Advertisement

Youth Para and Adaptive Sports Medicine

  • Mary E. DubonEmail author
  • Craig Rovito
  • D. Kiko Van Zandt
  • Cheri A. Blauwet
Pediatric Rehabilitation Medicine (A Houtrow and M Fuentes, Section Editors)
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on Pediatric Rehabilitation Medicine

Abstract

Purpose of Review

This review aims to provide an overview of sports medicine principles pertaining to youth Para athletes.

Recent Findings

While little research on youth Para athletics exists, recent elite Paralympic Games data confirms a higher rate of upper extremity injuries in wheelchair athletes and lower extremity injuries in ambulatory athletes, while showing a higher rate of acute injuries in the Winter Games and skin/soft-tissue injuries in Summer Games. These summer sport findings are consistent with historic youth Para sport data.

Summary

Clinicians caring for youth Para athletes should be aware of medical considerations for Para athletes with various medical conditions. While little research exists specifically on youth Para sport, we review pediatric rehabilitation medicine and sports medicine principles and data from the adult literature to help prepare clinicians caring for this population. Future research should focus on injury patterns and injury prevention in the youth Para sport population.

Keywords

Youth Para sport Youth adaptive sport Pediatric sports medicine Pediatric rehabilitation medicine Youth wheelchair athlete Pediatric wheelchair athlete 

Notes

Compliance with ethical standards

Conflict of interest

Mary Dubon reports that her husband is employed by and has stock ownership in an orthopedic PACS company, Medstrat. D. Kiko Van Zandt reports that from 2004 to 2013, she served as an assistant swim coach for the U.S. Paralympic Swim Team. This included a number of travel trips to foreign countries for competitions including the Paralympic Games, Pan American Games, World Championships, and Para Pan Pacific Championship. Travel, lodging, and meals were provided by U.S. Paralympics. A small stipend was also paid for services rendered for each trip. Craig Rovito and Cheri Blauwet declare no conflicts of interest relevant to this manuscript.

