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Para swimmers with limb deficiency are faced with the particular situation that they must use their head to finish each competition by a hit to the wall. Repetitive head impacts may impair behavioral and brain functions. We therefore investigated neurobehavioral functions of a Para swimmer with dysmelia before and after repetitive head impacts (T1) and without (T2). Average head impact at T1 constituted 13.6 g with a mean impact force of 6689.9 N. Behavioral and brain functions decreased from pre to post at T1 but not at T2. Para swimmers with limb deficiency are therefore affected from the same consequences onto brain health that are observed after repeated sport-related concussions.

Wearable technology can nowadays be used to improve para-swimming coaching; however, the extent to which individual anatomy affects features of swimming variability is unclear. Six paralympic swimmers were recruited, their upper-limb segment lengths were measured, and their absolute bilateral limb asymmetry indices (AbsLAIUL) were calculated. They were instrumented with a sacrum-worn inertial measurement unit and performed an in-water, fatiguing, freestyle aerobic test at incrementally faster paces. Stroke-to-stroke outcome and execution variability were calculated, respectively, using sample entropy (SampEn) and fractal dimension (FD) on forward and mediolateral linear acceleration signals. Significantly increased perceived exertion scores (F(4,28) = 154.1, p < 0.001) were observed. Execution and outcome variability increased in the forward (SampEn = F(4,25) = 11.86, p < 0.001; FD = F(4,24) = 6.17, p = 0.001) and mediolateral (SampEn = F(4,25) = 9.46, p < 0.001; FD = F(4,24) = 27.64, p < 0.001) directions. Modelling of FD (only) improved with AbsLAIUL as a covariate (forward = F(1,24) = 9.68, p = 0.005; mediolateral = F(1,24) = 8.57, p = 0.021), suggesting that AbsLAIUL affects only execution, but not outcome, variability. This information could help coaches determine which coordination indices should be personalized when monitoring variability during para-swimming training.

The aim was to investigate the effect of breathing conditions and swimming pace on the relationships between the impairment, the breathing laterality and motor coordination symmetry in elite front crawl Para swimmers. Fifteen elite Para swimmers with unilateral physical impairment or with visual impairment and unilateral breathing preference performed eight 25 m using four breathing conditions (every three strokes, every two strokes on preferred and non-preferred breathing side and apnea) at slow and fast paces in a randomized order. Multicamera video system and five sensors have been used to assess arm and leg stroke phases and to compute symmetry of arm coordination (SI IdC ) and of leg kick rate (SI KR ). Our findings emphasized motor coordination asymmetry whatever the breathing conditions and swimming paces, highlighting the influence of impairment. Multinomial logistic regression exhibited a high probability for motor coordination asymmetry (SI IdC and SI KR ) to be present in categories of Para swimmers with impairment and breathing laterality on the same side, suggesting the joined effect of unilateral impairment and unilateral breathing. Moreover, unilateral physical impairment and breathing laterality could also occur on different sides and generate motor coordination asymmetry on different sides and different levels (arms vs. legs). Finally, visual impairment seems amplify the effect of unilateral breathing on motor coordination asymmetry.

IntroductionThe aim of the study was to assess the impact of a structured sports initiation program for individuals with Spinal Cord Injury (SCI) on quality of life, satisfaction, and self-efficacy in activities of daily living, based on a quasi-experimental pre-post test format.Material and methodsThe program was developed in collaboration with a multidisciplinary team. The participants were allowed to try six different Paralympic sports (Para archery, Para athletics, Boccia, wheelchair tennis, Para swimming, and wheelchair fencing) over a 14-week period. The following outcome measures were tested at T0 (baseline) and T1 (14 weeks after): the Trunk Control Test (TCT), Spinal Cord Independence Measure III Self Report (SCIM), Short Form Health Survey 36 (SF-36), Moorong Self Efficacy Scale and the Wheelchair Use Confidence Scale for Manual users (WheelCon-M). The data was analysed using Wilcoxon’s rank test.ResultsOf the included participants, 66.8% demonstrated lesion D3 and D9, while 46.7% had complete SCI. Significant improvements were observed for measures of functional independence, quality of life, self-efficacy and wheelchair use confidence, but not trunk control.ConclusionsThe functional sports initiation program achieved encouraging results for people with SCI; it promoted not only functional improvements, particularly in the management of assistive devices, but also improvements in perceived independence, health-related quality of life, self-efficacy in daily activities, and wheelchair use confidence. The program enables participants to engage in challenging and motivating activities that simultaneously foster participation, social integration, well-being and enjoyment.

