Sports The 1976
for the
physically disabled
Olympiad (Toronto)
ROBERT W. JACKSON,* M.D., M.S. (TOR.), F.R.C.S.(C), AND ALIX
FREDRICKSON,† B.A., Toronto, Ontario, Canada From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
ABSTRACT The 1976
Olympiad for the Physically Disabled was the first olympiad with full competition for blind, paralyzed, and ampuMore than 1,500 from 38 countries took part in (12 events), blind (8 events), and amputee (11 events) games. Participants were classified by an international team of doctors. The athletes were accommodated in university tee athletes.
wheelchair
residences with small infirmaries. A school near the games site was used as a field hospital. Rest areas were also set up. Volunteers served on the medical staff (three doctors, three nurses, three receptionists, and three physical therapists on each of two shifts per day). In addition doctors, nurses, trainers, and physical therapists rotated around various venues at the games site. Physicians treated 285 patients (184 were athletes; others were spectators) for a variety of problems, physical therapists treated 119 athletes, and trainers treated 114 athletes. Contingency plans in case of mass disaster were made but were not needed. Disabled athletes are slightly more vulnerable to stress and fatigue than able-bodied athletes. The Toronto games will probably be remembered as the turning point in the emergence of sports for the disabled from a purely rehabilitation measure to a true sporting event in its own right. ii
T these games rebuild lives.&dquo; Nothing truer
or more
to the
point could be said about sports for the physically handicapped than those words uttered by Sir Ludwig Guttmann. I,2 Prior to World War II and the experience gained in the * Address correspondence to: Robert W. Jackson, M.D., M.S. (Tor.), F.R.C S (C), Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontano, Canada. Chairman, 1976 Olympiad for the Physically Disabled, Toronto, Ontario, Canada. t Director, Field Hospital, 1976 Olympiad for the Physically Disa-
bled
handling of spinal cord injuries caused by that holocaust, 80% of paraplegics were dead within 3 years from the complications of paraplegia. Sir Ludwig Guttmann, through his work with spinal injuries, was largely responsible for reversing those statistics. He showed that if a paraplegic is well nursed in the early stages and pressure sores and kidney infections are avoided, the individual can eventually learn to look after himself. Now, 80% of paraplegics have a normal life expectancy. Sir Ludwig was knighted in 1966 for his basic contribution to the care and well-being of this group of seriously disabled persons. He is proud of the role he played in transforming people who were previously welfare recipients, into tax-paying citizens and social contributors. Sir Ludwig must also be given credit for realizing the advantage of sport in the rehabilitation of persons who are paralyzed from trauma
or
disease.
THE BEGINNING The first international sporting event for paralyzed persons took place in 1952 at Stoke Mandeville Hospital in England, the home of the National Spinal Injuries Centre directed by Sir Ludwig Guttmann. On that occasion, a team of Dutch archers, all former servicemen and servicewomen, competed against a similar group of disabled athletes who were resident members of the Stoke Mandeville Spinal Injuries Unit. The contest was so successful that in each of the following years, more competitors took part, and more events were added to the games. The Stoke Mandeville Games soon became the highlight of the year for many of these severely disabled persons. Eventually, other persons who had paralyzing disorders due to poliomyelitis or birth defects were invited to compete in the annual games, and a medical classification system was developed whereby people of comparable disability were placed in the same class, to allow fair competition. Although not officially part of the Olympics, the Stoke Mandeville Games were formally recognized by the Interna293
tional Olympic Committee in 1956. This recognition came with the presentation of the Feamley Cup, which is given every 4 years to the sport that best typifies the aims of the Olympic movement, as outlined by Baron Pierre de Coubertin (1894 to
1922). THE GROWTH In 1960, the International Stoke Mandeville Games were moved from their traditional site in England to the site of the Olympic Games in Rome. Some 400 competitors from around the world took part. In 1964, they again moved from England, this time to Tokyo. The same facilities were used, with the Games taking place the week following the regular Olympics and involving 450 athletes from 25 countries. The name &dquo;Paralympics&dquo; was coined by the Japanese, but never officially adopted by the Stoke Mandeville Games Committee. In 1968, the International Stoke Mandeville Games should have been held in Mexico, but the organizers of disabled sports in that country were unable to obtain the support of their government and could not complete their plans. With less than 12 months to prepare, the State of Israel took on the large task of hosting the Games in which 750 athletes from 29 countries
