Sports for Individuals with a Physical Disability

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Introduction

The perception of ‘Sport’ and what it actually constitutes have been continually debated for decades with many definitions and concepts emerging over the years. The Council of Europe’s European Sports Charter [1] defines sport as “all forms of physical activity, which, through casual or organised participation, aim at expressing or improving physical fitness and mental well-being, forming social relationships or obtaining results in competition at all levels”.  In the Irish Department of Education’s Sport Strategic Plan ‘Targeting Sporting Change in Ireland - Sport in Ireland 1997 to 2006 and Beyond , they built on this definition in order to clarify the interpretation under three broad categories; [2]

Recreational Sport; An overriding emphasis on the social and health aspects of sport, with fun and friendship being ‘key components’.

Performance Sport; More structured programs that incorporate some form of competition. Usually organised around school or club structures, with ongoing coaching and involvement in competition from local to national level. Participants at this level are normally required to meet minimal standards of performance and are subject to the rules of the competition.

High Performance Sport; Elite level sport that is highly structured with performance measured against national and international standards. This level of participation requires both internal and external qualities, which are the ability to excel at a personal level as well as on an objective level. The athlete shows a desire for achievement, to prove themselves, reach their own personal limits but also maintain high performance standards.

While historically limitations and exclusions were imposed on the participation of men and women with a disability in sport, namely due to the myth that sport, being representative of physical prowess, could not include those who had a physical impairment.[3] The trend today is one of more progressive inclusion and acceptance, with opportunities for sports participation available within each of the broad categories of sport identified above. [3]

History of Sport for Individuals with a Physical Disability

Throughout the 18th and 19th Centuries sport began to be viewed as a tool for the rehabilitation of people with a disability. [4] But unquestionably it was Dr. Ludwig Guttmann, seen by some as the Paralympic Games equivalent to Pierre De Coubertin (Founder of Modern Olympic Games), who was the instrumental figure in establishing what has today become the International Paralympic Movement. [5] 
“Dr Guttman, you are the De Coubertin of the Paralysed” Pope John Paul XXIII [6]
Guttmann founded the National Spinal Injuries Unit at the Stoke Mandeville Hospital in Aylesbury, England at the request of the British Government in 1944 to address the needs of the large numbers of civilians and soldiers injured during World War II [3][5][7]. Guttman was a strong believer in ‘purposeful, dynamic physical management’ [5], the role that sport could play in the physical and mental rehabilitation of people with a spinal cord injury. So sport was introduced to the programme at Stoke Mandeville Hospital and became a vital element in the treatment of all patients [5][4]. Wheelchair Polo was the first competitive team sport developed at Stoke Mandeville but it was on the 28 July 1948, ‘by chance more than by design’, that the foundation of the first annual sports day, known as the ‘Stoke Mandeville Games’, coincided with the Opening Ceremony of the Olympic Games in London and an international movement was born.[5] The growth of the Paralympic Movement continued with a gradual expansion of sport events, countries and other disabilities competing at the annual International Stoke Mandeville Games which were held in Aylesbury three years out of four; and in the Olympic Year held in conjunction with the Olympic Games in the fourth year of the cycle. The Paralympic Games continue to be held, with few exceptions, in the same city and, since 1988 Seoul Summer Games and 1992 Tignes-Albertville Winter Games, at the same venue as the Olympic Games every four years.


Today, the Paralympics are elite sport events for athletes with physical and sensory disabilities. They emphasize the participants’ athletic achievements rather than their impairments. The movement has grown dramatically since its first days. The number of athletes participating in Summer Paralympic Games has increased from 400 athletes from 23 countries in Rome in 1960 to 4,342 athletes from 159 countries in Rio 2016, including 528 Events across 22 sports.

Sport as a Fundamental Right

“Sport and human rights have always been interconnected, particularly where societies reputation or national pride were at stake” Doris Corbett [8]
The World Health Organisation endorsed the concept that health and functional ability can be influenced through physical activity and sport as a daily component of everyday life for all individuals, including those with a disability. The adoption of the Convention on the Rights of Persons with Disabilities represented a fundamental step in ensuring the rights of people with a disability worldwide were recognised and put into practice.[9][10] Adopted by the General Assembly in December 2006, the Convention was one of the fastest treaties ever negotiated at the United Nations.[11] The convention is intended as a human rights instrument with an explicit, social development dimension.[12] As a human rights treaty it has obligations that are legally binding providing a legal framework to ensure people with a disability can access their fundamental human rights, one of which is the right to take part in cultural life, including participation in play, recreational, leisure and sporting activities, on an equal basis with others.[12] 


United Nations Convention on the Rights of Persons with Disabilities; Article 30.5 [13] With a view to enabling persons with disabilities to participate on an equal basis with others in recreational, leisure and sporting activities, States Parties shall take appropriate measures:

  1. To encourage and promote the participation, to the fullest extent possible, of persons with disabilities in mainstream sporting activities at all levels; 
  2. To ensure that persons with disabilities have an opportunity to organize, develop and participate in disability-specific sporting and recreational activities and, to this end, encourage the provision, on an equal basis with others, of appropriate instruction, training and resources;    

A rights-based approach to sport and physical activity is promoted by the Convention, which means not only the promotion of participation but more importantly of ‘QUALITY’ participation (Walker 2007). The central aim of this rights based approach is in the empowerment of people with a disability to demand their rightful entitlements and fully participate in society, promoting equality and challenging discrimination. [14][15]

Participation in Sport for People with a Disability

There is limited descriptive and comparative data on the participation rates and physical activity patterns of people with a disability but where that data does exist, it shows that people with a disability by and large engage in less physical activity than their able-bodied peers.[16][17] Global estimate’s suggest that more than 60% of adults worldwide do not engage in levels of physical activity that will benefit their health and that physical inactivity is reported as being even more prevalent among both women and people with a disability. [18]

The results of a survey carried out by the National Disability Authority [19] show that people with a disability in Ireland are less likely to be physically active with twice as many taking no regular exercise in comparison to their able-bodied peers. Sport England, the national sports development agency, in two separate surveys on participation in children and adults with a disability show sports participation rates and frequency of participation are significantly lower than their able-bodied counterparts and this remains true for a wide range of disabilities.[20][21]

Factors which Influence Participation in Sport

Participation in sport is influenced by a wide variety of factors. These factors include the perceived benefits of participation in sport, however there are also barriers or constraints, which may hinder participation. These factors and others, influencing participation in sport have been widely explored in relation to able-bodied sport [22][23][24][25] and more recently within the realms of disability sport.  

Initiation into Sport

“It’s all about discovery. My discovery is that swimming opened the door to everything: first it gave me freedom, then a place in society.” Beatrice Hess, France [26]
There are a number of studies that examine the socialisation of people with a disability into sport. Williams [27] explored the issue of disability sport socialisation in relation to identity construction and identified three key factors relation to initiation into disability sport; significant others, socialising situations and personal attributes. If we look at significant others, Ruddell & Shinew [28] suggest that multiple agents play a role in an athletes’ introduction to sport, being evident that a number of key individuals can have an influence on a persons socialisation, often working simultaneously with each individual unaware of the other’s influence.

Theses agents included; [28]

  • physiotherapist,
  • occupational therapist,
  • therapeutic recreation therapist,
  • social worker,
  • family particularly parents,
  • coaches, and
  • peers who play sport.

Williams & Kolkka [29] and Wu & Willams [30] discovered similar introductory agents to disability sport with both studies identifying people with a disability who play the sport as the main initial socialisation agent for both men and women. Unlike Olenik [31] who found that family were the key agents for the socialisation of women with a disability.

If we look at the contexts in which initial participation in sport take place there is much variation depending on the personal attributes of the individual such as; type of impairment, severity, age of onset and gender. For people with a Spinal Cord Injury, an acquired disability, the rehab setting rated as a key social context for re-introduction to sport.

Motives for Participation and Sustained Involvement 

There are now significantly more studies that are exploring the motives behind the participation of people with a disability in sport. Blinde and McCallister [32] found that people with a disability when asked, participated in physical activity and sport in order to maintain body functionality, for social interaction and for the psychological benefits of sport such as stress relief and increased self confidence. Additionally Henderson and Bendini [33] cited pleasure, fun, to feel better, to relax and reduce stress and to improve or maintain fitness as the major reasons why people with a disability chose to be physically active. Wu and Williams [30] discovered similar reasons. This work was conducted with people with a spinal cord injury, both male and female, who saw fitness, fun, health and competition as the major reasons to participate in sport after injury. Here it was noted that rehabilitation and social aspects also influenced the participation of other participants.[30] Both the studies by Blinde and McCallister [32] and Henderson and Bedini [33] also outline the importance of choice or perception of choice when it comes to ongoing participation in sport and physical activity. She found that female athletes rated friendship in sport as the major motive for participation whereas male athletes were more driven into competition for the need to achieve and obtain status. [34]

Constraints to Participation

Research on leisure and sport participation constraints are well established within the field of leisure studies including a wide array of empirical studies and considerable theoretical developments, with three main categories in which to classify constraints to participation in leisure suggested: [35][36][37]

  • Structural, which includes facilities, time, money and transportation;
  • Intrapersonal, or more specifically the psychological state of the individual such as stress, anxiety, and perceived self-skill; and
  • Interpersonal which explores the interaction between individuals.

