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The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time.To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics.Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS).Community settings, Sweden.From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D.Not applicable MAIN OUTCOME MEASURE: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III).Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p .001). Activity limitations increased (SCIM III total score mean 67 to 61, p .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries.These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.

To describe functional and structural impairments of the pulmonary system in middle-aged people with cervical and upper thoracic spinal cord injuries (SCI), and compare findings to the general population. To determine if the neurological level of injury (NLI) is related to functional and structural impairments, and if age is related to structural impairments.Cross-sectional study with matched controls. Data from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched control data were obtained from the Swedish CArdioPulmonary bioImage Study (SCAPIS).Outpatient SCI unit in southern Sweden.25 people (20% women, mean age 58 years, mean time since injury 28 years, NLIs C2-T6, American Spinal Injury Association Impairment Scale A-C).Not applicable.Lung function was assessed with spirometry, diffusing capacity and impulse oscillometry. Structural assessments were performed with computed tomography.Pulmonary function was generally worse compared to the controls. Structural impairments were common (75% of the participants and 65% of the controls; P = 0.36, NS). NLI was significantly related to some of the functional and structural impairments.Middle-aged people with long-term cervical and upper thoracic SCI can have substantial pulmonary functional impairments, whereas structural impairments do not differ considerably from the general population. Further larger and longitudinal studies should focus on the clinical impact of these impairments over time.

IntroductionThe interest in the health of Para athletes continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population. ObjectiveTo assess (1) the weekly proportion of elite Para athletes reporting anxiety/depression, low sleep levels (10 hours) 4 weeks prior to an illness (p = .016). ConclusionThis cohort of elite Para athletes reported relatively high levels of anxiety/depression, low sleep levels, and pain, which is a concern. High sleep levels and the risk for illness might be an indication of overtraining, which commonly leads to persistent fatigue and an increased susceptibility to infections. Monitoring of the health of elite Para athletes is recommended to be able to improve performance and health in this population.

ObjectiveTo describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures.MethodsDaily 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.Results4403 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; p1 day.ConclusionThe 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.

Cross-sectional and longitudinal. To (i) describe sense of coherence (SOC) and changes over six years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in SOC are associated with injury characteristics and changes in sociodemographics and secondary health conditions (SHCs; bowel-related and bladder-related problems, pain and spasticity). Community in Southern Sweden. From the initial 123 participants in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 76 individuals (33% women, median age 66 years, median time since injury 30 years, AIS A-D, 30% complete) responded to the 13-item SOC scale (range 13–91) twice with a 6-year interval. Data were analyzed with multivariable hierarchical regression. The participants rated a strong SOC at both assessments (median 73 and 76.5, respectively) which significantly increased over time. Overall, their marital status and vocational situation remained stable whereas SHCs increased. A change from not having a partner to having one was the only significant explanatory factor for a positive change in SOC. The present study describes, for the first time, changes in SOC over time and associated factors in older adults aging with long-term SCI. They generally maintain a strong ability to understand, handle, and being motivated when dealing with stressful events arising in their lives as a result of their SCI. The associations emphasize the importance of the social context for successful adaptation to living with SCI along the aging process.

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were interviewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (>70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants’ activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.

Study design Cross-sectional and longitudinal. Objectives To (i) describe health-related quality of life (HRQoL) and changes over 6 years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in HRQoL are associated with age, gender, and injury characteristics. Setting Community in southern Sweden. Methods From the initial 123 participants (years 2011–2012) in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 77 individuals (32% women, C1-L3, AIS A–D, median age 66 years, median time since injury 31 years, 30% complete injuries) were assessed 6 years later. HRQoL was rated with the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23). Associations were investigated using multivariable linear regression analyses. Results The median rating of global QoL (scale range 0–100) was relatively high at both assessments (67 and 83, respectively). There was a large variability in all HRQoL-domains and no significant changes over 6 years. As compared to an AIS D injury, a tetraplegia AIS A–C injury and tetraplegia and paraplegia AIS A–C injuries were associated with positive change in depressive symptoms and global QoL, respectively. Conclusions Older adults aging with long-term SCI show large variations in all HRQoL-domains and have the potential to maintain a high and stable level of HRQoL over time. Persons with AIS D injuries may need increased attention to mitigate negative changes in depressive symptoms and global QoL. Further studies are needed to identify modifiable factors associated with changes in HRQoL in older adults aging with long-term SCI.

