Br J Sp Med 1994; 28(1)

From the Games

Paralympics Barcelona 1 992

John Reynolds MB BS, MRCP(UK), Angela Stirk Grad Dip Phys Ed MCSP,Austin Thomas RGN RCNT RNT, BEd and Fiona Geary Grad Dip Phys MCSPBritish Paralympic Association, Croydon, Surrey, UK

The British Team at the 9th Paralympic Games in AW.September 1992 in Barcelona comprised 151 men and 54 Xwomen athletes in a total of 15 sports. They were

supported by a staff of 86 including a 12-strong medicalteam. The athletes were selected from the National

Championships of the five disability organizations:British Wheelchair Sports Federation; British Blind Sport;Cerebral Palsy Sport; British Amputee Sports Association;

and the British Les Autres Sports Association. This article

outlines the organization and experience of the medical

support team. The injury/illness profile was similar tothose in able bodied sport. The team went on to achieve 40

gold, 47 silver and 41 bronze medals, maintaining thirdplace on the medal table as achieved in Seoul in 1988.

Keywords: Paralympic, games, disabled sport

The Paralympic Games took place in Barcelona in thefirst two weeks of September 1992. The games are the Figure 1. Britain's Tanni Gray on her wa

most important sporting event in the world for thephysically and sensorily disabled athlete. The elite ofthe world's disabled athletes take part in competition §Mw

at the highest level.A total of 15 sports was staged, 12 of which appear

in the Olympic Games programme, though slightmodifications are made to their rules to adapt them todisabled sport. Three sports, including boccia,goalball and seven-a-side football are specifically fordisabled athletes.The UK team at the 9th Paralympic Games in

Barcelona 1992 comprised 151 men and 54 womenathletes, competing in a total of 15 sports. The team =_Adzwas supported by a staff of 86 comprising manage-ment, coaches, escorts, guide runners and a 12-strong medical team.

ay to a gold medal

Medical team compositionThe medical team included two physicians (anorthopaedic physician and a general practitioner),seven physiotherapists, two nurses with specialexpertise in spinal injury, and one prosthetist. Theteam was selected by the chief medical officer.Previous experience in sport and disability wereprerequisites to selection.

Figure 2. Wheelchair tennis

The British team was accommodated in a singleblock within the Olympic village. The medical suitewas situated on the ground floor adjacent to the UKadministrative headquarters, thus providing easyaccess for the team and management. The cliniccomprised a separate consulting room, a nursing areaand a large physiotherapy treatment area with fourcubicles fully equipped with treatment couches,desks, storage and ice maker. Toilet and washingfacilities were also included. All the facilities wereprovided to the UK delegation by the Spanish hosts.

14 Br J Sp Med 1994; 28(1)

Address for correspondence: Dr John Reynolds, Room G13A,Delta Point, 35 Wellesley Road, Croydon CR9 2YZ, UK

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Figure 3. Wheelchair basketball 'free throw'

Physiotherapy equipment listThe following equipment was kindly loaned to theBritish Paralympic Association for the duration of thegames: Enraf Nonius Sonapuls 464; Enraf NoniusEndolaser 476; Enraf Nonius Sonapuls 590; EnrafNonius Endomed 582 Interferential; Omega 3MLLaser (Omega Universal Technologies, London, UK);two Likon electrostimulators (Lederle, Gosport, UK);

Figure 4. Boccia - a game for the severely disabled cerebralpalsy athletes, akin to 'boules'

Figure 5. Wheelchair basketball at Barcelona Stadium

and six TENS of various makes (Raymar, Henley,UK).A large supply of consumable items and full range

of medication, most of which was donated, allowedthe physicians to treat the vast majority of problemswithout use of the local pharmacy. We are mostgrateful to the British Olympic Medical Centre atNorthwick Park Hospital and Southport and FormbyHospital Suppliers for supplying these stocks.

Figure 6. Wheelchair fencing

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Organization of the medical teamBefore the games it was decided to run a core medicalgroup rather than individual squads taking their ownmedical support. The physiotherapy rota was orga-nized so that at any one time there were at least twotherapists in the clinic between 07.30 hours and 22.00hours. The remaining therapists attended the mainsports venues to provide treatment/massage for theathletes before and after competition. The doctorsprovided morning and evening surgeries and alsovisited the competition venues whenever possible. A24-h on-call system was organized with the help of amobile telephone and paging system. The twonursing staff organized themselves to provide 24-hcover and constant presence within the clinic duringthe hours of opening. The medical service was begun4 days before the competition and closed the daybefore departure.

Host country back up facilitiesThe Paralympic organizing committee providedexcellent medical care for the athletes and supportstaff. Within the village, a large polyclinic offered24-h primary/emergency care, a full range of special-ist outpatient services, a pharmacy and a large andwell equipped rehabilitation department. At each ofthe sports venues they provided medical and first aidteams for the entire duration of competition. Firstclass hospital facilities were available if problemsexceeded the scope of individual team medicalfacilities and the polyclinic. All medical facilities wereprovided free of charge.

The sportsThe squad breakdown is shown in Table 1.

