Active Voice: Physically Challenged Athletes — Not “IF,” But “HOW”

By Lauren M. Simon, M.D., M.P.H., FACSM

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Lauren Simon is director of primary care sports medicine at Loma Linda University, Loma Linda, CA. In her family medicine and sports medicine practice, she focuses on promoting “optimal health” and active lifestyles for individuals of all ages and functional abilities. She also serves as team physician for the University of California-Riverside, University of Redlands and is medical director for the Redlands Bicycle Classic. Dr. Simon currently is a trustee on the ACSM’s board of trustees.

This commentary presents Dr. Simon’s views on the topic of an article she and one of her colleagues authored, which appears in the May/June 2014 issue of ACSM’s official review journal in sports medicine, Current Sports Medicine Reports (CSMR).

A mother’s fear and a child’s wish, a story of how sports medicine professionals were able to create a bridge connecting them. “Johnny,” an avid bicycle rider, was only nine years old when he was hit by a car. The injuries he sustained left him with an above-the-knee amputation. His mom feared she could not afford one of the costly handcycles that would enable him to ride again and socialize with his friends. Johnny just wanted to ride. Using the sports medicine team and a community outreach program for persons with disability, Johnny learned he did not actually need a handcycle, but instead received peer coaching from others with similar injuries and was fitted with a limb prosthesis that clipped into a standard upright bicycle pedal. Now, not only has he returned to riding with friends, but he competes in cycling events.

Physically challenged athletes may have a variety of impairments such as amputations from bone cancers, trauma as seen in war injuries and the Boston Marathon tragedy, and other medical conditions such as spinal cord injuries, visual impairment or cerebral palsy.

When caring for physically challenged athletes, it is important for sports medicine professionals to be knowledgeable about resources so they can promote active, healthy lifestyles in persons with disability. They also must be aware of adaptive equipment that may be used in sports and recreation. There are community outreach programs available in many areas of the US that provide these resources, including education, peer mentoring, athletic events for physically challenged persons and exposure to adaptive equipment.

On the West Coast, excellent examples of community outreach programs include the Loma Linda University PossAbilities program and the California State University-San Bernardino DisAbility Sports Festival. In these programs, physically challenged and able- bodied athletes can sample a variety of sports. They may try adaptive equipment, such as throwing chairs (which enables throwing sports implements from a seated position) or ice hockey sleds, with instruction provided by experienced paralympians, other elite athletes and volunteers. What is critically important about these programs is that they promote a philosophy of not “if” a physically challenged athlete can participate in a sport, but “how” best we can facilitate that activity for them.

As participation in sports for physically challenged athletes continues to increase from recreational and novice to elite competitions such as the Paralympics, the medical team preparation for the event coverage also expands. The sports medicine team has to consider the wide range of physical impairments the athletes may have, assign appropriate staffing and supplies to care for athletes in a specific sport/venue, provide disability–compatible access to care and practice emergency extraction of the athlete from the various adaptive devices they are using. Of note, athletes with varying disabilities but similar function may often compete with one another in a given sports event. For instance, an athlete with double above-knee amputations may compete in a wheelchair event with an athlete who has an L2 spinal cord injury — both having a similar level of function. The International Paralympic Committee Classification code provides these functional classification details.

The medical team may also be treating able-bodied athletes at events for physically challenged athletes. One example is a sighted athlete competing as a pilot, paired with a visually impaired athlete in a tandem bicycling event. In the most recent issue of CSMR, my colleague and I presented an article, titled “Preparing for events for physically challenged athletes,” in which we outlined specific considerations for providing appropriate medical supplies, addressing venue safety and training for medical personnel who are going to provide on-the-field care for physically challenged athletes. Among these issues, we discussed thermoregulatory problems, autonomic dysreflexia, skin breakdown, orthotic and prosthetic equipment and communication with visually or hearing impaired athletes. Preparation and practice are the key elements to providing optimal medical care for events with physically challenged athletes.