Evaluation of the SCAT 5 tool in the assessment of concussion in Para athletes: a Delphi study.

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.

Insight Into the Development and Competitiveness of Male UK-Based Stand-up Paddleboard Flatwater Distance Racing From 2013 to 2017.

ABSTRACT: Dyer, B. Insight into the development and competitiveness of male UK-based stand-up paddleboard flatwater distance racing from 2013 to 2017. J Strength Cond Res 35(2): 535-541, 2021-An analysis of 2 stand-up paddleboard "distance" events was undertaken to investigate any change in their participation, racing behavior, and whether such events should be approached differently by practitioners. The completion time paddler-to-paddler gap was investigated as a means of assessing the performances in 2 flatwater distance events from 2013 to 2017. The level of participation at these events had not noticeably changed. An analysis indicated that both events did not significantly change in their completion time paddler-to-paddler range from year to year when looking at 3 subgroups (p > 0.05) and did not differ significantly in behavior when normalized against each other (p > 0.05). Post hoc tests revealed that the paddler time gaps at an event held in 2015 were significantly different when compared with all the other years it had taken place (p < 0.05). The use of a performance intensity chart indicated that there was different finishing paddler-to-paddler gap behavior between the 2 events. Ultimately, it is proposed that athletes and coaches should be aware that 2 events with the same generic classification of being designated a "distance event" may warrant different training methodologies and tactical decision-making.

Questionnaire study to gain an insight into the manufacturing and fitting process of artificial eyes in children: an ocularist perspective.

PURPOSE: To gain an insight into the manufacturing and fitting of artificial eyes in children and potential improvements to the process. METHOD: An online qualitative survey was distributed to 39 ocularists/prosthetists in Europe and Canada. Participants were recruited through purposive sampling, specifically maximum variation sampling from the researcher's contacts and an online search. RESULTS: The findings highlighted the current impression technique as being the most difficult yet most important part of the current process for both the ocularist and child patient. Negatively affecting obtaining a good impression, the child patients distress can be reduced by their parents by providing encouragement, reassurance, practicing the insertion and removal of the artificial eye and being matter of fact. Whilst improvements to the current process provided mixed views, the incorporation of current technology was perceived as not being able to meet the requirements to produce aesthetically pleasing artificial eyes. CONCLUSION: The current artificial eye process can be seen as an interaction with its success being dependent on the child patient's acceptance and adjustment which is dependent on the factors associated to the process. Investigation into the needs of the patient and whether technology can improve the process are the next steps in its advancement.

The analysis and forecasting of male cycling time trial records established within England and Wales.

The format of cycling time trials in England, Wales and Northern Ireland, involves riders competing individually over several fixed race distances of 10-100 miles in length and using time constrained formats of 12 and 24 h in duration. Drawing on data provided by the national governing body that covers the regions of England and Wales, an analysis of six male competition record progressions was undertaken to illustrate its progression. Future forecasts are then projected through use of the Singular Spectrum Analysis technique. This method has not been applied to sport-based time series data before. All six records have seen a progressive improvement and are non-linear in nature. Five records saw their highest level of record change during the 1950-1969 period. Whilst new record frequency generally has reduced since this period, the magnitude of performance improvement has generally increased. The Singular Spectrum Analysis technique successfully provided forecasted projections in the short to medium term with a high level of fit to the time series data.

An Investigation Into the Measurement and Prediction of Mechanical Stiffness of Lower Limb Prostheses Used for Running.

Two energy return prosthesis are subjected to three different statically applied loading methods. This initial study proposes that statically applied loading to a sport prosthesis using several controlled methods were statistically robust enough to derive a mechanical stiffness value. However, any predicted stiffness is drawn into question when allowing any movement of the distal end. This uncertainty will make any evaluation or prescription of lower limb prosthesis technology based upon their stiffness incorrect. In addition, the peak calculated stiffness at the expected bodyweight induced ground impact load of a runner is judged the most representative assessment method. This study attempts to build on previous research advocating the need to monitor the performance of prosthesis lower limb technology in disability sport.

