This is Jill Milan presenting the Adaptive Sports and Recreation Pediatric Focused Review module. I have no relevant disclosures. During this presentation, we plan to review the history, adaptations, benefits, common injuries, and existing organizations associated with competitive and recreational adaptive sports. Competitive recreational activities have probably existed since people have been having impairments. A good example is the 32nd President of the United States, Franklin Delano Roosevelt. He created the Warm Springs, Georgia Polio Rehabilitation Facility after he contracted polio in 1921. There recreation was encouraged in addition to formal therapy. He also helped establish accessibility to the National Park System for camping, hunting, and fishing, and adapted his canoe, sailboat, and car so he could paddle, sail, and drive himself. The Special Olympics were first held in 1968 and organized by Eunice Kennedy Shriver. They are designed to promote physical activities for children with intellectual disabilities and currently involve 5 million athletes, 100,000 yearly competitions, and 172 nations. The International Paralympic Committee was formed in 1989 out of several separate international competitive adaptive sports agencies. They have been held in the same cities and venues as the Olympics since the Summer Games of Seoul, South Korea in 1988 and the Winter Games in Albertville, France in 1992. Adaptive sports in public schools received a boost with Section 504 of the Individuals with Disabilities Education Act, giving students with disabilities an equal right to participate in their school's extracurricular activities. The physical education teachers provide instruction in adaptive sports and recreation activities so all children can participate. Sports adaptations may involve equipment, rules, or the environment. Equipment examples include three-wheeled bikes with supportive seating and gear ratios, making it easier to pedal using hands or feet. Wheelchair-specialized wheelchairs always undergoing refinement for racing, team sports, or beaches, and adaptive fishing poles, bows, and guns for people with weak or missing limbs. An example of rules changes is the two-bounce rule for wheelchair tennis. Environmental adaptations can include the concept of universal playgrounds, swim lanes with water sprinklers near the end to cue blind swimmers, accessible parks, fishing piers, and boat landings. Many physical benefits have been associated with participation in adaptive sports and recreation. Children with a variety of underlying conditions, from spinal cord injury to osteogenesis imperfecta to burns, have shown improvement in aerobic capacity, bone density, muscle force, lean body mass, endurance, and pain in a variety of studies. Summer sports participation was linked to improved six-minute walk tests and the timed up-and-go test. The United States Department of Health and Human Services recommends that all children, including those with a disability, exercise at a moderate to vigorous intensity level for one hour daily, including aerobic, strengthening, and flexibility exercises. Psychosocial benefits have also been reported. Adaptive sports have been shown to provide opportunities to build social networks, experience freedom and success, and positively compare themselves to others. Those who are involved in sports have positive perceptions of health-related quality of life, and parents also viewed adaptive sports as a chance to network with other families. Unfortunately, people with cerebral palsy in the GMFCS 4-5 levels have reported less benefit and fewer opportunities for adaptive sports participation. Injury rates in elite Paralympic athletes were similar between males and females. The sports with the highest injury rate are alpine skiing, snowboarding, wheelchair rugby, and football five a side. In general, ambulatory athletes have more lower limb injuries, and athletes using a wheelchair have more upper limb injuries. Special Olympic athletes have far fewer medical problems than their elite counterparts. Of those seeking medical attention during competition, the overall incidence is under five percent, with nearly half of those related to illness rather than injury. Atlanto axial instability is common in children with Down syndrome. An x-ray is required by the United States Special Olympic Committee prior to competition. Repeat x-rays are not necessarily recommended unless there are changes in the neurologic exam. Injuries due to recreational activities are mostly minor and related to the underlying condition. For example, those with spinal cord injuries may have issues with pressure sores and temperature regulation while those with limb deficiencies may have irritation from their prosthetic limb. Environmental hazards are similar to non-adaptive recreational activities such as drowning, collisions with vehicles or stationary objects, and falls onto unsafe surfaces. Appropriate safety precautions are recommended such as life jackets, helmets, and familiarizing oneself with the course, trail, or obstacles. The following is a list of notable sports and recreation organizations. They can be a starting point for those interested in a variety of sports and recreation opportunities. In summary, adaptive sports and recreation participation is at least a century old. The coordination of the Paralympics and the Olympics has increased the popularity of competitive adaptive sports. Participation often requires adaptation of equipment, rules, and the environment. Participation has been shown to be beneficial both physically and psychosocially across a wide range of conditions. Injuries associated with participation include both acute and overuse types and are often affected by the type of equipment used, the specific sport, and the underlying condition. There are many existing organizations dedicated to promoting and providing opportunities for adaptive participation. The following references were selected to provide more detailed learning for those interested in adaptive sports and recreation.

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