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Dyer B, Ahmed OH, Dahlén S, Dalton K, Derman W, Donaldson A, Fagher K, Lexell J, Pinheiro L, Van de Vliet P, Weiler R, Webborn N. Evaluation of the SCAT 5 tool in the assessment of concussion in Para athletes: a Delphi study. Br J Sports Med 2024:bjsports-2023-107426. [PMID: 38684327 DOI: 10.1136/bjsports-2023-107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
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.
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Affiliation(s)
- Bryce Dyer
- Faculty of Science & Technology, Bournemouth University, Poole, UK
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Sara Dahlén
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kristin Dalton
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Wayne Derman
- Dept of Exercise, Sport & Lifestyle Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
- IOC Research Center, Stellenbosch, South Africa
| | - Amber Donaldson
- United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Kristina Fagher
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Larissa Pinheiro
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Richard Weiler
- Department of Public and Occupational Health, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
- Sport & Exercise Medicine Fortius Clinic, London, UK
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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2
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Van Gool SW, Van de Vliet P, Kampers LFC, Kosmal J, Sprenger T, Reich E, Schirrmacher V, Stuecker W. Methods behind oncolytic virus-based DC vaccines in cancer: Toward a multiphase combined treatment strategy for Glioblastoma (GBM) patients. Methods Cell Biol 2023; 183:51-113. [PMID: 38548421 DOI: 10.1016/bs.mcb.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Glioblastoma (GBM) remains an orphan cancer disease with poor outcome. Novel treatment strategies are needed. Immunotherapy has several modes of action. The addition of active specific immunotherapy with dendritic cell vaccines resulted in improved overall survival of patients. Integration of DC vaccination within the first-line combined treatment became a challenge, and immunogenic cell death immunotherapy during chemotherapy was introduced. We used a retrospective analysis using real world data to evaluate the complex combined treatment, which included individualized multimodal immunotherapy during and after standard of care, and which required adaptations during treatment, and found a further improvement of overall survival. We also discuss the use of real world data as evidence. Novel strategies to move the field of individualized multimodal immunotherapy forward for GBM patients are reviewed.
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Affiliation(s)
| | | | | | | | | | - Ella Reich
- Immun-onkologisches Zentrum Köln, Cologne, Germany
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3
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Van Gool SW, Makalowski J, Kampers LFC, Van de Vliet P, Sprenger T, Schirrmacher V, Stücker W. Dendritic cell vaccination for glioblastoma multiforme patients: has a new milestone been reached? Transl Cancer Res 2023; 12:2224-2228. [PMID: 37701100 PMCID: PMC10493805 DOI: 10.21037/tcr-23-603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
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4
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Van de Vliet P, Sprenger T, Kampers LFC, Makalowski J, Schirrmacher V, Stücker W, Van Gool SW. The Application of Evidence-Based Medicine in Individualized Medicine. Biomedicines 2023; 11:1793. [PMID: 37509433 PMCID: PMC10376974 DOI: 10.3390/biomedicines11071793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
The fundamental aim of healthcare is to improve overall health of the population by providing state-of-the-art healthcare for individuals at an affordable cost. The foundation for this system is largely referred to as "evidence-based medicine". Too often, evidence-based medicine is based solely on so-called "best research evidence", collected through randomized controlled trials while disregarding clinical expertise and patient expectations. As healthcare gravitates towards personalized and individualized medicine, such external clinical (research) evidence can inform, but never replace, individual clinical expertise. This applies in particular to orphan diseases, for which clinical trials are methodologically particularly problematic, and evidence derived from them is often questionable. Evidence-based medicine constitutes a complex process to allow doctors and patients to select the best possible solutions for each individual based on rapidly developing new therapeutic directions. This requires a revisit of the foundations of evidence-based medicine. A proposition as to how to manage evidence-based data in individualized immune-oncology is presented here.