Facilitators and barriers for participation in sports and physical activity for children with lower-limb absence: A systematic review.

Sports and recreational activities offer physical and psychological benefits to children with limb absence. Understanding what facilitators and barriers exist for the participation in sports and physical activity is vital to aid stakeholders to continue enabling facilitators and develop means to tackle existing barriers so that all children with lower-limb absence can participate in sport and physical activity as they wish. The aim of this systematic review was to identify facilitators and barriers that children with lower-limb absence experience when wanting to participate in sports and physical activity. Systematic review. Five databases were used to identify the literature relating to facilitators and barriers to sports and physical activity for children with lower-limb absence. These were Medline, Scopus, Cochrane, SPORTDiscus, and CINAHL. Google scholar was used as a secondary source. The review followed the "Preferred Reporting Item for Systematic Reviews and Meta-Analysis" guidelines. The review identified 10 articles for inclusion that met predefined inclusion criteria. The identified peer-review articles date from 1999 to 2021. The number of published articles steadily increases up to 2010 and then increase rapidly from 2016 to 2021. The results show although there are facilitators for sports participation for children with limb absence, there are many barriers which continue to hinder many children from participating in sports and physical activity. Facilitators that exist include advancements in prosthetic design and technology, increased opportunities, and physical and social benefits. Barriers that were reported include prosthesis failure, stigma, and high costs.

The design of an upper arm prosthesis utilising 3D printing conceived for the 2020 Tokyo paralympic games: A technical note.

This article describes the design and development of an upper-limb prosthesis for a current elite level paracyclist that was conceived for use in the 2020 Paralympic Games. The prosthetic limb was intended specifically for use in cycling time trial events. These are held on the road and in the velodrome whereby the athlete rides using a tucked aerodynamic position. The prosthesis was developed using computer aided design software and an extensive use of the 3D printed manufacturing process. The resulting technical note illustrates the design methodology and manufacturing considerations for a high performance form of assistive technology. However, it results in a solution that challenges the traditional aesthetic of prosthetic limbs intended for sport and physical activity.

The fair use of lower-limb running prostheses: A Delphi study.

The purpose of this paper is to investigate the role of lower-limb running prostheses and stakeholders' perceptions of fairness in relation to their use in competitive disability sport. A Delphi study was conducted over three rounds to solicit expert opinion in a developing area of knowledge. High levels of consensus were obtained. The findings suggest that the prosthesis is defined as a piece of sporting equipment to restore athletes' function to enable them to take part in disability sport. In addition, the panel determined that the development of this technology should be considered to be integral to the sport's ethos. Crucially, prostheses technology should be monitored and have limits placed upon it to ensure fairness for both participants and stakeholders.

An investigation into the relationship between paracycling athletes and their prosthetics technology: a proposed design framework.

Objective: Product attachment has been stated as an emotional relationship an end-user may develop with a tangible product or artefact. The objective of this study is to investigate this relationship with athletes who possess limb absence and utilise assistive sports technology competitively.Method: Five elite paracyclists were surveyed using a modified 31 question product attachment survey. The survey comprised the ability to capture both closed-ended and open-ended data. The survey design itself was derived from three previously validated product relationship questionnaires.Results: Four elite athletes with limb absence did not provide any firm evidence or indication to support the concept of a non-physical relationship with their prosthetic device. However, some respondents had (or wished) to incorporate some form of aesthetic-based prosthetic personalisation or customisation, as long as this did not impact on the prostheses functional performance. Furthermore, a thematic analysis of the participant's responses yielded a four-point assistive technology design philosophy framework. The emerging thematic areas were 1) The identification of the factors that influence performance in the athletes chosen sport; 2) To consider an 'appearance follows performance' approach; 3) To conduct sports specific trials of the prosthetic limb; and 4) To identify any need for prostheses decorative personalisation.Conclusions: The survey revealed some anecdotes of a sports technology to user relationship but this will require further exploration with different and larger sample populations. Use of the proposed four-point framework may help inform practitioners of what considerations could provide greater end-user satisfaction when designing and developing specialised prosthetic limbs for elite-level sport.Implications for rehabilitationWhilst the formal characteristics of product attachment were not broadly identified in this study, some indications may give credence for prosthetists to consider an "appearance follows performance" approach to sports prostheses design. This may improve end-user satisfaction with their assistive technology.The inclusion of prosthetic post-manufacture decoration and personalization would seem to be desirable to the end-user.By adopting the feedback given in this study, undertaking trials conducted at a race-specific intensity of the athlete end-user may reduce the need to perform post-manufacture ad-hoc prostheses modifications.