The number of studies that focus on the constraints of people with a disability in sport are still very limited. Sherrill and Rainbolt [38] in a study on elite athletes with cerebral palsy found lack of time, inadequate equipment and facilities including access, distance and availability, no one to train with, lack of transportation, lack of adequate knowledge among coaches, and lack of a regular coach as the major constraints to ongoing, regular participation. Ferrara, Dattilo & Dattilo [39] again identified inadequate facilities, inadequate equipment, lack of transportation and lack of coaches as major constraints to sports participation but also recognised that athletes experienced different constraints depending on their chosen sport. Blind athletes most often cited transportation as their major constraint whereas wheelchair athletes tended to have more equipment and/or financial constraints.[39] Crawford & Stodolska[36] also identify lack of qualified coaches, limited availability of equipment, inadequate facilities, negative attitudes towards people with a disability and lack of financial resources as the major determinants of sports participation or non-participation within a developing country context. One particular study identifies not only the barriers or constraints to physical activity but also identifies a number of factors that could facilitate participation. [40] They identified 178 barriers in their research, which they grouped under a number of themes including barriers related to the natural environment, equipment, economic issues, information, professional knowledge, perceptions and attitudes, and policies. [40] 

In many of the studies these same constraints to sport continue to reappear for both adults and children with a disability. The Sport England ‘Disability Survey - Young People With A Disability & Sport’ [41], found that, in children with a disability, the most common barriers to participation in physical activity were having no one to go with, unsuitability of local sports facilities, a lack of money, and health considerations. Other constraints included lack of transportation, unwelcoming staff, discrimination, children’s own inhibitions, and clubs do not provide for my disability.[41] In Ireland transportation and accessibility appear to be the major barrier to sports participation by people with a disability. The National Disability Authority Survey [42] shows that due to problems with accessibility and transportation people with a disability in Ireland are significantly more limited in their social life, in comparison to their able bodied peers. Almost a quarter of people with a disability have reported having no access to transportation, neither public transport nor a car, compared to just 5% of the able-bodied population. The National Training and Coaching Centre Consultation Paper, 'Building Pathways' [43] also examines the gaps in the Irish sports system and considers that there is, too often, insufficient acknowledgement of the barriers that exist to participation in sport and physical activity. The report also acknowledges that the National Governing Bodies of Sport are not proactive enough in providing opportunities for people with a disability and that a lack of knowledge and awareness of disability by mainstream coaches make them reluctant to engage with athletes with a disability.  
‘More often than not, barriers are made out of peoples ignorance towards something different.’ [44]

Sport Opportunities

Although participation in sport for individuals with a disability has increased over the years, the number of athletes participating, particularly in competitive sport continues to lag behind that of their able bodied counterparts. Almost any sport in which able-bodied athletes can participate in can be modified for participation by individuals with a disability including archery, athletics, basketball, cycling, bowling, canoeing, equestrian, fencing, golf, kayaking, rowing, rugby, sailing, shooting, skiing, ice hockey, swimming, table tennis, tennis, water skiing, power lifting and others. Competitive sport for people with a disability is found within Paralympic Sport structures, governed by the International Paralympic Committee and other International Sports Federations culminating in the Paralympic Games, a major international multi-sport event for athletes with a physical disability including athletes with physical impairments such as spinal cord injury, amputations, blindness, and cerebral palsy, visual impairments and intellectual impairments.

Paralympic Sport

Paralympic sports refers to competitive sporting activities organised as part of the global Paralympic movement, comprise all the sports contested in the Summer and Winter Paralympic Games. Globally, the International Paralympic Committee is recognized as the leading organization, with direct governance of nine paralympic sports, and responsibility for the Paralympic Games. Other international organizations, notably the International Wheelchair and Amputee Sports Federation (IWAS), the International Blind Sports Federation (IBSA), and the Cerebral Palsy International Sports and Recreation Association (CP-ISRA) govern sports that are specific to certain impairment groups.[45] In addition, certain single-sport federations govern specific sports for athletes with a disability, either as part of an able-bodied sports federation such as the International Federation for Equestrian Sports (FEI), or as a sports federation specifically for athletes with a disability such as the International Wheelchair Basketball Federation and the International Wheelchair Rugby Federation. [46]

The Tokyo 2020 Paralympic Games will have 540 Events across 22 Sports, including the introduction of new sports, badminton and taekwondo, for the first time. The Beijing 2022 Winter Paralympics will include 64 events across 6 sports. The number and kinds of events may change from one Paralympic Games to another. 

Classification

Classification is a unique and integral part of disability sport. It provides a structure for competition, ensuring fair and equitable competition at all levels of sport. Paralympic athletes have an impairment in body structures and functions that leads to a competitive disadvantage in sport. Consequently, criteria are put in place to ensure that winning is determined by skill, fitness, power, endurance, tactical ability and mental focus.

