Analysis of biomechanics in athletes with disabilities: a systematic and narrative review

Lopes, Jaqueline; Guimarães, Kamylla Albuquerque; Lopes, Simone Maria; Pérego, Sany Martins; Andrade, Claudia

doi:10.1590/fm.2023.36201

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REVIEW ARTICLE • Fisioter. Mov. 36 • 2023 • https://doi.org/10.1590/fm.2023.36201 copy

Analysis of biomechanics in athletes with disabilities: a systematic and narrative review

Análise da biomecânica em atletas com deficiência: uma revisão sistemática e narrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Specifically in athletes with disabilities, investigations and biomechanical understanding seem to be even more relevant, as they provide data on how a certain type of disability limits sports practice and also describe parameters that allow the suggestion of relevant adaptations capable of guaranteeing a higher level comfort to practitioners.

Objective

To describe patterns of biomechanical behavior during exercise in athletes with disabilities, and to discuss possible relationships between the type of disability and the sport practiced.

Methods

This study performed a search in five electronic databases from the oldest records available until July 2020 using a search strategy that combined terms related to "athletes with disabilities" and "biomechanical analysis." Inclusion criteria: population (amateur or professional athletes with disabilities), intervention (sports practice), study design (observational), outcome (having evaluated biomechanics during sports practice). The biomechanical variables of interest included kinematic, kinetic, or electromyographic outcome measures.

Results

Tewnty-six articles met the inclusion criteria (n = 705 participants). Biomechanical analysis showed that there is a greater inclination in the angle of the head and an increase in the kinematic variables in blind athletes, which result in less distance, speed, and performance; compensatory body patterns, reduced mooring strength, speed, joint amplitude, and reduced final performance are observed in amputated limbs of amputees; and there was a strong correlation between the subject's functional classification and kinematic parameters in wheelchair athletes, with this being proportional to the level of impairment.

Conclusion

The outcomes demonstrated that the type of disability and the level of functional limitation are proportionally related to biomechanics in athletes with disabilities.

Athletic injury; Athletic performance; Disability sport; Disabled person; Physical therapy specialty

Study, year	1	2	3	4	5	6	7	8	9	10
Gorton, 1987¹⁴	✓	✓	NR	✓	✓	✓	x	NR	x	5 (55.5%)
Ridgway et al., 1988¹⁹	✓	✓	NR	✓	✓	✓	x	NR	x	5 (55.5%)
Hutzler et al., 1995²⁷	✓	✓	NR	✓	x	✓	x	✓	x	8 (88.8%)
Wang et al., 1995³¹	✓	✓	NR	✓	✓	✓	x	✓	x	8 (88.8%)
Goosey et al., 1997²¹	✓	✓	NR	✓	x	✓	x	✓	x	5 (55.5%)
van der Woude et al., 1998²⁸	✓	✓	NR	x	x	✓	x	✓	✓	7 (77.7%)
Okawa et al., 1999³⁵	✓	✓	NR	✓	✓	✓	x	✓	✓	7 (77.7%)
Chow et al., 2000²⁴	✓	✓	NR	x	✓	✓	x	✓	x	5 (55.5%)
Nolan et al., 2006¹⁶	✓	x	NR	✓	x	✓	x	✓	x	4 (44.4%)
Chen et al., 2010³⁰	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Fung et al., 2010²⁰	✓	✓	NR	x	x	✓	x	✓	x	4 (44.4%)
Sarro et al., 2010²³	✓	x	NR	x	x	✓	x	✓	x	3 (33.3%)
Gastaldi et al., 2012³²	✓	✓	NR	x	x	✓	x	✓	x	4 (44.4%)
Panoutsakopoulos et al., 2013¹⁵	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Cavedon et al., 2014²⁵	✓	✓	NR	✓	✓	✓	x	x	x	5 (55.5%)
Lee et al., 2014¹¹	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Taboga et al., 2016¹⁷	✓	x	NR	✓	✓	✓	x	✓	x	5 (55.5%)
Torralba-Jórdan et al., 2016³³	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Willwacher et al., 2016¹⁸	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Bjerkefors et al., 2018¹²	✓	✓	NR	x	✓	✓	x	✓	x	5 (55.5%)
Haydon et al., 2018²⁶	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Junior et al., 2018¹⁰	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Mason et al., 2018²²	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Warner et al., 2018²⁹	✓	✓	NR	✓	✓	✓	✓	✓	✓	8 (88.8%)
Kertészné Német et al., 2019¹³	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)
Padulles et al., 2019³⁴	✓	✓	NR	✓	✓	✓	x	✓	x	6 (66.6%)

