Effect of a Neuromodulation Protocol Associated With Sports Training on the Precision Sports Performance of a Wheelchair Basketball Para-Athlete: A Case Study

OBJECTIVE

To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks.

METHODS

A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values.

RESULTS

There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%.

CONCLUSION

The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player.

Muscle Activity and Morphology in Slalom Skiing by a Single-Leg Amputee Ski Racer: A Case Study of a Paralympic Athlete

The aim of this study was to clarify the characteristics of skiing by a single-leg amputee ski racer from the viewpoints of muscle activity, morphology, and the relationship between both elements through comparisons with those of a non-disabled ski racer. One elite athlete, classified as LW2 (left thigh amputation), and one non-disabled athlete, as a control, participated in this study. The cross-sectional area of thigh muscles was measured through magnetic resonance imaging. Additionally, muscle activities and joint and segment kinematics during slalom skiing were measured using electromyography and inertial measurement units, respectively. The muscle activities and joint kinematics of the amputee racer in the turn in which he performed with the inside edge of the ski were similar to those of the outside leg of the non-disabled racer over a turn. In contrast, at the turn in which the amputee racer performed with the outside edge (more difficult side), the amputee racer largely activated the biceps femoris (BF) in the first half of the turn compared to the non-disabled racer. The reason could be to control the angular momentum of the trunk during the forward tilting motion. This is because a greater activity of the BF was observed during the period in which the forward tilt of the trunk was increased, and the mean activity of the BF was the greatest during the first half of the right turn in which the range of the motion of the forward tilt was the greatest. In terms of muscle morphology of the amputee racer, a significant hypertrophy of the BF and vastus lateralis was observed compared to the non-disabled racers. The well-developed BF was considered to be related to the large activity during the turn performed with the outside edge of the ski.

Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (n = 9 males, n = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg⁻¹ FFM·day⁻¹; and males < 25 kcal·kg⁻¹ FFM·day⁻¹; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.

Kinematic Parameters After Repeated Swimming Efforts in Higher and Lower Proficiency Swimmers and Para-Swimmers

Purpose: The aim of this study was to determine changes in swimming parameters, stroke coordination, and symmetry after repeated high-intensity swimming efforts in swimmers of different performance levels and para-swimmers. Method: Forty swimmers (20 able-bodied, allocated to higher and lower performance groups-G1 and G2, respectively-and 20 impaired swimmers-S5 to S10) were recorded by four underwater cameras while performing repeated 50 m maximum front-crawl swimming with a ten-second interval for each time endured by the swimmer. A cycle stroke was digitized using SIMI Reality Motion Systems in the first and last trials to analyze the kinematic parameters. The comparison among groups and conditions was performed by Mixed ANOVA Models with p < .05. Results: For all groups, swimming velocity, stroke rate, and stroke index showed reduction over time, while stroke length and intracyclic velocity variation did not show significant changes. Conclusions: Training to maintain stroke rate is necessary to support performance since it is the main cause of velocity decrease. Stroke dimensions and individual underwater phases were not sufficient to distinguish groups or conditions. Hand velocity decreased probably due to a decline in energy capacity, propulsive force and passive drag caused by the fatigue process.

Association Between Hormonal Status, Stress, Recovery, and Motivation of Paralympic Swimmers

Purpose: The present study aimed to investigate associations between hormonal profile (cortisol and testosterone) and the psychobiological aspects of Paralympic athletes during a competitive season. Method: Male Brazilian Paralympic swimmers (n = 11) were evaluated in three Training Camps (TC) during the cycle of training for the Paralympic Games RIO 2016. Questionnaires were used for data collection of stress and recovery, motivation in sport and hormonal status was assessed by salivary samples of cortisol ([Csal]) and testosterone ([Tsal]) concentrations. The Friedman test was used to identify overall significant differences at the three TC for each variable. When the overall p value indicated statistical significance (p < .05), a post hoc Wilcoxon signed-rank test for paired data was used to compare pairs of TC. The Spearman correlation was used to identify associations between the hormonal profile and the psychobiological aspects. Results: There was an association between the [Csal] and the "Conflicts/Pressure" sub-scale (r = 0.60; p = .04) in TC1 and the "Lack of Energy" subscale (r = 0.63; p = .03) in TC2. In the TC3, there were correlations between [Tsal] and "To Know" intrinsic motivation (r = 0.83, p < .01), "Objectives"(r = 0.66, p < .02), "Experiences" (r = 0.65, p < .02) and "Amotivation" (r = -0.70, p = .01). There were also associations between the [Tsal] and the "Social Recovery" (r = 0.77, p < .01), "General Wellness" (r = 0.73, p < .01), "Sleep Quality" (r = 0.63, p = .03) and "Self-efficacy" (r = 0.60, p = .05) subscales. In TC3, there was an association between [Tsal] and the "Success" (r = 0.61, p = .04), "Sleep Quality" (r = 0.62, p = .03), "Personal Accomplish" (r = 0.82, p < .01), "Self-efficacy" (r = 0.82, p < .05), "Self-regulation" (r = 0.85, p < .01) and "Physical Recovery" (r = 0.80, p < .01) subscales. The data demonstrate associations between biomarkers (salivary testosterone and cortisol) and psychobiological domains of Paralympic swimmers.

