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Para and Adapted Sports Medicine, An Issue of Physical Medicine and Rehabilitation Clinics of North America

Para and Adapted Sports Medicine, An Issue of Physical Medicine and Rehabilitation Clinics of North America

Yetsa A. Tuakli-Wosornu | Wayne Derman

(2018)

Additional Information

Book Details

Abstract

This issue of Physical Medicine and Rehabilitation Clinics will cover a number of important topics related to Para and Adapted Sports Medicine. The issue is under the editorial direction of Drs. Yetsa Tuakli and Wayne Derman. Topics in this issue will include: Representations of self and disability through para sport; Prosthetics in para sport; Evidence-based classification of para athletes; Autonomic nervous system in para athletes with spinal cord injury; Training and performance characteristics of para swimmers; Concussion in para athletes; Engineering and technology in wheelchair sport; The Athlete with brain injury; Social inclusion through para sport; and Para athletic identity from competition to retirement.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Para and Adapted\rSports Medicine\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents ix
Foreword: Maximizing One’s Potential ix
Preface: Contemporary Medical, Scientific & Social Perspectives on Para Sport ix
Illness Among Paralympic Athletes: Epidemiology, Risk Markers, and Preventative Strategies ix
Acute and Chronic Musculoskeletal Injury in Para Sport: A Critical Review ix
Autonomic Nervous System in Paralympic Athletes with Spinal Cord Injury ix
Athletes with Brain Injury: Pathophysiologic and Medical Challenges x
Key Nutritional Strategies to Optimize Performance in Para Athletes x
Concussion in Para Sport x
Applying Scientific Principles to Enhance Paralympic Classification Now and in the Future: A Research Primer for Rehabilita ... x
Performance Characteristics of Para Swimmers: How Effective Is the Swimming Classification System? xi
Engineering and Technology in Wheelchair Sport xi
Sport-Specific Limb Prostheses in Para Sport xi
Para Sport Athletic Identity from Competition to Retirement: A Brief Review and Future Research Directions xii
The Social Empowerment of Difference: The Potential Influence of Para Sport xii
Social Inclusion Through Para Sport: A Critical Reflection on the Current State of Play xii
Paralympic Games: History and Legacy of a Global Movement xii
PHYSICAL MEDICINEANDREHABILITATION\rCLINICS OF NORTH AMERICA\r xiii
FORTHCOMING ISSUES xiii
August 2018 xiii
November 2018 xiii
February 2019 xiii
RECENT ISSUES xiii
February 2018 xiii
November 2017 xiii
August 2017 xiii
Foreword:\rMaximizing One’s Potential xv
Preface:\rContemporary Medical, Scientific & Social Perspectives on Para Sport xvii
Illness Among Paralympic Athletes 185
Key points 185
INTRODUCTION 185
METHODOLOGY 186
RISK OF ILLNESS IN PARALYMPIC ATHLETES 187
Incidence Rate and Incidence Proportion of Illness in Paralympic Athletes Versus Olympic Athletes 187
Incidence of Illness in Paralympic Athletes in Different Organ Systems 187
RISK MARKERS FOR ILLNESS IN PARALYMPIC ATHLETES 187
Extrinsic Risk Markers for Illness in Paralympic Athletes 189
Precompetition versus competition period 189
Sport code 189
Other possible extrinsic risk markers for illness 192
Intrinsic Risk Markers for Illness in Paralympic Athletes 193
Age 193
Sex 193
Other possible intrinsic risk markers for illness in Paralympic athletes 193
Impairment type 193
Underlying unique medical conditions in Paralympic athletes 194
PREVENTATIVE STRATEGIES TO DECREASE RISK OF ILLNESS IN PARALYMPIC ATHLETES 198
General Preventative Strategies 198
Specific Preventative Strategies 198
SUMMARY 198
ACKNOWLEDGMENTS 201
REFERENCES 201
Acute and Chronic Musculoskeletal Injury in Para Sport 205
Key points 205
INTRODUCTION 206
METHODS 206
RESULTS 207
Summary of Search Results 207
Eligible impairment categories 207
General injury trends in summer and winter Para sports 207
Summer Sports 235
Athletics 235
Football (5-a-side, 7-a-side, intellectual impairment, amputee) 235
Swimming 236
Sitting volleyball 236
Para powerlifting 236
Wheelchair fencing 236
Para cycling 236
Overhead summer Para sports 236
