Abstract Objective Tandem cycling requires a coordinated effort between the pilot and the stoker. Previous research suggests that randomly paired tandem cyclists produce lower power output than when cycling solo. This study examined how a cyclist’s individual ability and their position on the tandem (pilot or stoker) affects pair performance, when partners are either closely matched or differ substantially in solo cycling capacity, as this might be relevant for training and selection. Methods Twenty-three trained cyclists completed three 10-minute time trials: solo, equal-capacity tandem (≤25 W difference in solo performance), and unequal-capacity tandem (≥40 W difference). Mean power output, heart rate, cadence, and rating of perceived exertion (RPE) were recorded. Positions (pilot or stoker) were counterbalanced. Linear mixed-effects models assessed effects of capacity and position. Results Relative to solo cycling, equal-capacity tandem pairs revealed lower power output (-3.9%), lower heart rate (-2.3%), and lower RPE (-11.5%). Unequal-capacity tandems differed from solo only in heart rate (-2.7%). Stokers produced lower power relative to solo (-5.3%) and relative to pilots (-3.7%) and reported lower RPE relative to solo (-13.9%), while pilots matched their solo power at a lower heart rate (-2.9%). Cadence did not differ across conditions. Total tandem power averaged 95.6% of combined solo power, and differences in partner capacity did not significantly affect combined power output. Conclusion This study provides the first known experimental data on how partner matching affects individual and combined power output in tandem cycling. Equal- and unequal-capacity tandem pairs showed similar performance. Lower power and RPE among stokers suggest reduced engagement or a redistribution of effort between riders. These findings highlight that effective tandem performance depends on physiological capacity and rider position on the tandem, but not on the difference in capacity between partners.

PURPOSE:This study aimed to evaluate both inter- and intra-observer reliability of ultrasound-based muscle thickness measurements in able-bodied (AB) individuals, as well as intra-observer reliability in individuals with spinal cord injury (SCI). METHODS:Ultrasound measurements of the gluteus maximus, medius, minimus and biceps femoris long head were performed on 31 AB participants and 30 participants with SCI. Each AB participant was scanned on two occasions by three observers, with three repetitions per muscle per occasion. The muscle thickness in participants with SCI was measured using three repetitions during a single test occasion, conducted by one observer. A generalizability (G) study was conducted to assess the reliability of the measurements. RESULTS:In AB participants, intra-observer reliability for gluteal muscles ranged from G-coefficient: 0.57 to 0.89, and for biceps femoris long head from G-coefficient: 0.60 to 0.76. Inter-observer reliability in AB participants was G-coefficient:0.48-0.72 for the gluteal muscles and G-coefficient: 0.52 for the biceps femoris. In contrast, intra-observer reliability in participants with SCI was excellent across all muscles (G-coefficient: 0.95-0.99). CONCLUSION:Ultrasound can assess muscle thickness with moderate to good intra-observer reliability in AB participants, but with only poor to moderate inter-observer reliability. In contrast, intra-observer reliability was excellent in participants with SCI. Reliability depends on observer experience and varies across muscles and populations.

Objective To examine the effects of the Wim Hof Method (WHM), with cold exposure (WHM-C) and without (WHM-NC), on mental and physical health in individuals with chronic spinal cord injury (SCI).Design Randomized-controlled trial.Setting Rehabilitation center.Participants Sixty-two adults with chronic SCI (37% tetraplegia, 41% motor complete) were randomized into three groups: WHM-C, WHM-NC, and usual care (UC).Intervention The intervention groups participated in a 7-week program involving weekly supervised sessions and daily home practice. WHM-NC included breathing exercises and mindset training, while WHM-C also incorporated cold exposure. UC participants received no intervention.Main measures The primary outcome was the Mental Health Inventory (MHI-5) score. Secondary outcomes included inflammatory and metabolic markers, pulmonary function, body composition, sleep quality, spasticity, chronic pain, and psychological stress.Results WHM-NC had eight dropouts, mostly due to motivation or unrelated medical issues, while WHM-C and UC had one dropout each. No significant differences in MHI-5 scores were observed between groups. However, WHM-C participants reported reduced pain interference in daily activities compared to UC (p=0.027). WHM-C also showed improvements in inspiratory parameters FIV1 (+27%, p=0.02) and PIF (+23%, p=0.02) and a significant reduction in fasting glucose concentration (-6%, p=0.006) compared to UC.Conclusions While 44% of WHM-NC dropped out, WHM-C appears to be a feasible, effective intervention for improving aspects of physical health and pain perception in a broad group of individuals with chronic SCI, although no significant mental health benefits were observed.