BACKGROUND: Many persons with late effects of polio (LEoP) perceive walking limitations in everyday life. A common rating scale to assess walking limitations is the Walking Impact Scale (Walk-12). However, there is limited knowledge about its psychometric properties. OBJECTIVE: To investigate the psychometric properties of Walk-12 in persons with LEoP. DESIGN: Rasch model analysis of cross-sectional data. SETTING: University Hospital. PARTICIPANTS: A total of 325 persons with LEoP (175 women; mean age 70 ± 10 yr). MAIN OUTCOME MEASUREMENT: The Walk-12, comprising 12 items with five response categories ranging from 1 (not at all) to 5 (extremely). METHODS: Data of Walk-12 were collected by a postal survey. The Rasch model analysis was used to analyze unidimensionality of the scale, local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. RESULTS: The analysis revealed that Walk-12 was multidimensional and suffered from some local dependency. Targeting was compromised among persons with less and worse walking limitations. Hierarchically, the most difficult item to perform was "running" and the easiest was "walking indoors with support". There was a minor DIF for gender in one item ("support when walking outdoors"). Reliability was high (PSI = 0.94). Disordered response category thresholds were found for three items; when merging the middle response categories for these items model fit slightly improved and unidimensionality was achieved. CONCLUSION: The Walk-12, in its current version, does not fully meet the rigorous psychometric Rasch measurement standards in persons with LEoP. Further development of the scale is warranted, including merging response categories and complementing Walk-12 with objective measures of gait in order to improve targeting. As these limitations can be considered minor, the current version of Walk-12 can still be useful for research and clinical practice. This article is protected by copyright. All rights reserved.

Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were interviewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (gt;70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants' activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.

Fear of falling (FoF) is very common in persons with late effects of polio (LEoP). An internationally recognized rating scale to assess FoF is the Falls Efficacy Scale-International (FES-I). Yet, there is limited knowledge about its measurement properties in persons with LEoP.To investigate the measurement properties of the FES-I (16-item version) and the short FES-I (7-item version) in persons with LEoP.Explorative factor analysis and Rasch model analysis of cross-sectional data.University hospital.A total of 321 persons with LEoP (mean age ± standard deviation [SD] 70 ± 10 years, 173 women).The FES-I and the short FES-I, comprising four response options about concerns of falling ranging from 1 (not at all concerned) to 4 (very concerned).Data were collected by a postal survey. First, a factor analysis was performed to investigate the unidimensionality of the scale. Thereafter, a Rasch model analysis was used to further analyze the measurement properties of the FES-I and the short FES-I, such as local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed.The factor analysis revealed that the FES-I was unidimensional, even though the Rasch analysis showed some misfit to the Rasch model and local dependency. Targeting for the FES-I and the short FES-I was somewhat suboptimal as the participants on average reported less FoF than expected. A negligible gender DIF was found for two items in the FES-I and for one item in the short FES-I. Reliability was high (PSI0.86), and the response category thresholds worked as intended for both the FES-I and the short FES-I.The FES-I and the short FES-I have sufficient measurement properties in persons with LEoP. Both versions can be used to assess fear of falling (or FoF) in this population.