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Affiliation(s)
| | - Tobias Sprenger
- Immune-Oncological Centre Cologne (IOZK), D-50674 Cologne, Germany
| | | | | | | | - Wilfried Stücker
- Immune-Oncological Centre Cologne (IOZK), D-50674 Cologne, Germany
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5
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Matiashchuk A, Makalowski J, Bitar M, Van de Vliet P, Stuecker W, Van Gool S. IMG-07. Contralateral transient contrast enhancement in a patient with IDH1wt MGMT promoter-methylated GBM responding to TMZ and individualized multimodal immunotherapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Immunotherapy-induced MRI changes remain challenging when treating GBM patients with immunotherapy as part of a combined treatment. The iRANO criteria provide a decision-tree in order to avoid over- and under-treatment reactions when contrast-enhancing lesions become visible and should be interpreted. We report a 34-year female, 34 weeks pregnant, who presented with epilepsy, and was diagnosed with IDH1wt MGMT promoter-methylated GBM after biopsy. On MRI, the left occipital lesion was mostly cystic-necrotic with peripheral contrast enhancement, and crossed over the corpus callosum to the right. The volume was calculated as 64 cm³ (abc/2 formula). She was treated with radiochemotherapy and 12 TMZm cycles. Within each TMZ cycle 5 days of immunogenic cell death (ICD) therapy (5 injections with Newcastle Disease Virus and 5 sessions of modulated electrohyperthermia (Oncotherm 50 min 40-60 Watt) was added at days 8 to 12. After all chemo-/ICD-therapy we continued with active specific immunotherapy: two autologous mature monocyte-derived dendritic cell vaccines loaded with ICD therapy-induced serum-derived antigenic extracellular microvesicles and apoptotic bodies (IO-Vac®). One month after the second IO-Vac®, 17 months after diagnosis, a temporal right FLAIR-visible region showed expansion, and three months later also diffuse contrast enhancement, which was confirmed in a control scan one month later. The original tumor was meanwhile reduced to 16 cm³. However, in the last available scan, two months after the former, the contrast enhancement was disappeared, and the pathologic area on FLAIR was diminished. The original tumor size was reduced to 2 cm³, two year after first diagnosis. She showed allergic skin reactions to TMZ, which was covered with systemic histamine intake. There were no side effects related to multimodal immunotherapy. Transient MRI changes can be observed even in distance from the original tumor and can be interpreted as immune-mediated effects when the original tumor is responding.
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6
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Van Gool S, Makalowski J, Bitar M, Van de Vliet P, Schirrmacher V, Stuecker W. IMMU-03. Synergy between TMZ and individualized multimodal immunotherapy to improve Overall Survival of IDH1 wild-type MGMT promoter-unmethylated GBM patients. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The prognosis of IDH1 wild-type MGMT promoter-unmethylated GBM patients remains poor. Addition of Temozolomide (TMZ) to first-line local treatment shifted the median overall survival (OS) from 11.8 to 12.6 months. We retrospectively analysed the value of individualized multimodal immunotherapy (IMI) to improve OS in these patients. All adults meeting the criteria and treated 06/2015-06/2021 were selected. Thirty-two patients (12f, 20m) had a median age of 47y (range 18-69) and a KPI of 70 (50-100). Extent of resection was complete (11), <complete (12) or not documented (9). Seven patients were treated with surgery/radio(chemo)therapy and subsequent IMI (Group-1); 25 patients were treated with radiochemotherapy followed by maintenance TMZ plus IMI during and after TMZ (Group-2). Age, KPI and extent of resection were not different amongst both groups. The median OS of group-1 patients was 11m (2y OS: 0%). Surprisingly the median OS of group-2 patients was 22m with 2y OS of 36% (CI95%: 16-57), which was significantly (Log-rank: p = 0.0001) different from group-1. The data suggest that addition of IMI after local therapy on its own has no relevant effect on OS in these GBM patients, similar to maintenance TMZ. However, the combination of both TMZ + IMI significantly improved OS. This finding might also have implications in the search for novel combined treatment approaches for children with malignant glioma.