Background Rotation of the trunk about its long axis or ‘body roll’ is essential for maximising front crawl swimming performance yet research on how physical impairment affects body roll is extremely limited. This study quantifies body roll kinematics in swimmers with and without central motor and neuromuscular impairments (CMNI). It was hypothesised that body roll kinematics differ between CMNI and non-disabled swimmers, are associated with sport class (level of impairment) and are influenced by upper and lower-limb functional levels. Methods Three-dimensional motion analysis of 27 CMNI (sport classes 2–9) and 13 non-disabled competitive swimmers at 100–200 m race pace provided body roll kinematics, including shoulder and hip roll ranges and torso twist. Health conditions of the CMNI group were cerebral palsy ( n = 12), spinal cord injury ( n = 10) and neuromuscular disorders ( n = 5). CMNI swimmers were divided into three upper-limb [mild ( n = 9), moderate ( n = 9), severe ( n = 9)] and three lower-limb function subgroups [bilateral ( n = 2), unilateral ( n = 6), without kick ( n = 19)] based on their Froude efficiency (a measure of how effectively upper limbs contribute to propulsion) and the number of lower limbs actively kicking during trials, respectively. Results The CMNI group exhibited lower shoulder roll range (104 ± 11° vs. 88 ± 21°, p < 0.05) and torso twist (58 ± 13° vs. 48 ± 22°, p < 0.05) but greater hip roll range (62 ± 10° vs. 75 ± 29°, p < 0.05) than the non-disabled group. Statistical non-parametric mapping revealed less shoulder roll from 0 to 28%, less hip roll from 0 to 10%, greater hip roll from 91 to 100%, and less torso twist from 15 to 32% and from 75 to 81% of the cycle, in the CMNI than the non-disabled group ( p < 0.05). CMNI body roll patterns varied widely, but discrete and continuous variables did not differ between upper-limb subgroups or between lower-limb subgroups. Conclusions CMNI swimmers exhibit different body roll patterns to non-disabled swimmers. The study findings can be used to inform Para swimming coaches and improve the sport-specificity of land-based and water-based assessments currently used to classify CMNI swimmers. Key Points This is the first comprehensive study of body roll in Para swimmers. It establishes the effect of central motor and neuromuscular impairment (CMNI) on front crawl body roll kinematics and how this impacts swimming performance. Para swimmers with CMNI present considerable variation in their body roll strategies due to different levels of function in the upper limbs, trunk and lower limbs, either individually or in combination, reflecting unique self-organising adaptation to their individual organism constraints. Torso twist angles during non-disabled and CMNI front crawl swimming are notably lower than the threshold angle currently applied by World Para Swimming classifiers in their land-based test to define impaired trunk rotation. This indicates that the threshold may not be valid for classifying Para swimmers as it exceeds the amount of torso twist actually required during front crawl.

Para swimmers categorized as S10 and S12 are of particular interest due to their disability grading being closest to that of able-bodied swimmers, making them an ideal group for investigating disparities in limb coordination patterns. This study aimed to investigate whether S10 and S12 para swimmers, whose disability grading for movement and visual ability, respectively, were the closest to that of able-bodied swimmers, would differ in terms of the biomechanics of limb coordination. This study recruited twenty para swimmers (ten with minor limb absence (S10) in the hand and ten with minor visual impairment (S12)). Using panoramic video, the phase duration, stroke length, stroke rate, index of coordination, synchronization, and inter-limb coordination were digitized and compared in the context of a front-crawl sprinting test. The results showed a significantly different duration of the recovery phase for S10 para swimmers at the affected side, where a more random coordination pattern between arm and leg at the pull and push phases was statistically seen. The variation of the inter-limb coordination gradually increased for S10 para swimmers from hand entry to the end of push, but gradually reduced for S12 para swimmers. These results suggest that the same pace was achieved by different hand–leg coordination patterns according to their physical constraints. Consequently, the unique coordination patterns of different para swimmers from this study offer an opportunity to explore the adaptive strategies and biomechanical adjustments that enable optimal performance for para swimmers.