participated. Also at this time, countries around the world were grouping into regional conferences to gain additional experience in international competition. The Pan American Paraplegic Games were established in 1967, and European Games and Far Eastern and South Pacific Games soon followed. In 1972, the International Stoke Mandeville Games were held in Heidelberg, Germany, a few weeks preceding the ablebodied Olympics in Munich. One thousand competitors took part in Heidelberg and 44 countries were represented. The possibility of opening the games up to athletes with disabilities other than paraplegia was also considered, and demonstrations by amputee and blind athletes from the German Disabled Sports Movement were well received by both the participants and the spectators. In 1976, the first Olympiad for the Physically Disabled, with full competition for blind, paralyzed, and amputee athletes, was held in Toronto, Canada.3 More than 1,500 athletes from 38 countries took part. The Toronto Games will probably be remembered as the turning point in the emergence of sports for the disabled from a purely rehabilitation measure to a true sporting event in its own right. The Toronto Olympiad will also be remembered for the intrusion of politics into the Games, thus making handicapped athletes no more or no less immune from the manipulations of government than able-bodied athletes have been in the last few years. At Toronto, the inclusion of a South African team, even though it was fully integrated and chosen on merit without regard to color or creed, was not acceptable to the governments of eight countries who felt obliged to withdraw their athletes at the last minute. It was also not acceptable to the Canadian Government, who, despite significant public criticism, withdrew both their financial and their moral support. Fortunately, the public, either realizing the importance of the rehabilitative aspects of the games or 294
the intrusion of politics into sport, responded with such enthusiasm that the games were successfully completed without a financial deficit.
reacting against
TYPES OF COMPETITION A wide variety of sports can be enjoyed by disabled athletes. For the most part, the rules are the same, or only minimally modified. The events that are part of international competitions are listed in Table 1. However, many other sports are possible, such as riding, canoeing, bowling, and so on.
MEDICAL ASPECTS OF SPORTS FOR THE DISABLED Classification Medical classification is an important part of any games for the physically handicapped. It is absolutely essential that all of the competitors in a class have an equal degree of disability in order to permit fair and equal competition. For example, although all competitors in the Blind Games are &dquo;legally&dquo; blind, those with partial sight are placed in a class separate from those who are totally blind, as there is a slight advantage if you can perceive light and dark or appreciate shadows. Two categories are therefore established for blind competition. In the amputee games, above the knee amputees obviously cannot compete with the same proficiency as below the knee amputees. Consequently, 12 categories have been established for combinations of the loss of one or both legs, either above or below the knee, along with various levels of amputation of the upper extremity. The wheelchair games now include all neurologic or paralyzing disorders and six categories have been established. A minimal degree of loss of function is necessary before a person is eligible to enter competition. For example, a drop-foot on one side, perhaps due to poliomyelitis is not considered a severe enough disability to permit participation in wheelchair games. Basically, the class of participation depends on the level of spinal cord involvement. The quadriplegic athletes are divided into three categories, those without triceps, those with triceps, and those with some function in the hands resulting from a lesion at the level of the first thoracic vertebra and sparing of intrinsics or from a central cord lesion. The paraplegic athletes, without any trunk muscles are in a category above those with TABLE I List of competitions
abdominal musculature and both are obviously above those with some hip extension or flexion. Classification is done by an international team of doctors, who are certified by the international governing body. Protests and reclassifications are possible and occur frequently. Some athletes actually try to feign a more serious degree of disability in order to be placed in a category with less formidable opposition. Record setters may be reexamined by the medical panel to ensure that the athlete has been properly classified, before the record is allowed to stand. some
donated by pharmaceutical companies and various institutions donated or loaned equipment. Because the sports venues were several miles from the residences, it was impossible for athletes to be taken back and forth for rest periods. Rest areas were therefore provided in the field hospital and were very well used, especially during rainy and hot days. The staff noticed that many athletes were overtired and there were many requests for extra blankets. This service was expanded considerably during the games as the medical committee had not anticipated the extent to which rest areas would be utilized.
