The Influence of Trunk Impairment Level on the Kinematic Characteristics of Alpine Sit-Skiing: A Case Study of Paralympic Medalists

This study aimed to examine the relationship between the trunk impairment level and the trunk kinematic characteristics during alpine sit-skiing from a classification perspective. Three Paralympic medalists in sitting classes (LW10-2, LW11, and LW12-2) participated in the present study. To simulate the racing conditions, giant slalom gates were set. To measure the kinematics of the skier and sit-ski during skiing, a motion capture method with inertial measurement units was used. The muscle activities of the trunk muscles were evaluated using electromyography. Chest lateral flexion, chest flexion, and hip flexion/extension angle during sit-skiing were reduced due to impairment. Additionally, the insufficient lateral flexion (angulation) caused a decrease in edging angle, and that the insufficient chest and hip flexion/extension caused a lower loading in the latter half of the turn through smaller vertical movement. Since edging angle and loading are key factors in ski control, the three joint motions could be measures of sport-specific activity limitation in sit-skiing classification. Between the LW10-2 and LW11 skiers, no distinct differences in trunk kinematics were found. Assuming the scaling factor of race time as a measure of skiing performance, one possible reason is that the difference in skiing performance the LW10-2 and LW11 skiers is considerably smaller relative to differences between the LW11 and LW12-2 skiers. There were no distinct differences among classes in the results of muscle activity, and therefore, this information appears to play a minimal role for classification. Key points

• Chest lateral flexion, chest flexion, and hip flexion/extension angle could be measures of sport-specific activity limitation in sit-skiing classification.
• Classification studies on the sit-skiers with more severe impairments might require a large number of subjects and methods with high statistical power.
• Information on muscle activity (electromyography) would be less important in classification.

Key words: Paralympic alpine skiing, classification, monoski, giant slalom, inertial measurement unit     

A Comparison between Alpine Skiing,Cross-Country Skiing and Indoor Cycling on Cardiorespiratory and Metabolic Response

Since physical inactivity especially prevails during winter months, we set out to identify outdoor alternatives to indoor cycling (IC) by comparing the metabolic and cardiorespiratory responses during alpine skiing (AS), cross-country skiing (XCS) and IC and analyse the effects of sex, age and fitness level in this comparison. Twenty one healthy subjects performed alpine skiing (AS), cross-country skiing (XCS), and IC. Oxygen uptake (VO₂), total energy expenditure (EE), heart rate (HR), lactate, blood glucose and rate of perceived exertion (RPE) were determined during three 4-min stages of low, moderate and high intensity. During XCS and IC VO_2max and EE were higher than during AS. At least 2½ hours of AS are necessary to reach the same EE as during one hour of XCS or IC. HR, VO₂, lactate, and RPE_arms were highest during XCS, whereas RPE_whole-body was similar and RPE_legs lower than during AS and IC, respectively. Weight adjusted VO₂ and EE were higher in men than in women while fitness level had no effect. Male, fit and young participants were able to increase their EE and VO₂ values more pronounced. Both AS and XCS can be individually tailored to serve as alternatives to IC and may thus help to overcome the winter activity deficit. XCS was found to be the most effective activity for generating a high EE and VO₂ while AS was the most demanding activity for the legs.

Key points

• During cross-country skiing and indoor cycling VO_2max and energy expenditure were higher than during alpine skiing
• Approximately 2½ hours of alpine skiing are necessary to reach the same energy expenditure of one hour of cross-country skiing or indoor cycling.
• Alpine skiing and cross-country skiing can be individually tailored to serve as sports alternatives in winter to activity deficit.
• By applying different skiing modes as parallel ski steering, carving long radii and short turn skiing, metabolic and cardiorespiratory response can be increased during alpine skiing.
• Male, fit and young participants were able to increase their energy expenditure and VO₂ more pronounced with an increase in intensity compared with their counterparts

Key words: Borg, blood lactate, cross-country skiing, cycling, energy expenditure, fitness level, oxygen uptake, gender     

Changes in Quadriceps Muscle Activity During Sustained Recreational Alpine Skiing

During a day of skiing thousands of repeated contractions take place. Previous research on prolonged recreational alpine skiing show that physiological changes occur and hence some level of fatigue is inevitable. In the present paper the effect of prolonged skiing on the recruitment and coordination of the muscle activity was investigated. Six subjects performed 24 standardized runs. Muscle activity during the first two (PREskiing) and the last two (POSTskiing) runs was measured from the vastus lateralis (VL) and rectus femoris (RF) using EMG and quantified using wavelet and principal component analysis. The frequency content of the EMG signal shifted in seven out of eight cases significantly towards lower frequencies with highest effects observed for RF on outside leg. A significant pronounced outside leg loading occurred during POSTskiing and the timing of muscle activity peaks occurred more towards turn completion. Specific EMG frequency changes were observed at certain time points throughout the time windows and not over the whole double turn. It is suggested that general muscular fatigue, where additional specific muscle fibers have to be recruited due to the reduced power output of other fibers did not occur. The EMG frequency decrease and intensity changes for RF and VL are caused by altered timing (coordination) within the turn towards a most likely more uncontrolled skiing technique. Hence, these data provide evidence to suggest recreational skiers alter their skiing technique before a potential change in muscle fiber recruitment occurs.

Key points

• The frequency content of the EMG signal shifted in seven out of eight cases significantly towards lower frequencies with highest effects observed for RF.
• General muscular fatigue, where additional specific fibers have to be recruited due to the reduced power output of other fibers, did not occur.
• A modified skiing style towards a less functional and hence more uncontrolled skiing technique seems to be a key issue with respect to the influence on muscle recruitment for applied prolonged skiing session.