OBJECTIVE To assess the healthcare costs of pressure injuries (PIs) among patients with a spinal cord injury (SCI) in a Dutch rehabilitation center and determine if those costs were associated with patients' age or sex. METHODS The direct healthcare costs of PIs were estimated using data from electronic health records of a Dutch rehabilitation center. This dataset contained demographic, clinical, and resource use information of all patients with an SCI or a PI who were treated at the rehabilitation center because of a PI between 2009 and 2022. Standard prices were used to value inpatient rehabilitation, whereas a micro-costing approach was used to value outpatient consultations and material costs. Using ordinary least squares regression analyses, the authors assessed whether the costs were associated with age and sex, after correcting for the patients' length of PI care. RESULTS Between 2009 and 2022, 409 patients with an SCI were treated at the rehabilitation center for a PI. The patients' mean total length of PI care was 883 +/- 1,266 days (median, 137 days; interquartile range, 10-1,620). The mean total rehabilitation cost of PIs among these patients was 15,412 (USD $16,836) per patient with a mean total annual rehabilitation cost of 6,368 (USD $6,956) per patient. Costs were not significantly associated with age and sex. CONCLUSIONS The healthcare costs of PIs among patients with an SCI in a Dutch rehabilitation center represent a significant economic burden. Prevention of PIs seems warranted, not only from a clinical perspective, but also from a health economic perspective.

PURPOSE:Athletes with hand function impairment are eligible to compete in handcycling using assistive technology designed to compensate for their reduced grip strength. However, there is no evidence suggesting that these athletes perform similarly to their peers without such impairments. This study examined the impact of three simulated hand function impairments on handcycling performance in non-disabled novices. MATERIALS AND METHODS:Fourteen non-disabled individuals voluntarily participated in four measurement sessions using a standard handbike. Different hand function levels were simulated in the four sessions (no impairment and three simulated conditions: asymmetry, finger, and wrist impairments) using strapping and gloves to enable cyclic motion. Each session included two 4-minute submaximal handcycling tests (at 30 W and 45 W) and one 20-second isokinetic sprint. Repeated measures ANOVA was used to analyze differences among the hand function conditions in oxygen uptake (VO2sub) during submaximal tests and peak and mean power output (PO (W)) during the sprints. RESULTS:No significant differences in VO2sub were observed across the four conditions. During the sprint, participants achieved higher peak PO without impairments compared to the simulated impairments, with values 14-17% higher (p < 0.01). However, no significant differences were found in mean PO, which was 5-9% higher without impairments but did not reach statistical significance (p ≥ 0.05). CONCLUSION:The results suggest that individuals without hand function impairments may have an advantage over their peers with impairments during maximal efforts but not during submaximal efforts. However, these findings need to be validated in handcycling athletes.

Objective: The feasibility, safety, and efficacy of automated multi-channel functional electrical stimulation-assisted gait training was assessed in individuals with chronic incomplete spinal cord injury, using an electrical stimulation suit with built-in surface electrodes and motion capture sensors (Teslasuit). Design: 10-week functional electrical stimulation-assisted gait training, twice weekly for 30 min. Subjects/Patients: Five individuals with chronic incomplete spinal cord injury (≥ 12 months post-injury, ASIA C/D, minimal Walking Index Spinal Cord Injury II ≥ 9). Methods: The quadriceps, gluteii, hamstrings, tibialis anterior, and gastrocnemius muscles were stimulated bilaterally during gait. Feasibility and safety were evaluated via questionnaires, session adherence, and adverse events. Gait function was assessed using a 10 m walk test, Walking Index Spinal Cord Injury II, and Hoffer classification at baseline, post-intervention, and follow-up. Surface electromyography and spatiotemporal parameters (walking speed, step length and width, cadence) were recorded during the 10 m walk test. Results: All participants completed the training (91% adherence) with no serious adverse events. Temporary skin redness, muscle soreness, and fatigue were reported by participants. Post-intervention, 4 participants increased their walking speed, step length, and cadence, with 2 maintaining and 2 further improving at follow-up. No consistent changes were found in muscle activity post training. Conclusion: Automated multi-channel functional electrical stimulation-assisted gait training was feasible, safe, and well received. Preliminary findings suggest that gait improved in most participants, though individual responses varied. The results highlight the potential of multi-channel functional electrical stimulation-assisted gait training as a valuable tool for enhancing gait recovery.