Development of high performance parasport prosthetic limbs: A proposed framework and case study.

Sport with a disability has progressed from undertaking physical activity for recreation to one of a high performance environment at competitions such as the Paralympic Games. There is currently limited information and guidance to help inform stakeholders as to how to develop the high performance technology of elite athletes who possess limb absence. In this manuscript, a conceptual framework for high performance prosthetic limb creation is presented. This utilises a synthesis between contemporary product design theory and a review of existing case studies. This proposed framework is then applied to a case study. Ultimately, the framework provides an indicative guide to the creation of prosthetic limbs that emphasise technological performance enhancement over that of mere sporting participation.

A Pragmatic Approach to Resolving Technological Unfairness: the Case of Nike's Vaporfly and Alphafly Running Footwear.

BACKGROUND: Technology is often introduced into sport to facilitate it or to improve human performance within it. On occasion, some forms of novel technology require regulation or prevention entirely to ensure that a sport remains fair and accessible. Recently, the Nike Vaporfly and Alphafly shoes have received some concerns over their appropriateness for use in competitive distance running. METHODS: This paper evaluates the use of these shoes against an existing framework for sports technology discourse and adopts a pragmatic approach to attempt to resolve them. RESULTS: It is proposed that the three concerns regarding cost, access and coercion cannot be ruled out but likely remain short-term issues. As a result, it is proposed that these running shoes are acceptable forms of technology but that ongoing vigilance will be required as such technologies develop further in the future. CONCLUSIONS: The Nike Vaporfly/Alphafly shoes do push the perceived acceptability of running shoes to the limits of the current sports regulations. However, the alleged gains have not manifested themselves to a level that could be considered excessive when reviewing historical performances or when evaluated against a set of well-cited criteria. The sport will need to adopt a stance of ongoing vigilance as such technologies continue to develop or be optimised in the future.

The aerodynamic impact of a range of prostheses designs when cycling with a trans-tibial amputation.

Previous studies have proposed that an aerodynamically optimized prosthetic limb could provide performance enhancement for competitive paracyclists. Four different designs of prosthetic limbs were assessed for their impact upon the aerodynamic drag of an elite cyclist with a lower-limb amputation. The pylon area acted as the controlled location for the differences in design between the test prostheses. A validated field test method was used to derive the participant's total aerodynamic drag when using the prostheses designs. The field test method produced a repeatable experimental process and demonstrated that small changes in form made to the pylon region resulted in measurable differences to the participant's cycling performance. In addition, statistical significance was obtained between a baseline design and the prostheses prototype with the greatest aspect ratio (p= <.05). The magnitude of improvements recorded in this study could potentially influence a rider's finishing time at international sporting events like the Paralympic Games.Implications for RehabilitationSmall changes in form made to a cycling prostheses design can potentially deliver worthwhile performance enhancement.Prosthetists may obtain greater end-user satisfaction by taking a broader approach to sports prostheses design than just fit and biomechanical function alone.This study indicates that other regions of the cycling prosthesis could now benefit from aerodynamic optimization with the aim to further improve paracycling performance.

The impact of lower-limb prosthetic limb use in international C4 track para-cycling.