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7
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Van Gool SW, Makalowski J, Bitar M, Van de Vliet P, Schirrmacher V, Stuecker W. Synergy between TMZ and individualized multimodal immunotherapy to improve overall survival of IDH1 wild-type MGMT promoter-unmethylated GBM patients. Genes Immun 2022; 23:255-259. [PMID: 35173295 PMCID: PMC9758045 DOI: 10.1038/s41435-022-00162-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023]
Abstract
The prognosis of IDH1 wild-type MGMT promoter-unmethylated GBM patients remains poor. Addition of Temozolomide (TMZ) to first-line local treatment shifted the median overall survival (OS) from 11.8 to 12.6 months. We retrospectively analyzed the value of individualized multimodal immunotherapy (IMI) to improve OS in these patients. All adults meeting the criteria and treated 06/2015-06/2021 were selected. Thirty-two patients (12f, 20m) had a median age of 47 y (range 18-69) and a KPI of 70 (50-100). Extent of resection was complete (11), <complete (12) or not documented (9). Seven patients were treated with surgery/radio(chemo)therapy and subsequent IMI (Group-1); 25 patients were treated with radiochemotherapy followed by maintenance TMZ plus IMI during and after TMZ (Group-2). Age, KPI and extent of resection were not different amongst both groups. The median OS of group-1 patients was 11 m (2 y OS: 0%). Surprisingly the median OS of group-2 patients was 22 m with 2 y OS of 36% (CI95%: 16-57), which was significantly (Log-rank: p = 0.0001) different from group-1. The data suggest that addition of IMI after local therapy on its own has no relevant effect on OS in these GBM patients, similar to maintenance TMZ. However, the combination of both TMZ + IMI significantly improved OS.
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Affiliation(s)
- Stefaan W. Van Gool
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
| | - Jennifer Makalowski
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
| | - Michael Bitar
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
| | - Peter Van de Vliet
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
| | - Volker Schirrmacher
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
| | - Wilfried Stuecker
- Immun-Onkologisches Zentrum Köln (IOZK), Hohenstaufenring 30-32, 50674 Köln, Germany
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Weiler R, Blauwet C, Clarke D, Dalton K, Derman W, Fagher K, Gouttebarge V, Kissick J, Lee K, Lexell J, Van de Vliet P, Verhagen E, Webborn N, Virgile A, Ahmed OH. Infographic. The first position statement of the Concussion in Para Sport Group. Br J Sports Med 2021; 56:417-418. [PMID: 34610914 PMCID: PMC8938659 DOI: 10.1136/bjsports-2021-104530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Richard Weiler
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Sport & Exercise Medicine, Fortius Clinic, London, UK.,Para Football Foundation, Arnhem, The Netherlands
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - David Clarke
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Kristine Dalton
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division Orthopaedic Surgery, Dept of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,IOC Research Center, Cape Town, South Africa
| | - Kristina Fagher
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Vincent Gouttebarge
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Section of Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - James Kissick
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Medical Committee, International Paralympic Committee, Bonn, Nordrhein-Westfalen, Germany
| | - Kenneth Lee
- Spinal Cord Injury/Disorder, Physical Medicine & Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jan Lexell
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden.,Medical Committee, International Paralympic Committee, Bonn, Nordrhein-Westfalen, Germany
| | - Peter Van de Vliet
- Immune-Oncological Centre Cologne, Cologne, Germany.,Former Medical & Scientific Director International Paralympic Committee, Bonn, Nordrhein-Westfalen, Germany
| | - Evert Verhagen
- Department of Public and Occupational Health, EMGO, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Adam Virgile
- College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Osman Hassan Ahmed
- Para Football Foundation, Arnhem, The Netherlands.,Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK.,University of Portsmouth School of Sport Health and Exercise Science, Portsmouth, Hampshire, UK
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Derman W, Badenhorst M, Blauwet C, Emery CA, Fagher K, Lee YH, Kissick J, Lexell J, Miller IS, Pluim BM, Schwellnus M, Steffen K, Van de Vliet P, Webborn N, Weiler R. Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport. Br J Sports Med 2021; 55:1068-1076. [PMID: 33853834 DOI: 10.1136/bjsports-2020-103464] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/04/2022]
Abstract
In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.
