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When we’re free to move, anything is possible.

Lauren Woolstencroft, Canadian alpine skier, eight-time Paralympic gold medallist

Participation and interest in sports for people with disabilities have increased exponentially over the last 70 years. Since the first formal competition in 1948, with only 16 competitors at the Stoke Mandeville Games, the Paralympic Games has become the third-biggest sporting event in the world. At the Rio 2016 Summer Paralympic Games, 4328 athletes from 159 countries competed in 22 sports in front of over two million spectators, and the International Paralympic Committee’s (IPC) digital media activities engaged close to one billion people.

In this chapter we:

  • provide a brief history of sport for people with disabilities

  • discuss the importance of physical activity for the health of people with disabilities

  • outline the classification system that promotes fair competition among persons with varied types of disabilities

  • review the epidemiology of injury and illness at both the Summer and Winter Paralympic Games, and discuss important medical issues for Paralympic athletes

  • discuss anti-doping in Paralympic sport

  • highlight some key considerations for travelling with teams of athletes with disability.


People with disabilities have participated in sport in at least a limited, unstructured way for more than 100 years. In 1944, Dr Ludwig Guttmann introduced sporting activity as part of the rehabilitation process for those with spinal cord injury at the Spinal Injuries Unit at Stoke Mandeville Hospital in England. On the opening day of the 1948 Olympic Games in London, Guttmann arranged an archery contest between two spinal injury units on the lawns of the hospital. Thus began the Stoke Mandeville Games. Four years later a team of Dutch ex-servicemen joined the competition and the International Stoke Mandeville Games were founded.

Guttmann believed that ‘by restoring activity in mind and body—by instilling self-respect, self-discipline, a competitive spirit and comradeship—sport develops mental attitudes that are essential for social reintegration’.1 With time, athletics, swimming, table tennis and basketball increased the diversity of opportunities for people with disabilities. In 1960, the International Stoke Mandeville Games were held in Rome after the Olympic Games, and this launched the plan to hold these quadrennial games in the Olympic Games host city where possible. Between 1976 and 1980, opportunities for athletes with vision impairment, limb deficiencies and athletes with cerebral palsy were added to the program. Subsequently, athletes with a more diverse range of physical impairments and athletes with intellectual impairment were also included.

In 1985, the term ‘Paralympic’ was coined to describe a games ‘parallel to the Olympics’, and in 1989, the IPC was formed. Ever since, the games have taken the form of the modern Paralympic Games. Historically, different sports were organised by various international disability sport organisations, but as the movement progressed, many sports transitioned to be organised by their ...

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