Leveling the Playing Field for Paralympians

9 March 2010

Paralympic athletes are special, by anyone's measure. But not all disabilities are created equal, and it could be argued, based on evidence gathered by an award winning researcher on autonomic dysfunction of spinal cord injury, that the classifications for the Paralympics do not reflect the unique challenges faced by some of the participants. It comes down to blood pressure.

Dr. Andrei Krassioukov, an associate professor in UBC’s Department of Medicine, Division of Physical Medicine and Rehabilitation, is working towards the development of new Paralympic classifications that would recognize that some athletes with spinal cord injuries who suffer from autonomic dysfunction cannot regulate their blood pressure and heart rate in the same way as people whose spinal cords are intact, such as amputees. Blood pressure tends to be lower than normal with autonomic dysfunction, and painful or sudden stimulation such as demanding exercise can lead to dangerous increases in blood pressure, a condition known as autonomic dysreflexia (AD). This, in turn, can result in stroke, severe cardiac dysfunction, myocardial infarction and death.

"With respect to the Paralympic athletes, amputees have perfectly normal spinal cords and intact nervous systems," Dr. Krassioukov says. "By comparison, people with spinal cord injuries are at an enormous disadvantage even though their motor function could look similar to people with amputation."

Currently, the International Paralympic Committee reviews only an athlete's physical capacity, factors such as balance in a wheelchair, hand functioning and range of motion. "Our goal is to develop additions to the classifications for Paralympics that would include an evaluation of a Paralympic athlete’s autonomic functions," says Dr. Krassioukov.

To that end, Dr. Krassioukov and his research team at the International Collaboration On Repair Discoveries (ICORD), supported in part by MSFHR through the Disabilities Health Research Network, will run an autonomic research clinic within the athletes' village during the 2010 Paralympics in Vancouver, to monitor athletes who could experience AD. Their focus will be on curling and sledge hockey athletes.

While this may seem like a perfectly reasonable thing to do, it's been a long road to get to this point. "When I began in my research in Canada I was told that there was no autonomic dysfunction in people with spinal cord injuries, and that I should change my ideas," Dr. Krassioukov says. "The following year, Christopher Reeve suffered a spinal cord injury and as a result he and his wife contributed funding to my research."

Today, some 25 years later, not only is there an awareness that autonomic dysfunction exists in people with spinal cord injuries, there is also a growing understanding of just how seriously it can impact a person's life.

"The leading cause of death in people with spinal cord injuries is cardiovascular disease and it happens at a higher rate than in the able bodied population," Dr. Krassioukov says. "The average life span is also shorter, in general, up to twenty years less for people with spinal cord injuries. In the last 20 years it has improved, but not dramatically."

All the more reason to ensure that the Paralympics will more accurately reflect the particular challenges faced by athletes with spinal cord injuries. And the benefits of doing so could have broad effects. "If changes are implemented to the Paralympic athletes' classifications, it is possible that people who were previously unable to compete may be able to do so," Dr. Krassioukov says.

Dr. Krassioukov’s research is also funded by the Craig H Neilson Foundation, the Heart & Stroke Foundation, and the Rick Hansen Foundation.

Pictured above right is Dr. Andrei Krassioukov.

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