Why Parkinson's Disease Should Be Recognized By the International Paralympic Committee

Warren Rosenberg, Ph.D., Member-American College of Sports Medicine October 23, 2020

“To Enable Paralympic Athletes to Achieve Sporting Excellence and Inspire and Excite the World.”

“To promote and contribute to the development of sport opportunities and competitions, from initiation to elite level, for Paralympic athletes as the foundation of elite Paralympic sport.”

Two powerful statements, indeed, outlining elements of the Vision and Mission of International Paralympic Committee and the Paralympic Games. If only it were so.

Unfortunately, while the internationally respected medical journal, The Lancet, recognizes Parkinson’s disease as one of the world’s leading sources of neurological disability, the IPC fails to recognize Parkinson’s disease, and the athletes who compete with the affliction, as worthy of inclusion.

Summarized in a 2018 article in the international medical journal, The Lancet 17(11):939-953(2018)) “Neurological disorders are now the leading source of disability globally and ageing is increasing the burden of neurodegenerative disorders, including Parkinson’s disease.” When viewed against the IPC’s ten eligible impairments that would qualify a condition as being eligible for inclusion in the Paralympic Games, it is clear that Parkinson’s disease meets at least one of them.

According to the TOKYO 2020 PARALYMPIC GAMES, QUALIFICATION REGULATIONS, REVISED EDITION, JULY 2020, the sport of Table Tennis is one of the 22 sanctioned sports included in the Tokyo Paralympic Games allowing for 280 athletes to participate. Given the International Paralympic Committee’s “International Standard for Eligible Impairments", and both the list of ten eligible impairment categories and Perhaps someone @Paralympics can help explain why Parkinson's patients, afflicted with Ataxia and Athetosis are not eligible for the Paralympic games - or am I mistaken. Both conditions are among the 10 designated eligible impairments for competing in the Paralympics. In the IPC’s own guidelines (section 2 chapter 3.13 of the IPC Handbook), “the list of Eligible Impairments is an exhaustive list – an Athlete must have one of these Eligible Impairments in order to participate in Para sport. The list of Eligible Impairments also includes examples of Underlying Health Conditions that may lead to an Eligible Impairment. These examples are not exhaustive.”

THERE ARE 10 ELIGIBLE IMPAIRMENT TYPES:

IMPAIRED MUSCLE POWER Reduced force generated by muscles or muscle groups, such as muscles of one limb or the lower half of the body, as caused, for example, by spinal cord injuries, spina bifida or polio

IMPAIRED PASSIVE RANGE OF MOVEMENT Range of movement in one or more joints is reduced permanently, for example due to arthrogryposis. Hypermobility of joints, joint instability, and acute conditions, such as arthritis, are not considered eligible impairments.

LIMB DEFICIENCY Total or partial absence of bones or joints as a consequence of trauma (e.g. car accident), illness (e.g. bone cancer) or congenital limb deficiency (e.g. dysmelia).

LEG LENGTH DIFFERENCE Bone shortening in one leg due to congenital deficiency or trauma.

SHORT STATURE Reduced standing height due to abnormal dimensions of bones of upper and lower limbs or trunk, for example due to achondroplasia or growth hormone dysfunction.

ATAXIA Lack of co-ordination of muscle movements due to a neurological condition, such as cerebral palsy, brain injury or multiple sclerosis.

ATHETOSIS Generally characterized by unbalanced, involuntary movements and a difficulty in maintaining a symmetrical posture, due to a neurological condition, such as cerebral palsy, brain injury or multiple sclerosis.

VISION IMPAIRMENT Vision is impacted by either an impairment of the eye structure, optical nerves or optical pathways, or the visual cortex.

INTELLECTUAL IMPAIRMENT A limitation in intellectual functioning and adaptive behavior as expressed in conceptual, social and practical adaptive skills, which originates before the age of 18.

Further, excluded from the IPC’s list of Eligible Impairments are:

4.1. A number of Health Conditions do not lead to an Eligible Impairment and are not Underlying Health Conditions. If an Athlete has both a Health Condition that will not lead to an Eligible Impairment and an Underlying Health Condition the Athlete may be eligible to compete in Para sports.

4.2. An Athlete who has a Health Condition (including, but not limited to, one of the Health Conditions listed below) but who does not have an Underlying Health Condition will not be eligible to compete in Para sport.

4.3. Health Conditions that:

4.3.1. Primarily cause pain;

4.3.2. Primarily cause fatigue; 4.3.3. Primarily cause joint hypermobility or hypotonia; or 4.3.4. Are primarily psychological or psychosomatic in nature, do not lead to an Eligible Impairment.

Contemporary research findings in both science and medicine indicate that, of the above criteria, athletes with Parkinson’s disease clearly demonstrate Impaired Muscle Power and Hypertonia. At least two independent research studies show that Hypertonia is a clinical manifestation of Parkinson’s disease characterizing it as both a “cardinal feature”, and a “main symptom” of the disease. “A cardinal feature of Parkinson’s disease is muscle hypertonicity” (Wright, W.G. et.al. Axial hypertonicity in Parkinson’s disease: Direct measurements of trunk and hip torque. Exp Neurol. 208(1):38-46. 2007

“Parkinson’s disease (PD) is a progressive neurodegenerative disorder, the main symptoms of which are hypertonicity and difficulties emerging during performance of stepping movements due to increased muscle stiffness.” (Solopova, I.A., et. al. Investigation of muscle tone in patients with Parkinson’s disease in unloading conditions. Human Physiology 40:125-131. 2014)

In a published meta-analysis of seventeen independent research studies, it was concluded that “recent studies using sensitive mechanical devices have provided evidence that muscle strength is reduced in patients with Parkinson’s disease compared with age-matched controls” and that the observed muscle weakness was a primary symptom and not secondary to other causes, “isokinetic muscle strength was decreased in patients with Parkinson’s disease and that muscle weakness was not specifically related to tremor or rigidity.” (Cano-de-la-Cuerda R., et. al., Is There Muscular Weakness in Parkinson’s Disease? American Journal of Physical Medicine & Rehabilitation. 89:70-76.2010.)

The science is clear. Athletes afflicted with Parkinson’s disease should be included as International Paralympic Athletes.