Para sailing and rowing 237
Winter Sports 237
Para skiing/snowboarding 237
Para ice hockey (formerly called IPC ice sledge hockey) 237
DISCUSSION 237
The Lifetime Injury Model 237
SUMMARY 238
REFERENCES 238
OVID MEDLINE SEARCH STRATEGY 243
Autonomic Nervous System in Paralympic Athletes with Spinal Cord Injury 245
Key points 245
INTRODUCTION 245
ORGANIZATION OF THE AUTONOMIC NERVOUS SYSTEM 246
CLASSIFICATION OF SPINAL CORD INJURY 248
Neurologic Classification 248
Evaluation of Remaining Autonomic Functions 248
Paralympic Classification 249
CONSEQUENCES OF SPINAL CORD INJURY 250
Sensorimotor Dysfunction 250
Autonomic Dysfunction 250
Impact of autonomic dysfunction on the heart 250
Cardiovascular disease in athletes with spinal cord injury 251
Cardiac output in athletes with spinal cord injury 251
Heart rate responses in athletes with spinal cord injury 252
Resting blood pressure in athletes with spinal cord injury 252
Orthostatic hypotension in athletes with spinal cord injury 253
Autonomic dysreflexia in athletes with spinal cord injury 253
Impact of blood pressure instability on performance in athletes with spinal cord injury 254
Respiratory dysfunction in athletes with spinal cord injury 254
Impairment of thermoregulation in athletes with spinal cord injury 255
Neurogenic lower urinary tract dysfunction in athletes with spinal cord injury 256
Neurogenic bowel dysfunction in athletes with spinal cord injury 257
Enhancement of Performance During Competition 257
SUMMARY 258
REFERENCES 259
Athletes with Brain Injury 267
Key points 267
INTRODUCTION 267
DEFINITION AND CAUSES OF BRAIN INJURY 268
Congenital Brain Injury 268
Acquired Brain Injury 268
PATHOPHYSIOLOGIC CHALLENGES OF ATHLETES WITH BRAIN INJURY 268
Neuromuscular Control of Movement 268
Decreased central output 268
Movement dysfunction associated with brain injury 268
Hypertonia 269
Incoordination 269
Coactivation 269
Measurement of Muscle Irregularities in a Clinical Setting 269
Gravitation Toward the Affected Side 269
Athletes May Gravitate Toward Improved Function 271
Residual Effect of Brain Injury 271
Rehabilitation of Individuals with Hemiplegic Brain Injury 271
PARTICIPATION IN SPORT 271
Sports for Athletes with Brain Injury 272
Paralympic Classification 272
Sport Classification 272
Performance of Athletes with Brain Injury at the Paralympic Games 273
MEDICAL CHALLENGES OF ATHLETES WITH BRAIN INJURY 273
Exercise-Related Medical Challenges 273
Ankle and foot deformities 273
Pain 274
Fatigue 274
Musculoskeletal injury 274
Maximal exertion and muscle spasms 275
Degenerative arthritis 275
Non–exercise-related Medical Challenges 275
Postimpairment Syndrome and the Effect of Sedentary Behavior 275
Psychological Resilience 277
SUMMARY 277
REFERENCES 277
Key Nutritional Strategies to Optimize Performance in Para Athletes 283
Key points 283
INTRODUCTION 283
NUTRITION CONSIDERATIONS IN PARA ATHLETES 284
NUTRIENTS THAT IMPACT ATHLETIC PERFORMANCE 287
Energy 287
Energy expenditure 287
Feeding concerns 287
Inadequate energy intake 287
Carbohydrate 288
Fueling recommendations 289
Muscle glycogen resynthesis post exercise 289
Gastrointestinal concerns 289
Protein 290
Meal plan example for a moderate training day 290
Iron 291
Iron testing in athletes 291
Treatment considerations 292
Inhibition and enhancement of iron 292
Vitamin D and Bone Health 293
Benefits of optimal vitamin D status in athletes 294
Causes of vitamin D insufficiency 294
Vitamin D testing in athletes 294
Recommendations to optimize vitamin D status 294
Recommendations to optimize bone health 295
SUMMARY/DISCUSSION 296
REFERENCES 296
Concussion in Para Sport 299
Key points 299
INCIDENCE 300
Paralympic Games Injury Surveillance 300
Sport-Specific Studies 303
Football 5-a-side 303
Wheelchair basketball 303
Para ice hockey 304
Summary 305
ASSESSMENT 305
MANAGEMENT 307
RISK REDUCTION 307
Education 308
Enforcement 308
Engineering 309
“MIND THE GAP” 310
REFERENCES 310
Applying Scientific Principles to Enhance Paralympic Classification Now and in the Future 313
Key points 313
INTRODUCTION 314
Vision of the Paralympic Movement and Evidence-Based Classification 314
Governance and Terminology in Para Sport 314
