Performance and fatigue charateristics of paralympic athletes with cerebral palsy

Includes bibliographical referencesThe studies described in this thesis were the first to investigate in - depth body composition, exercise performance and neuromuscular characteristics of elite Paralympic athletes with cerebral palsy (CP). In the first study, in - depth whole body and site specific body composition was investigated in six athletes with CP using dual - energy x - ray absorptiometry. There were no differences between non - affected and affected sides with respect to bone mineral density and fat mass. Fat free soft tissue mass was lower on the affected side in bot h upper and lower limbs of the athletes. The novel findings of this study provided the first insight into anthropometric and bone physiology of elite Paralympic athletes with CP, and the possible residual effect of CP in these individuals. In the second study, five athletes with CP and 16 able - bodied (AB) age and performance matched controls performed a 30 second Wingate sprint cycle test. Power output was significantly higher in the AB group, although fatigue indices were statistically similar between groups. Muscle activity changed similarly in all muscle groups tested, in both affected and non - affected sides, in both CP and AB groups. However, certain neuromuscular irregularities were identified in the CP group. The similarity in fatigue profile was a novel finding. It was proposed that this similarity in fatigue was the result of long term high level athletic training required for Paralympic competition. Study three tested the similarity in fatigue between CP and AB athletes (that was described in the second study), using an externally paced fatiguing running trial. Six athletes with CP and 12 AB athletes performed one 40 m sprint test and vertical jump tests off both legs, the affected leg individually and the non - affected leg individually, before and after an adapted multistage shuttle run test to exhaustion. The 40 m sprint test, vertical jump off both legs and vertical jump off the affected leg were significantly compromised in the CP group, while vertical jump off the non - affected leg was similar between groups. Both groups fatigued similarly with regard to performance and muscle activity. The third study's finding s generally supported those of the second study. However, it was shown that although athletes with CP may represent a group of individuals who have achieved maximal physiological adaptation toward AB levels, the activity generated by both legs was performed towards the capacity of the affected leg. Study four attempted to elucidate explanations for the novel findings in studies 2 and 3 through investigation of pacing strategies employed by these athletes. Six athletes with CP and 13 AB athletes performed two trials of eight sets of ten shuttles (totalling 1600 m). One trial was distance deceived and the other was non distance deceived. The CP group ran slower than the AB group in both trials, and differences in pacing were observed in the deceived trial in the CP group. This novel study provided evidence for a possible pacing strategy underlying the exercise performance and fatigue profiles observed in the athletes with CP documented in the previous studies. The work described in this thesis lends novel insights and understanding to the physiology and physiological adaptations of highly functioning ambulant athletes with CP. The findings might have important implications with respect to the understanding of rehabilitation, coaching and clinical management of individuals with CP

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the Covid-19 pandemic: A prospective cohort study of 66 045 athlete days

Objective To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo. Methods Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organizing committee medical facilities (81 countries, 567 athletes)

Injury incidence according to athlete impairment type during the 2012 and 2016 Summer Paralympic Games : a combined analysis of 101 108 athlete days

OBJECTIVES : The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area. METHODS : A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and ‘all others’ (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap. RESULTS : The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments. CONCLUSIONS : Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes.http://bjsm.bmj.comhj2024Sports MedicineSDG-03:Good heatlh and well-bein

Evaluating workforce needs : an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games

OBJECTIVES : To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games. METHODS : A cross-sectional observational study was conducted. National Paralympic Committee’s HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics. RESULTS : The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes. CONCLUSION : HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.The 2021 IOC Medical and Scientific Research Fund and the IOC Research Centre South Africa grant.http://bjsm.bmj.comhj2024Sports MedicineSDG-03:Good heatlh and well-bein

Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days

OBJECTIVETo describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games. METHODS A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems. RESULTSThe total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35–75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively). CONCLUSION (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35–75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games

High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games:a prospective cohort study of 51 198 athlete days