Study, year	Characteristics of participants	Disability type	Sports practiced	Analysis methods	Variables analyzed	Movement analyzed	Outcomes
Gorton, 1987¹⁴	n = 26 26 men Age: NR	Blind and visually impaired	Athletics	Camcorders	Selected center, of gravity,displacements, speeds, and joint angles	100 m race,during real competition	"The inclinationof the head varied a lot. The anterior position of the head may be related to blindness."
Ridgway et al., 1988¹⁹	n = 31 31 men Age: NR	Wheelchair	Athletics	Camcorders	Cycle speed,cycle duration, cycle rate, cycle distance, and percentage of propulsion and recovery	800 m race	"In general, thehighest speeds, rates, and distances of the cycle occurred in the classes with the highest functional impairments."
Hutzler et al.,1995²⁷	n = 11 11 men Age: 30.3 ± 5.4 years	Wheelchair	Basketball	Electrically locked and controlled roller device	Power and speed	High-speed "Wingate" exercise test, lasting 30 s	"The speed variables of the subjects included in this study had a significant relationship with the power variables."
Wang et al.,1995³¹	n = 10 10 men Age: NR	Wheelchair	Athletics (Sprinters)	3-D cinema-tography with mirror	Speed,angulation, recovery	Running: four selected speeds were investigated	"As the speed increased, the actuation phase was executed more quickly, while the range of the pushing angle remained constant."
Goosey et al., 1997 ²¹	n = 23 13 men and 10 women Age: 18-41 years	Wheelchair	Athletics	Camcorders	Inclination angle, elbow angle and cycle dynamics, speed, and performance	800 m race	"Junior athletes adopted a more upright position and spent less time in contact with the rim (25%) than senior athletes. A moderate correlation was found between cycle distance and performance time (r = -0.68; p < 0.01). "
van der Woude et al., 1998²⁸	n = 67 17 woman and 50 men Age: 29.1 ± 7.0 years	Wheelchair	Athletics	Computer- -controlled ergometer	Propulsion and power production	30-second running test on a computer- -controlled wheelchair ergometer	"The output powers were highly variable and seemed to be associated with the level of commitment."
Okawa et al.,1999³⁵	n = 11 11 men Age: 20-46 years	Wheelchairs (paraplegia)	Marathon runners	Video camera	Push time, cycle time, total push time, and angular speed	Propulsion in a wheelchair until exhaustion, in the laboratory (for 5 min)	"Improvement in the total pulse angle must be achieved by extending the total pulse time and increasing the angular pulse speed."
Chow et al., 2000²⁴	n = 17 17 men Age: 19-48 years	Wheelchair	Shot put	Video camera	Kinematic data (speed, release angle and height)	Each player made six attempts to throw the weight, and the best was recorded	"The measu-rements were smaller than in athletes without disabilities, so that all of them were significantly correlated with the functional classification and the measured distance (p < 0.05)."
Nolan et al.,2006¹⁶	n = 17 17 women Age: NR	Lower limb amputation (8 transfemoral and 9 transtibial)	Athletics (long jump)	Video camera (sagittal plane)	Center of mass height, vertical speed	Long jump at the 2004 Paralympic Games	"Transfemoral amputees had a higher center of mass height than transtibial amputees. And speed related to jumping performance."
Chen et al., 2010³⁰	n = 7 5 men and 2 women Age: NR	Wheelchair	Runners	Video camera (2-D MaxTRAQ software was used using reflective markers)	Velocity	Running	"Angular and linear speeds increased at the wrist joint, indicating that the higher linear speed was transferred from the arm to the forearm and then from the hand during the propulsion of the wheelchair."
Fung et al., 2010²⁰	n = 14 8 men and 6 women Age: NR	Wheelchair	Fencing	Camcorders	Maximum lunge speed, lunge angle, and fast return speed	Simulated test with fencing movements	"Two classes of functional impairments were assessed. The biomecha-nical data were similar for both classes ".
Sarro et al., 2010²³	n = 10 10 men Age: 36.9 ± 5.7 years	Wheelchairs (spinal cord injury and quad amputation)	Rugby	Camcorders	Total distance traveled during the game; distance traveled during each quarter; distance covered in four different speed ranges	Rugby game	"There is a strong correlation between the functional classification of wheelchair rugby players and the distances covered during a game, especially at high speeds."
Gastaldi et al., 2012³²	n = 50 35 men and 15 women Age: 36.9 ± 8.9 years	Paralympic athletes with different types of disabilities	Cross-country skiing	Video camera (high speed stereophoto- grammetric without marker)	Kinematic biomechanical parameters and technical parameters	1-kilometer sprint,Paralympic Winter Games (2010)	"There was great variability in the sports gesture due to the residual functional capacities and sitting posture of each athlete. However, the polling cycles of disciplines classified into different classes have similar characteristics. "
Panoutsako-poulos et al., 2013¹⁵	n = 31 17 men and 14 women Age: 24.8 ± 6.4 years	Blind and visually impaired	Athletics	Stationary digital video camera	ADM, speed,jump, and distance	Speed test	"The distance and speed were shorter (p < 0.05) for the group with the greatest visual impairment."
Cavedon et al., 2014²⁵	n = 43 43 men Age: 33.8 ± 9.02 years	Wheelchair	Tennis	Video camera (2D motion analysis)	Joint angles of the upper limbs and ball speed	Serve analysis	"Severity of impairment significantly (p < 0.05) affected post-impact ball velocity and shoulder angle at the instant of ball impact."