Sense of Coherence (SOC), comprising comprehensibility, manageability and meaningfulness, is important for the sense of living a good life with Late Effects of Polio (LEoP). However, there is a lack of knowledge about the meaning of these three components. The aim of this study was to explore in-depth the meaning of SOC among persons living with LEoP, in terms of comprehensibility, manageability and meaningfulness. A directed content analysis was performed based on individual interviews with 7 men and 7 women with LEoP (mean age 73 years). SOC in persons with LEoP existed in two overarching themes that were closely intertwined: a state of motion and a state of being. The state of motion comprised active approaches, choices and actions, and was a process aimed at achieving a stronger comprehensibility, manageability and meaningfulness. The state of being comprised the comprehensibility, manageability and meaningfulness that the persons currently experienced. A profound understanding of SOC as both a state of motion and state being is essential for rehabilitation professionals when providing self-management support to persons living with LEoP. This understanding can increase their sense of living a good life and also be used in the rehabilitation of other life-long conditions.

Background: The Life Satisfaction Questionnaire (LiSat-11), including one global item and 10 domain-specific items, is used to evaluate life satisfaction in persons with the late effects of polio (LEoPs). However, there is a lack of knowledge about its psychometric properties. Objective: To evaluate the test-retest reliability of the LiSat-11 and the associations between the global and domain-specific items in persons with LEoPs. Design: A test-retest design, where data were collected by a postal survey. Setting: University Hospital, Outpatient Clinic. Participants: A cross-sectional sample of persons (20 women and 31 men; mean age 72 years) with LEoPs. Main Outcome Measurements: LiSat-11, assessing how satisfied a person is with different aspects of life, such as life as a whole, vocation, economy, leisure, contacts with friends and acquaintances, sexual life, activities of daily living (ADLs), family life, partner relationship, somatic health, and psychological health. Methods: LiSat-11 was administered on two occasions, 2 weeks apart. The test-retest reliability was evaluated by Kappa statistics, the percent agreement (PA), and the Svensson rank-invariant method. The association between the items was evaluated with the Spearman rank correlation coefficient (rho). Results: The Kappa coefficients showed good to excellent agreement (0.64-0.90) and the PA ≤1 point was high (>92%) for all items. No items showed any systematic or random disagreements according to the Svensson method. All domain-specific items correlated significantly with the global item “Life as a whole” (P

BackgroundA concussion is a common injury in many sports, including para sport. Aside from a more comprehensive need for concussion education, clinicians face difficulties applying concussion assessment and management guidelines to para athletes.1 At present, there is a lack of para-sport concussion research, and prior International Concussion in Sport (CIS) consensus papers have not addressed this specific population. To rectify this issue and improve concussion management provided to para athletes, the Concussion in Para Sport (CIPS) multidisciplinary expert group was created.2MethodsThe CIPS group undertook an in-depth analysis of issues specific to the para athlete within the established key clinical domains of the current (2017) Consensus Statement on Concussion in Sport.3 The existing Sports Concussion Assessment Tool 5 (SCAT5) was evaluated as part of this process and helped identify para athlete-specific concerns. Four CIPS working groups were tasked with exploring the following key clinical areas of concussion in para sport described in the most recent consensus statement of concussion in sport2: (Less)

Objectives: With increased long-term survival after traumatic brain injury (TBI), there is a need to understand the life situation many years after the injury. In this study, we have assessed persons on average 16 years after their injury and determined changes over 6 years in overall outcome, living condition, marital status and vocational situation, and in their functioning and disability. Materials & Methods: Individuals (n = 49, mean age 45 years, 28-70 years) who were assessed 6-15 years (average 10 years) post-TBI were reassessed 12-21 years after their injury (average 16 years) using internationally established TBI outcome measures. Results: From the first to the second assessment, overall outcome using the Glasgow Outcome Scale (GOS) was stable for a large majority and no significant changes in marital status or vocational situation was found. There was some significant, but very small, decline regarding cognitive function, home integration and social integration. In the multiple regression analysis, there was a small significant decline in the Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment subscale score for women with a moderate-to-severe injury. Conclusions: The very small changes over 6 years imply that persons with a TBI can reach and maintain a stable level of functioning many years post-TBI. Women with a moderate-to-severe TBI seem to be more vulnerable and may experience a small decline in some aspects of their functioning related to anxiety, depression, irritability, pain and headache and fatigue. The relatively small sample requires further studies to confirm these findings. (Less)

