Paralympics 2012: creating a foundation and determining success
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453244
2012
POI36310.1177/0309364612453244CurranProsthetics and Orthotics International
INTERNATIONAL
SOCIETY FOR PROSTHETICS
AND ORTHOTICS
Editorial
Prosthetics and Orthotics International
Paralympics 2012: creating a foundation 36(3) 255–259
© The International Society for
Prosthetics and Orthotics 2012
and determining success Reprints and permission:
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DOI: 10.1177/0309364612453244
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Sarah A Curran
Editor-in-Chief
Cardiff Metropolitan University, UK
‘There are no secrets to success. It is the result of preparation, associated with a rise in chronic disease (e.g. diabetes mel-
hard work, and learning from failure’. litus, peripheral vascular disease), road traffic incidents and
Colin Powell the current war conflicts. This increase will place further
financial burden on governments and health-care systems.
There is no doubt that the Paralympic Games represent the Sport, however, can be considered as a cost-effective and
pinnacle of sporting achievement and showcase excep- valuable method of rehabilitation, which in turn can culti-
tional levels of talent. The journey taken to reach this level vate a positive approach to an active and healthy social
is characterised by relentless training regimes and unflinch- lifestyle.
ing drive to succeed. While it is fair to assume that the The number of individuals with a disability taking part
majority of clinicians and researchers will not be involved in sport has grown substantially over the last 60 years. One
in the management of a Paralympian, many will deal with of the main influencing factors associated with this increase
individuals with a disability who express an interest in is the rehabilitation of personnel injured in the Second
participating and/or competing in sport. This view is sup- World War and the vision and dedication of Sir Ludwig
ported by the significant impact sport has on society as a Guttmann, a professor of neurosurgery. Guttmann believed
whole, with ever-increasing numbers leading an active and that sport undertaken by individuals with disability could
healthy lifestyle. From the family out jogging in their local be competitive and exciting, and perhaps more importantly,
park to a well-disciplined Olympian/Paralympian, all lev- he considered it as playing a vital role in rehabilitation. In
els of ability and commitment find an expression in sport. 1948, on the same day as the opening ceremony of the
The arrival of the London 2012 Olympic and Paralympic London Olympic Games, the first Stoke Mandeville Games
Games will be a defining moment for many, and with the were held in England and involved an archery competition
supporting media coverage and abundance of analysis, it is between patients from Stoke Mandeville and the Star and
hoped that it will stimulate interest in sport and active par- Garter Home, Richmond, Surrey.3 From 1949, the Stoke
ticipation. This vision applies equally to the disabled as Mandeville Games became an annual event and grew in
well as the able-bodied. stature in terms of competitors; the First International Stoke
Although it is known that participation within sport in Mandeville Games were held in 1952. A year later, the term
individuals with a disability dates back to the eighteenth ‘Paralympic’ was introduced to the media (Bucks Advertiser
and nineteenth centuries,1 the opportunities that exist today and Aylesbury News),4 and while the exact origin of the
have evolved greatly. Many, however, would argue that this term is vague, it is thought to derive from combining the
is not universal with limited progress and opportunity for words ‘paraplegic’ and ‘Olympic’. Although officially
people with disability to participate in sport in developing known as the Ninth International Stoke Mandeville Games,
countries. With more than one billion people worldwide the First Paralympic Games were held in Rome, Italy, in
currently living with some form of disability,2 this figure is 1960, but was reserved for spinal cord injury competitors
set to increase with an ageing population, complications only. The games expanded in 1976 and included
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256 Prosthetics and Orthotics International 36(3)
competitors who were visually impaired, amputees and les should be worn for daily activities, everyday, and this by
autres (other conditions that result in disorders of the loco- definition includes participation in sport. While this expla-
motor system). That same year also saw the inaugural nation appears theoretically sound and logical, present day
Winter Paralympic Games, which were held in Örnsköldvik, prostheses and perhaps the more cost-effective devices
Sweden. The evolution of the Paralympic Games repre- worn by an amputee do not have the ability, robustness and
sents the appetite for sport among the disabled, and this adaptability to allow the individual to participate in sport.
