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Objective: To describe the epidemiology of sports injury at the Pyeongchang 2018 Paralympic Winter Games.Methods: 567 athletes from 49 countries were monitored daily for 12 days over the Pyeongchang 2018 Paralympic Winter Games (6804 athlete days). Injury data were obtained daily from teams with their own medical support (41 teams and 557 athletes) and teams without their own medical support (8 teams and 10 athletes) through two electronic data capturing systems.Results: 112 of 567 athletes (19.8%) reported a total of 142 injuries, with an injury incidence rate (IR) of 20.9 per 1000 athlete days (95% CI 17.4 to 25.0). The highest IR was reported for para snowboard (IR of 40.5 per 1000 athlete days [95% CI 28.5 to 57.5]; p<0.02), particularly in the lower limb and head/face/neck anatomical areas. Across all sports at the Games, acute traumatic injuries (IR of 16.2 per 1000 athlete days [95% CI 13.2 to 19.8]) and injuries to the shoulder/arm/elbow complex (IR of 5.7 per 1000 athlete days [95% CI 4.2 to 7.8]) were most common. However, most injuries (78.9%) did not require time loss.Conclusion: The new Paralympic Winter Games sport of Para snowboard requires attention to implement actions that will reduce injury risk. The shoulder was the most injured single joint-a consistent finding in elite para sport. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: This study investigated bone mineral density (BMD, g/cm²), fat mass (FM, kg), and fat-free soft tissue mass (FFSTM, kg) in Paralympic athletes with cerebral palsy (CP) using dual-energy x-ray absorptiometry. Methods: Bone mineral density, BMD Z scores (standard deviations), FM, and FFSTM were measured for the whole body and at the lumbar spine, femoral neck, and total hip sites on both nonaffected and affected sides of 6 athletes with hemiplegic CP. Results: There were no differences between nonaffected and affected sides with respect to site-specific BMD and BMD Z scores and FM. Fat-free soft tissue mass was significantly lower on the affected side in both upper and lower limbs (15% lower; P<0.05). Conclusion: The present study is the first to describe similar BMD between sides, symmetry in FM, and asymmetry in FFSTM in Paralympic athletes with CP. These findings have important consequences for rehabilitation, as they indicate the potential for positive physiological adaptation as a result of exercise training over long periods of time. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: This study investigated performance, neuromuscular characteristics, and fatigue in Paralympic athletes with cerebral palsy (CP) during a maximal explosive performance trial, compared with well-trained, sprint-specific able-bodied athletes. Design: Six Paralympic athletes with hemiplegic CP and 12 able-bodied athletes performed one 40-m sprint test (in seconds) and Vertical Jump Tests off both legs (in centimeters), the affected leg individually (in centimeters), and the nonaffected leg individually (in centimeters) before and after an adapted Multistage Shuttle Run Test to exhaustion. Electromyography of five bilateral muscles was measured for mean amplitude (percentage maximum activation). Results: The 40-m sprint test, Vertical Jump Test off both legs, and Vertical Jump Test off the affected leg were significantly compromised in the CP group, whereas the Vertical Jump Test off the nonaffected leg was similar between groups (P < 0.05). Both groups fatigued similarly in performance and electromyography. Affected side electromyography was higher than nonaffected electromyography in the Vertical Jump Test off both legs and Vertical Jump Test off the affected leg in both groups. Conclusions: The similarity in fatigue between CP and able-bodied groups confirms that Paralympic athletes with CP may have overcome deficits associated with CP documented in sedentary children. The identified asymmetry may assist with a deeper understanding of performance deficits in CP, as it is indicated that activity generated by both legs is performed toward the capacity of the affected leg. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the sprint cycling performance and neuromuscular characteristics of Paralympic athletes with cerebral palsy (CP) during a fatiguing maximal cycling trial compared with those of able-bodied (AB) athletes. Design: Five elite athletes with CP and 1 6 AB age- and performance-matched controls performed a 30-sec Wingate cycle test. Power output (W/kg) and fatigue index (%) were calculated. Electromyography was measured in five bilateral muscles and expressed in mean amplitude (mV) and median frequency (Flz). Results: Power output was significantly higher in the AB group (10.4 [0.5] W/kg) than in the CP group (9.8 [0.5] W/kg) (P < 0.05). Fatigue index was statistically similar between the AB (27% [0.1%]) and CP (25% [0.1%]) groups. Electromyographic mean amplitude and frequency changed similarly in all muscle groups tested, in both affected and nonaffected sides, in the CP and AB groups (P< 0.05). Neuromuscular irregularities were identified in the CP group. Conclusions: The similarity in fatigue between the CP and AB groups indicates that elite athletes with CP may have a different exercise response to others with CP. The authors propose that this may result from high-level training over many years. This has rehabilitative implications, as it indicates near-maximal adaptation of the CP body toward normal levels. [ABSTRACT FROM AUTHOR]

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., (Copyright © 2024 The Authors. Published by Wolters Kluwer incorporated on behalf of The International Society for Prosthetics and Orthotics.)

Objective: Osteoarthritis (OA) is a major cause of impairment. Research has shown that individuals with unilateral lower limb amputation (ULLA) are 17 times more likely to develop OA on their sound side limb. Therefore, this review aimed to describe similarities and differences in the biomechanical loading variables of individuals with OA and those with ULLA., Design: Researchers systematically searched PubMed-Medline, EBSCOhost and Web of Science for articles published between January 1990 and February 2022. Included studies investigated the biomechanical profiles (peak external knee adduction moment (KAM); peak external knee flexion moment (KFM); ground reaction force; external knee adduction moment loading rate; external knee adduction moment impulse) of both population groups., Results: A total of 31 articles were included in this review. Only KAM and KFM presented similar profiles in both groups, whilst all other variables were dissimilar. The use of advanced prostheses reduced the loading on the sound side of individuals with ULLA., Conclusion: As both KAM and KFM are surrogate measures for knee contact forces, interventions need to target these variables to help manage and prevent the development of OA. Interventions, particularly for addressing these variables in individuals with ULLA, should be further investigated in future research., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures., Methods: Daily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system., Results: 4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p<0.0001). Dermatological and respiratory illnesses had the highest incidence (1.1 and 0.8, respectively). Illness burden was 4.9 days per 1000 athlete days and 23% of illnesses resulted in time loss from training/competition>1 day., Conclusion: The incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk., Competing Interests: Competing interests: All authors have declared no competing interests. WD is an associate editor of BJSM IPHP editions., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)