DISABILITY SPORT

however it does help to have access to a robust, wide and height-adjustable couch in the clinic, and a portable version for travel. For wheelchair dependent athletes, height adjustability assists transfers and for those with balance problems, a wider couch promotes confidence.

An athlete should normally be able to transfer him/herself on to the couch and should not need to be lifted, although always offer to assist. Ask the athlete to tell you when they need help and how they would like you to do it rather than let them struggle, or pro- vide unnecessary help.

Small equipment that is particularly versatile and useful is a foam wedge or roll to assist positioning, a range of weighted podium balls (medicine balls with handles), a wide range of exercise bands or cords of differing resistance (including handles, and latex free), TNS and biofeedback units.

SUMMARY There is little firm evidence for practice in relation to the manage- ment of sport and disability! This is mainly because athletes have very diverse needs, and the impact of disability varies greatly. There are also relatively few similar athletes making it hard for researchers to obtain sufficient numbers for research studies, and to produce statistically significant results. For that reason the therapist needs to rely on sound clinical reasoning based mostly on theory and experience. Practitioners should be innovative, and consider shar- ing case experiences (with the athlete's permission) to forward the body of knowledge and facilitate learning.

Key points for management:- 1. Use an holistic approach 2. Encompass ADL activities and impacts 3. Aim for reduction of load, and modifications rather than elimi- nation

4. Explain targets and reasons to facilitate compliance to all who need to know 5. Use a joint approach to problem-solving to reach consensus agreement.

THE AUTHOR

Linda Mitchell is the consultant physiotherapist to the British Paralympic Association (since 2002), and is chief physiotherapist to the GB team at the Paralympic Games. She is also a freelance sports physiotherapist and regularly lectures on several MSc programmes.

References 1. Ferrara et al. A longitudinal study of injuries to athletes with disabili- ties. International Journal of Sports Medicine 2000;21:221-224 2. Disability Discrimination Act (1995) www.disability.gov.uk 3. Jones J. Training Guide to Cerebral Palsy Sports. Human Kinetics 1988. ISBN-10: 0873221257 4. Lockette KF, and Keyes AM. Conditioning with Physical Disabilities. Human Kinetics 1994. ISBN-10: 0873226143

USEFUL WEBSITES

■ Wheelchair Tennis – www.itftennis.com/wheelchair ■ BBC Disability Sport – www.bbc.co.uk/disabilitysport ■ CP Sport – www.cpisra.com

www.sportex.net

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