Research the 1976 Olympiad in Toronto and before that in the 1972 Games in Heidelberg, research studies were carried out on many of the competing athletes to determine the highest level of fitness that is compatible with a specific degree of disability. This information is of course important to those involved in rehabilitation, to ascertain how successful their efforts are in each individual case.
During
Treatment facilities
Medical care and treatment of disabled athletes are similar to the care and treatment of any athlete competing in an international sporting event. A description of the medical facilities established for the 1976 Toronto Olympiad may be of interest in pointing out some of the problems encountered, not only in treating the athletes, but in operating a comprehensive medical service on a limited budget due to governmental cutbacks. The athletes were accommodated in University residences and transported 15 miles each day to the Games site, a 250acre park on the outskirts of the city. Small infirmaries were available at the residences, in case any problems occurred during the night. As the Games were held during the summer, a school near the Games site was available for conversion into a field hospital. The school was chosen because it already had ramps instead of stairs and had adequate space for physiotherapy equipment, a small office, examining rooms, rest areas, storage space, and hospital beds. Doors to toilets were removed to facilitate use by athletes in wheelchairs. All diagnostic roentgenograms were taken at a local hospital. The Director of the Field Hospital was requested to equip and staff a unit capable of coping with 1,500 amputee, blind, and paraplegic athletes, and their attending staff of coaches and trainers. Emergency care for volunteers and spectators (myocardial infarctions, sprained ankles, etc.) was also to be considered, but was not to be the prime responsibility of the medical committee. The Director was also asked to be prepared for mass casualties such as might occur if a bus overturned, a spectator stand collapsed, or, bearing in mind the politically motivated violence that has become apparent in recent international events, a bomb exploded or some other unexpected disaster occurred. This last request naturally necessitated a fairly large field hospital (extra classrooms could be converted in an emergency) and additional staff, equipment, and medical supplies should they be necessary. Arrangements were made with eight Toronto hospitals to care for the visitors (three were used). Medical supplies were
Medical care All of the medical staff were volunteers. During the actual games the field hospital was manned two shifts per day, each shift incorporating at least three doctors, three nurses, three receptionists, and three physical therapists. In addition there were two doctors, four or more trainers, two nurses, and two physical therapists rotating around the various venues at the Games site. Physicians treated 285 patients for a variety of problems. Of these, 184 were athletes and the others were spectators (many of whom were in wheelchairs), volunteers, and support staff. The most common medical problems included injuries to hands, wrists, legs, knees, feet and toes; boils, and abscesses; gastrointestinal distress; physical and mental distress; and renal and urinary infections. Injuries, illnesses, and general first aid care to the three categories of disabled competitors was fairly proportionate to the numbers competing, with a slightly higher incidence among the paraplegics. Pressure sores were not a
problem (Table 2). Sixty physical [physio] therapists treated 119 athletes. Strains of the deltoid, upper back, triceps, trapezius, and hamstrings were common problems. Twenty trainers stationed at the stadium and at the pool treated 114 athletes. The beds at the trainers’ posts were popular and the trainers suggested that in the future, more &dquo;on-site&dquo; rest areas be made available. They reported a predictable number of blisters, sunburn, and fatigue as well as a number of athletes with severe headaches. They also treated a large number of hand, knuckle, and elbow abrasions, and strains of the trapezius and deltoid muscles in the wheelchair athletes. A significant number of ankle injuries were seen in the blind athletes. The medical staff realized that disabled athletes, no matter how &dquo;fit,&dquo; were slightly more vulnerable to stress and fatigue than able-bodied athletes, due to the sheer difficulty in mobility and their chronic bowel and skin problems.
PROBLEMS FACING DISABLED ATHLETES Lack of recognition Until the Toronto Games, there was a distinct reluctance on the part of the public, the press, and able-bodied sportsmen to recognize the disadvantaged athlete as a serious competitor. The tendency was always to compare his performance with that of an able-bodied performer and of course, because of his physical disability, the performance of the disadvantaged athlete was usually less. However, as no one expects a feather295
TABLE2 Conditions treated&dquo; at 1976 Olympiad for
physically disabled
(Toronto)
raisers from the communities men achieve their goals.
helping the handicapped sports-
BENEFITS OF SPORTS To the individual
Sport and recreation is almost more important for the disabled person than it is for the able-bodied.
