key distinctions. physical conditions. Other reviews by Jefferies et al.,17 Deans Specifically, more dynamic sports with varied movements seem et al.,18 and Martin19 emphasize the growing importance of to be the most difficult to reproduce, especially combat sports. sports psychology for AMCs. As a result, new methodologies for Even those represented in the Paralympics can be achieved only providing sufficient psychological assessments to AMCs by sports through the use of wheelchairs. Perhaps, this underscores the psychologists have arisen.20 present shortcomings in prosthetic devices, which tend to be Social and political issues are the focus of an overwhelm- most powerful for single-plane movements. ing majority of publications concerning athletes with physical Further disparities can be seen in the world records posted conditions. Often, these are related to civil rights, accessibility, in the two competitions. The IPC tracks records only in four and unfair treatment. One such example is the disparity in me- sports: athletics, powerlifting, shooting, and swimming.31 dia coverage for para-athletes when compared with able-bodied athletes. Traditional media sources have failed to give equal coverage to AMCs, and when they do, the language used has Table 1. Basic Olympic and Paralympic events lists commonly been perceived as negative and offensive.21,22 Fur- ther, some have criticized the ‘‘disempowerment’’ of para-athletes Olympics underlying the structure of competition. A clear separation from and the Olympics, substantial funding differences, and disparate media Olympics Paralympics Paralympics coverage make the Paralympics, and equivalently AMC sports, less Badminton Aquatics Boccia Y inclusive than it is often stated and intended to be.22 27 Bobsleigh Archery Goalball To our knowledge, few academic publications have reviewed Boxing Athletics Wheelchair dance* assistive technology for AMCs. Burkett28 recently conducted Golf Basketball* two such reviews, one examining technology used exclusively Gymnastics Biathlon in summer Paralympic competitions and a secondary piece fo- Handball Canoe/kayak cusing on technology for the winter Paralympics.29 In addition, Hockey Curling* Magdalinski30 briefly discussed assistive sports technology in a Luge Cycling Modern pentathalon Equestrian 2012 review of prostheses and artificial skins. Previous studies Skating Fencing* of assistive devices for sports mostly focus on prostheses or ex- Taekwondo Football clusively Paralympic technology. Here, we review the current Wrestling Ice hockey state of para-sports performance