Adaptive Sports Medicine (eBook)

Arthur J. De Luigi, DO, MedStar National Rehabilitation Hospital/Georgetown University Hospital, Professor of Rehabilitation Medicine, Washington, DC, USA Dr. De Luigi is internationally recognized as a leader in Adaptive Sports Medicine through his extensive experience with disabled athletes, holding positions as the Medical Director and Head Team Physician for the U.S. Adaptive Alpine Ski Team, Medical Director of the Walter Reed Army Medical Center Adaptive Sports Medicine Program, and coverage of Paralympic athletes at the United States Olympic Training Center. He is currently the Head Team Physician and Director of Sports Performance for the Washington Wizards, Medical Director for the Washington Mystics, and Team Physician for the Washington Spirit.He has served as the Medical Director of the Army Ten Miler and Co-Medical Director of the Salt Lake Marathon. Additionally, he has served as a physician for the United States Olympic Committee, U.S. Ski and Snowboarding Association, USA Basketball, USA Boxing, US Lacrosse, University of Utah, Catholic University, Salt Lake Bees baseball team (Los Angeles Angels AAA affiliate), and the Washington Nationals.

Preface 7
Acknowledgments 9
Contents 10
List of Contributors 13
Part I: Adaptive Sports Medicine: History, Technology and Biomechanics 17
1: History of Adaptive and Disabled Rights within Society, Thus Creating the Fertile Soil to Grow, Adaptive Sports 18
History of Adaptive Sports and Disabled Rights Movement 18
Before It All: When Disability Was Criminal 18
Early Wars and the Advance of Disabled Rights 19
The Great Depression and Disabled Rights 21
WWII: German Atrocities and Post-­War Benefits for Disabled Veterans 21
1960s: Women’s Rights Movement, Civil Rights Movement, and Disabled Rights Movements 23
Rights to Education 24
The Development of Organized Adaptive Sports: Many Paths Toward the Same Goal 26
Physical Activity for Rehabilitation 26
Evolution of Sports from Recreational to Competitive: The Development of Paralympics 28
Disabled Sport USA, Becoming the Largest Organization in the United States, from Humble Beginnings 30
Leveling the Playing Field: Adaptive Athletes in Able-Bodied Events 31
Conclusion: The Future of Adaptive Sports 32
References 32
2: Wheelchair Sports Technology and Biomechanics 35
Introduction: The Role of Technology in Wheelchair Sports 35
Brief History of Wheelchair Sports Technology 36
Importance of Seating for Sports Wheelchairs 37
Wheelchair Slalom 38
Wheelchair Basketball 39
Wheelchair Rugby 41
Wheelchair Softball 41
Wheelchair Racing 43
Handcycling 45
References 48
3: Technology and Biomechanics of Adaptive Sports Prostheses 49
Introduction 49
Benefits to Participating in Adaptive Sports for Persons with a Limb Deficiency 49
Advances in Sports Prosthetics 50
General Use Versus Sports Prosthesis: Principles of Design for Prostheses 50
Standard General Use or Utility Prosthesis 50
Sport-Specific Prosthesis 51
Prosthetic Design Alignment and Componentry 51
General Alignment for Sports Prostheses 51
Biomechanics and Force Reduction in Sports Prostheses 52
Considerations for Various Sport-­Specific Prostheses 53
Running Prosthesis 53
Transtibial Running Prostheses 53
Transfemoral Running Prostheses 53
Adaptive Cycling Prostheses 54
Adaptive Golfing Prostheses 55
Winter Sports Adaptive Equipment 55
Adaptive Alpine (Downhill) Skiing Equipment 55
Adaptive Nordic (Cross-Country) Skiing Equipment 56
Adaptive Snowboarding Prostheses 57
Water Sports 57
Adaptive Swimming Prostheses 57
Adaptive Kayaking Prostheses 58
Adaptive Rock Climbing Prostheses 58
Hiking Prostheses 58
Energy Cost of Ambulation 59
Controversies 59
References 60
Part II: Medical Considerations in Adaptive Sports Medicine 62