OBJECTIVE:This randomised controlled trial evaluated the efficacy of the Tailored Injury Prevention in Adapted Sports (TIPAS) intervention on sports-related health problems in athletes participating in adaptive sports with physical impairments. METHODS:We randomly assigned 60 athletes participating in adaptive sports with physical impairments to an intervention group and 47 to a control group. The intervention group received direct, automated, predetermined preventive and management measures tailored to their weekly reported health problems, physical impairments and sports. The primary outcome was injury and illness prevalence over 40 weeks. Secondary outcomes were incidence, weekly cumulative severity score, weekly time loss, and total burden. A multinomial mixed methods analysis was performed to identify an intervention effect over time. RESULTS:The athletes (53 women, 54 men; age±45 years) reported 449 health problems (162 illnesses, 287 injuries) during the study period. The overall prevalence of health problems was 44% in the intervention group and 46% in the control group. Over time, no significant main intervention effect was found (illnesses OR: 1.02; 95% CI: 0.52 to 1.99; and injuries OR: 1.01; 95% CI: 0.55 to 1.86). However, a significant positive time×group interaction effect (p<0.001) indicated a reduction in injury prevalence in the intervention group over time, though not for illnesses. The rates versus severity analysis showed a significantly lower illness severity in the intervention group relative to the control group. CONCLUSION:The TIPAS intervention provides a non-significant decrease in the overall prevalence of sport-related injuries and illnesses and may reduce the severity of sport-related illnesses throughout a Dutch sports season. This tailored online preventive strategy provides an accessible programme to consider in adapted sports suited to athletes' physical impairments, sports participation and current health status. Trial registration number: ICTRP register: NL-OMON24078.

Tandem cycling is a Paralympic discipline where two cyclists share one bicycle and requires synchronization and shared effort. In this study, we investigated how individual performance on a solo bicycle compares to tandem cycling. Twelve trained cyclists, that were unfamiliar with tandem cycling, completed a submaximal cycling test, a 30 s Wingate test, and a 10 min time trial under solo and tandem conditions. Performance metrics included gross efficiency, maximal power output, mean power output, heart rate, and cadence. The results showed that mean power output during the 10 min time trial was significantly lower on a tandem than on a solo bicycle (257 ± 66 W vs. 282 ± 80 W and p = 0.004), whereas cadence was higher (102.0 ± 7.7 rpm vs. 93.6 ± 4.7 rpm and p = 0.002). Gross efficiency, maximal power output, mean power output over 30 s, and heart rate over 10 min did not differ significantly between solo and tandem cycling. These findings suggest that although tandem cycling influences cadence and power, it does not reduce efficiency or short-duration maximal performance. Given the differences in power output and cadence, coaches and athletes should carefully interpret solo cycling performance metrics when applied to tandem racing and training, especially in novice tandem cyclists. Future research should investigate the role of power output matching and tandem experience, and further explore the interaction between pilot and stoker to optimize performance outcomes.

Study design A three-arm randomized controlled trial. Objectives To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI). Setting Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions). Methods S ixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress. Ethics and dissemination Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation. Trial registration number NCT05704322.

Purpose: The main aim of this study was to compare sitting pressure (peak pressure index (PPI) and peak pressure gradient (PPG)) between a daily wheelchair and fixed-frame handcycle, thereby assessing the effect of handcycle backrest angle, movement intensity and cushion type. Materials and methods: Twenty able-bodied participants performed static and dynamic (two intensities) tests in a wheelchair and handcycle. A honeycomb wheelchair cushion and standard foam handcycle cushion were used. Handcycle backrest angles were 45° and 60°. The PPI and PPG at the sacro-coccygeal (SC) and ischial tuberosity (IT) regions were determined with a pressure mat. Results: PPI at the IT-region was higher in the 60° handcycle condition than in the wheelchair (p = 0.04), while PPG at the IT-region did not differ significantly between the wheelchair and handcycle conditions (p > 0.05). PPI and PPG were higher at the 45° handcycle SC-region compared to the wheelchair IT-region (p < 0.03). PPI and PPG at the IT-region were higher with the 60° than with the 45° backrest angle (p < 0.01), while at the SC-region PPI was higher with the 45° backrest angle (p = 0.047). No clear influence of movement intensity was found. PPI and PPG at the IT-region and PPI of the SC-region in the handcycle were significantly lower with the wheelchair cushion than with the handcycle cushion (p < 0.01). Conclusion: Overall, sitting pressure was higher in the handcycle compared to the daily wheelchair. For handcyclists using an upright position, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear.