An investigation was undertaken to ascertain any impact or significance of athletes within the C4 paracycling classification between those who use a lower-limb prostheses and those who do not. A statistical evaluation of event completion time was undertaken to assess C4 cyclists when competing at the World Championships and the Paralympic Games in the 1 km track time trial. The C4 athletes who utilize a prostheses consistently outperformed non-amputees in the C4 classification from 2011 to 2016 on a competition-to-competition basis. However, when the participations were grouped as a whole together and an identified outlier athlete was removed, it was then demonstrated that there was no statistical significance between those who required the use of a lower-limb prostheses to those that did not when either evaluated on a competition-by-competition or on an amputee and non-amputee group-by-group basis (p ≥ 0.05). As a result, this study proposes that those requiring the use of lower-limb prostheses are neither advantaged nor disadvantaged in the C4 classification category when competing in the 1 km time trial at this time. Implications for Rehabilitation This analysis indicates that at this time, there is no evidence to suggest that use of such technology is advantageous in this category or should be seen as controversial. The design of lower-limb prosthetic limb technology in cycling should continue to be developed and optimized unabated. This study begins to address the cited lack of peer-reviewed information regarding paracycling with limb absence available to practitioners.

The influence of lower-limb prostheses technology on Paracanoeing time-trial performance.

Within the Paracanoeing discipline, it is important to ensure that appropriate control is achieved by a paddler with a disability. However, this Paralympic Games discipline has seen very little attention to date. The aims of this study were to understand the kinematic impact to a paracanoeist when not utilizing the use of a prosthetic lower-limb. A kayaker with a uni-lateral transfemoral amputation completed several 200 m maximal efforts both with and without their prosthesis. When the prosthetic limb was removed, there were significant differences found in stroke rate, stroke speed, stroke length and overall power output. Sagittal and frontal video analysis demonstrated the residual limb movements when paddling and indicated where support would be required to improve the kayak's control. It is recommended that those with lower-limb absence wishing to paddle a kayak competitively utilize the use of a prostheses designed for the kayaking environment that supports the residual limb at both the upper and inner thigh and the distal end. Implications for rehabilitation This paper is the first study to investigate both biomechanical and assistive technology-related issues in the new Paralympic Games sport of Paracanoeing. For participants possessing lower-limb absence, a prosthetic limb that is designed specifically for the kayaking environment is recommended when Paracanoeing to maximize efficient propulsion. Use of an ergometer and multiple 2D cameras provides practitioners the ability to optimize both the comfort and fit of a prosthetic limb. Use of an ergometer and multiple 2D cameras provides both athletes and practitioners the ability to optimize the points of human contact within a kayak to ensure comfort and control.

Validation of the virtual elevation field test method when assessing the aerodynamics of para-cyclists with a uni-lateral trans-tibial amputation.

Lower-limb amputees typically require some form of prosthetic limb to ride a bicycle for recreation or when competing. At elite-level racing speeds, aerodynamic drag can represent the majority of the resistance acting against a cyclists' forward motion. As a result, the reduction of such resistance is beneficial to an amputee whereby the form and function of the prosthetic limb can be optimized through engineering. To measure the performance of such limbs, field testing provides a cost-effective and context-specific method of aerodynamic drag measurement. However, few methods have been formally validated and none have been applied to amputees with lower-limb amputations. In this paper, an elite level para-cyclist wore two different prosthetic limb designs and had their total aerodynamic drag of a wind tunnel reference method statistically correlated against a velodrome-based virtual elevation field test method. The calculated coefficient of variation was in the range of 0.7-0.9% for the wind tunnel method and 2-3% for the virtual elevation method. A 0.03 m2 difference was identified in the absolute values recorded between the two methods. Ultimately, both methods exhibited high levels of precision, yet relative results to each other. The virtual elevation method is proposed as a suitable technique to assess the aerodynamic drag of amputee para-cyclists. Implications for rehabilitation This assessment method will provide practitioners a reliable means of assessing the impact of changes made to prosthetics design for cyclists with limb absence. The proposed method offers a low cost and geographically accessible solution compared to others proposed in the past. This assessment method has significant potential for impact among prosthetic limb users looking to improve their cycling performance whereas previous attention in this field has been extremely limited.

Development of a high-performance transtibial cycling-specific prosthesis for the London 2012 Paralympic Games.