4: Review of Injury Epidemiology in Paralympic Sports 63
Introduction 63
Evolution of Paralympic Sports 63
Definition of Injury 64
Review of the Literature 64
Anatomic Location of Injury 65
Winter Sports 65
Summer Sports 65
Type of Injury 66
Acute vs. Chronic 66
Diagnosis 67
Rate of Injury 67
Winter Sports 67
Summer Sports 68
Discussion 68
References 69
5: Medical Considerations in Adaptive Sports 71
Pre-participation Physical Examination 71
Medical Complications 73
Spinal Cord Injuries 73
General (Thermoregulation) 73
Dermatologic 73
Nervous System 73
Musculoskeletal 74
Visceral 75
Limb-Deficient Athletes 75
General 75
Dermatologic 75
Nervous System 76
Musculoskeletal 76
Cerebral Palsy (CP) 76
Dermatologic 76
Nervous System 77
Cardiovascular 77
Musculoskeletal 77
Medications 77
Visually Impaired 78
Musculoskeletal 78
Intellectually Disabled Athletes 78
General (Thermoregulation) 78
Nervous System 78
Cardiovascular 79
Musculoskeletal 79
Medications 79
Les Autres 79
Injury Prevention and Treatment 79
Environmental Illness 80
References 80
6: Emergent Care of the Adaptive Athlete 82
Introduction 82
Emergency Department Care 82
Airway 83
Breathing (Respiratory) 85
Circulation 86
Disability 87
References 88
7: Surgical Considerations in the Adaptive Athlete 89
Introduction 89
Surgical Outcomes 89
Introduction 89
Outcome Scores 91
Outcomes 91
Arthroplasty 91
Rotator Cuff Repair 92
References 94
8: Rehabilitation of the Adaptive Athlete 96
Introduction 96
The Progression of the Adaptive Games to Present 96
Major Contributors to the Movement 97
The Benefits of Exercise and Competition for Adaptive Athletes 97
Types of Disabilities Involved 97
Rehabilitation and Care for Disabled Athletes 98
References 99
Part III: Adaptive Sports 100
9: Adaptive Running 101
Introduction/History 101
Disability Groups 102
Classification 102
Equipment 103
Prostheses for Amputee Athletes 103
Racing Wheelchairs 104
Wheelchair Propulsion Techniques 105
Injuries and Injury Prevention 106
Special Considerations 107
Autonomic Dysreflexia/“Boosting” 107
Impaired Thermoregulation 109
References 109
10: Adaptive Cycling 111
Introduction 111
The Adaptive Sports Cycle and Wheelchair 111
Adaptive Cycling History and as a Paralympic Sport 111
Adaptive Cycle Design and Technology 113
Prosthetic Design and Technology for Limb Deficient Adaptive Cyclists 114
Sports Wheelchair Technology 115
Injuries and Medical Concerns 116
Autonomic Syndromes, Environment, and Boosting 116
Musculoskeletal, Neurologic, and Pain Syndromes 116
Gastrointestinal/Genitourinary 117
Cardiopulmonary 117
Dermatologic and Skin Conditions 118
Endocrine 118
Psychological Factors 118
References 119
11: Adaptive Golf: History, Rules and Equipment Modifications, and Sport-Specific Injuries 120
The Game of Golf: A Brief History 120
Adaptive Golf: Legislation and Community Perception 121
Adaptive Golf: Clubs and Events 121
The National Amputee Golf Association [13] 122
The National Alliance for Accessible Golf [14] 122
The Adaptive Golf Association [15] 122
Training and Lead-Up Activities 122
Rules/Modifications of the Game 122
Blind Golfers [19] 123
Amputee Golfers [20] 123
Golfers Requiring Canes or Crutches [21] 123
Golfers Requiring Wheelchairs [22] 123
Golfers with Intellectual Disabilities [23] 123
Adaptive Equipment 124
Golfers with Loss of Upper Limb Function [24] 124
Golfers with Loss of Lower Limb Function [24] 124
Miscellaneous 125
Golf Injuries and Rehabilitation 125
Low Back Injury 125
Shoulder Injuries 126
Elbow, Wrist and Hand Injuries 126
Lower Limb Injuries 127
Head and Neck Injuries 127
Conclusion/Summary 127
References 127
12: Wheelchair Basketball 130
Introduction 130
Disability Groups and Classifications 130
Equipment 132
Medical Conditions and Injuries 134
Musculoskeletal Injuries 134
Nerve Injuries 136
