medicine. Together, however, they can jointly assess
an individual and clear them safely for participation.- Practitioners should avoid mass screening stations for
individuals with disabilities in favor of private office
setting visits. - It is recommended that the PPA be performed by a
medical team that is involved in the longitudinal care
of the disabled athlete, as knowledge of baseline func-
tioning is essential. - Individuals with conditions such as osteogenesis
imperfecta, arthrogryposis, hemophilia, high cervical
lesions, or those missing one of a paired set of organs
should avoid contact sports or sports with a high risk
of falling. - The specific elements required in the PPE are deter-
mined by the sport, the level of participation, the ath-
letic organization, the clinical indications, and the
athlete. The PPE should provide information to guide
the athlete, trainer, coach, and team physician toward
safe participation, activity limitations, and disability-
specific training. - The objectives of the examination include the following:
- Identify conditions that may require further medical
evaluation before the athlete enters into training,
require close supervision during training, and may
predispose to injury.
•Determine the athlete’s general health to assess fit-
ness level and performance. - Counsel on health-related issues and methods for
safe participation.
•Provide referral for identified conditions that require
further evaluation and/or monitoring to physicians
familiar with the disability and the management of
the identified conditions.
- Identify conditions that may require further medical
- In addition to the standard components of a history,
the elements of the history for an athlete with a dis-
ability also should include athletic goals, pre-disability,
present level of training, sports participation, over-
the-counter (OTC) agents taken, presence of impair-
ments, past family cardiopulmonary history, level of
functional independence for mobility and self-care,
and needs for adaptive equipment. - The elements of the disability and sports-specific
physical examination are tailored for the individual.
Sensory deficits, neurologic deficits, joint stability and
range of motion(ROM), muscle strength, flexibility,
skin integrity, medications, and adaptive equipment
needs must be assessed. During the musculoskeletal
examination of an athlete who uses a wheelchair, eval-
uate the stability, flexibility, and strength of the com-
monly injured sites (e.g., shoulder, hand and wrist, and
lower extremities) as well as the trunk. - Special attention should be made during the PPA for
skin breakdown on insensate pressure areas as well as
sites that come in contact with orthotics/prosthetics.
Also a careful history of heat/cold injuries and
changes in neurologic function should be solicited.- During the musculoskeletal examination of an indi-
vidual who has had a lower extremity(LE) amputa-
tion, assess the stability, flexibility, and strength of the
trunk, as well as the hip girdle and the unaffected and
affected LE with or without the prosthesis.
•For individuals with upper extremity(UE) amputa-
tions, the stability, flexibility, and strength of the
shoulder girdle must be assessed in the unaffected and
affected extremity with and without prosthesis, in
addition to a trunk and LE evaluation.
•For the athlete with brain injury, stroke, or multiple
sclerosis(MS), it is prudent to assess the limitations
of the unaffected and affected areas based on mobility
and sports-specific tasks. - Cardiovascular and pulmonary examinations can
identify conditions that can cause cardiopulmonary
collapse or disease progression. Suggested guidelines
for cardiovascular screening of the athlete are avail-
able from the American Heart Association, American
College of Cardiology, and American College of
Sports Medicine.
•A PPE is performed upon entry into sports and should
be repeated at least every 2–3 years. An interim exam-
ination prior to each sport season may be necessary if
the athlete’s health condition changes.
EPIDEMIOLOGY- Injury patterns for disabled athletes are similar to those
for athletes without disabilities; however, location of
injuries appears to be disability and sport dependent.
Lower extremity injures are more common in ambula-
tory athletes (visually impaired, amputee, cerebral
palsy), whereas upper extremity injuries are more fre-
quent in athletes who use a wheelchair (Ferrara and
Peterson, 2000).
•A 3-year, cross-disability prospective study found the
injury rate of disabled athletes to be 9.30/1000 athlete-
exposures (Ferrara and Buckley, 1996). An injury rate
less than what has been reported in college football
(12.0–15.0/1000) and college soccer (9.8/1000), but
higher than that reported in men’s and women’s col-
lege basketball (7.0/1000 and 7.3/1000 respectively)
(Buckley and Powell, 1982; Buckley, 1982).
•A 6-year longitudinal study on reported injuries from
disabled sports organizations, revealed illnesses
(29.8%) were the most common, followed by muscu-
lar strains (22.1%), tendonitis (9.5%), sprains (5.8%),
contusions (5.6%), and abrasions (5.1%). The body
part most commonly injured was the thorax/spine
588 SECTION 7 • SPECIAL POPULATIONS