rapid growth suggests that the challenges faced by early Furthermore, this debate is limited in other sports such as
disabled athletes should serve as an inspiration for new swimming where individuals will remove their prosthesis
generations of disabled athletes who can find life-affirming since it hinders their technique and performance.13
challenges and satisfaction through participation in sport. However, as Burkett14 points out, a key issue in the role of
Readers with a keen interest in the history of the Paralympic technology and in the context of disability and sport is
Games Movement are therefore referred to comprehensive whether it is essential for performance or enhances perfor-
texts of Bailey,3 Gold and Gold,1 Goodman5 and mance. It is beyond the scope of this editorial to debate this
Vanlandewijck and Thompson.6 issue in detail; however, it is likely that following London
While Guttmann is regarded by many as the ‘Father of 2012, further demands and challenges will be placed on the
the Paralympic Movement’, his vision of the Paralympic international sporting bodies, such as the International
Games running in tandem with the Olympics remains unful- Paralympic Committee, to reach a scientific consensus on
filled. Some may argue that such synchronisation would the use of technology and its devices in sport.
undermine the Paralympians and that it should continue to Within any sport, there are athletes who characterise true
stand alone to better represent the talent, dedication and technical brilliance, and this is no more apparent than in a
devotion of arguably more inspirational athletes, their Paralympian. Present and past examples include the previ-
coaches and support teams. Whatever your thoughts, as a ously mentioned Oscar Pistorius (South Africa), Louise
reader, a clinician and a researcher, while heroes will be Sauvage (Australia, wheelchair Paralympian – now retired),
made during the Olympics, the same will be true of the Dame Tanni Grey-Thompson (Great Britain, wheelchair
Paralympics, which will certainly capture the imagination of Paralympian – now retired) and Evan O’Hanlon (Australia,
many with the true talent and determination on show. It also T38 (cerebral palsy), 100 and 200 m). These athletes are
remains to be seen how many of the 279 world records set at automatically recognised within their sport for their effi-
the 2008 Beijing Paralympic Games7 will be recreated. ciency in motion and performance. However, in order to
achieve this, the athlete must possess a physical stature that
can cope with the demands of the sports biomechanics.
Moreover, their neuromusculoskeletal system must coordi-
Technology, sport and disability
nate in an effective manner, and the physiological system
‘Technology is a queer thing. It brings you gifts with one hand, must be able to maintain the performance of the sequences
and it stabs you in the back with the other’. of motion. These features are combined with the psycho-
logical skills required to focus the mind and effort. This is
CP Snow, New York Times, 15 March 1971 challenging enough for the able-bodied athlete, but the
demands for integrated function and compensation for ath-
Technology is a word ingrained within modern life that letes with a disability are even greater. This and the repeti-
enables progress and development within daily and social tive nature of training and high performance can predispose
activities. As technology progresses, the demands, capa- the athlete to acute and chronic injuries. Recognition of this
bilities and expectations increase. Within the context of fact by the clinician beyond the rehabilitation phase and
sport and disability, advances in technology are regarded as optimising technique and performance to minimise the risk
the foundation, particularly when prostheses, wheelchair of injury in terms of prevention is therefore an important
and its related devices are considered.8–10 The application aspect of comprehensive sports management.
of technology can, however, be contentious with the key While earlier discussion may be biased to the
argument based on the potential to create an unfair advan- Paralympian, it is at the foundational level that more recog-
tage of one athlete to the next.11 The most well-known and nition, assistance and support from clinicians, coaches and
reported example relates to Oscar Pistorius, also known as researchers are required. Developing and optimising a tech-
the ‘Blade Runner’. While there is no doubt of Pistorius’s nique within a particular sport in an athlete with a disability
skill and talent, the use of state-of-the-art prosthesis tech- is based on a series of building blocks, which integrate bal-
nology (J-shaped carbon-fibre Össur Flex-Foot Cheetah) is ance, stability, mobility and symmetry. For many individu-
regarded by some authors to have assisted his qualification als who have a disability, however, their recreational needs
for the 400 m, London 2012 Olympic Games. In a ‘Letter are not always considered, particularly during the rehabili-
to the Editor’, Chockalingam et al.12 argued that if a true tation phase. For example, a new transtibial amputee who
prosthesis serves to replace a missing body part, then it prior to the loss of his/her limb was a keen recreational