Although
disabled individual has the desire to be
an
not every athlete and some as his recreational
might prefer stamp collecting, music, or art outlet, participation in sports does improve mobility, balance, endurance, decrease weight, and perhaps, more important than any of these physical advantages, eliminates or helps to diminish the sense of depression that so often accompanies a serious and permanent physical disability.
To society
&dquo;
Total mcludes
cians,
some overlap of care athletes physical therapists, and trainers.
received from
physi-
_
weight lifter to lift as much as a heavyweight lifter, the featherweight’s performance in his own class can be as exciting for the spectator and as rewarding for the individual as the heavyweight’s performance in his class. In a similar way, the performance of some disabled athletes are truly remarkable. A one-legged high jumper named Amie Boldt from Canada has hopped up to the bar and cleared 6 feet 13/4 inches; a paralyzed athlete named David Kiley from the United States has raced the metric mile (1,500 m), in a wheelchair, in 5 min and 14 sec; a blind athlete named Kozyk from Poland has run the 100-m dash in 11.6 sec, guided only by the sound of his coach’s voice calling to him from the end of the track; and a paraplegic (resulting from poliomyelitis) participant named Jon Brown from the United States has bench-pressed 585 lb, an amount far in excess of the great Russian weight lifter Alexeyev’s personal best in the bench press at 518 lb. These performances are truly worthy of note and are not achieved without dedication and consistent training. These athletic performances are every bit as commendable as the sub-4-min mile or the 7 ft 6 inch highjump. It is time that the World Press, amateur sport governing bodies, coaches, trainers, and physical educators realized this fact. Lack of opportunity The second problem facing the physically disadvantaged athlete is that the opportunities to train and compete are not as great as those for the able-bodied athlete. Communities should make such facilities available. Swimming pools and gymnasiums should be made accessible to wheelchairs. Support is also necessary in terms of manpower, with coaches and fund 296
Disabled persons who rise beyond the rehabilitative and recreational aspects of sport to engage in competition at national or international levels are obviously at the apex of the pyramid. Through their efforts, benefits accrue to all of the physically disadvantaged persons in the community. The publicity attendant upon a disabled athlete achieving some remarkable feat does a great deal toward removing the social stigma and economic barriers that exist between the handicapped and the able-bodied community. The prospective employer, for example, faced with a wheelchair-bound applicant, might have favorable second thoughts concerning the person’s job capability, if he is aware that a similar wheelchair-bound person has raced a mile injust over 5 min or lifted almost 600 lb in a bench press. Similarly, architects might think more about the structural barriers that impede wheelchairs, such as stairs or narrow checkout channels in supermarkets, and restaurants might have a braille menu available on request. All of these and more benefits can materialize when the community is made aware of the potential of the disabled athlete, and the problems of all disabled people. THE FUTURE Sport has been instrumental in promoting integration and providing a means for seriously disabled people to reenter the main stream of life. Eventually, sports for the disabled will become integrated with able-bodied sports and programs will be in existence to accommodate any person with any physical handicap, should he or she seriously wish to get involved in a recreational or competitive sporting activity. 1,5 Sport has done a lot toward making people realize that sickness and disability are not synonymous, and that it is not what you have lost, it is what you have left that counts.
REFERENCES 1. Guttmann L: Textbook of Sport for the Disabled. London, HM & M Publishers Limited, 1976 2. Guttmann L: Reflection on the 1976 Toronto Olympiad for the physically disabled. Paraplegia 14: 225-240, 1976 3. Jackson RW: What did we learn from the Torontolympiad? Can Family Physician 23: 66-69, 1977 4. Ryan AJ (moderator), Jackson RW, McCann BC, et al: Round Table. Sport and recreation for the handicapped Physician Sportsmed 6: 44-61, 1978 5 Weisman M, Godfrey J: So Get On With It. New York, Doubleday and Company, Inc, 1976
for the
physically disabled
Olympiad (Toronto)
ROBERT W. JACKSON,* M.D., M.S. (TOR.), F.R.C.S.(C), AND ALIX
FREDRICKSON,† B.A., Toronto, Ontario, Canada From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
ABSTRACT The 1976
Olympiad for the Physically Disabled was the first olympiad with full competition for blind, paralyzed, and ampuMore than 1,500 from 38 countries took part in (12 events), blind (8 events), and amputee (11 events) games. Participants were classified by an international team of doctors. The athletes were accommodated in university tee athletes.
