The challenges and rewards of Paralympic medicine

In the Lancet paper, "Paralympic medicine," Nick Webborn of the British Paralympic Association and Peter Van de Vliet of the International Paralympic Committee Medical and Scientific Department, outline some of the issues that arise for health-care professionals when maintaining health in elite athletes with a variety of impairments.

They point out that the complex mix of medical issues among Paralympic athletes can be challenging for health-care providers and event medical staff, and call for increased awareness of Paralympians' health needs among medical professionals. They also call for more research into the long-term potential for injuries caused by the latest prosthetic technologies, with very little scientific understanding currently available of the types of injuries and stresses that these technologies may cause.

The authors also examine the issue of performance enhancement in Paralympic athletes, with some practices – such as Botulinum toxin being used to control spasticity in athletes with Cerebral palsy – resulting in athletes' classification altering. The danger of voluntary inducement of autonomic dysreflexia – where athletes with spinal injuries give themselves a painful stimulus to trigger a reaction that results in performance-enhancing high blood pressure – is also highlighted.

"Provision of health care for Paralympic athletes is probably the most challenging and rewarding area of sports medicine," say the authors. "The complex mix of medical issues can be challenging for health-care providers and medical staff at the events, and the medical needs of the athlete group need to be understood and medical staff trained appropriately."