BACKGROUND: With increased participation in Paralympic sports, the burden of sports-related injuries and illnesses may increase. However, there is limited knowledge about the epidemiology of sports-related injuries and illnesses in Paralympic sports (SRIIPS).OBJECTIVE: To describe among Swedish Paralympic athletes the 1-year retrospective period prevalence of severe SRIIPS and the point prevalence of all SRIIPS and to examine differences in prevalence proportions between athletes with different impairments, behaviors, and sport characteristics.DESIGN: Cross-sectional study.SETTING: Swedish Paralympic Programme.PARTICIPANTS: One hundred and four Paralympic athletes with visual, physical, and intellectual impairment.METHODS: An eHealth application adapted to Paralympic athletes was used to collect self-report data on existing and previous SRIIPS, as well as impairment, behavior, and sport characteristics.MAIN OUTCOME MEASUREMENTS: One-year retrospective period prevalence and point prevalence.RESULTS: The period prevalence of severe injuries was 31% (95% CI 23-40) and the point prevalence 32% (95% CI 24-41). The period prevalence of severe illnesses was 14% (95% CI 9-23), and 13% of the athletes (95% CI 8-22) reported a current illness. More severe injuries (P

BACKGROUND: Sense of Coherence (SOC) is important for successful adaptation in persons with life-long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics and disability related factors in persons with LEoP.OBJECTIVE: To explore the associations between SOC, sociodemographics and disability related factors in persons with LEoP.DESIGN: A cross-sectional design.SETTING: University hospital outpatient clinic.STUDY PARTICIPANTS: Ninety-three persons (mean age 74 years, 52% women) with LEoP.MAIN OUTCOME MEASUREMENTS: Swedish versions of the Sense of Coherence scale (SOC-13), Self-reported Impairments in Persons with late effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL-I) (subscales "Daily functioning" and "Perceptions of Self") and Satisfaction With Life Scale (SWLS).METHODS: The participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable.RESULTS: Higher age, less bothered by symptoms of LEoP, better perceptions of self and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R2 Adj= 0.60, p

Objective: Although life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions. Design: Cross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). Setting: Community settings in southern Sweden. Participants: Seventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years. Interventions: Not applicable. Outcome measures: The Life Satisfaction Questionnaire (LiSat-11). Results: The participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains. Conclusion: Life satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury. (Less)

Introduction Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO. Materials and Methods A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires. Results The AFO significantly improved (P 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear. Conclusions A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly. © (Less)

Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program., Funding: The study was supported by grants from the Stiftelsen för bistånd åt rörelsehindrade i Skåne, Sweden, Gyllenstiernska Krapperupsstiftelsen (The Gyllenstierna Krapperup Foundation), Sweden and the Faculty of Medicine at Lund University, Lund, Sweden. The funding agencies were not involved in any aspects of the study design, data collection, data interpretation or manuscript preparation.

Objective: To assess the 52-week incidence proportion and incidence rate of sports-related concussion (SRC) among elite Para athletes, and to analyze the injury mechanisms.Method: In total, 70 male and 37 female Swedish elite Para athletes (median age 29 years) with vision, physical and intellectual impairment, weekly self-reported sports-related injuries including concussion in an eHealth application adapted to Para athletes. Descriptive statistics were used to assess the incidence rate and incidence proportion. Chi-square statistics were used to analyze differences in the proportion of SRC.Results: A total of 13 SRC were reported: three athletes each sustained two SRC. The incidence proportion was 9.3% (95% CI 4.8-16.7), and the incidence rate 0.5 SRC/1000 hours (95% CI 0.3-0.9) of sports exposure. Athletes with vision impairment and female athletes reported a significantly higher proportion of SRC. A majority of the injuries (n = 9; 69%) occurred during sport-specific training. The injury mechanisms were collision with object (n = 7; 54%), collision with person (n = 4; 31%), and poor playing field conditions (n = 2; 16%).Conclusion: The incidence of concussion among elite Paralympic athletes is comparable to sports for able-bodied athletes. Athletes with vision impairment and female athletes reported a significantly higher incidence of SRC, and collisions were the most common injury mechanism. These results can form the basis for future preventive research studies.