wheelchair
residences with small infirmaries. A school near the games site was used as a field hospital. Rest areas were also set up. Volunteers served on the medical staff (three doctors, three nurses, three receptionists, and three physical therapists on each of two shifts per day). In addition doctors, nurses, trainers, and physical therapists rotated around various venues at the games site. Physicians treated 285 patients (184 were athletes; others were spectators) for a variety of problems, physical therapists treated 119 athletes, and trainers treated 114 athletes. Contingency plans in case of mass disaster were made but were not needed. Disabled athletes are slightly more vulnerable to stress and fatigue than able-bodied athletes. The Toronto games will probably be remembered as the turning point in the emergence of sports for the disabled from a purely rehabilitation measure to a true sporting event in its own right. ii
T these games rebuild lives.&dquo; Nothing truer
or more
to the
point could be said about sports for the physically handicapped than those words uttered by Sir Ludwig Guttmann. I,2 Prior to World War II and the experience gained in the * Address correspondence to: Robert W. Jackson, M.D., M.S. (Tor.), F.R.C S (C), Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontano, Canada. Chairman, 1976 Olympiad for the Physically Disabled, Toronto, Ontario, Canada. t Director, Field Hospital, 1976 Olympiad for the Physically Disa-
bled
handling of spinal cord injuries caused by that holocaust, 80% of paraplegics were dead within 3 years from the complications of paraplegia. Sir Ludwig Guttmann, through his work with spinal injuries, was largely responsible for reversing those statistics. He showed that if a paraplegic is well nursed in the early stages and pressure sores and kidney infections are avoided, the individual can eventually learn to look after himself. Now, 80% of paraplegics have a normal life expectancy. Sir Ludwig was knighted in 1966 for his basic contribution to the care and well-being of this group of seriously disabled persons. He is proud of the role he played in transforming people who were previously welfare recipients, into tax-paying citizens and social contributors. Sir Ludwig must also be given credit for realizing the advantage of sport in the rehabilitation of persons who are paralyzed from trauma
or
disease.
THE BEGINNING The first international sporting event for paralyzed persons took place in 1952 at Stoke Mandeville Hospital in England, the home of the National Spinal Injuries Centre directed by Sir Ludwig Guttmann. On that occasion, a team of Dutch archers, all former servicemen and servicewomen, competed against a similar group of disabled athletes who were resident members of the Stoke Mandeville Spinal Injuries Unit. The contest was so successful that in each of the following years, more competitors took part, and more events were added to the games. The Stoke Mandeville Games soon became the highlight of the year for many of these severely disabled persons. Eventually, other persons who had paralyzing disorders due to poliomyelitis or birth defects were invited to compete in the annual games, and a medical classification system was developed whereby people of comparable disability were placed in the same class, to allow fair competition. Although not officially part of the Olympics, the Stoke Mandeville Games were formally recognized by the Interna293
tional Olympic Committee in 1956. This recognition came with the presentation of the Feamley Cup, which is given every 4 years to the sport that best typifies the aims of the Olympic movement, as outlined by Baron Pierre de Coubertin (1894 to
1922). THE GROWTH In 1960, the International Stoke Mandeville Games were moved from their traditional site in England to the site of the Olympic Games in Rome. Some 400 competitors from around the world took part. In 1964, they again moved from England, this time to Tokyo. The same facilities were used, with the Games taking place the week following the regular Olympics and involving 450 athletes from 25 countries. The name &dquo;Paralympics&dquo; was coined by the Japanese, but never officially adopted by the Stoke Mandeville Games Committee. In 1968, the International Stoke Mandeville Games should have been held in Mexico, but the organizers of disabled sports in that country were unable to obtain the support of their government and could not complete their plans. With less than 12 months to prepare, the State of Israel took on the large task of hosting the Games in which 750 athletes from 29 countries