In November 2007, the International Paralympic Committee (IPC) General Assembly passed the IPC Classification Code and International Standards (“the Code”), a universal code for classification that implements policies and procedures across all sports within the Paralympic movement. The intent of the Code is to bring consistency to certain aspects of the classification process, specifically as it relates to;

  • Ensuring accountability and principles of fair play
  • The protection of the rights of all Athletes and Classifiers
  • The Evaluation of Athletes
  • Protest and Appeals

The Paralympic Movement adopted the definitions for the eligible impairment types as described in the World Health Organization International Classification of Functioning, Disability and Health (2001, WHO, Geneva) Each Paralympic Sport must clearly define what impairment groups they provide sports opportunities for. This is described in the Classification Rules of each sport. While some sports include athletes of all impairment types (eg. Athletics and Swimming), other sports are limited to one impairment type (eg. Goalball) or a selection of impairment types (eg. Cycling).

Paralympic Sport incorporates opportunities for a wide range of athletes with a physical impairment, which are outlined in further detail below. The presence of an eligible impairment is a prerequisite but not the sole criterion of entry into a particular Paralympic Sport. It is not sufficient simply to have one of the below impairment types; the athlete must also meet the minimal eligibility criteria as set out by the specific sporting body. Specific and objective testing is used to determine whether a person’s impairment results in sufficient activity limitation to perform the core elements of the relevant sport.

  • Impaired Muscle Power; Impairments in this category have in common that there is reduced force generated by the contraction of a muscle or muscle groups (e.g. muscles of one limb, one side of the body, the lower half of the body). Examples of conditions included in this category are spinal cord injury, peripheral nerve injury, muscular dystrophy, post poliomyelitis, and spina bifida. 
  • Impaired Passive Range of Movement; Range of movement in one or more joint is reduced in a systematically way. Note that hypermobility of joints, joint instability (e.g. shoulder dislocation), and acute conditions of reduced range of movement (e.g. arthritis type of impairment without permanent impairment) typically will be excluded as ‘eligible impairments’. Examples of conditions included in this category are arthrogryposis, osteogenesis imperfecta, and ankylosis.
  • Limb Deficiency; There is a total or partial absence of the bones or joints as a consequence of trauma (e.g. traumatic amputation), illness (e.g. bone cancer) or congenital limb deficiency (e.g. dysmelia)
  • Leg Length Difference; Due to congenital deficiency or trauma, bone shortening occurs in one leg. Examples of conditions included in this category are perthes disease, and dysplasia
  • Short Stature; Standing height is reduced due to atypical dimensions of bones of upper and lower limbs or trunk. Examples of conditions included in this category are achondroplasia, and dwarfism.
  • Hypertonia; A condition marked by an abnormal increase in muscle tension and a reduced ability of a muscle to stretch. Hypertonia may result from injury, disease, or conditions that involve damage to the central nervous system. 
  • Ataxia; Ataxia is a neurological sign and symptom that consists of a lack of co-ordination of muscle movements.
  • Athetosis; Athetosis can vary from mild to severe motor dysfunction. It is generally characterized by unbalanced, involuntary movements of muscle tone and a difficulty maintaining a symmetrical posture.
Sports Impaired Muscle Power Impaired Passive ROM Limb Deficiency Leg Length Difference Short Stature Hypertonia Ataxia Athetosis
Paralympic Summer Sports
Archery
Athletics
Badminton
Basketball
Boccia
Canoe
Cycling
Equestrian
Fencing
Football 7-a-side
Goalball
Judo
Powerlifting
Rowing
Rugby
Shooting
Swimming
Table Tennis
Taekwando
Tennis
Triathlon
Volleyball
Paralympic Winter Sports
Alpine Skiing
Nordic Skiing - Biathlon
Nordic Skiing - Cross Country
Curling
Ice Hockey
Snowboard
Non-Paralympic Sports
Rock Climbing

Resources

International Paralympic Committee

Founded on 22 September 1989 as an international non-profit organisation, the IPC is an athlete-centred organisation composed of an elected Governing Board, a management team and various Standing Committees and Councils. The IPC’s primary responsibilities are to support our 200 plus members develop Para sport and advocate social inclusion, ensure the successful delivery and organisation of the Paralympic Games and act as the international federation for 10 Para sports. They can provide information on the disability sport organisations responsible for paralympic sport within each of their 200 plus member countries.

Parasport

Parasport, developed by ParalympicsGB in partnership with Toyota, is a UK based Website, to connect disabled people with more opportunities to get active than ever before. Our ambition is to create the UK’s biggest fun and vibrant community for players, parents and coaches to share their experiences of para sport, and find useful hints, tips and information on what’s happening near you. This includes in depth listings and all the information you need to connect to local inclusive opportunities.

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