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Affiliation(s)
- Wayne Derman
- Institute of Sport and Exercise Medicine (ISEM), Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa .,International Olympic Committee Research Centre, South Africa.,IPC Medical Committee, Bonn, Germany
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine (ISEM), Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.,International Olympic Committee Research Centre, South Africa.,Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Cheri Blauwet
- IPC Medical Committee, Bonn, Germany.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,International Olympic Committee Research Center, Calgary, Alberta, Canada
| | - Kristina Fagher
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Young-Hee Lee
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Seodaemun-gu, Korea (the Republic of).,International Olympic Committee Research Center, Seoul, Korea (the Republic of).,Yonsei Institute of Sports Science and Exercise Medicine, Seoul, Korea (the Republic of)
| | - James Kissick
- IPC Medical Committee, Bonn, Germany.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jan Lexell
- IPC Medical Committee, Bonn, Germany.,Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Ian Stuart Miller
- English Institute of Sport, Manchester, UK.,British Paralympic Association, London, UK
| | - Babette M Pluim
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands.,Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands
| | - Martin Schwellnus
- International Olympic Committee Research Centre, South Africa.,Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
| | - Kathrin Steffen
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,International Olympic Committee Research Center, Norway.,The Norwegian Olympic Training Center (Olympiatoppen), Oslo, Norway
| | - Peter Van de Vliet
- Former Medical & Scientific Director International Paralympic Committee, Bonn, Germany.,Immune-Oncological Centre, Cologne, Germany
| | - Nick Webborn
- IPC Medical Committee, Bonn, Germany.,Centre for Sport and Exercise Science and Medicine (SESAME), School of Sport and Service Management, University of Brighton, Brighton, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Richard Weiler
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands.,Fortius Clinic, London, UK
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Weiler R, Blauwet C, Clarke D, Dalton K, Derman W, Fagher K, Gouttebarge V, Kissick J, Lee K, Lexell J, Van de Vliet P, Verhagen E, Webborn N, Ahmed OH. Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group. Br J Sports Med 2021; 55:1187-1195. [PMID: 33837003 PMCID: PMC8551975 DOI: 10.1136/bjsports-2020-103696] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/03/2022]
Abstract
Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.
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Affiliation(s)
- Richard Weiler
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands.,Sport & Exercise Medicine, Fortius Clinic, London, UK.,Para Football Foundation, Arnhem, The Netherlands
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | | | - Kristine Dalton
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.,IOC Research Center, South Africa, South Africa
| | - Kristina Fagher
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Vincent Gouttebarge
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - James Kissick
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,International Paralympic Committee Medical Committee, Ottawa, Ontario, Canada
| | - Kenneth Lee
- Spinal Cord Injury/Disorder, Physical Medicine & Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jan Lexell
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, UK
| | - Osman Hassan Ahmed
- Para Football Foundation, Arnhem, The Netherlands.,University Hospitals Dorset NHS Foundation Trust, Poole, UK.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
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11
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Van Biesen D, Burns J, Mactavish J, Van de Vliet P, Vanlandewijck Y. Conceptual model of sport-specific classification for para-athletes with intellectual impairment. J Sports Sci 2021; 39:19-29. [PMID: 33560177 DOI: 10.1080/02640414.2021.1881280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.
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Affiliation(s)
- Debbie Van Biesen
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Jan Burns
- Faculty of Social and Applied Sciences, Canterbury Christ Church University, Canterbury, UK
| | | | | | - Yves Vanlandewijck
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Belgium
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Hogarth L, Burkett B, Van de Vliet P, Payton C. Maximal Fully Tethered Swim Performance in Para Swimmers With Physical Impairment. Int J Sports Physiol Perform 2020; 15:816-824. [PMID: 32131047 DOI: 10.1123/ijspp.2019-0515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/18/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022]
Abstract
The assessment of swimming propulsion should be a cornerstone of Paralympic swimming classification. However, current methods do not objectively account for this component. PURPOSE To evaluate the swimming propulsion of swimmers with and without physical impairment using a 30-second maximal fully tethered freestyle swim test. METHODS Tethered forces were recorded during maximal fully tethered swimming in 80 competitive swimmers with (n = 70) and without (n = 10) physical impairment. The relationships between absolute and normalized tether forces and maximal freestyle swim speed were established using general additive models. RESULTS Para swimmers with physical impairment had lower absolute and normalized tether forces than able-bodied swimmers, and there were moderate positive correlations found between tether forces and sport class (τ = .52-.55, P < .001). There was a nonlinear relationship between tether force and maximal freestyle swim speed in the participant cohort (adjusted R2 = .78-.80, P < .001). Para swimmers with limb deficiency showed stronger relationships between tether force and maximal freestyle swim speed (adjusted R2 = .78-.82, P < .001) than did Para swimmers with hypertonia (adjusted R2 = .54-.73, P < .001) and impaired muscle power (adjusted R2 = .61-.70, P < .001). CONCLUSIONS Physical impairments affect Para swimmers' tether forces during maximal fully tethered freestyle swimming, explaining a significant proportion of their activity limitation. It is recommended that maximal fully tethered swimming be included in Paralympic swimming classification as an objective assessment of swimming propulsion.