participated. Also at this time, countries around the world were grouping into regional conferences to gain additional experience in international competition. The Pan American Paraplegic Games were established in 1967, and European Games and Far Eastern and South Pacific Games soon followed. In 1972, the International Stoke Mandeville Games were held in Heidelberg, Germany, a few weeks preceding the ablebodied Olympics in Munich. One thousand competitors took part in Heidelberg and 44 countries were represented. The possibility of opening the games up to athletes with disabilities other than paraplegia was also considered, and demonstrations by amputee and blind athletes from the German Disabled Sports Movement were well received by both the participants and the spectators. In 1976, the first Olympiad for the Physically Disabled, with full competition for blind, paralyzed, and amputee athletes, was held in Toronto, Canada.3 More than 1,500 athletes from 38 countries took part. The Toronto Games will probably be remembered as the turning point in the emergence of sports for the disabled from a purely rehabilitation measure to a true sporting event in its own right. The Toronto Olympiad will also be remembered for the intrusion of politics into the Games, thus making handicapped athletes no more or no less immune from the manipulations of government than able-bodied athletes have been in the last few years. At Toronto, the inclusion of a South African team, even though it was fully integrated and chosen on merit without regard to color or creed, was not acceptable to the governments of eight countries who felt obliged to withdraw their athletes at the last minute. It was also not acceptable to the Canadian Government, who, despite significant public criticism, withdrew both their financial and their moral support. Fortunately, the public, either realizing the importance of the rehabilitative aspects of the games or 294
the intrusion of politics into sport, responded with such enthusiasm that the games were successfully completed without a financial deficit.
reacting against
TYPES OF COMPETITION A wide variety of sports can be enjoyed by disabled athletes. For the most part, the rules are the same, or only minimally modified. The events that are part of international competitions are listed in Table 1. However, many other sports are possible, such as riding, canoeing, bowling, and so on.
MEDICAL ASPECTS OF SPORTS FOR THE DISABLED Classification Medical classification is an important part of any games for the physically handicapped. It is absolutely essential that all of the competitors in a class have an equal degree of disability in order to permit fair and equal competition. For example, although all competitors in the Blind Games are &dquo;legally&dquo; blind, those with partial sight are placed in a class separate from those who are totally blind, as there is a slight advantage if you can perceive light and dark or appreciate shadows. Two categories are therefore established for blind competition. In the amputee games, above the knee amputees obviously cannot compete with the same proficiency as below the knee amputees. Consequently, 12 categories have been established for combinations of the loss of one or both legs, either above or below the knee, along with various levels of amputation of the upper extremity. The wheelchair games now include all neurologic or paralyzing disorders and six categories have been established. A minimal degree of loss of function is necessary before a person is eligible to enter competition. For example, a drop-foot on one side, perhaps due to poliomyelitis is not considered a severe enough disability to permit participation in wheelchair games. Basically, the class of participation depends on the level of spinal cord involvement. The quadriplegic athletes are divided into three categories, those without triceps, those with triceps, and those with some function in the hands resulting from a lesion at the level of the first thoracic vertebra and sparing of intrinsics or from a central cord lesion. The paraplegic athletes, without any trunk muscles are in a category above those with TABLE I List of competitions
abdominal musculature and both are obviously above those with some hip extension or flexion. Classification is done by an international team of doctors, who are certified by the international governing body. Protests and reclassifications are possible and occur frequently. Some athletes actually try to feign a more serious degree of disability in order to be placed in a category with less formidable opposition. Record setters may be reexamined by the medical panel to ensure that the athlete has been properly classified, before the record is allowed to stand. some
donated by pharmaceutical companies and various institutions donated or loaned equipment. Because the sports venues were several miles from the residences, it was impossible for athletes to be taken back and forth for rest periods. Rest areas were therefore provided in the field hospital and were very well used, especially during rainy and hot days. The staff noticed that many athletes were overtired and there were many requests for extra blankets. This service was expanded considerably during the games as the medical committee had not anticipated the extent to which rest areas would be utilized.