Spasticity 137
Endocrine 137
Cardiovascular 138
References 140
13: Wheelchair Rugby 142
Introduction to the Sport 142
History 142
Who Plays It (Spinal Cord Injury) 144
Rules of the Sport 146
Equipment (Modified Wheelchairs) 148
Common Injuries 149
Musculoskeletal Injuries 150
Peripheral Nerve Entrapment 150
Thermoregulation 150
Pressure Ulcers 151
Spasticity 151
Neurogenic Bowel and Bladder 151
Heterotropic Ossification 152
Autonomic Dysreflexia 152
References 153
14: Power (Wheelchair) Soccer 155
Introduction [1] 155
Basics of Competition [5, 6] 156
Field of Play (Fig. 14.1) 156
Dimensions 156
Surface 156
Equipment 156
Ball 157
Adapted Power Wheelchair 157
Power Wheelchair Biomechanics 159
Match 159
Game Play 159
Scoring 159
Officiating: Referee ± Assistants [11] 160
Fouls 161
Classifications [3] 161
Injury Epidemiology 161
Injury Prevention 161
Benefits of Participation 162
Barriers to Participation 162
Special Considerations [31] 163
Summary 163
Bibliography 164
References 164
15: Wheelchair Softball 166
Classification Process for Wheelchair Softball Athletes 166
Rules and Regulations of the Game 167
Field Setup 167
Rules of Play 168
Equipment 169
Biomechanics 169
Injuries and Injury Prevention 170
Mild Traumatic Brain Injuries (TBI) and Facial Injuries 171
Shoulder Injuries: Rotator Cuff, Labrum, Impingement, Scapular Dyskinesis 172
Elbow Injuries 172
Wrist and Hand Injuries 172
Lower Extremity Injuries 173
Skin and Other Soft Tissue Injuries 173
Appendix 173
Muscle Strength Grades 173
References 173
16: Wheelchair Dance Sport 176
Introduction 176
Rules and Regulations 176
Rules of WDS 177
General Rules 177
Movements/Lifts 177
Time Requirements 177
Judging 177
Classification Process for Wheelchair Dance Sport Athletes 177
Equipment 178
Wheelchairs 178
Dance Floor 178
Biomechanics 179
Common Injuries and Injury Prevention 179
Common Wheelchair Athlete Injuries 180
Upper Limb Injuries 180
Spine Injuries 180
Soft Tissue Injuries 180
Lower Extremity Injuries 180
Injury Prevention for Wheelchair Sports (General) 181
Able-Bodied Dance Sport Injuries 181
Injury Prevention in WDS 182
Summary 182
Appendix 182
Modified Ashworth Scale [1] 182
Daniels and Worthingham Scale [2] 182
References 183
17: Wheelchair Fencing 185
Introduction 185
Rules and Regulations 185
Common Competition Rules 185
Holding the Weapon 186
On Guard: Beginning, Stopping, and Restarting a Bout 186
Lifting from the Chair and Balance 187
Stoppage: Wheelchair Damage and Injuries 187
Field of Play 187
Equipment 187
Wheelchair 187
Weapons 188
Classification Process for Wheelchair Fencing 188
Biomechanics 189
Common Injuries and Injury Prevention 190
Common Wheelchair Athlete Injuries 190
Upper Limb Injuries 190
Spine Injuries 190
Soft Tissue Injuries 191
Lower Extremity Injuries 191
Common Wheelchair Fencing Injuries 191
Able-Bodied Fencing Injuries 191
Injury Prevention in Wheelchair Fencing 191
Injury Prevention for Wheelchair Sports (General) 191
References 192
18: Wheelchair Curling 194
Introduction 194
Equipment 194
The Sheet 194
Stones 194
Wheelchair 196
Rules and Regulations 196
General Rules 196
The Injured Player 196
Wheelchair Setup (Picture 18.3) 196
Wheelchair Anchoring 197
Classification Process for Wheelchair Curling Athletes 197
Biomechanics 198
Common Injuries and Injury Prevention 198
Common Wheelchair Athlete Injuries 198
Upper Limb Injuries 198
Spine Injuries 199
Soft Tissue Injuries 200
Lower Extremity Injuries 200
Wheelchair Curling Injuries 200
Able-Bodied Curling Injuries 200
Injury Prevention in Wheelchair Curling 200
Injury Prevention for Wheelchair Sports (General) 201
Summary 201
Appendix 202
Oxford Scale [33] 202
Ashworth Scale [34] 202
References 202
19: Wheelchair Tennis and Para-table Tennis 204
Wheelchair Tennis: Introduction 204