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Alqahtani S, Joseph J, Dicianno B, Layton NA, Toro ML, Ferretti E, Tuakli-Wosornu YA, Chhabra H, Neyedli H, Lopes CR, Alqahtani MM, Van de Vliet P, Kumagaya SI, Kim JB, McKinney V, Yang YS, Goldberg M, Cooper R. Stakeholder perspectives on research and development priorities for mobility assistive-technology: a literature review. Disabil Rehabil Assist Technol 2019; 16:362-376. [DOI: 10.1080/17483107.2019.1650300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Saleh Alqahtani
- Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - James Joseph
- Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, HERL, Pittsburgh, PA, USA
| | - Brad Dicianno
- Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Natasha Ann Layton
- Living with Disability Research Centre/Summer Foundation, LaTrobe University, Bundoora, Australia
| | | | - Eliana Ferretti
- Department of Science of Human Movement, University of Estacio de Sa – University Center São Paulo, Sao Paulo, Brazil
| | - Yetsa A. Tuakli-Wosornu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | | | - Heather Neyedli
- School of Health and Human Performance Department, Dalhousie University, Nova Scotia, Canada
| | - Celia Regina Lopes
- Department of Physical Education, Federal University of Uberlândia – Umuarama Campus, Uberlandia, Brazil
| | - Mazen M. Alqahtani
- Physical Therapy Department, AlMajmaah University, AlMajmaah, Saudi Arabia
| | | | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Bunkyo-ku, Japan
| | - Jong-Bae Kim
- Yonsei University – Wonju Campus, Wonju, the Republic of Korea
| | - Vic McKinney
- Department of Health & Rehabilitation Sciences, University of Cape Town, Rondebosch, South Africa
| | - Yu-Sheng Yang
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mary Goldberg
- Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory Cooper
- VA Pittsburgh Healthcare System, HERL, Pittsburgh, PA, USA
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Hogarth L, Payton C, Nicholson V, Spathis J, Tweedy S, Connick M, Beckman E, Van de Vliet P, Burkett B. Classifying motor coordination impairment in Para swimmers with brain injury. J Sci Med Sport 2019; 22:526-531. [DOI: 10.1016/j.jsams.2018.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Derman W, Blauwet C, Webborn N, Schwellnus M, Vliet PVD, Lazarovski D. Mitigating risk of injury in alpine skiing in the Pyeongchang 2018 Paralympic Winter Games: the time is now! Br J Sports Med 2018; 52:419-420. [DOI: 10.1136/bjsports-2017-098864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 11/04/2022]
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Derman W, Schwellnus MP, Jordaan E, Runciman P, Blauwet C, Webborn N, Lexell J, Van de Vliet P, Tuakli-Wosornu Y, Kissick J, Stomphorst J. Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med 2017; 52:17-23. [DOI: 10.1136/bjsports-2017-097962] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveTo describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games.MethodsA total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems.ResultsThe total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35–75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively).Conclusion(1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35–75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.
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Blauwet CA, Cushman D, Emery C, Willick SE, Webborn N, Derman W, Schwellnus M, Stomphorst J, Van de Vliet P. Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games. Am J Sports Med 2016; 44:1455-62. [PMID: 26920432 DOI: 10.1177/0363546516629949] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied. PURPOSE To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-days) by impairment, event discipline, sex, and age were examined. RESULTS The overall IR was 22.1 injuries per 1000 athlete-days (95% CI, 19.5-24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injuries (IR, 10.2; 95% CI, 4.2-16.2) when compared with ambulant athletes from other impairment categories. Athletes in seated throwing experienced a higher incidence of injuries (IR, 23.7; 95% CI, 17.5-30.0) when compared with athletes in wheelchair racing (IR, 10.6; 95% CI, 5.5-15.6). In both track and field disciplines, the majority of injuries did not result in time loss from competition or training. Ambulant athletes experienced the greatest proportion of injuries to the thigh (16.4% of all injuries; IR, 4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest proportion of injuries to the shoulder/clavicle (19.3% of all injuries; IR, 3.4), observed predominantly in field athletes. CONCLUSION This is the first prospective cohort study examining injury IRs and associated factors in the sport of athletics at the Paralympic Games. Injury patterns were specific to the event discipline and athlete impairment. The majority of injuries occurred to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes) and did not result in time loss.