Human rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Tuakli-Wosornu YA, Derman W. Preface Contemporary Medical, Scientific & Social Perspectives on Para Sport Para and Adapted Sports Medicine. Phys Med Rehabil Clin N Am. 2018;29:xvii–xviii. Overview of definitions and perspectives on Para sport. CrossRefGoogle Scholar
  2. 2.
    Paralympics History - History of the Paralympic Movement. In: Int. Paralympic Comm. https://www.paralympic.org/the-ipc/history-of-the-movement. Accessed 19 Jul 2018.
  3. 3.
    • Bloemen MAT, Backx FJG, Takken T, Wittink H, Benner J, Mollema J, et al. Factors associated with physical activity in children and adolescents with a physical disability: a systematic review. Dev Med Child Neurol. 2015;57:137–48. Systematic review of factors associated with physical activity participation in youth with physical disabilities. CrossRefGoogle Scholar
  4. 4.
    Buffart L, Westendorp T, van den Berg-Emons R, Stam H, Roebroeck M. Perceived barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities. J Rehabil Med. 2009;41:881–5.CrossRefGoogle Scholar
  5. 5.
    Maher CA, Williams MT, Olds T, Lane AE. Physical and sedentary activity in adolescents with cerebral palsy. Dev Med Child Neurol. 2007;49:450–7.CrossRefGoogle Scholar
  6. 6.
    Rimmer JA, Rowland JL. Physical activity for youth with disabilities: a critical need in an underserved population. Dev Neurorehabil. 2008;11:141–8.CrossRefGoogle Scholar
  7. 7.
    Schoenmakers MAGC, de Groot JF, Gorter JW, Hillaert JLM, Helders PJM, Takken T. Muscle strength, aerobic capacity and physical activity in independent ambulating children with lumbosacral spina bifida. Disabil Rehabil. 2009;31:259–66.CrossRefGoogle Scholar
  8. 8.
    Zwier JN, Schie v, PE m, Becher JG, Smits D-W, Gorter JW, et al. Physical activity in young children with cerebral palsy. Disabil Rehabil. 2010;32:1501–8.CrossRefGoogle Scholar
  9. 9.
    Woodmansee C, Hahne A, Imms C, Shields N. Comparing participation in physical recreation activities between children with disability and children with typical development: a secondary analysis of matched data. Res Dev Disabil. 2016;49–50:268–76.CrossRefGoogle Scholar
  10. 10.
    Ryan JM, Hensey O, McLoughlin B, Lyons A, Gormley J. Associations of sedentary behaviour, physical activity, blood pressure and anthropometric measures with cardiorespiratory fitness in Children with cerebral palsy. PLoS One. 2015;10:e0123267.CrossRefGoogle Scholar
  11. 11.
    Morris PJ. Physical activity recommendations for Children and adolescents with chronic disease. Curr Sports Med Rep. 2008;7:353–8.CrossRefGoogle Scholar
  12. 12.
    Shinohara T, Suzuki N, Oba M, Kawasumi M, Kimizuka M, Mita K. Effect of exercise at the AT point for children with cerebral palsy. Bull Hosp Jt Dis. 61:63–7.Google Scholar
  13. 13.
    Shapiro DR, Malone LA. Quality of life and psychological affect related to sport participation in children and youth athletes with physical disabilities: a parent and athlete perspective. Disabil Health J. 2016;9:385–91.CrossRefGoogle Scholar
  14. 14.
    Chang F, Pan Z, Autruong P, J Ma KD. Quality of life change in children with physical disabilities after participation in an adaptive ski and snowboard program. Dev Med Child Neurol. 2016;58:38–9.Google Scholar
  15. 15.
    Paralympic Sports - List of Para Sports and Events. https://www.paralympic.org/sports. Accessed 19 Jul 2018.
  16. 16.
    (2018) Boccia International Sports Federation International Boccia Rules - 2018. http://www.bisfed.com/wp-content/uploads/2014/01/V.3_with_markup.pdf. Accessed 22 Jul 2018.
  17. 17.
    (2014) UCI Para-cycling Classification Guide. http://www.uci.ch/mm/Document/News/NewsGeneral/16/59/20/UCIClassificationGuide_English.pdf. Accessed 22 Jul 2018.
  18. 18.
    (2012) Para-equestrian classification manual equestrian competition for athletes with disabilities. https://inside.fei.org/system/files/PED_2012Classification manual_21feb_markup_version.pdf. Accessed 22 Jul 2018.
  19. 19.
    (2018) IWRF Wheelchair Rugby Ready : Before playing. http://www.wheelchairrugbyready.com/?module=1&section=3&subsection=41. Accessed 22 Jul 2018.
  20. 20.
    Tweedy SM, Beckman EM, Connick MJ. Paralympic classification: conceptual basis, current methods, and research update. PM R. 2014;6(8 Suppl):S11–7.  https://doi.org/10.1016/j.pmrj.2014.04.013.