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

Persons with Parkinson’s disease (PD) need to adapt to their progressive disability to achieve and maintain a high degree of life satisfaction (LS), but little is known about the meaning of LS and adaptation. This study aimed to gain an in-depth understanding of the meaning of LS and adaptation in persons with PD. Open-ended in-depth interviews were performed with 13 persons diagnosed with PD, 9 women, 3 men, and one non-binary person (mean age 54 years, mean time since diagnosis 3.4 years). The interviews were analyzed using a phenomenological–hermeneutic approach. The participants were in the process of adapting to their new health situation. There were two quite distinct groups: one that adapted through acceptance and one that struggled to resist the disease and the profound impact it had on their lives. The thematic structural analysis covers eight themes illustrating the meaning of LS and adaptation, through either acceptance or resistance. Adaptation to PD involves a transitional process characterized by either acceptance or resistance, which influences a person’s LS. Acceptance makes LS possible, whereas resistance constitutes a behavioral barrier to adaptation and LS. Rehabilitation professionals need to understand this individual process to be able to support a person with PD to reach and maintain a high level of LS. Understanding the link between LS and adaptation can support rehabilitation professionals to provide targeted interventions for people with PD.

The Swedish Agency for Health Technology Assessment and Assessment of Social Services has evaluated quantitative and qualitative research regarding rehabilitation for persons with traumatic brain injury (TBI) through systematic reviews. The results indicate that specialized brain injury rehabilitation for persons with post-concussion symptoms after mild TBI results in improved health, when compared to usual care (results with low certainty according to GRADE). As few high-quality studies were identified, it was not possible to assess the effects of vocational rehabilitation, rehabilitation with case management/coordinator, residential living or specialized brain rehabilitation for persons with moderate to severe TBI. A synthesis of qualitative studies showed that persons with TBI experience insufficient coordination of health services and access to rehabilitation (results with low to moderate confidence according to CERQual).

ObjectiveTo describe the epidemiology of sports injury at the Pyeongchang 2018 Paralympic Winter Games.Methods567 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.Results112 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]; pConclusionThe 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.

ObjectiveTo describe the incidence rate (IR) and illness burden (IB) at the Pyeongchang 2018 Paralympic Winter Games.MethodsA 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.ResultsThere 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.ConclusionThis 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.

BACKGROUND Sense of coherence (SOC), comprising "comprehensibility", "manageability" and "meaningfulness", is important for successful adaptation in persons with late effects of polio (LEoP) and can be used as an estimate of the ability to cope with stressors. Coping behaviours are the actions a person performs to reduce stress and can be divided into problem-focused coping, emotion-focused coping and less useful coping. Our knowledge is very limited of what coping behaviours persons with LEoP use to manage their life situation as well as the association between SOC and coping behaviours. OBJECTIVE The aims of this cross-sectional study were to assess coping behaviours and to explore the association between SOC and coping behaviours in persons with LEoP. METHODS In total, 93 ambulant persons (52% women, mean [SD] age 74 [8] years) with clinically and electromyographically verified LEoP responded to a postal survey with the Sense of Coherence Scale 13 items (SOC-13) and the Brief Cope Scale. Three linear regression analyses were used to explore the association between SOC and problem-focused coping, emotion-focused coping and less useful coping, controlling for age and sex. RESULTS The most-used coping behaviours belonged to the categories problem-focused and emotion-focused coping. We found a significant negative association between SOC and less useful coping; less useful coping explained 34% of the variance of SOC (adj R2 = 0.34, p

