Phoebe Runciman

Para Alpine skiing is one of the largest sports at the Paralympic Winter Games. Recent studies report high injury rates in this sport. However, limited evidence exists regarding sport‐specific injury characteristics, which is essential for targeted prevention. The aim of this study was to describe the overall incidence proportion and incidence of injuries reported by athletes participating in Alpine skiing at the Sochi 2014, PyeongChang 2018, and Beijing 2022 Paralympic Winter Games, and to describe injuries by sex, age, impairment, competition period, onset (chronicity), anatomical area, and estimated injury burden. Prospective epidemiological data regarding injuries at the three Paralympic Games (including 486 athletes and 6002 athlete days) were reported by medical staff through the validated web‐based injury and illness surveillance system (WEB‐IISS) and Paralympic polyclinics. Data were coded and analyzed according to the IOC Para consensus statement using descriptive and analytical statistics (incidence, incidence proportion with 95% CIs, and generalized linear Poisson's regression modeling). The overall injury incidence was 29.4 (95% CI 24.9–34.6) injuries per 1000 athlete days, with an incidence proportion of 28.4%. Injury incidence was significantly higher in the pre‐competition period (54.4; 95% CI 42.5–69.7) compared with the competition period (21.2; 95% CI 17.2–26.1). Acute injuries predominated, with 24% of athletes sustaining at least one acute injury during the Games. The head/face/neck (24%) and knee (20%) were most affected. Common mechanisms included collisions and loss of control. Ten percent of injuries resulted in > 28 days of expected time loss, and the overall injury burden was 70.6 days lost per 1000 days. No difference in injury incidence was found with regards to sex and age. Athletes with limb deficiency reported the highest injury proportions, followed by those with spinal cord injury. Across three Paralympic Games, nearly one‐third of Para Alpine skiers sustained an injury. These findings highlight a need for enhanced prevention strategies, particularly those targeting the high‐risk pre‐competition period and focusing on mechanisms to protect the head/face/neck and knee.

Physiological exercise testing is an important component in the training and development of Para athletes. It helps to evaluate initial fitness and strength levels, monitor training progress, guide training programs, identify injury risks, and investigate the potential benefits of equipment changes. Given the diverse range of disabilities among Para athletes, physiological testing must be adapted to meet individual needs and capabilities. In this chapter, we first provide a comprehensive overview of physiological exercise testing, covering assessments of aerobic and anaerobic capacity, as well as muscular strength. The role of field testing is briefly described. Lastly, specific test considerations are outlined for wheelchair athletes, athletes with cerebral palsy, and athletes with intellectual disabilities.

Para athletes are at higher risk for sports-related injuries, illnesses and other health conditions when participating in sports. In fact, the unique demands placed on Para athletes, both in terms of the specific impairments they experience and the adaptive equipment they use, can lead to a distinctive set of challenges and risks in the context of sports-related health compared to nondisabled athletes. It has been suggested that the impairment itself should be considered as an intrinsic risk factor for a sports-related injury or illness. This chapter presents the most important impairment-related mechanisms that may contribute to an injury or illness for the most common athlete impairment categories. Furthermore, this chapter highlights the need for pre-participation screening, athlete health monitoring and prevention of sports injuries and illnesses in Para sport.

Background: Wheelchair basketball is one of the most popular Para sports globally. However, there is limited literature on the epidemiology of injuries sustained by wheelchair basketball players. Objectives: This study aimed to describe injuries sustained by Paralympic athletes participating in wheelchair basketball at the London 2012 and Rio 2016 Paralympic Games. Methods: This study is a sub-study of the ongoing Paralympic injury and illness surveillance studies. Injury information from 430 athletes who participated in wheelchair basketball at the two Paralympic Games was analysed. Injuries were described by overall incidence, age, sex, onset, anatomical area, type of impairment, and time loss. Results: In total, 75 injuries were documented in 66 athletes during the Paralympic Games, with an injury incidence of 12.5 (95% CI 9.6-15.3) injuries per 1000 athlete days. The upper limb was the most injured anatomical region (55%), and athletes with spinal cord-related disorders incurred the most injuries (55%). At the Rio 2016 Paralympic Games, most injuries (88%) were associated with no time loss. Conclusion: This study's findings are consistent with existing literature describing the incidence observed in other wheelchair-based sports at the Paralympic Games. Injuries affecting the upper limb may indicate the influence of the nature of the sport and/or the additional load and inadequate rest of the upper limb in athletes who use wheelchairs outside of sporting activities, particularly in those with spinal cord-related disorders. These findings can assist medical staff in understanding the high incidence of low-burden upper limb injuries among athletes competing in wheelchair basketball.

Introduction: Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking. Methods: A blinded, randomized control trial was conducted in a group of K3–K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances (p < 0.05) and Cohen d. Results: Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m²) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force (p = 0.02) and external knee adduction moment (p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side (p < 0.01). Conclusion: Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals’ ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.

The aim of this systematic review was to evaluate eye illnesses in para athletes in the winter and summer settings. A search was conducted using PubMed-Medline, EbscoHost, and Web of Science for full-text original research articles published anytime until November 2022. Studies that reported quantitative data on eye illness in highly active individuals and para athletes, at any level of performance (elite/nonelite/recreational), aged 15–75 yrs were included. Of the eight studies included, two reported eye pathologies in athletes with visual impairment only, and six studies reported specific factors associated with eye illnesses in various impairments. Illnesses in the eye and adnexa were more prevalent in winter (incidence: 1.6–2.2/1000 athlete days) compared to summer (incidence: 0.3–0.5/1000 athlete days) settings. Eye illnesses were reported in athletes with limb deficiency (33.5%), spinal cord injury (29.4%), visual impairment (10.6%), and central neurologic impairment (15.2%). The findings of this review indicate that: (1) eye illness in para athletes is an understudied area; and (2) eye illnesses are present in athletes with impairments other than visual impairment. There is a need for further research on eye illness, particularly in winter sports settings to understand the types and nature of eye illness affecting para athletes during competition and training settings.

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 (pConclusion 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.