This is the second significant dataset to document the incidence of injury in a Summer Paralympic Games setting. Pre-competition injury rates were significantly higher than competition injury rates. The sports of football 5-a-side, judo and football 7-a-side had a significantly higher incidence of injury, compared to all other sports, whilst boccia and Para swimming had a significantly lower injury rate. The shoulder joint was the most commonly injured anatomical area. Acute injuries constituted the highest injury rate at the Games

Incidence rate and burden of illness at the Pyeongchang 2018 Paralympic Winter Games

OBJECTIVE : To describe the incidence rate (IR) and illness burden (IB) at the Pyeongchang 2018 Paralympic Winter Games. METHODS : A total of 567 athletes from 49 countries were monitored for 12 days over the Pyeongchang 2018 Games (6804 athlete days). Illness data were obtained daily from teams with (41 teams, 557 athletes) and teams without (8 teams, 10 athletes) their own medical support, through electronic data capturing systems. RESULTS : There were 87 illnesses reported, with an illness IR of 12.8 illnesses per 1000 athlete days (95% CI 10.2 to 16.0) and IB of 6.8 days lost per 1000 athlete days (95% CI 3.4 to 13.5). The highest IR was reported for Para snowboard (IR of 19.7 [95% CI 12.0 to 32.2]). Illnesses in the respiratory system (IR of 4.1 [95% CI 2.9 to 5.9]; IB of 1.4 [95% CI 0.6 to 3.0]), skin and subcutaneous system (IR of 2.5 [95% CI 1.5 to 4.1]; IB of 0.6 [95% CI 0.1 to 2.9]), and eye and ocular adnexa (IR of 1.6 [95% CI 0.9 to 3.1]; IB of 0.5 [95% CI 0.1 to 3.3]) were the most common. CONCLUSION : This is the first study to report both the IR and IB in this setting. There was a high IR of illness in the new sport of Para snowboard. The respiratory system had both the highest IR and IB.http://bjsm.bmj.comhj2019Sports Medicin

High incidence of injuries at the Pyeongchang 2018 paralympic winter games: A prospective cohort study of 6804 athlete days

Given the increase in health surveillance research in the sporting arena, the International Paralympic Committee (IPC) seeks to preserve the health of the para athlete in several ways including high-quality epidemiological research on injury and illness in the Paralympic Games.1–5 Web-based studies began at the London 2012 Summer Paralympic Games1 and have continued at the Rio 20165 Summer Games and at Paralympic Winter Games at the Sochi 20144 and Pyeongchang 2018 Game

Incidence of injury and illness at the Beijing 2022 Paralympic Winter Games held in a closed-loop environment : a prospective cohort study of 7332 athlete days

DATA SHARING STATEMENT : No data are available.OBJECTIVE : To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions. METHODS : Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI). RESULTS : 564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6–15.8) and 6.1 illnesses (4.5–8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2–26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9–2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05). CONCLUSION : The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.The IOC Research Centre South Africa grant and International Paralympic Committee research support.http://bjsm.bmj.comhj2024Sports MedicineSDG-03:Good heatlh and well-bein

Effects of exercise training on performance and function in individuals with cerebral palsy: A critical review

This critical review article describes the exercise performance capabilities, and the effect of exercise training interventions, in individuals with cerebral palsy (CP). A literature search was conducted using PubMed, Medline, Embase, Scopus, Web of Science, Science Direct and Google Scholar databases from the earliest possible date to December 2014. Large impairments in exercise performance have been reported in individuals with CP, as well as large improvements following the implementation of training interventions. The physiology underlying the functional and physical impairments in CP were also reviewed, and grouped into categories, namely: motor impairments, central impairment, skeletal muscle morphology and physical inactivity. Although much research exists on individuals with CP, there is conflicting evidence for the benefits of exercise training in these individuals. This is due to the use of sedentary, paediatric populations and varied methodologies. Investigating individuals who have undergone high-volume exercise training from a young age might result in a better understanding of functional and physical performance in individuals with CP.Key words: Disability; Physical activity; Rehabilitation; Physiology