  21. 21.
    World Para Swimming Classification & Categories - SB9, SM8. In: World Para Swim. https://www.paralympic.org/swimming/classification. Accessed 21 Jul 2018.
  22. 22.
    Balan V. Aspects of the swimming lesson design at disabled children. Procedia Soc Behav Sci. 2015;197:1679–83.CrossRefGoogle Scholar
  23. 23.
    Dummer, G., Watkinds, D. Moving to the Next Level: Swimming Instruction for Persons with Disabilities. 37th National Adapted Physical Education Conference, Promoting Physical Activity for All, California Association for Health, Physical Education, Recreation and Dance. November, 2008, San Diego, CA.Google Scholar
  24. 24.
    Gelinas JE, Reid G. The developmental validity of traditional learn-to-swim progressions for Children with physical disabilities. Adapt Phys Act Q. 2000;17:269–85.Google Scholar
  25. 25.
    Fulton SK, Pyne DB, Hopkins WG, Burkett B. Training characteristics of Paralympic swimmers. J Strength Cond Res. 2010;24:471–8.CrossRefGoogle Scholar
  26. 26.
    Bergeron MF. Hydration in the pediatric athlete — how to guide your patients. Curr Sports Med Rep. 2015;14:288–93.CrossRefGoogle Scholar
  27. 27.
    Committee on Nutrition and the Council on Sports Medicine and Fitness. Sports drinks and energy drinks for children and adolescents: are they appropriate? Pediatrics. 2011;127(6):1182–9.Google Scholar
  28. 28.
    Council on Sports Medicine and Fitness and Council on School Health, Bergeron MF, Devore C, Rice SG, American Academy of Pediatrics. Policy statement—climatic heat stress and exercising children and adolescents. Pediatrics. 2011;128:e741–7.Google Scholar
  29. 29.
    International Standards for Neurological Classification of SCI (ISNCSCI) Worksheet. In: ISNCSCI. http://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf. Accessed 19 Jul 2018.
  30. 30.
    Osorio M, Reyes MR, Massagli TL. Pediatric spinal cord injury. Curr Phys Med Rehabil Rep. 2014;2:158–68.CrossRefGoogle Scholar
  31. 31.
    Mulcahey MJ, Gaughan JP, Chafetz RS, Vogel LC, Samdani AF, Betz RR. Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury. Arch Phys Med Rehabil. 2011;92:1264–9.CrossRefGoogle Scholar
  32. 32.
    Chafetz RS, Gaughan JP, Vogel LC, Betz R, Mulcahey MJ. The international standards for neurological classification of spinal cord injury: intra-rater agreement of total motor and sensory scores in the pediatric population. J Spinal Cord Med. 2009;32:157–61.CrossRefGoogle Scholar
  33. 33.
    ISNCSCI Exam pediatric brochure. In: ISNCSCI http://asia-spinalinjury.org/wp-content/uploads/2018/01/ASIA_Exam_Pediatric-Brochure-11-16-17.pdf. Accessed 3 Mar 2019.
  34. 34.
    Dec KL, Sparrow KJ, McKeag DB. The physically-challenged athlete. Sports Med. 2000;29:245–58.CrossRefGoogle Scholar
  35. 35.
    Patel DR, Greydanus DE. Sport participation by physically and cognitively challenged young athletes. 2010.  https://doi.org/10.1016/j.pcl.2010.03.002.
  36. 36.
    Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic Dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90:682–95.CrossRefGoogle Scholar
  37. 37.
    Paralyzed Veterans of America. Consortium for spinal cord medicine clinical practice guidelines: acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities, 2nd Edition. http://www.pva.org/media/pdf/cpg_autonomic%20dysreflexia.pdf (2001). Accessed 22 Jan 2019.
  38. 38.
    McGinnis KB, Vogel LC, McDonald CM, Porth S, Hickey KJ, Davis M, et al. Recognition and management of autonomic dysreflexia in pediatric spinal cord injury. J Spinal Cord Med. 2004;27(Suppl 1):S61–74.CrossRefGoogle Scholar
  39. 39.
    Blauwet CA, Benjamin-Laing H, Stomphorst J, Van de Vliet P, Pit-Grosheide P, Willick SE. Testing for boosting at the Paralympic games: policies, results and future directions. Br J Sports Med. 2013;47:832–7.CrossRefGoogle Scholar
  40. 40.
    • Vogel LC, Zebracki K, Betz RR, Mulcahey MJ. Spinal cord injury in the child and young adult. London: Wiley; 2015. Book covering important considerations when caring for youth with spinal cord injuries. Google Scholar
  41. 41.
    Wu SSH, Ahn C, Emmons KR, Salcido R(S). Pressure ulcers in pediatric patients with spinal cord injury. Adv Skin Wound Care. 2009;22:273–84.CrossRefGoogle Scholar
  42. 42.
    Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clin J Sport Med. 2007;17:55–60.CrossRefGoogle Scholar
  43. 43.
    (2013) The international society for clinical densitometry 2013 official positions: adult & pediatric. https://iscd.app.box.com/v/OP-ISCD-2013-Adult-Ped-Eng. Accessed 20 Jul 2018.
  44. 44.
    Kokorelis C, Trovato M. Osteoporosis / osteopenia in children. In: PM&RknowledgeNOW. 2018. https://now.aapmr.org/osteoporosis-osteopenia-in-children/. Accessed 20 Jul 2018.
  45. 45.
    Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW, Task force on childhood motor disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003;111:e89–97.CrossRefGoogle Scholar
  46. 46.
    Garcia-Arguello LY, O’horo JC, Farrell A, Blakney R, Sohail MR, Evans CT, et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord. 2017;55:526–34.CrossRefGoogle Scholar
  47. 47.
    Massa LM, Hoffman JM, Cardenas DD. Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization. J Spinal Cord Med. 2009;32:568–73.CrossRefGoogle Scholar
  48. 48.
    Koff SA, Mott Children C. Estimating bladder capacity in children. Urology. 1983;XXI:248.CrossRefGoogle Scholar
  49. 49.
    Griggs KE, Havenith G, Paulson TAW, Price M J, Goosey-Tolfrey VL. Effects of cooling before and during simulated match play on thermoregulatory responses of athletes with tetraplegia. J Sci Med Sport. 2017;20:819–24.CrossRefGoogle Scholar
  50. 50.
    Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8–14.Google Scholar
  51. 51.
    Fehlings D, Brown L, Harvey A, Himmelmann K, Lin JP, Macintosh A, et al. Pharmacological and neurosurgical interventions for managing dystonia in cerebral palsy: a systematic review. Dev Med Child Neurol. 2018;60:356–66.CrossRefGoogle Scholar
  52. 52.
    Harvey AR, Baker LB, Reddihough DS, Scheinberg A, Williams K. Trihexyphenidyl for dystonia in cerebral palsy. Cochrane Database Syst Rev. 2018.  https://doi.org/10.1002/14651858.CD012430.pub2.
  53. 53.
    Clore ET. Seizure precautions for pediatric bedside nurses. Pediatr Nurs. 2010;36:191–4. http://www.ncbi.nlm.nih.gov/pubmed/?term=20860258
  54. 54.
    Vernier E. Taking Seizure Precautions | Epilepsy Foundation. 2015. https://www.epilepsy.com/article/2015/5/taking-seizure-precautions. Accessed 21 Jul 2018.
  55. 55.
    Seizure Precautions. In: Healthline. https://www.healthline.com/health/seizure-precautions. Accessed 21 Jul 2018.
  56. 56.
    Murphy KP. Cerebral palsy lifetime care - four musculoskeletal conditions. Dev Med Child Neurol. 2009;51:30–7.CrossRefGoogle Scholar
  57. 57.
    Harada T, Ebara S, Anwar MM, et al. The cervical spine in athetoid cerebral palsy: a radiological study of 180 patients. J Bone Joint Surg Br. 1996;78(4):613–9.Google Scholar
  58. 58.
    • Michael A, Alexander DJM. Pediatric rehabilitation, fifth edition: principles and practice. 5th ed. New York: Demos Medical Publishing; 2015. Textbook on Pediatric Rehabilitation Medicine concepts and principles. Google Scholar
  59. 59.
    Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS. Spina bifida. Lancet. 2004;364:1885–95.CrossRefGoogle Scholar
  60. 60.
    •• Runciman P. Athletes with Brain Injury: Pathophysiologic and Medical Challenges. Phys Med Rehabil Clin N Am. 2018;29:267–81. Summary of considerations for athletes with brain injury. CrossRefGoogle Scholar
  61. 61.
    Wilson PE, Clayton GH. Sports and disability. PM R. 2010;2:46–54.CrossRefGoogle Scholar
  62. 62.
    Miele VJ, Bailes JE, Martin NA. Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy. Neurosurg Focus. 2006;21:E9.PubMedGoogle Scholar
  63. 63.
    Saigal R, Hunt Batjer H, Ellenbogen RG, Berger MS. Return to Play for Neurosurgical Patients.  https://doi.org/10.1016/j.wneu.2014.06.043.
  64. 64.
    Le JT, Scott-Wyard PR. Pediatric limb differences and amputations. Phys Med Rehabil Clin N Am. 2015;26:95–108.CrossRefGoogle Scholar
  65. 65.
    •• Kostek MC, Gordon B. Exercise is an adjuvant to contemporary dystrophy treatments. Exerc Sport Sci Rev. 2018;46:34–41. Commentary on considerations for exercise in individuals with muscular dystrophy. CrossRefGoogle Scholar
  66. 66.
    •• Birnkrant DJ, Bushby K, Muscular JW, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management HHS Public Access. Lancet Neurol. 2018;17:251–67. 2018 guidelines for caring for individuals with Duchenne muscular dystrophy, part 1. CrossRefGoogle Scholar
