OBJECTIVE:To describe the epidemiology of injuries and illnesses at the Paris 2024 Paralympic Games. METHODS:Injuries and illnesses were recorded daily via a web-based injury and illness surveillance system and local organising committee medical facilities. Adjusted incidences (injuries/illnesses per 1000 athlete days; 95% CIs), injury prevalence (IP; %) and injury burden (days lost per 1000 athlete days; 95% CIs) are reported. RESULTS:In total, 4450 athletes (1978 female; 2472 male) from 163 National Paralympic Committees were monitored prospectively during the 14-day Games period (62300 athlete days). A total of 535 injuries (IP=10.9%) were reported in 485 athletes, with an incidence of 8.6 (7.9-9.4). Taekwondo (27.3 (20.7-35.8)), football 5-a-side (22.3 (14.4-37.7)) and sitting volleyball (19.9 (14.8-26.7)) showed higher incidences of injury compared to other sports (p<0.001). Injury burden was 8.5 (6.5-11.1) and 19.1% of injuries resulting in time loss from training/competition. The highest burden was observed in taekwondo (64.3 (35.9-115.2)) and football 5-a-side (23.4 (6.2-88.3)). A total of 520 illnesses were reported in 467 athletes (IP=10.5%), with an incidence of 8.3 (7.6-9.1). Illness incidence for female athletes (10.6 (9.4-11.9)) was higher than recorded for male athletes (6.6 (5.7-7.5)); p<0.001 and higher in triathlon (18.2 (12.6-26.7)) compared to other sports (p<0.05). CONCLUSION:The incidence and burden of injury in taekwondo and football 5-a-side were significantly higher compared with other sports at the Paris 2024 Paralympic Games. The highest incidence of illness was observed in triathlon and female athletes had a higher illness incidence than male athletes.

There is limited understanding about players perceptions and physical demands of wheelchair tennis grass play. This study conducted a quantitative pilot study exploring wheelchair configurations, court hardnesses, and potential court damage. Insights informed the primary qualitative investigation into player perceptions and best practice for wheelchair tennis on grass. Performance data were collected from six players during three tests using different configurations on grass, with hardness values between 197-233Gmax. Sixteen semi-structured interviews with players and support staff offered insights about wheelchair tennis grass play. Qualitative interview findings revealed two themes: navigating performance and de-mystifying wheelchair tennis. On-court findings indicated thicker castors and tyres resulted in reduced rolling resistances (− 8

ABSTRACT:With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data. The aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes. We conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95 https://doi.org/10.37766/inplasy2023.3.0060 ).

ObjectiveTo identify the priority injuries and illnesses across UK summer Paralympic World Class Programmes (WCP).MethodsFour years (2016-2019) of electronic medical records from 360 athletes across 17 Paralympic WCP sports were analysed. Methods were based on the 2021 International Paralympic Committee translation of the original 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. This included reporting incidence (count of injury per athlete year) and burden (time loss days per athlete year) of injuries by impairment category.Results836 injuries and 453 illnesses were recorded during the surveillance period, accounting for 34 638 and 10 032 time-loss days, respectively. 216 (60%) athletes reported at least one injury, while 171 (47.5%) reported at least one illness. There were 0.9 injuries per athlete year, resulting in a mean injury burden of 38.1 days per athlete year. The lumbar/pelvis, shoulder and thoracic/ribs body region had the greatest incidence whereas the shoulder, lumbar/pelvis and wrist had the greatest injury burden. All impairment categories had shoulder or lumbar/pelvis as the body region with the greatest incidence, however the burden of body areas did not always reflect the incidence. Athletes reported 0.5 illnesses per athlete year, resulting in an average illness burden of 11.3 days per athlete year. The respiratory, gastrointestinal, dermatological and genitourinary organ systems had the greatest illness incidence.ConclusionsTo optimise health and performance in Paralympic sport athletes, system-wide mitigation initiatives should target priority injury problems occurring in the lumbar/pelvis, shoulder, thoracic spine/ribs and wrist. Illness types causing the greatest burden vary with impairment group, and illness mitigation initiatives should consider athlete impairment types in their design, while continuing to note the high incidence of respiratory and gastrointestinal illness across all impairments. Further research should examine associated risk factors and the influence of impairment categorisation.

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes’ health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete’s performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement’s purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE’s effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete’s needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete’s health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

Objective To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions. Methods Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI). Results 564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6-15.8) and 6.1 illnesses (4.5-8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2-26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9-2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05). Conclusion The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.

OBJECTIVES:To investigate if the sport concussion assessment tool version 5 (SCAT5) could be suitable for application to Para athletes with a visual impairment, a spinal cord injury, or a limb deficiency.METHODS:A 16-member expert panel performed a Delphi technique protocol. The first round encompassed an open-ended questionnaire, with round 2 onwards being composed of a series of closed-ended statements requiring each expert's opinion using a five-point Likert scale. A predetermined threshold of 66% was used to decide whether agreement had been reached by the panel.RESULTS:The Delphi study resulted in a four-round process. After round 1, 92 initial statements were constructed with 91 statements obtaining the targeted level of agreement by round 4. The expert panellist completion rate of the full four-round process was 94%. In the case of athletes with a suspected concussion with either limb deficiencies or spinal cord injuries, the panel agreed that a baseline assessment would be needed on record is ideal before a modified SCAT5 assessment. With respect to visual impairments, it was conceded that some tests were either difficult, infeasible or should be omitted entirely depending on the type of visual impairment.CONCLUSION:It is proposed that the SCAT5 could be conducted on athletes with limb deficiencies or spinal cord injuries with some minor modifications and by establishing a baseline assessment to form a comparison. However, it cannot be recommended for athletes with visual impairment in its current form. Further research is needed to determine how potential concussions could be more effectively evaluated in athletes with different impairments.