Rules and Regulations 204
Court Setup 204
Classification Process of Wheelchair Tennis Athletes 204
Quad Division Criteria 205
Rules of Play 206
General Rules 206
Serves 206
Plays 206
Scoring: Game, Set, Match 206
Important Medical Rules 206
Equipment 207
Wheelchair 207
Racquet and Ball 207
Biomechanics 207
Common Injuries and Injury Prevention 208
Common Wheelchair Athlete Injuries 208
Upper Limb Injuries 208
Spine Injuries 209
Soft Tissue Injuries 209
Lower Extremity Injuries 209
Wheelchair Tennis Injuries 209
Able-Bodied Tennis Injuries 210
Injury Prevention in Wheelchair Tennis Players 210
Injury Prevention for Wheelchair Sports (General) 210
Summary 211
Para-table Tennis: Introduction 211
Rules and Regulations 212
Court Setup 212
Classification of Para-table Tennis Players 212
Rules of Play 214
General Overview of Terms [56] 214
General Rules 214
Points 214
Equipment 214
Ball and Racquet 214
Wheelchair 215
Biomechanics 215
Common Injuries and Injury Prevention 216
Common Wheelchair Athlete Injuries 216
Upper Limb Injuries 216
Spine Injuries 217
Soft Tissue Injuries 217
Lower Extremity Injuries 217
Para-table Tennis Injuries 217
Able-Bodied Table Tennis Injuries 217
Injury Prevention in Para-table Tennis 217
Injury Prevention for Wheelchair Sports (General) 218
Summary 218
References 219
20: Adaptive Volleyball 221
Introduction to the Sport and Game Characteristics 221
Eligible Players/Classification 222
Rules [7] 222
Special Positions [7] 222
Coach 222
Assistant Coach 224
Team Leader (Captain) 224
Libero 224
Equipment [7] 224
Playing Area 224
Playing Surface 225
Net, Posts, and Antennae 225
Balls 226
Players’ Equipment and Uniforms 226
Change of Equipment 226
Prohibited Objects 227
Common Injuries 227
References 227
21: Adaptive Water Sports 229
Introduction to Adaptive Water Sports 229
Adaptive Rowing 229
Background 229
Classifications 230
Equipment 231
Adaptive Sailing 232
Background 232
Equipment 233
Adaptive Swimming 234
Background 234
Equipment 236
Other Adaptive Water Sports Including Recreational Sports 238
Adaptive Canoeing/Kayaking 238
Adaptive Water Skiing 239
Common Injuries/Prevention to All Adaptive Water Sports 241
Injuries in Adaptive Swimming 242
Injuries in Adaptive Rowing 243
Injuries in Adaptive Sailing 244
Overview, Conclusions, and External Resources 244
References 244
22: Ice Sled Hockey (Sledge Hockey Outside the United States) 246
Introduction 246
Rules 246
Eligibility 246
Equipment 247
Protective Gear 247
Sled 247
Sticks 247
Medical Management of the Ice Sled Hockey Athlete 247
Infections 247
Dermatologic 248
Cardiovascular 248
Neuromusculoskeletal 249
Discussion 250
References 250
23: Adaptive Alpine Skiing and Para-snowboarding 251
Introduction 251
References 297
24: Adaptive Throwing Sports: Discus, Javelin, Shot Put, and Boccia 300
Classification Overview 300
Field Events: Discus, Javelin, and Shot Put 300
Adaptive Discus 301
Adaptive Javelin 301
Adaptive Shot Put 302
Boccia 302
Adaptive Equipment 304
Sports Medicine Overview 304
Unique Medical Issues 304
Injuries by Disability 305
Injuries by Sport 305
Discus 306
Javelin 306
Shot Put 309
Boccia 310
References 310
25: Shooting Sports (Archery, Air Rifle, Trapshooting) 312
Adaptive Archery 312
Introduction to the Sport and the Characteristics 312
Sports Governance 312
Classification System 313
Wheelchair and Ambulatory Sports, USA 313
US Paralympic Archery 313
World Archery Federation 313
Rule 314
Wheelchair and Ambulatory Sports, USA 314
Paralympics 314
Equipment 314
Adaptive Equipment 315
Common Injuries in Adaptive Archery 315
Parashooting 316
Introduction to the Sport and the Characteristics 316
Sports Governance 316
Competition 316
Disability Groups/Classification System 316
Rules 317
Shooting Positions 317
Rifle 317
Adaptive Equipment 318