Research the 1976 Olympiad in Toronto and before that in the 1972 Games in Heidelberg, research studies were carried out on many of the competing athletes to determine the highest level of fitness that is compatible with a specific degree of disability. This information is of course important to those involved in rehabilitation, to ascertain how successful their efforts are in each individual case.
During
Treatment facilities
Medical care and treatment of disabled athletes are similar to the care and treatment of any athlete competing in an international sporting event. A description of the medical facilities established for the 1976 Toronto Olympiad may be of interest in pointing out some of the problems encountered, not only in treating the athletes, but in operating a comprehensive medical service on a limited budget due to governmental cutbacks. The athletes were accommodated in University residences and transported 15 miles each day to the Games site, a 250acre park on the outskirts of the city. Small infirmaries were available at the residences, in case any problems occurred during the night. As the Games were held during the summer, a school near the Games site was available for conversion into a field hospital. The school was chosen because it already had ramps instead of stairs and had adequate space for physiotherapy equipment, a small office, examining rooms, rest areas, storage space, and hospital beds. Doors to toilets were removed to facilitate use by athletes in wheelchairs. All diagnostic roentgenograms were taken at a local hospital. The Director of the Field Hospital was requested to equip and staff a unit capable of coping with 1,500 amputee, blind, and paraplegic athletes, and their attending staff of coaches and trainers. Emergency care for volunteers and spectators (myocardial infarctions, sprained ankles, etc.) was also to be considered, but was not to be the prime responsibility of the medical committee. The Director was also asked to be prepared for mass casualties such as might occur if a bus overturned, a spectator stand collapsed, or, bearing in mind the politically motivated violence that has become apparent in recent international events, a bomb exploded or some other unexpected disaster occurred. This last request naturally necessitated a fairly large field hospital (extra classrooms could be converted in an emergency) and additional staff, equipment, and medical supplies should they be necessary. Arrangements were made with eight Toronto hospitals to care for the visitors (three were used). Medical supplies were
Medical care All of the medical staff were volunteers. During the actual games the field hospital was manned two shifts per day, each shift incorporating at least three doctors, three nurses, three receptionists, and three physical therapists. In addition there were two doctors, four or more trainers, two nurses, and two physical therapists rotating around the various venues at the Games site. Physicians treated 285 patients for a variety of problems. Of these, 184 were athletes and the others were spectators (many of whom were in wheelchairs), volunteers, and support staff. The most common medical problems included injuries to hands, wrists, legs, knees, feet and toes; boils, and abscesses; gastrointestinal distress; physical and mental distress; and renal and urinary infections. Injuries, illnesses, and general first aid care to the three categories of disabled competitors was fairly proportionate to the numbers competing, with a slightly higher incidence among the paraplegics. Pressure sores were not a
problem (Table 2). Sixty physical [physio] therapists treated 119 athletes. Strains of the deltoid, upper back, triceps, trapezius, and hamstrings were common problems. Twenty trainers stationed at the stadium and at the pool treated 114 athletes. The beds at the trainers’ posts were popular and the trainers suggested that in the future, more &dquo;on-site&dquo; rest areas be made available. They reported a predictable number of blisters, sunburn, and fatigue as well as a number of athletes with severe headaches. They also treated a large number of hand, knuckle, and elbow abrasions, and strains of the trapezius and deltoid muscles in the wheelchair athletes. A significant number of ankle injuries were seen in the blind athletes. The medical staff realized that disabled athletes, no matter how &dquo;fit,&dquo; were slightly more vulnerable to stress and fatigue than able-bodied athletes, due to the sheer difficulty in mobility and their chronic bowel and skin problems.
PROBLEMS FACING DISABLED ATHLETES Lack of recognition Until the Toronto Games, there was a distinct reluctance on the part of the public, the press, and able-bodied sportsmen to recognize the disadvantaged athlete as a serious competitor. The tendency was always to compare his performance with that of an able-bodied performer and of course, because of his physical disability, the performance of the disadvantaged athlete was usually less. However, as no one expects a feather295
TABLE2 Conditions treated&dquo; at 1976 Olympiad for
physically disabled
(Toronto)
raisers from the communities men achieve their goals.
helping the handicapped sports-
BENEFITS OF SPORTS To the individual
Sport and recreation is almost more important for the disabled person than it is for the able-bodied.