Cervical spinal cord injury (SCI) leads to permanent impairment of arm and hand functions. Here we conducted a prospective, single-arm, multicenter, open-label, non-significant risk trial that evaluated the safety and efficacy of ARC EX Therapy to improve arm and hand functions in people with chronic SCI. ARC EX Therapy involves the delivery of externally applied electrical stimulation over the cervical spinal cord during structured rehabilitation. The primary endpoints were safety and efficacy as measured by whether the majority of participants exhibited significant improvement in both strength and functional performance in response to ARC EX Therapy compared to the end of an equivalent period of rehabilitation alone. Sixty participants completed the protocol. No serious adverse events related to ARC EX Therapy were reported, and the primary effectiveness endpoint was met. Seventy-two percent of participants demonstrated improvements greater than the minimally important difference criteria for both strength and functional domains. Secondary endpoint analysis revealed significant improvements in fingertip pinch force, hand prehension and strength, upper extremity motor and sensory abilities and self-reported increases in quality of life. These results demonstrate the safety and efficacy of ARC EX Therapy to improve hand and arm functions in people living with cervical SCI. ClinicalTrials.gov identifier: NCT04697472 .

Elite para-cycling needs an overview of relevant and valid research to better understand and improve performance and to develop the sport, using evidence-based decision making. The aim of this scoping review was to 1) provide a research overview of performance and performance determining factors in elite para-cycling to aid coaches and elite athletes, and 2) highlight the gaps in the literature. Four databases (PubMed, SportDiscus, Scopus and MEDLINE) were systematically searched for studies on para-cycling performance and performance factors and 68 relevant studies were identified. Using a conceptual framework based on a power balance model, most studies were categorized as Athlete and Interface focused, while fewer studies focused on Equipment, External conditions, or Impairment. We found several practical matters regarding training, bike fitting, aerodynamics, and prosthetics design to help coaches and elite athletes to improve performance. However, more research is needed in all categories to improve performance and develop the sport. International collaboration among coaches, researchers, and governing bodies is vital to gain valuable research data.

Quality field tests of athletic performance are important tools for coaches and athletes to evaluate athlete capabilities and changes over time. Current field tests for wheelchair rugby have not been well evaluated. The purpose of this study was to examine the validity and reliability of five wheelchair rugby field tests (ball passing, two sprint tests, two agility tests). Wheelchair rugby players (n = 12) performed the field tests on 2 occasions, separated by 2 weeks, and performed a maximal isokinetic upper-extremity strength test (shoulder flexors and extensors). Spearman correlation was used to examine the relationship among the different field tests as well as to study the relationship with upper-extremity strength and athlete classification. Field test scores were evaluated for reliability across time with intraclass correlation (ICC) and the smallest detectable differences were determined. All tests, except passing, were highly correlated with each other (ρ > 0.85). Test-retest reliability (ICC) ranged between 0.89 - 0.99. Only the long sprint clockwise showed a good correlation with average upper-extremity force production (ρ > 0.75). All wheeling field tests had moderate to excellent correlation with athlete classification (ρ = 0.75 - 0.90). Based on these results, these wheelchair rugby field tests were deemed reliable and have discriminative validity (based on classification), though it may not be necessary to perform all tests to gauge an athlete's overall rugby skill level. Although the results are promising, a full validation should be conducted with a larger sample size.

Background/aim The participation of individuals with physical impairment in sports has numerous benefits, yet there is also the risk of sustaining sport-related injuries or illnesses. Therefore, prevention programmes of these problems are needed to ensure that individuals can maintain a healthy, active lifestyle. Currently, very few prevention interventions are accessible for these athletes. Therefore, the article aims to describe the development process of the Tailored Injury Prevention in Adapted Sports intervention, an online tailored injury and illness prevention intervention for athletes with a physical impairment.Methods The development was guided by the Knowledge Transfer Scheme (KTS).Results In the first step, a cohort study and a qualitative study were conducted to define the problem statement. In the second step, a systematic review was performed in order to learn from theory. Steps 3 and 4 involved an iterative process involving collaboration with diverse expert groups. This included defining athletes’ needs and creating a health problem blueprint, after which the intervention content was created. To ensure accuracy and completeness, a feedback loop was incorporated. In the final phase of this step, we refined the language used within the intervention together with athletes. Finally, an effect and process evaluation will take place in the last step of the KTS.Conclusions Through a five-step approach of the KTS, we developed an online injury and illness prevention intervention for athletes with a physical impairment. This intervention provides direct, timely feedback based on their current health status. Furthermore, it takes the sport and the physical impairment of the athletes into account with regard to the given prevention advices.

CONTEXT:Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports. OBJECTIVE:To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention. DATA SOURCES:A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist. STUDY SELECTION:The search yielded 3006 articles, of which 64 met all inclusion criteria. STUDY DESIGN:Systematic review with quality assessment. LEVEL OF EVIDENCE:Level 3. DATA EXTRACTION:Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence. RESULTS:A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days). CONCLUSION:This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.