IPC-Specific Equipment 319
Trapshooting 319
Introduction 319
Classification 319
Rules 320
Adaptive Equipment 320
Common Injuries 320
References 321
26: Weight Lifting in Adaptive Sport 322
History of Adaptive Powerlifting Sport 322
Classification 322
Rules 323
Adaptive Powerlifting Equipments and Apparels 323
Adaptive Powerlifting Injuries 324
Shoulder Injuries 324
Rotator Cuff Impingement and Tear 324
Glenohumeral Arthritis 326
Osteolysis of the Distal Clavicle 327
Pectoralis Major Rupture 327
Olecranon Bursitis 328
Low Back Pain 328
Prevention of Adaptive Weight Lifting Injuries 329
References 329
27: Adaptive Combative Sports (Judo, Boxing, Wrestling, Mixed Martial Arts) 331
History of Combative Sports (Introduction) 331
Impairments in Combat Sports 331
Classifications/Rules 332
Equipment 333
Role of the Physician 335
Before the Match (Pre-competition Responsibilities) 335
During the Match (Responsibilities During Competition) 335
After the Match (Post-competition Responsibilities) 336
Common Injuries and Management 336
Nasal Trauma 336
Epistaxis 336
Nasal Septal Hematoma 336
Nasal Fracture 336
Eyes 337
Subconjunctival Hemorrhage 337
Corneal Abrasion 337
Periorbital Hematoma 337
Hyphema 337
Retinal Detachment 337
Orbital Blowout Fracture 337
Facial Fractures 338
Nasal Fracture 338
Midface Fracture 338
Mandible Fractures 338
Lacerations 338
Concussion 339
References 339
28: Adaptive Extreme Sports 341
Introduction 341
Adaptive Rock Climbing 341
Classifications 341
Styles of Climbing 341
Rules of Competition 342
Adaptive Equipment 343
Standard Equipment 343
Neurological/Physical Disability/Seated 343
Limb-Deficient Athlete 344
Injuries 345
Injury Prevention 346
Adaptive SCUBA Diving 346
Certification, Rules, and Regulations 346
Equipment and Technique 347
Adaptive Equipment 348
Limb-Deficient Divers 348
Neurodisability 348
Injuries 349
Special Considerations for the Adaptive Diver 351
References 352
Part IV: Selected Topics in Adaptive Sports Medicine 354
29: Adaptive Sports Event Planning 355
Preplanning 355
Rehearsals 357
Injury Surveillance and Medical Clearance 358
Liability/Medical Malpractice 360
Event Coverage 361
Personnel 361
Medical Supplies 362
After-Action Review 364
References 364
30: Policy and Advocacy Initiatives to Promote the Benefits of Sports Participation for Individuals with Disability 366
Introduction 366
Disability and Health Disparities 366
Higher Rates of Obesity and Chronic Disease Among Individuals with Disability 367
Individuals with Disability Engage in Less Physical Activity 367
Lower Rates of Employment Among Individuals with Disability 368
Factors that Influence Physical Activity and Sports Participation in Individuals with Disabilities 368
Environmental Barriers and Facilitators 369
Personal Barriers and Facilitators 370
Social Barriers and Facilitators 370
Public Health Response Aimed to Increase Physical Activity in Individuals with Disabilities 371
Integration of Disability into All Mainstream Programs 371
Disability-Specific Programming 373
Adaptive Sports Organizations Extending Their Public Health Reach 373
Relevant Policy History 374
Future Considerations 375
References 377
31: Controversies in Adaptive Sports 380
Introduction 380
Doping in Adaptive Sports 380
Medications 381
Anabolic Steroids 381
Beta-Blockers 381
Beta2-Agonists 381
Blood Doping 382
Erythropoietin 382
Boosting in Adaptive Sports 382
Autonomic Dysreflexia 382
Effect of Autonomic Dysfunction on Exercise Performance 383
How Widespread Is the Boosting Phenomenon? 384
The Positions of the Governing Bodies of Adaptive Sports 385
How Effective Is the Current Method for Detecting Boosting and Preventing Adverse Events? 385
Future Approaches to Detecting Boosting 385
Equipment and Technology Issues 386
References 386
Index 388