  67. 67.
    •• Birnkrant DJ, Bushby K, Muscular JW, Bann CM, Alman BA, Apkon SD, et al. Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management HHS Public Access. Lancet Neurol. 2018;17:347–61. 2018 guidelines for caring for individuals with Duchenne muscular dystrophy, part 2. CrossRefGoogle Scholar
  68. 68.
    Katz Sand I. Classification, diagnosis, and differential diagnosis of multiple sclerosis. Curr Opin Neurol. 2015;28:193–205.CrossRefGoogle Scholar
  69. 69.
    Trotter TL, Hall JG, American Academy of Pediatrics Committee on Genetics. Health supervision for children with achondroplasia. Pediatrics. 2005;116:771–83.CrossRefGoogle Scholar
  70. 70.
    World Anti-Doping Agency (WADA). In: WADA. https://www.wada-ama.org/. Accessed 19 Jul 2018.
  71. 71.
    Tsitsimpikou C, Jamurtas A, Fitch K, Papalexis P, Tsarouhas K, Jamurtas AZ. Medication use by athletes during the Athens 2004 Paralympic games. Br J Sports Med. 2009;43:1062–6.CrossRefGoogle Scholar
  72. 72.
    •• Tuakli-Wosornu YA, Mashkovskiy E, Ottesen T, Gentry M, Jensen D. Acute and chronic musculoskeletal injury in para sport: a critical review. Phys Med Rehabil Clin N Am. 2018;29:205–43. Critical review of musculoskeletal injuries in Para athletes. CrossRefGoogle Scholar
  73. 73.
    •• Derman W, Schwellnus MP, Jordaan E, Runciman P, Van de Vliet P, Blauwet C, et al. High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days. Br J Sports Med. 2016;50:1069–74. Summary of injury data from the Sochi 2014 Winter Paralympic Games. CrossRefGoogle Scholar
  74. 74.
    •• Derman W, Runciman P, Schwellnus M, et al. High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med. 2018;52:24–31. Summary of injury data from the Rio 2016 Summer Paralympic Games. CrossRefGoogle Scholar
  75. 75.
    Wilson PE, Washington RL. Pediatric wheelchair athletics: sports injuries and prevention. Paraplegia. 1993;31:330–7.PubMedGoogle Scholar
  76. 76.
    Bernhardt DT, Roberts WO, American Academy of Family Physicians., American Academy of Pediatrics. PPE: preparticipation physical evaluation. Itasca: American Academy of Pediatrics; 2010.Google Scholar
  77. 77.
    Siow HM, Cameron DB, Ganley TJ. Preparticipation sports evaluation: issues for healthy children and athletes with disabilities. J Pediatr Orthop. 2010;30:S17–20.CrossRefGoogle Scholar
  78. 78.
    Fullerton HD, Borckardt JJ, Alfano AP, Borckardt JJ, Alfano AP. Shoulder pain: a comparison of wheelchair athletes and nonathletic wheelchair users. Med Sci Sports Exerc. 2003;35:1958–61.CrossRefGoogle Scholar
  79. 79.
    Wilroy J, Hibberd E. Evaluation of a shoulder injury prevention program in wheelchair basketball. J Sport Rehabil. 2017:1–21.Google Scholar
  80. 80.
    Heyward OW, Vegter RJK, de Groot S, van der Woude LHV. Shoulder complaints in wheelchair athletes: a systematic review. PLoS One. 2017;12:e0188410.CrossRefGoogle Scholar
  81. 81.
    •• Brenner JS. Sports specialization and intensive training in young athletes. Am Acad Pediatr Pediatr. 2016.  https://doi.org/10.1542/peds.2016-2148. Clinical Report from the American Academy of Pediatrics on the topic of sports specialization in youth athletes.
  82. 82.
    • Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes. Am J Sports Med. 2015;43:794–801. Large study examining the risks of sports specialization in youth athletes. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mary E. Dubon
    • 1
    • 2
    • 3
    • 4
    Email author
  • Craig Rovito
    • 4
    • 5
  • D. Kiko Van Zandt
    • 6
  • Cheri A. Blauwet
    • 4
    • 5
    • 7
  1. 1.Division of Orthopaedic Surgery and Sports MedicineAnn & Robert H. Children’s Hospital of Chicago/McGaw Medical Center of Northwestern UniversityChicagoUSA
  2. 2.Department of Pediatric Rehabilitation MedicineSpaulding Rehabilitation HospitalCharlestownUSA
  3. 3.Department of Orthopedic Surgery and Division of Sports MedicineBoston Children’s HospitalBostonUSA
  4. 4.Harvard Medical SchoolBostonUSA
  5. 5.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownUSA
  6. 6.Department of Rehabilitation MedicineSeattle Children’s HospitalSeattleUSA
  7. 7.Brigham and Women’s Hospital Orthopedic Sports Medicine ServiceBostonUSA

Personalised recommendations