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runner expresses a desire to continue with this activity. The important aspect of the rehabilitation phase. In a systematic
initial rehabilitation team, which in an ideal world would be review, the psychological attributes and well-being of the
multidisciplinary, should discuss the expectations of the Paralympic athletes are explored by Jefferies et al. This
patient and the long-term functional goals. In general, for article points to a number of limitations of the existing lit-
many sporting activities, running appears to be the basis. erature on the topic area. In particular, the authors highlight
This in turn identifies the need for the rehabilitation team to the need to foster a holistic view by integrating a psycho-
acknowledge this and incorporate programs and assistive logical profile of disabled athletes in order to optimise per-
technology for active individuals. Perhaps the key message formance. The final review is provided by Bragaru et al.,
here is the need to recognise that the health benefits associ- who examine the use of sport prosthesis for upper and
ated with exercise apply to the disabled, every bit as much lower limbs. They note that the majority of the existing lit-
as to the able-bodied. In fact, due to the many psychologi- erature is descriptive in nature, which is typically based on
cal issues that the disabled may be faced with and the expert opinions and technical notes. Although not inclusive
potential for sport and exercise to manage these, it is emi- of Paralympic events, they present a range of sports such as
nently desirable that sport is promoted within this group. swimming, cycling, running, basketball, fishing, skiing and
This will only happen when the impediments to participa- golf. While this latter sport can challenge the best of us in
tion are removed – setting forth the true challenge for mod- terms of skill and technique, it is a sport that can be played
ern researchers and clinicians. In essence, optimising from young through to old, with excitement (as well as
function should not just be for activities of daily living, but frustration!). In considering this point, and in terms of dis-
for sport that should be seen as an essential activity of daily ability, there is potential scope for golf to be included as an
living to which the disabled have a right. event in future Paralympic Games, and would echo the
reintroduction of golf (last included in 1904) as an Olympic
sport at Rio de Janeiro in 2016. Perhaps more importantly,
Objectives of this Special Issue it may allow more direct comparisons to be drawn between
the Olympics and Paralympics, which can only enhance
The London 2012 Paralympic Games provides a timely and credibility, exposure, talent, opportunities and funding.
exciting opportunity to explore and present informative In keeping with the traditional format of the journal, the
research that has clinical relevance from the foundational reviews are followed by a series of original research reports,
level of the novice sports person with a disability to the the first four of which are focused on running, jumping and
elite Paralympian. This Special Issue contributes to the sprint abilities of amputees. Using two-dimensional, sagit-
understanding and development of clinical perspectives tal plane kinematics, Nolan et al. examined the take-off
and science of sport and disability from around the world. technique for the long jump of Paralympians with a unilat-
By the time this particular issue of Prosthetics and Orthotics eral transtibial amputation and carbon-fibre prosthesis.
International is in print, the London 2012 Olympics will They show how the prosthesis limb acts similar to a ‘spring-
have been completed, and the Paralympics will already be board’ that conserves horizontal velocity. The authors note
well underway with new records and role models being the importance of an alternative and correct technique
created. needed for those individuals expressing a desire to take-off
This Special Issue begins with four reviews, the first of using their prosthetic limb. The questionable role of fair-
which by Deans et al., explores the motivations that inspire ness concerning sprint prostheses at the Paralympics is
and the barriers that face prosthesis users in sport . Of the explored by Dyer et al. This article builds on from previous
12 articles examined, they note that only a small number of research and examines the proposed use and pilot testing of
individuals who have had an amputation are participating a unilateral jump technique for athletes with unilateral
in some form of physical activity/sport. When compared amputation. Using the RS Footscan (RScan Ltd, Ipswich,
with motivation, they highlight the dominance of barriers UK), they show that six jumps are required to obtain relia-
and attempt to reinforce the need for daily physical activity/ ble findings. While further research is required to deter-
sport for all. The role of elite sport participation as part of mine the influence of fatigue, this assessment provides a
the rehabilitation strategy for war-injured veterans is exam- method of determining fairness for use in lower limb sprint
ined by Chockalingam et al. in the second review. Their prostheses.