StatisticsOut of a total team of 291 competitors and staff, 201team members attended the medical centre at some

Table 1. The numbers in the UK team participating in the differentsports

Sport No.

Athletics 60Swimming 43Archery 10Basketball 12Boccia 4Cycling 5Tennis 4Fencing 7Judo 5Powerlifting 4Weightlifting 4Shooting 11Soccer 11Table tennis 13Volleyball 10

time during the games: 82 were seen by doctors; 77were seen by nurses; and 146 were seen byphysiotherapists.

Serious illness and injury was fortunately rare. Noadmission to hospital was necessary. One athlete wasseen by a specialist for acute renal colic but settledquickly without further problems. Another athletewith Factor VIII deficiency suffered a significanthaemarthrosis and soft tissue bleed but was managedsuccessfully within the UK medical centre with FactorVIII and immobilization. On return to the UK ittranspired that a staff member had continued toexperience diarrhoeal illness, and subsequent investi-gation confirmed amoebiasis. In view of the highlevels of hygiene control within the village it isassumed that the infection was contracted elsewhere.The commonest problems encountered by the

doctors and nurses, given as percentages of the totalnumber of consultations, were: mosquito bites (11%);fungal infection (10%); upper respiratory tract infec-tions (9%); diarrhoea/vomiting (8%); sleep disturb-ance (5%); and pressure sores (4%).The physiotherapy workload was predictably high,

both for active treatment and massage. Injury ratesby body region are shown in Table 2.

Table 3 indicates the percentage of each squadsuffering injury before or during training/competition.

Table 2. Percentage injury rates by body region

Body region %

Cervical spine 17Shoulder 9Knee 5Fingers 3Ribs 3Lumbar spine 11Hand 6Stump sores 5Thumb 3Elbows 3

Table 3. Injuries to all squads during training and competition

Sport % injured

Track and field 80Swimming 69Cycling 17Volleyball 90Judo 80Tennis 75Weightlifting 50Basketball 79Shooting 55Football 73Archery 60Fencing 71Table tennis 69Power lifting 75

Support staff 42

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DiscussionThe 9th Paralympic Games were undoubtedly a greatsuccess. The organization was superb and thecompetition standards higher than ever before. Theathletes are the elite of their sport and train toexceptionally high levels of fitness and skill. Conse-quent upon this is a significantly high level of trainingand competition injury. The relationship between themedical staff and the athletes was extremely good.The balance in the medical team proved to be aboutright and we could not recommend higher levels ofmedical staffing for a team of this size. The onlysignificant change for the future may be the inclusionof one or two massage therapists to relieve somephysiotherapy time.To date many of our paralympic athletes have not

developed close relationships with sports injury'experts'. There is not yet any provision made forthem to receive private physiotherapy care shouldthey become injured. Before the games all teammembers were required to declare any medicalproblems. Not unsurprisingly few injuries weredeclared. On arrival in the paralympic villagehowever, quite large numbers of athletes and supportstaff were presenting almost immediately for treat-ment to pre-existing injuries. Fortunately most werefairly minor. There would appear to be a need,however, to improve our pre-event screening proce-dures, and to provide much better access to specialisthelp should an elite athlete become injured.

Traditionally, disabled athletes have often com-peted in a number of events during the course ofmajor games. As standards have risen this hasbecome increasingly demanding on the athletes.There were a number of occasions in Barcelona whenour competitors were overstretched by trying tocompete in too many events. Some resulted insignificant injury and reduced performance ability.One of our recommendations to team management isto look closely at this point to try to prevent problemsat future competitions.

It may be of interest to those readers who have notworked with disabled athletes to see that the medicalproblems encountered on a trip such as this areessentially the same as in able bodied sport. Due tothe presence of a high proportion of wheelchairathletes, there do tend to be more upper bodyproblems compared with the normal preponderanceof lower limb injury. Few problems occur that arespecific to the competitors' disabilities. Therefore, inmedical team selection, we feel that emphasis shouldbe placed on orthopaedic medical skills and sportsinjury experience, rather than neurological training.There is of course a place for the neurophysiotherap-ist for those athletes with severe spasticity. In themodem paralympic team however, these comprisebut a few.On a note of self criticism, when we came to look at

the treatment statistics for these games it rapidlybecame apparent that our record keeping had beenfar from ideal. Many follow-up physiotherapy ses-sions had not been recorded and massage before andafter events was hardly ever noted. The figures wehave given therefore, are a significant under-representation. We estimate that an adjustment of15% would give a more realistic picture of totaltreatment sessions. A lack of recorded soft tissuediagnosis has also made an analysis of the phy-siotherapy experience difficult. In the light of theseproblems the British Paralympic Association medicalcommission is in the process of designing anappropriate treatment record card to encourage moreaccurate documentation in the future.

In conclusion we can only say that it was a greatprivilege to be part of the UK team at the 9thParalympic Games. Disabled sport has most certainlycome of age and we are fortunate to have a strongsquad of fine athletes in the UK. We wouldrecommend that more medical and paramedicalpersonnel involve themselves in the support of thisimportant group of athletes.

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