Abstract
The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many wheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries, particularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living, training and competition. The overall purpose of this narrative review was to use the constraints-led approach of dynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter hand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no studies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their data, we have used this approach to select some potential constraints and discussed how they may alter wheelchair performance and/or injury risk. Organism constraints examined included player classifications, wheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and types of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on forces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the research studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future research being given.
Highlights
Wheelchair sports such as basketball, rugby, tennis and racing e.g. 100 m through to the Marathon, are becoming increasingly popular for many athletes with disabilities and spectators, with the pinnacle for these athletes being the Paralympic Games
As we found no studies that have directly utilised the dynamical systems approach to interpret their data in Paralympic athlete studies, we thought it appropriate to conduct a narrative review of the literature for how common alterations to the three levels of constraints under which wheelchair locomotion is performed may alter performance and/or injury risk
Task and environmental constraints could be examined in such a narrative review of the literature, we have focused on selected examples of each of these constraints that we feel have the most relevance to these athletes
Summary
Wheelchair sports such as basketball, rugby, tennis and racing e.g. 100 m through to the Marathon, are becoming increasingly popular for many athletes with disabilities and spectators, with the pinnacle for these athletes being the Paralympic Games. The results of these studies examining the effect of different task constraints type of sport (racing vs court) and indirectly the effect of speed have a number of implications They suggest that to develop sufficient levels of functional variability to perform well in different competitive conditions and tasks and minimise injury risk, Paralympic athletes need to train utilising some variations of the three levels of constraint that they will likely encounter in competition. Using surfaces with greater friction or small inclines could be used as a more specific resistance training tool than gym-based exercises for manual wheelchair users, as is done with sled towing for increasing able bodied sprinting speed [39,40] This is reflected in the results of Richter et al [30], who found that peak hand rim forces increased markedly with increasing grade, with an average 218% increase from the level to a 6° grade condition. Studies such as Hintzy et al [41] that used able bodied females to examine the force-velocity characteristics of maximal wheelchair sprinting and Lutgendorf et al [44] who examined the use of different forms of gloves for wheelchair rugby movement may not be representative of results that would be obtained with Paralympic athletes
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