Although
disabled individual has the desire to be
an
not every athlete and some as his recreational
might prefer stamp collecting, music, or art outlet, participation in sports does improve mobility, balance, endurance, decrease weight, and perhaps, more important than any of these physical advantages, eliminates or helps to diminish the sense of depression that so often accompanies a serious and permanent physical disability.
To society
&dquo;
Total mcludes
cians,
some overlap of care athletes physical therapists, and trainers.
received from
physi-
_
weight lifter to lift as much as a heavyweight lifter, the featherweight’s performance in his own class can be as exciting for the spectator and as rewarding for the individual as the heavyweight’s performance in his class. In a similar way, the performance of some disabled athletes are truly remarkable. A one-legged high jumper named Amie Boldt from Canada has hopped up to the bar and cleared 6 feet 13/4 inches; a paralyzed athlete named David Kiley from the United States has raced the metric mile (1,500 m), in a wheelchair, in 5 min and 14 sec; a blind athlete named Kozyk from Poland has run the 100-m dash in 11.6 sec, guided only by the sound of his coach’s voice calling to him from the end of the track; and a paraplegic (resulting from poliomyelitis) participant named Jon Brown from the United States has bench-pressed 585 lb, an amount far in excess of the great Russian weight lifter Alexeyev’s personal best in the bench press at 518 lb. These performances are truly worthy of note and are not achieved without dedication and consistent training. These athletic performances are every bit as commendable as the sub-4-min mile or the 7 ft 6 inch highjump. It is time that the World Press, amateur sport governing bodies, coaches, trainers, and physical educators realized this fact. Lack of opportunity The second problem facing the physically disadvantaged athlete is that the opportunities to train and compete are not as great as those for the able-bodied athlete. Communities should make such facilities available. Swimming pools and gymnasiums should be made accessible to wheelchairs. Support is also necessary in terms of manpower, with coaches and fund 296
Disabled persons who rise beyond the rehabilitative and recreational aspects of sport to engage in competition at national or international levels are obviously at the apex of the pyramid. Through their efforts, benefits accrue to all of the physically disadvantaged persons in the community. The publicity attendant upon a disabled athlete achieving some remarkable feat does a great deal toward removing the social stigma and economic barriers that exist between the handicapped and the able-bodied community. The prospective employer, for example, faced with a wheelchair-bound applicant, might have favorable second thoughts concerning the person’s job capability, if he is aware that a similar wheelchair-bound person has raced a mile injust over 5 min or lifted almost 600 lb in a bench press. Similarly, architects might think more about the structural barriers that impede wheelchairs, such as stairs or narrow checkout channels in supermarkets, and restaurants might have a braille menu available on request. All of these and more benefits can materialize when the community is made aware of the potential of the disabled athlete, and the problems of all disabled people. THE FUTURE Sport has been instrumental in promoting integration and providing a means for seriously disabled people to reenter the main stream of life. Eventually, sports for the disabled will become integrated with able-bodied sports and programs will be in existence to accommodate any person with any physical handicap, should he or she seriously wish to get involved in a recreational or competitive sporting activity. 1,5 Sport has done a lot toward making people realize that sickness and disability are not synonymous, and that it is not what you have lost, it is what you have left that counts.
REFERENCES 1. Guttmann L: Textbook of Sport for the Disabled. London, HM & M Publishers Limited, 1976 2. Guttmann L: Reflection on the 1976 Toronto Olympiad for the physically disabled. Paraplegia 14: 225-240, 1976 3. Jackson RW: What did we learn from the Torontolympiad? Can Family Physician 23: 66-69, 1977 4. Ryan AJ (moderator), Jackson RW, McCann BC, et al: Round Table. Sport and recreation for the handicapped Physician Sportsmed 6: 44-61, 1978 5 Weisman M, Godfrey J: So Get On With It. New York, Doubleday and Company, Inc, 1976