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Affiliation(s)
- Cheri A Blauwet
- Medical Committee, International Paralympic Committee, Bonn, Germany Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada International Olympic Committee Research Centre, Calgary, Canada
| | - Stuart E Willick
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany Centre for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, UK
| | - Wayne Derman
- Medical Committee, International Paralympic Committee, Bonn, Germany Institute for Sport and Exercise Medicine, Division of Orthopaedics, Stellenbosch University, Stellenbosch, South Africa International Olympic Committee Research Centre, Cape Town, South Africa
| | - Martin Schwellnus
- International Olympic Committee Research Centre, Cape Town, South Africa Institute for Sport, Exercise Medicine and Lifestyle Research, Department of Orthopaedics, University of Pretoria, Pretoria, South Africa Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jaap Stomphorst
- Medical Committee, International Paralympic Committee, Bonn, Germany Sports Medicine Department, Isala Klinieken, Zwolle, the Netherlands
| | - Peter Van de Vliet
- Medical and Scientific Department, International Paralympic Committee, Bonn, Germany
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Webborn N, Cushman D, Blauwet CA, Emery C, Derman W, Schwellnus M, Stomphorst J, Van de Vliet P, Willick SE. The Epidemiology of Injuries in Football at the London 2012 Paralympic Games. PM R 2016; 8:545-52. [DOI: 10.1016/j.pmrj.2015.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 11/17/2022]
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Bethapudi S, Campbell RSD, Budgett R, Willick SE, Van de Vliet P. Imaging services at the Paralympic Games London 2012: analysis of demand and distribution of workload. Br J Sports Med 2014; 49:20-4. [PMID: 24705230 DOI: 10.1136/bjsports-2013-093386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Very little data have been published on medical imaging services at disability games. 7.9 million euros (£6.6 million, US$11 million) were invested in setting up radiology facilities within purpose built polyclinics at the London 2012 Olympic and Paralympic games. This paper details imaging services at the 2012 Paralympic Games. Data analysis on imaging at 2012 Olympics has been published in a separate paper. AIM To analyse the workload on the polyclinics' radiology services, provided for the Paralympic athletes during the London 2012 Paralympic Games. METHOD Data were prospectively collected during the period of the Paralympic games from the Picture Archive Communications System (PACS) and the Radiological Information System (RIS). Data were correlated with the medical encounter database (ATOS). RESULTS 655 imaging episodes were recorded, which comprised 38.8% (n=254) MRI, 33% (n=216) plain radiographs, 24% (n=157) ultrasound scans and 4.2% (n=28) CT scans. Investigations on the Paralympic athletes accounted for 65.2% of workload, with the remainder divided between Paralympic family and workforce. CONCLUSIONS MRI was the most used imaging resource and CT was the least used imaging modality at the Paralympic village polyclinic. Analysis of demographic data provides a useful index for planning radiology infrastructure and manpower at future international competitions for athletes with a disability.
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Affiliation(s)
- Sarath Bethapudi
- British Society of Skeletal Radiology (BSSR)/Faculty of Sport and Exercise Medicine (FSEM) 2012 Fellow, London 2012 Olympics and Paralympic Games, London, UK County Durham and Darlington NHS Foundation trust, Durham, UK
| | - Robert S D Campbell
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Richard Budgett
- London 2012 Olympic and Paralympic Games, London, UK English Institute of Sports, Bisham Abbey, Marlow, Buckinghamshire, UK International Olympic Committee (IOC) Medical Commission, Lausanne, Switzerland
| | - Stuart E Willick
- Member of Medical Committee, International Paralympic Committee (IPC), Bonn, Germany Department of Physical Medicine and Rehabilitation, University of Utah Medical School, Salt Lake City, Utah, USA
| | - Peter Van de Vliet
- Medical and Scientific Department, IPC, Bonn, Germany Faculty of Kinesiology and Recreation Management, Health, Leisure and Human Performance Research Institute, University of Manitoba, Canada
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Blauwet CA, Benjamin-Laing H, Stomphorst J, Van de Vliet P, Pit-Grosheide P, Willick SE. Testing for boosting at the Paralympic games: policies, results and future directions. Br J Sports Med 2013; 47:832-7. [PMID: 23681503 DOI: 10.1136/bjsports-2012-092103] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND 'Boosting' is defined as the intentional induction of autonomic dysreflexia (AD) by athletes with a spinal cord injury (SCI) at or above the level of T6 for the purpose of improving sports performance. Boosting has been shown to confer up to a 9.7% improvement in race time. Additionally, to compete in a hazardous dysreflexic state, whether intentional or unintentional, would present an extreme health risk to the athlete. For these reasons, the International Paralympic Committee strictly bans the practice of boosting, and has developed a protocol to test for its presence. METHODS Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test. RESULTS A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98-178) and 82 mm Hg (range 44-112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD. DISCUSSION Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing protocol and the development of further educational initiatives.