Energy Availability in Male and Female Elite Wheelchair Athletes over Seven Consecutive Training Days

Background: Low energy availability (LEA) is a major problem as athletes often restrict their energy intake. It has been shown that LEA occurs often in female and endurance athletes and in athletes from weight-sensitive or aesthetic sports. The purpose of this study was to investigate energy availability (EA) in elite wheelchair athletes. Methods: Fourteen elite wheelchair athletes (8 males; 6 females) participated. Data were collected using a weighed seven-day food and training diary to estimate energy intake and exercise energy expenditure. Resting energy expenditure and body composition were measured, whereas energy balance (EB) was calculated. Results: Measured over 7 days, EA was significantly different (36.1 ± 6.7 kcal kg⁻¹ FFM day⁻¹) in male compared to female (25.1 ± 7.1 kcal kg⁻¹ FFM day⁻¹) athletes (p < 0.001). From all analyzed days, LEA occurred in 73% of the days in female athletes and in 30% of the days in male athletes. EB was positive in male athletes (+169.1 ± 304.5 kcal) and negative (−288.9 ± 304.8 kcal) in female athletes. Conclusions: A higher prevalence of LEA was found in female compared to male athletes. A higher energy intake would be recommended to meet energy needs and to maximize training adaptation.

Maximal Fully Tethered Swim Performance in Para Swimmers With Physical Impairment

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.

Is V̇O2peak a Valid Estimation of V̇O2max in Swimmers with Physical Impairments?

Purpose: Peak and maximal oxygen uptake ([Formula: see text] and [Formula: see text], respectively) are used in assessing aerobic power. For swimmers with physical impairments, it is unclear whether the physiological variables obtained in 200-m and Nx200-m tests are similar. The objective of this study is to assess the validity of [Formula: see text] as an estimator of [Formula: see text] and complementary physiological variables, in particular, carbon dioxide production ([Formula: see text]), respiratory exchange ratio (RER), minute-ventilation ([Formula: see text] and absolute (HR) and relative (%HRmax) heart rates-which were obtained in a time trial test (200-m) and an incremental intermittent test (Nx200-m) performed by swimmers with physical impairments. Methods: Eleven well-trained swimmers with physical impairments performed 200-m all-out and Nx200-m from low to all-out (controlled by a visual pacer), both with a respiratory valve system and a portable gas analyzer. Results: A paired Student's t-test showed no statistical difference (p > .05) for all comparisons. The intraclass correlation coefficient (ICC) was 0.97 and 0.98 for [Formula: see text] in l/min and ml/kg/min, respectively; ICC = 0.75 to 0.9 for [Formula: see text] (l/min and ml/kg/min),[Formula: see text] (in l/min) and HR (beats/min); ICC = 0.5 and 0.75 for %HRmax; and ICC < 0.5 for RER. Passing-Bablok regression showed that the dispersions were acceptable, considering the proportionality, except for HR and %HRmax. Bland-Altman method showed a high level of agreement for all variables. Conclusions: The [Formula: see text] and [Formula: see text], as well as the physiological variables [Formula: see text] and HR obtained, respectively, by 200-m and Nx200-m tests in swimmers with physical impairment were not different.

Quality of life, concern of falling and satisfaction of the sit-ski aid in sit-skiers with spinal cord injury: observational study

STUDY DESIGN

Observational study.

OBJECTIVE

To describe (1) user satisfaction, (2) the Quality of Life (QoL) and (3) fear of falling in individuals with tetraplegia or paraplegia who used a mono-ski for sit-skiing.

SETTING

Spinal units and Sport associations.

METHODS

An observational study of people with spinal cord injury (SCI) who used a sit-ski. Participants were recruited in various SCI rehabilitation centers and sport associations. Participants completed three assessment tools: the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0); the World Health Organization Quality of Life (WHOQoL-BREF); the Spinal Cord Injury Fall Concern Scale (SCI-FCS). Results were evaluated with chi-squared test and Kolmogorov-Smirnov's test and the significance was set for p values < 0.05.