The aim of the study was to present the methodology, cohort demographics, and initial results of the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA).The SPICA is based on the Swedish CArdioPulmonary BioImage Study, a study on cardiopulmonary diseases in a cohort of 30,000 people. The assessments in the SPICA cover the structure and function of the cardiopulmonary and autonomic systems using bioimaging and functional analyses, together with a study-specific questionnaire and generic and spinal cord injury-specific assessment tools. The inclusion criteria were as follows: age 50-65 yrs, traumatic spinal cord injury of 5 yrs or more, and injury levels C1-T6, American Spinal Injury Association Impairment Scale A-C.Of 38 potential participants, 25 comprised the final sample (20% women, mean age 58 yrs, mean time since injury 28 yrs). Eight percent had sustained a cardiovascular event, and 72% were classified as a high risk for cardiovascular disease. Asthma was previously diagnosed in only 8%, and none had chronic obstructive pulmonary disease.The risk for cardiovascular disease in people with severe high-level spinal cord injury is a major clinical concern. Forthcoming studies in the SPICA will provide new knowledge of cardiopulmonary health in this cohort, which can guide future research and be used to develop long-term management.

Introduction Sports-related injuries and illnesses in Paralympic sport (SRIIPS) are a concern, but knowledge about the etiology and risk factors is limited. The aim of this study was to describe the annual incidence, type, and severity of injuries and illnesses among Swedish Paralympic athletes and to assess risk factors. Methods Swedish Paralympic athletes (n = 107) self-reported SRIIPS every week during 52 weeks using an eHealth application. Incidence proportions (IP) and incidence rates (IR) were used as measures of disease burden. Time-to-event methods (Kaplan-Meier and Cox regression) were used to identify risk factors. Results The annual IP for injury was 68% and for illness 77%. The injury IR was 6.9/1000 hours and the illness IR 9.3/1000 hours. The median time to injury was 19 weeks (95% CI: 10.5-27.4) and to illness 9 weeks (95% CI: 1.4-16.6). Most injuries occurred during training, and 34% were classified as severe (>= 21 days of time loss). An increased injury risk was observed among athletes in team sports (HR 1.88; 95% CI: 1.19-2.99), athletes with a previous severe injury (HR 2.37; 95% CI: 1.47-3.83), and male athletes (HR 1.76; 95% CI: 1.06-2.93). The most common illness type was infection (84%). Athletes in team sports (HR 1.64; 95% CI: 1.05-2.54) and males with a previous illness (HR = 2.13; 95% CI: 1.04-4.36) had a higher illness risk. Conclusion Paralympic athletes report a high incidence of injuries and illnesses over time. This emphasizes the need to develop preventive strategies of SRIIPS and optimize medical services for this heterogeneous athlete population. Funding Agencies|Swedish National Centre for Research in Sports [F2016-0024, P2019-0010]

Purpose: To describe the experiences of growing up after acute paralytic poliomyelitis and strategies used to adapt to the new situation. Methods: Seven women and seven men (mean age 70 years, min-max 61-78 years) with late effects of polio, who had contracted paralytic polio in their childhood. Data were collected using semi-structured interviews, transcribed verbatim, and analyzed by systematic text condensation. Results: Memories of contracting acute paralytic poliomyelitis involved being immobilized and sent away from home for surgical and physiotherapeutic treatment. Growing up in a social context that was often tough and unfriendly resulted in the development of strategies, such as optimistic thinking, trying to blend in, trusting one's ability to manage, and to handle the preconceptions and expectations of others. At the onset of late effects of polio, some of these strategies were still functioning, whereas overachieving, disregarding pain, and weariness were not. Conclusion: The challenges of growing up with a disability following paralytic polio led to the development of various psychological strategies for managing daily life. By understanding these experiences and strategies, knowledge may be gained in assisting rehabilitation professionals to better support persons with late effects of polio in adapting to the new situation. Implications for rehabilitation. At the onset of late effects of polio, strategies developed earlier in life, such as overachieving, disregarding pain, and weariness, may not function anymore. Understanding the experiences of growing up with poliomyelitis can support rehabilitation professionals to provide targeted interventions for people with late effects of polio and enable them to develop new adaptive strategies. Developing new strategies, such as accepting increased symptoms, and augmenting self-esteem and self-efficacy, may improve daily functioning among people with late effects of polio.