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Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02118, USA.
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Derman W, Schwellnus M, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Marques NAP, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N, Willick SE. Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff. Br J Sports Med 2013; 47:420-5. [DOI: 10.1136/bjsports-2013-092375] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schwellnus M, Derman W, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Patino Marques NA, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N, Willick SE. Factors associated with illness in athletes participating in the London 2012 Paralympic Games: a prospective cohort study involving 49,910 athlete-days. Br J Sports Med 2013; 47:433-40. [PMID: 23525473 DOI: 10.1136/bjsports-2013-092371] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The incidence and factors associated with illness in Paralympic athletes have not been documented. AIM To determine the factors associated with illness in athletes participating in the London 2012 Paralympic Games. METHODS A cohort of 3565 athletes from 160 of the 164 participating countries in the London 2012 Paralympic Games were followed over a 14-day period (precompetition period=3 days, competition period=11 days; 49 910 athlete-days). Daily illness data were obtained from (1) teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a novel web-based system and (2) teams without their own medical support through the local organising committee database (82 teams, 236 athletes). Illness information from all athletes included age, gender, type of sport and the main system affected. MAIN OUTCOME MEASUREMENT Incidence rate (IR) of illness (illness per 1000 athlete-days) and factors associated with IR (time period, gender, age and sport). RESULTS The IR of illness was 13.2 (95% CI 12.2 to 14.2). The highest IR of illness was in the respiratory system, followed by the skin, digestive, nervous and genitourinary systems. The IR in the precompetition period was similar to that in the competition period, but the IR was significantly higher in athletics compared with other sports. Age and gender were not independent predictors of illness. CONCLUSIONS Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics).
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Affiliation(s)
- Martin Schwellnus
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
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Willick SE, Webborn N, Emery C, Blauwet CA, Pit-Grosheide P, Stomphorst J, Van de Vliet P, Patino Marques NA, Martinez-Ferrer JO, Jordaan E, Derman W, Schwellnus M. The epidemiology of injuries at the London 2012 Paralympic Games. Br J Sports Med 2013; 47:426-32. [DOI: 10.1136/bjsports-2013-092374] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.
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Affiliation(s)
- Nick Webborn
- Centre for Sport Research, Chelsea School of Sport, University of Brighton, Eastbourne, UK.
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Knapen J, Van de Vliet P, Van Coppenolle H, David A, Peuskens J, Pieters G, Knapen K. Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients. Psychother Psychosom 2006; 74:353-61. [PMID: 16244511 DOI: 10.1159/000087782] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The first objective of this study was to compare the changes in physical self-concept, global self-esteem, depression and anxiety after participation in one of two 16-week psychomotor therapy programs for nonpsychotic psychiatric inpatients. The second objective was to study the relationship between changes in these variables. METHODS One hundred and ninety-nine inpatients were randomly assigned to either a personalized psychomotor fitness program, consisting of aerobic exercise and weight training, or a general program of psychomotor therapy, consisting of different forms of physical exercises and relaxation training. Physical self-concept was evaluated using the Dutch version of the Physical Self-Perception Profile at baseline, after 8 weeks, and after completion of the 16-week interventions. At the same time points, additional variables of global self-esteem, depression and anxiety were assessed by means of the Rosenberg Self-Esteem Inventory, the Beck Depression Inventory and the Trait Anxiety Inventory, respectively. RESULTS After 16 weeks, both groups showed significant improvements in all outcome measures (p values ranged from 0.01 to < 0.0001), with no between-group differences. In both groups, the improvement in physical self-concept was correlated with increased global self-esteem and decreased depression and anxiety levels (p < 0.01). CONCLUSIONS The results suggest that both psychomotor therapy programs are equally effective in enhancing physical self-concept. The relationship between improvements in physical self-concept and enhancements in global self-esteem, depression and anxiety supports the potential role of the physical self-concept in the recovery process of depressed and anxious psychiatric inpatients.
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Affiliation(s)
- Jan Knapen
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
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