BACKGROUND AND AIM: It has been reported that cycling-specific research relating to participants with an amputation is extremely limited in both volume and frequency. However, practitioners might participate in the development of cycling-specific prosthetic limbs. This technical note presents the development of a successful design of a prosthetic limb developed specifically for competitive cycling. TECHNIQUE: This project resulted in a hollow composite construction which was low in weight and shaped to reduce a rider's aerodynamic drag. DISCUSSION: The new prosthesis reduces the overall mass of more traditional designs by a significant amount yet provides a more aerodynamic shape over traditional approaches. These decisions have yielded a measurable increase in cycling performance. While further refinement is needed to reduce the aerodynamic drag as much as possible, this project highlights the benefits that can exist by optimising the design of sports-specific prosthetic limbs. Clinical relevance This project resulted in the creation of a cycling-specific prosthesis which was tailored to the needs of a high-performance environment. Whilst further optimisation is possible, this project provides insight into the development of sports-specific prostheses.

Swimming with limb absence: A systematic review.

Swimming with limb absence is undertaken as a source of leisure or rehabilitation and forms part of the current Paralympic Games competition programme. Whilst it is often proposed that research into sport with limb absence can be limited, this study identified the volume, type and historical interest of research regarding swimming with limb absence. A modified PRISMA search protocol was adopted for this review, and five bibliographic databases were used to identify relevant articles. The review identified 24 papers which met the pre-defined inclusion criteria. The identified peer-reviewed publications dated from 1983 to 2015. The trend of publication indicated an initial focus on the design of prosthetics technology with emphasis then shifting specifically to an interest in swimming biomechanics from 2006. The overall trend of publication in this field is a positive one. In this review, four clear themes emerged. These included the general background of swimming with limb absence, the development of lower limb prosthetics technology, swimming with limb absence whilst performing the front crawl stroke and the technique used by those with unilateral elbow disarticulation. From these, four further themes have been identified for pursuit in the immediate future. This review will assist those who are interested in prescribing swimming with limb absence as a form of exercise or to those who wish to pursue it competitively.

Cycling with an amputation: A systematic review.

BACKGROUND: Cycling with any form of limb amputation has progressed from an activity of leisure or rehabilitation to elite level competition as part of the Paralympic Games programme. OBJECTIVE: While it is often proposed that research into sport with an amputation can be extremely limited, this study intended to identify the volume, type and historical strategy in this area. STUDY DESIGN: This study comprises a documented systematic literature review of cycling undertaken with any form of limb amputation. METHOD: This study used four online search engines to identify relevant peer-reviewed literature. These included SPORTDiscus, CINAHL, Scopus and MEDLINE. Google Scholar was also used as a secondary source. The initial results were then subjected to a set of pre-defined inclusion criteria. The resulting publications were then analysed for content and thematic commonality. RESULTS: The review identified 20 articles which met pre-defined inclusion criteria. The identified peer-reviewed publications were dated from the period 2004 to 2014. CONCLUSIONS: Three clear themes emerged from the historical research. There was both a paucity of peer-reviewed literature with respect to cycling with an amputation and the design of adaptive or assistive technology to replace limb loss. However, publications have been rising substantially over the last 5 years. CLINICAL RELEVANCE: This review study established the historical strategy and content of cycling with an amputation and identified the existing research themes. This will assist in summarising the current level of knowledge and help signpost such work in the future.

The controversy of sports technology: a systematic review.

Changes or introductions of technology or equipment can affect how a sport is played or influence its performances. This article conducted a systematic review of peer-reviewed literature to identify any case studies of controversial events surrounding the implementation or use of sports technology. 56 articles were identified that highlighted 31 different case studies found over a three decade time period. Thematic analysis revealed six distinctive themes when reviewing the articles. Whilst the sport of golf had the highest number of case studies, it was found that a significant level of attention had been recorded in the cases of Oscar Pistorius use of prosthetic legs in athletics and the use of full length swimsuits in swimming. The trend surrounding the number of articles was shown to be initially intermittent but saw a peak period from 2008 to 2010. However, the frequency of such articles since this peak has been more consistent. It is proposed that long periods of time without intervention or resolution by a governing body often increases the peer-reviewed attention paid to such cases in examples such as those identified in this systematic review.