AbstractIn persons with a spinal cord injury (SCI), resistance training using neuromuscular electrical stimulation (NMES‐RT) increases lean mass in the lower limbs. However, whether protein supplementation in conjunction with NMES‐RT further enhances this training effect is unknown. In this randomized controlled pilot trial, 15 individuals with chronic SCI engaged in 3 times/week NMES‐RT, with (NMES+PRO, n = 8) or without protein supplementation (NMES, n = 7), for 12 weeks. Before and after the intervention, whole body and regional body composition (DXA) and fasting glucose and insulin concentrations were assessed in plasma. Adherence to the intervention components was ≥96%. Thigh lean mass was increased to a greater extent after NMES+PRO compared to NMES (0.3 (0.2, 0.4) kg; p < 0.001). Furthermore, fasting insulin concentration and Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR) were decreased similarly in both groups (fasting insulin: 1 [−9, 11] pmol∙L−1; HOMA‐IR: 0.1 [−0.3, 0.5] AU; both p ≥ 0.617). Twelve weeks of home‐based NMES‐RT increased thigh lean mass, an effect that was potentiated by protein supplementation. In combination with the excellent adherence and apparent improvement in cardiometabolic health outcomes, these findings support further investigation through a full‐scale randomized controlled trial.

OBJECTIVE:Data from the Paralympic Games indicate a fluctuating injury incidence in the Paralympic sport goalball, but the mechanisms behind have not been explored. The aims of this study are to (1) quantitatively analyze goalball injuries reported in the London 2012 and Rio 2016 Paralympic Games, (2) qualitatively explain the differences between both games, and (3) qualitatively assess general injury mechanisms and prevention opportunities of injuries in Goalball.DESIGN:This is a mixed-method study. Injury incidence rates were analyzed from data collected during the 2012 and 2016 Paralympic Games. Then, semistructured interviews of games participants qualitatively explored injury mechanisms and prevention opportunities.RESULTS:A reduction of injuries occurred from 2012 (incidence rate, 19.5; 95% confidence interval, 12.5-26.5) to 2016 (incidence rate: 5.6; 95% confidence interval, 1.7-9.5). In both games, acute traumatic injuries were most common. Female athletes reported higher rate of injuries compared with males ( P = 0.05). Qualitative data revealed that causes of injuries were collisions, overuse, and poor physical conditioning. The differences between the two games were explained by equipment, environment, and preparations.CONCLUSIONS:The result from this study indicates that injuries in goalball are multifactorial. Ultimately, the mixed-method data from this study can help the sports context develop prevention measures.

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; 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. 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.

Head injuries and concussion in Para sport have garnered increasing attention in recent years. Concerns have been raised regarding the reporting and identification of concussions sustained during Para sport, where little clinical information may be available. Risk factor identification, baseline screening, recognition/diagnostic tools and management strategies used in ablebodied sporting populations may not be valid in this population, due to the athletes’ underlying impairment and variation in comorbidities. To date, most attention has been paid to athletes with visual impairment competing in contact and high velocity sports, with data showing these athletes are at higher risk for concussions compared with ablebodied athletes.

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Tennis is a multidirectional high-intensity intermittent sport for male and female individuals played across multiple surfaces. Although several studies have attempted to characterise the physical demands of tennis, a meta-analysis is still lacking. We aimed to describe and synthesise the physical demands of tennis across the different court surfaces, performance levels and sexes. PubMed, Embase, CINAHL and SPORTDiscus were searched from inception to 19 April, 2022. A backward citation search was conducted for included articles using Scopus. The PECOS framework was used to formulate eligibility criteria. Population: tennis players of regional, national or international playing levels (juniors and adults). Exposure: singles match play. Comparison: sex (male/female), court surface (hard, clay, grass). Outcome: duration of play, on-court movement and stroke performance. Study design: cross-sectional, longitudinal. Pooled means or mean differences with 95 https://doi.org/10.17605/OSF.IO/MDWFY ).

Objective This scoping review examines how different levels and types of partial foot amputation affect gait and explores how these findings may affect the minimal impairment criteria for wheelchair tennis. Methods Four databases (PubMed, Embase, CINAHL and SPORTDiscus) were systematically searched in February 2021 for terms related to partial foot amputation and ambulation. The search was updated in February 2022. All study designs investigating gait-related outcomes in individuals with partial foot amputation were included and independently screened by two reviewers based on Arksey and O’Malley’s methodological framework and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Results Twenty-nine publications with data from 252 participants with partial foot amputation in 25 studies were analysed. Toe amputations were associated with minor gait abnormalities, and great toe amputations caused loss of push-off in a forward and lateral direction. Metatarsophalangeal amputations were associated with loss of stability and decreased gait speed. Ray amputations were associated with decreased gait speed and reduced lower extremity range of motion. Transmetatarsal amputations and more proximal amputations were associated with abnormal gait, substantial loss of power generation across the ankle and impaired mobility. Conclusions Partial foot amputation was associated with various gait changes, depending on the type of amputation. Different levels and types of foot amputation are likely to affect tennis performance. We recommend including first ray, transmetatarsal, Chopart and Lisfranc amputations in the minimum impairment criteria, excluding toe amputations (digits two to five), and we are unsure whether to include or exclude great toe, ray (two to five) and metatarsophalangeal amputations. Trial registration The protocol of this scoping review was previously registered at the Open Science Framework Registry ( https://osf.io/8gh9y ) and published.