Background The value of social support in enhancing performance is well established in non-impaired and sub-international level athletes with impairments. Despite this, no research to date has explored the experiences of social support in elite para-athletes. The aim of this study was to explore the experiences of social support in elite British para-swimmers and the influence on their wellbeing and performance. Methods A hermeneutic phenomenological study involving semi-structured interviews was undertaken with 8 elite British para-swimmers (3 male, 5 female, mean age 24.9 years). Participants represented 5 para-swimming classes and all 10 of the International Paralympic Committee impairment categories. Data were analysed following a modified version of the Framework Method. Research quality and trustworthiness were ensured through employing techniques including data triangulation, member checking and reflexivity. Results Five themes and 11 sub-themes were generated. The five themes were: ‘the coach-athlete relationship’, ‘team bond’, ‘tangible aid’, ‘The Podium Illusion’ and ‘British para-swimming’. The overall findings and the magnitude of support mentioned in the fourth theme led to the development of a new model called ‘The Podium Illusion’ which reflects the magnitude of support that is available to elite para-swimmers to help maximise their performance and wellbeing. Conclusion Social support is essential for athlete wellbeing and performance. Findings underpin a new model, ‘The Podium Illusion’.

ObjectiveThis study aims to evaluate the effect of a performance-focused swimming programme on motor function in previously untrained adolescents with cerebral palsy and high support needs (CPHSN) and to determine whether the motor decline typical of adolescents with CPHSN occurred in these swimmers.MethodsA Multiple-Baseline, Single-Case Experimental Design (MB-SCED) study comprising five phases and a 30-month follow-up was conducted. Participants were two males and one female, all aged 15 years, untrained and with CPHSN. The intervention was a 46-month swimming training programme, focused exclusively on improving performance. Outcomes were swim performance (velocity); training load (rating of perceived exertion min/week; swim distance/week) and Gross Motor Function Measure-66-Item Set (GMFM-66). MB-SCED data were analysed using interrupted time-series simulation analysis. Motor function over 46 months was modelled (generalised additive model) using GMFM-66 scores and compared with a model of predicted motor decline.ResultsImprovements in GMFM-66 scores in response to training were significant (p<0.001), and two periods of training withdrawal each resulted in significant motor decline (p≤0.001). Participant motor function remained above baseline levels for the study duration, and, importantly, participants did not experience the motor decline typical of other adolescents with CPHSN. Weekly training volumes were also commensurate with WHO recommended physical activity levels.ConclusionsResults suggest that adolescents with CPHSN who meet physical activity guidelines through participation in competitive swimming may prevent motor decline. However, this population is clinically complex, and in order to permit safe, effective participation in competitive sport, priority should be placed on the development of programmes delivered by skilled multiprofessional teams.Trial registration numberACTRN12616000326493.

ObjectiveTo describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.MethodsWe monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention.ResultsBetween 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1–3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions.ConclusionAt any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

To evaluate upper limb performance, trunk extensor endurance, and serratus anterior strength in para swimmers over a sports season. A cohort study conducted over eleven months. Three assessments were performed at pre-season, mid-season, and post-season, evaluating the CKCUEST, Sorensen Test, and isometric strength of the serratus anterior. Twelve para swimmers from a sports center. Generalized Mixed Models were used to assess seasonal changes and the influence of sex, age, type of impairment, and season phase. Coefficients of variation for each variable were calculated along with 95% confidence intervals (CIs), with a 5% significance level. Sorensen Test values decreased during the season (C: 22.0; CI: 33.9 to −10.4; p < 0.01). A serratus anterior isometric strength difference was observed post-season between para athletes with motor impairments and those with visual/intellectual impairments on the dominant side (C: 3.3; CI: 6.2 to −0.5; p = 0.02). Sorensen Test values declined in mid-season, and para athletes with motor impairments showed lower serratus anterior strength in post-season. CKCUEST values remained stable throughout the season. •Seasonal Changes in upper limb and Trunk Performance in para-athlete Swimmers.•A significant reduction in trunk muscle performance was observed during the season.•Para swimmers with motor impairments showed lower values of isometric serratus anterior strength.•The CKCUEST test showed no significant changes throughout the season.