Study, year	Characteristics of participants	Disability type	Sports practiced	Analysis methods	Variables analyzed	Movement analyzed	Outcomes
Lee et al., 2014¹¹	n = 9 9 women Age: 16.1 ± 3.2 years	Amputee	Swimming	Camcorders	Mooring force,stroke rate, stroke phase durations, and inter-arm angle	30-second maximum effort crawl swim	"There was a re-lative decrease in the mooring force (this rate was higher in amputees); the angle between the arms and the duration of the relative phase remained constant. "
Taboga et al.,2016¹⁷	n = 11 7 men and 4 women Age: 26.7 ± 10.0 years	Lower limb amputation (transtibial)	Athletics (sprinters)	Video camera	Stride length,frequency, and speed	Running	"Amputee run-ners ran 3.9% slower with the affected leg compared to the normal leg (p < 0.05)."
Torralba-Jórdan et al., 2016³³	n = 12 12 men Age: NR	Blind and visually impaired	Athletics (Long Jump)	Video cameras (Exilim F1,recording 2 at high speed)	Walking speed, step frequency,step length, contact time, flight time, and center of mass height	Competition during London Paralympic Games (2012)	"The increase in the space-time variables of the last stage of the race influences the result of the jump, decreasing performance."
Willwacher et al., 2016¹⁸	n = 154 103 men and 51 women Age: 20.8 ± 3.7 years	Lower limb amputation	Athletics (sprinters)	Digital force platforms	Performance,power, time, and speed	100-meter race	"The applica-tion of mid-lateral force had little influence on power. There was a non-significant reduction in performance in the amputee group."
Bjerkefors et al.,2018¹²	n = 41 13 women and 28 men Age: 35 ± 9 years	Amputees,spinal cord injury, spina bifida, and clubfoot	Canoeing	Camcorders (Qualisys Track Manager system; Visual 3D)	Joint angles were correlated with power	Ergometric paddle of high intensity kayak	"There were significant differences in RM between the able-bodied kayakers and the three para-kayak groups for the shoulders; trunk and pelvis; and legs during paddling.
Haydon et al., 2018²⁶	n = 25 25 men Age: 30.5 ± 7.0 years	Wheelchair	Rugby	Video camera; and inertial measure	Kinematic data (joint angles,speed)	Five 5-meter sprints in a stationary position	"Significant differences in kinematic variables were observed between the classification groups, (p < 0.05)."
Junior et al., 2018¹⁰	n = 8 8 men Age: 25.0 ± 2.9 years	Amputee	Swimming	Video cameras (reflective markers)	Velocity, stroke length, and frequency	Six 200-meter sprints following an incremental protocol. The data were recorded at distances of 100 and 175 m	"To achieve higher speeds,swimmers with lower limb amputations need to increase the effort to maintain body alignment, and swimmers with upper limb amputations need to make up for the lack of the propulsive segment."
Mason et al., 2018²²	n = 10 10 participants Age: 34 ± 5 years	Wheelchair	Rugby	Camcorders	Kinematic data on scapulothoracic movement in relation to performance	Two 3-minute exercise sessions on the wheelchair at two submaximal speeds (3 and 6 km/h)	"Participants with bilateral shoulder pain exhibited a scapula less turned upward during propulsion; however, great inter-individual variability in scapular kinematics was observed."
Warner et al.,2018²⁹	n = 43 30 men and 13 women Age: 26.5 ± 6.7 years	Wheelchair	Sneakers	Clinical examination	Scapular kinematics	Raising and lowering of the humerus	"Wheelchair athletes had greater posterior scapular inclination during humeral elevation and lowering on the dominant side than on the non-dominant side. The dominant scapulae of tennis players in wheelchairs were significantly (p = 0.014) more turned upward."
Kertészné Német et al., 2019¹³	n = 13 13 men Age: 18-40 years	Amputees,spinal cord injury, spina bifida, and echinovaro foot	Canoeing	Video cameras (three-dimen-sional system Vicon - MX T40); and surface electromyo-graphy (EMG)	Joint angles,power, performance, and muscle activity	Ergometric paddling	"The upper limb ROM was not significantly different between disabled and non-disabled athletes (p > 0.05). Muscle activities were significantly different between the group with and without disabilities (p < 0.05)."
Padulles et al., 2019³⁴	n = 11 11 participants Age: NR	Amputee (4 transtibial, 5 transfemoral, and 2 single amputees below the knee)	Athletics long jump	Video cameras (Four Exilim-F1)	Distance, time,stride frequency, speed, center of mass height, take-off stride angle, and stride length	Long jump	"77.8% of para-athletes take off with their legs supported by the prosthesis. The horizontal speed during the last three strides before takeoff was shown to have a high correlation with the official jump distance."

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