RESULTS

Fifteen participants were included. Results showed positive and statistically significant values for all the items of the SCI-FCS related to fear of falling, and for most of the items of the WHOQoL-BREF related to QoL and the QUEST 2.0 related to satisfaction with the device.

CONCLUSIONS

This study highlights that sit skiing is correlated with high levels of satisfaction with the mono-ski, increases in QoL, and low levels of fear of falling. In adding these findings to the existent literature, it can be stated with more certainty that sit-skiing is a sport that can be recommended in rehabilitation and sports therapy programs.

Accuracy of Impedance Cardiography for Hemodynamic Assessment During Rest and Exercise in Wheelchair Rugby Players

Purpose: The aim of the study was to analyze the accuracy of impedance cardiography (ICG) for hemodynamic assessment in wheelchair rugby players during rest and exercise. Method: The study included 21 players (mean age 33.0 ± 5.4, 86% male) with posttraumatic tetraplegia. ECG, echocardiography, and gas exchange analysis during rest and exercise were used to obtain heart rate (HR), stroke volume (SV), and cardiac output (CO) for comparison with PhysioFlow®. Results: There was a good correlation between reference methods and ICG for HR, SV, CO at rest and CO at peak exercise (r = 0.69-0.77, p < .001) and a very good correlation for peak HR (r = 0.91, p < .0001). ICG overestimated SV at rest, CO at rest, and peak CO, which resulted in low intraclass correlation coefficients (ICC = 0.250 and 0.570). Conclusions: ICG can serve as a good estimate of basic hemodynamic parameters during rest and exercise in wheelchair rugby players but overestimates stroke volume and cardiac output.

[Criteria for granting permission for disabled persons to participate in the Ready for Labor and Defense training program]

Rehabilitation, adaptation, and social integration of the disabled are the priority issues of social welfare policy in the Russian Federation. This includes the enhancement of availability ofphysical education and adapted sports programs. One of the best practices for the improvement ofphysical activity among the population is the "Ready for labour and defense" training system (GTO). However, it is not adapted for those with physical challenges and disabilities. To involve this special fraction of the population in physical activity and participation in the GTO system, disability groups eligible for this activity need to be identified. They can include individuals with visual (VI), intellectual (II), hearing (HI), and locomotor problems as well as those with transplanted organs (TO). Also, minimum disability criteria (MDC) for the participants from each group which would make them eligible to practice an adapted GTO system should be defined. The development of MDC for individuals with VI, II, HI, and TO is relatively easy as they are common for most adapted sports. However, it remains a challenge for persons with locomotor problems since they make up a very diverse group bearing in mind that the rules of the International Paralympic Committee envisage different MDC for different adapted sports. There are two possible solutions: (1) to develop specialized MDC for each sport discipline included in the GTO system, (2) to develop universal MDC for all disciplines. The next step in promoting the GTO system among individuals with physical challenges and disabilities will be the development of the para- GTO program that would be unique and adapted for all categories of the disabled individuals.

Kinematic analysis of the wheelchair tennis serve: Implications for classification

The aim of the present study was to assess the validity of the classification system used in Open-class wheelchair tennis by investigating the relationship between post-impact ball velocity in the serve (measured using a sports radar gun) and the severity of impairment. Shoulder and wrist angles at the instant of ball impact were also estimated from 2D motion analysis. Forty-three nationally ranked Italian Open-class wheelchair tennis players were assigned to four groups (A–D) according to descending level of activity limitation. Ten successful flat serves (WFSs) and 10 successful kick serves (WKSs) for each player were recorded. One-way ANOVA showed that the severity of impairment significantly (P < 0.05) affected post-impact ball velocity and shoulder angle at the instant of ball impact. Furthermore, the mean value of post-impact ball velocity in WFS increased from group A to group D, i.e., with descending level of activity limitation. The results of this cross-sectional study indicate that the severity of impairment per se is associated with velocity of the wheelchair tennis serve, suggesting that the current classification is flawed in that it overlooks the impact of severity of impairment on players' performance.

Athletes with Implantable Cardioverter Defibrillators

Athletes with an implantable cardioverter defibrillator (ICD) represent a diverse group of individuals who may be at an increased risk of sudden cardiac death when engaging in vigorous physical activity. Therefore, they are excluded by the current guidelines from participating in most competitive sports except those classified as low intensity, such as bowling and golf. The lack of substantial data on the natural history of the cardiac diseases affecting these athletes as well as the unknown efficacy of ICDs in terminating life-threatening arrhythmias occurring during intense exercise has resulted in the restrictive nature of these now decade old guidelines.