analysis of the existing literature suggests that while ‘thera- Running in amputee sprinters is the focus of the article
peutic recreation’ is gaining in popularity, there is a clear by Hobara et al. Using a spring–mass model to determine
need for incorporation of protocols, which are multidisci- leg stiffness, they compared and calculated body mass,
plinary in nature, to facilitate the identification of individu- ground contact and flight times during a one-legged hop-
als with potential to participate at elite level. They also ping action. They show that both transtibial and transfemo-
point out that the United Kingdom and other areas of the ral amputees had a higher leg stiffness compared with the
world can learn from the experiences of the US Army that non-amputees. Their analysis also demonstrates that the
endorse participation in sport at an elite level as an sprint ability of an amputee can be predicted from leg
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stiffness during the one-legged hopping task, which can exist for athletes with a disability. The companies that
aid the planning of training of athletes. The contribution of design and create prostheses and other assistive devices for
Strike et al. compares the influence of a shock-absorbing sport remain central to the development of facilitating the
pylon with a rigid condition in recreational transtibial inclusion of disabled athletes in sport from the novice to
amputees during running. Their findings question the use the elite Paralympian. In recognition of this contribution,
of the pylon in reducing the impact forces during a flat this Special Issue provides a series of short papers based
level speed of 4.0 m·s–1. on Clinical Perspectives in Research and Product
Differences in upper body kinematics of children who Development. The four papers, which include contributions
are experienced and inexperienced wheelchair users are from Össur (UK), Adaptive Sport Ankle Prosthesis (USA),
examined by Starrs et al. They note that during three func- novel Gmbh pressure systems (Germany) and performance
tional propulsive assessments, the inexperienced user per- analysis in sport (Canada), are clinically based. The first
formed better demonstrating a larger shoulder flexion two papers represent dialogue that is product centred,
angle. This differed from the experienced wheelchair users, which focuses on the contributions of innovative prosthesis
who showed a larger elbow range of motion, and lends sup- design. The remaining two papers are analysis driven, the
port that the shoulder is a key joint for an efficient propul- first of which is based on novel Gmbh, a company which
sive technique. The role of core stability, (a popular topic incorporates pressure analysis into the assessment of ampu-
within the sporting world in general), balance and strength tees and wheelchair users with their pliance® and in-shoe
in amputee football (soccer) players is explored by Aytar (pedar®) systems. The final paper of the series represents a
et al. Their analysis shows a relationship between core sta- comprehensive discourse integrating the use of biomechan-
bility and sacroiliac mobility and suggests that this should ics, performance analysis in athletes with a disability. The
be evaluated as part of performance analysis in amputee discussion focuses on a wide range of issues and highlights
soccer players. In a slightly alternative approach, the role of the complexity of modern training of athletes with a disa-
functional improvement and social participation in sports bility that can be used to analyse the novice through to the
of children with mild to moderate mental retardation is elite Paralympian.
investigated by Ghosh and Datta. This article is written This Special Issue attempts to address and contribute to
from the perspective of a developing nation (Kolkata, the scientific literature in terms of progression, perfor-
India), and the authors demonstrate how participation in mance and rehabilitation of athletes with a disability.
sport activities aided the functional well-being, but note the Perhaps more importantly, from a clinical perspective, it
community anxieties of their participation. The last of the serves as a timely reminder that as clinicians, we have a
original research reports is by Frossard, who presents the duty to treat individuals with a disability – to enable them
performance dispersion for evidence-based classification to participate in sport and lead a healthy lifestyle in spite of
of female and male shot-put throwers. This data was gath- their disability. The London 2012 Paralympics Games will
ered from the 2008 Beijing Paralympic Games which represent an accumulation of intense, unique and exciting
allowed the formulation of comparative matrices, perfor- opportunities for many. Whichever nation you are from (or
mance continuum and dispersion plots that can be used to support), it is hoped that each athlete, a medal winner or
understand the classification of related variable. not, will obtain the recognition they truly deserve and
The four running-related articles previously described inspire the champions of tomorrow. Happy reading and
are complimented by a case study by Waetjen et al., who viewing!
show how a change from rearfoot to a forefoot strike can
reduce ground reaction forces at impact and loading at the
Acknowledgements
knee of the intact limb in a runner with transtibial amputa-
tion. This case study lends support to the current debate Prosthetics and Orthotics International is grateful to Brendan
with strike patterns in able-bodied runners.15–17 McMullan, London 2012 Organizing Committee, and Alexis
It is clear that the Paralympic Games will incite various Vapaille, Marketing and Communication Administrator, International
interests from around the world, each of which can have an Paralympic Committee, for granting the permission to use the
impact from a social and cultural perspective. In a technical Paralympic Games and International Paralympic Committee logos,
note, Lee et al. report on an innovative design of an adap- respectively.
tive seating system. Although presented for dragon boating,
the set-up mechanism of action in terms of stability for ath- References
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