Implications of Para Sport Governance for Researchers 316
Taxonomic Evolution of Para Sport Classification 316
Specific Aims 320
THE CURRENT CLASSIFICATION PROCESS 320
Taxonomic Foundations for an Evidence-Based Classification System 320
The Athlete Classification Process 321
USING THE SCIENTIFIC METHOD TO ENHANCE CLASSIFICATION 323
Descriptive Versus Experimental Science 323
Improving Extant Systems of Classification Through Science 324
Developing New Systems of Classification 326
THE FIRST DATA-DRIVEN PARA SPORT CLASSIFICATION STRUCTURE 328
Translational Research: Getting Evidence-Based Systems of Classification into Practice 329
ROLES FOR PHYSICAL MEDICINE AND REHABILITATION SPECIALISTS IN PARA SPORT CLASSIFICATION 330
SUMMARY 330
REFERENCES 331
Performance Characteristics of Para Swimmers 333
Key points 333
INTRODUCTION 333
METHODOLOGY 335
RESULTS 335
DISCUSSION 339
SUMMARY 345
REFERENCES 345
Engineering and Technology in Wheelchair Sport 347
Key points 347
INTRODUCTION 347
FUNDAMENTAL PRINCIPLES OF SPORTS WHEELCHAIR DESIGN 348
Weight 348
Stiffness and Strength 348
Resistance 348
Ergonomics 348
ADVANCED DESIGN AND FABRICATION TOOLS 349
BREAKTHROUGH SPORT WHEELCHAIRS 350
TECHNOLOGICAL INEQUITIES 352
APPROPRIATE WHEELCHAIR DESIGN AND USE IN RESOURCE-SCARCE ENVIRONMENTS 353
Social Enterprise and Policy 354
Design Features of Wheelchairs in Resource-Scarce Environments 354
ELECTRONIC TOOLS AND TECHNOLOGIES FOR SPORT AND PHYSICAL ACTIVITY 355
Wearable Technologies 355
Computer-Assisted Rehabilitation Environment 356
Resistance Training and Vibration Exercise 358
The SmartWheel 359
Video Game Motivation for Exercise 362
APPLICATIONS AND WEB SITES THAT PROVIDE WORKOUT IDEAS AND INSTRUCTION 362
Applications and Web Sites for Accessible Fitness Information and Resources 362
Applications and Web Sites for Developing Sport-Specific Skills 363
SUMMARY 363
REFERENCES 363
Sport-Specific Limb Prostheses in Para Sport 371
Key points 371
INTRODUCTION 371
AMPUTATION 372
Upper Limb Amputation 372
Lower Limb Amputation 372
CLASSIFICATION 372
PROSTHETIC COMPONENTS 373
Upper Limb Prostheses 373
Lower Limb Prostheses 373
Cycling prostheses 374
Bicycle setup considerations 375
Regulations regarding prostheses 376
Long jump prostheses 376
Differences in jump techniques between amputees and able-bodied athletes 377
Running-specific prostheses 378
Unilateral versus bilateral prostheses 379
Transtibial versus transfemoral amputees 380
FACTORS INFLUENCING PARTICIPATION SPORT AND PHYSICAL ACTIVITY 380
MEDICAL FACTORS RELATED TO AMPUTEES 381
SUMMARY 382
REFERENCES 382
Para Sport Athletic Identity from Competition to Retirement 387
Key points 387
INTRODUCTION 387
Quantitative Research 388
Athletic Identity Measurement Scale 388
Correlates of athletic identity 389
Athletic identity and Para sport participation 389
Qualitative Research 389
Athletic identity among persons with acquired disability 389
Affirmative model challenges disablist attitudes 390
Athletic identity is correlated with personal and social identities 390
Para Sport Athletic Identity: Future Research Directions 391
Identity development in Para athletes with congenital and acquired disabilities 391
Narrative identity 393
Identity implications of leaving sport 393
SUMMARY 394
REFERENCES 394
The Social Empowerment of Difference 397
Key points 397
INTRODUCTION 397
THE HEGEMONIC POWER OF ABLEIST NORMS 399
WHY DIFFERENCE MUST MATTER IN PARA SPORTS 401
THE CHALLENGE DIFFERENCE IMPOSES ON PARA SPORTS 404
SUMMARY 405
REFERENCES 406
Social Inclusion Through Para sport 409
Key points 409
INTRODUCTION 409
THE IMPORTANCE AND VALUE OF PARA SPORT 410
SEPARATE AND UNEQUAL? 411
HOW FAIR AND INCLUSIVE ARE THE PARALYMPIC GAMES? 412
DO THE PARALYMPIC GAMES INCREASE PARTICIPATION IN PARA SPORT? 412
DO THE PARALYMPIC GAMES PERPETUATE UNHELPFUL IMAGES AND STEREOTYPES? 413
TENSIONS BETWEEN BIOMEDICAL AND SOCIAL MODELS OF DISABILITY 413
WHAT ROLE WILL SPORTS MEDICINE PLAY IN THE FUTURE OF THE PARALYMPIC GAMES? 414
SUMMARY 414
REFERENCES 415
Paralympic Games 417
Key points 417
DISABILITY SPORT 417
PARA SPORT 418
THE MODERN PARALYMPIC GAMES 419
INTERNATIONAL PARALYMPIC COMMITTEE AND INTERNATIONAL OLYMPIC COMMITTEE RELATIONSHIP 420
GAMES LEGACY 422
REFERENCES 424