Paraplegics are individuals who are paralyzed from the waist down, usually as the result of a lower spinal cord injury (SCI). Quadriplegics are individuals who have lost complete or partial use of all four limbs, usually as the result of an upper spinal cord injury. Quadriplegia is also known as tetraplegia, meaning “four paralysis,” or “paralysis of all four limbs.” Individuals who have lost the use of their legs are generally confined to wheelchairs, so athletic events in which they may participate are sometimes referred to as wheelchair athletics or wheelchair sports. Paraplegics and quadriplegics are sometimes classified as “disabled” persons, although that term is obviously inappropriate for individuals who may be limited in some physical activities, but who are also clearly capable of very significant physical accomplishments in many areas, such as recreational sports and world-class athletics. Sports and other athletic events in which paraplegic, quadriplegic, and other disabled individuals compete are sometimes referred to as adapted sports.
In spite of their physical limitations, paraplegics and quadriplegics are active in a wide variety of sports and recreational activities, often with the assistance of equipment and rules that are specially adapted to their specific needs.
There appears to be no data or statistics on the number of paraplegic and quadriplegics who are actively engaged in recreational or sporting activities. Wheelchair & Ambulatory Sports, USA, the parent group for much of disabled athletics, had a membership in 2010 of just over 900 males and females, ranging in age from 8 to 76. They classified themselves as recreational participants, active competitive athletes, coaches, and officials.
Special competitive athletic events designed exclusively for paraplegics and quadriplegics had their origin shortly after World War II, largely as a consequence of the many men and women who suffered physical injuries as a result of their military service. In 1948, Dr. Ludwig Guttmann at the Stoke Mandeville Hospital in Aylesbury, United Kingdom, organized an event designed to coincide with the Games of the XIV Olympiad, being held in London. Called the Stoke Mandeville Games for the Paralysed, the competition consisted of archery contests for 16 male and female veterans with spinal cord injuries incurred during the war. Some version of the Stoke Mandeville Games has been repeated almost every year since then, often with an expanded agenda of events. In 1952, a team from the Netherlands joined the games, making the event an international event for the first time. In 1960, the Ninth Annual International Stoke Mandeville Games were held in Rome in conjunction with the Games of the XVII Olympiad. The Ninth Stoke Mandeville Games later became known as the First Paralympics Games, a sporting event now held in association with the Summer and Winter Olympic Games, immediately following those events at the same location as the Olympics.
During this period, the formalization of sporting and athletic events for paraplegics and quadriplegics was also developing in other parts of the world. In 1946, two chapters of the Paralyzed Veterans of America, in California and New England, each played the first game of wheelchair basketball within two weeks of each other. Two years later, six wheelchair basketball teams were in existence, and they had begun playing each other in cross-country games. The National Wheelchair Basketball Association was formed in 1948, an association that currently has 22 conferences and 165 teams.
Over time, opportunities for paraplegics and quadriplegics were extended to more and more sports. For example, the National Foundation for Wheelchair Tennis was founded in 1980. The organization has grown in popularity and 112 players took part in the tennis portion of the 2008 Paralympics competition in Beijing. Opportunities for younger paraplegics and quadriplegics were first formalized in 1984 with the creation of the National Junior Disability Championships (NJDC), held in Delaware for contestants ages 7–19. The NJDC is held annually with competitions in archery, pentathlon, swimming, table tennis, three-on-three wheelchair basketball, and track and field. In 2011, more than 250 athletes aged 7–21 took part in the NJDC games in Saginaw, Michigan. Paraplegic and quadriplegic athletes can participate in a wide range of events, including archery, basketball, billiards, bowling, fencing, floor hockey (a form of ice hockey), football, handcycling, hang gliding, racquetball, rock climbing, sailing, scuba diving, shooting, skiing, soccer, swimming, table tennis, tennis, track and field, and weightlifting.
Most sports and athletic events designed for paraplegics and quadriplegics involve modifications of the equipment or rules, or both, for the event. These modifications have been developed and codified by governing bodies in each sport, including Wheelchair Archery, USA; International Wheelchair Basketball Federation; American Wheelchair Bowling Association; Universal Wheelchair Football Association; American Wheelchair Table Tennis Association; International Wheelchair Tennis Federation; and Handicapped Scuba Association. Adaptations have been proposed and promulgated by groups with a general interest in disabled sporting events, such as America's Athletes with Disabilities; Disabled Sports, USA; International Wheelchair & Amputee Sports Federation; National Center on Physical Activity and Disability; and United States Paralympic Committee.
Some examples of the types of modifications used for paraplegic and quadriplegic athletes include:
Preparation for an adapted sport requires somewhat more preparation than would be needed for a nonadapted sport. Many governing organizations require that participants have a preparticipation examination (PPE) before they are allowed to take part in a sport. The PPE consists of a number of elements, one of which is confirmation that the athlete has completed acute rehabilitation from his or her injury, that is, they are no longer recovering from the specific event that resulted in his or her disability. The PPE should focus on being certain that the athlete understands the demands of the proposed sport or athletic event, with special recognition of the ways in which the sport might place demands on the body. In general, authorities recommend that disabled athletes develop and maintain a close relationship with a healthcare provider with whom they can discuss the demands of any given sport and the progress or problems one may be experiencing in taking part in that sport. In addition to these general expectations, prospective participants must be aware of and prepared for the special demands posed by any specific sport in which one hopes to participate.
Disabled athletes may, and sometimes are required to, use special equipment designed to protect them in the sport in which they have chosen to participate. This equipment should be used in addition to whatever basic equipment is a natural part of the sport.
The training and conditioning program that is best for any one athlete depends on a number of factors in addition to the general physical and mental skills that would be expected of any athlete engaged in a given sport. As part of a PPE, athletes are encouraged to work with their medical advisors to develop a specific training program that is appropriate to the sport being attempted as well as to one's own physical attributes. One common goal of a training program is to help an individual learn how to respond in case of an accident that may present problems not normally occurring with a nondisabled participant. For example, a physical therapist may be able to teach a person how to fall out of a wheelchair in the safest possible way, protecting the neck and head from damage; how to avoid falling out of the chair itself; and how most easily to get back into the chair if one does fall out.
Individuals with spinal cord injuries are more subject to a variety of medical complications than are their noninjured colleagues. While these conditions are not necessarily aggravated by participation in sports and athletic events, participants and their medical advisors should be aware of such possible complications when they participate in an activity or event. Some common complications of spinal cord injury include temperature regulation disorders, pressure sores from sitting too long in a wheelchair, and urinary tract complications that often develop as a by-product of spinal cord injury.
In addition to these basic health issues, men and women who participate in adapted sports are also subject to injuries related to the sport in which they are engaged. Research suggests that the most common injuries are relatively mild and seldom life-threatening. They include abrasions, blisters, cuts, lacerations, and soft-tissue damage. Other common injuries include:
As with injuries that result from nonadapted games and sports, injuries like these can be avoided or reduced by proper training and conditioning procedures. For example, the athlete should perform stretching and warm-up exercises before beginning participation in an event and should be provided with some relief from sitting whenever possible during an event. The participant should advise a colleague or medical advisor if a medical problem appears to be developing, so that it can be avoided if possible. Equipment should be provided to reduce injuries resulting from long periods of sitting in a chair, such as extra padding around the torso or on the seat. Padded wheel rims and the use of gloves can help reduce the risk of damage to fingers and hands during operation of a wheelchair.
See also Fitness for individuals with disabilities .
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David E. Newton, AB, MA, EdD