Key words: Muscle coordination, recruitment, electromyography, wavelet analysis     

Alpine Skiing and Anaerobic Performance in Solid Organ Transplant Recipients

Limited information has been published about sporting activities in solid organ transplant recipients. The aim of this study was to assess “in the field” performance capacities of a group of transplant recipients involved in an alpine skiing competition. We studied 16 transplant recipients (13 men and 3 women) who had undergone transplantations (11 kidney, 4 liver, and 1 heart) at 89 ± 68 months prior while participating in an alpine skiing race. The patients performed a countermovement jumping test to measure the explosive power of the lower limbs. In all patients blood lactate concentrations (La) were measured at the end of a giant slalom race. The maximum displacement of the center of mass during the jumping test was 22.4 ± 9.3 cm; the time to complete the giant slalom was 75.5 ± 16.5 seconds and La was 3.5 ± 0.8 mmol/L. We observed significant linear relationships between race time and La (R² = 0.4733; P < .01) and between race time and performance in the jumping test (R² = 0.3655; P < .05). This study indicated that recovery of anaerobic and technical sporting activities is possible in organ transplant recipients. Muscular power and anaerobic performances among a selected group of solid organ transplant recipients were similar to those of the general untrained population.     

Multi-Axis Prosthetic Knee Resembles Alpine Skiing Movements of an Intact Leg

The purpose of the study was to analyse the flexion angles of the ski boot, ankle and knee joints of an above-knee prosthesis and to compare them with an intact leg and a control group of skiers. One subject with an above-knee amputation of the right leg and eight healthy subjects simulated the movement of a skiing turn by performing two-leg squats in laboratory conditions. By adding additional loads in proportion to body weight (BW; +1/3 BW, +2/3 BW, +3/3 BW), various skiing regimes were simulated. Change of Flexion Angle (CoFA) and Range of Motion (RoM) in the ski boot, ankle and knee joints were calculated and compared. An average RoM in the skiing boot on the side of prosthesis (4.4 ± 1.1°) was significantly lower compared to an intact leg (5.9 ± 1.8°) and the control group (6.5 ± 2.3°). In the ankle joint, the average RoM was determined to be 13.2±2.9° in the prosthesis, 12.7 ± 2.8° in an intact leg and 14.8±3.6 in the control group. However, the RoM of the knee joint in the prosthesis (42.2 ± 4.2°) was significantly larger than that of the intact leg (34.7 ± 4.4°). The average RoM of the knee joint in the control group was 47.8 ± 5.4°. The influences of additional loads on the kinematics of the lower extremities were different on the side of the prosthesis and on the intact leg. In contrast, additional loads did not produce any significant differences in the control group. Although different CoFAs in the ski boot, ankle and knee joints were used, an above-knee prosthesis with a built-in multi-axis prosthetic knee enables comparable leg kinematics in simulated alpine skiing.

Key points

• The RoM in the ski boot on the side of the prosthetic leg was smaller than the RoM of the intact leg and the control group of healthy subjects.
• The RoM in the ankle joint of prosthetic leg was comparable to that of the intact leg and the control group of healthy subjects.
• The RoM in the prosthetic knee joint was greater than the RoM in the knee joint of the intact leg and smaller than that of the control group.
• The total knee flexions in the laboratory measurements were comparable with field measurements.
• Additional load affects the RoM of the ski boot, ankle and knee joints for the amputated skier in both legs. No significant influence from the additional load was found on the RoM in the control group of healthy subjects.
• The above-knee prosthesis with a multiple-axis prosthetic knee reproduces the alpine skiing kinematics of an intact leg.

Key words: Above-knee amputation, Alpine skiing, impairment, kinematics, prosthesis     

Physiological Responses of Elderly Recreational Alpine Skiers of Different Fitness and Skiing Abilities

We measured physiological responses of elderly recreational skiers of different fitness and skiing abilities. Six subjects (mean age: 61.2 ± 4.6 yrs; Wt: 76.8 ± 15.6 kg; Ht: 1.69 ± 0.10 m; BMI: 26.9 ± 5.0) were tested in a laboratory and during 30 and 75 min of recreational downhill skiing. Oxygen uptake (VO₂), heart rate (HR), blood lactate (LA) concentration, and diastolic (DBP) and systolic (SBP) blood pressure were used to estimate energy demands while skiing. During maximal testing in a laboratory, subjects achieved a mean maximal VO₂max of 28.2 ± 7.5 ml.kg^-1.min^-1 and a mean HRpeak of 165 ± 4 bpm (98 ± 1% of HRmax). Mean maximal workload measured on a cycle ergometer was 2.2 ± 0.7 W.kg^-1 with a mean LApeak of 7.4 ± 1 mmol.l^-1. During field testing, mean VO₂ during skiing was 12 ± 2 ml.kg^-1.min^-1 (45 ± 16% of VO₂max). Skiing VO_2peak was 19 ± 5 ml. kg^-1.min^-1 (72 ± 23% of VO₂max) was lower than VO₂max in the lab (p = 0.04). Mean HR during skiing was 126 ± 2 bpm (77 ± 1% of HRmax from lab tests). Skiing HRpeak was 162 ± 2 bpm. This was not different from HRmax in the lab (p = 0.68). Mean LA after 30 and 75 min of skiing was not different (2.2 ± 0.8 mmol.l^-1 and 2.0 ± 0.8, respectively, p = 0.71). Both LA samples during skiing were lower than lab tests (p < 0.0001). There was no difference for DBP between field and laboratory tests; however, SBP increased after 30 min of skiing to 171 ± 20 (p < 0.009) and 165 ± 17 (p < 0.003) after 75 min. These remained below the mean peak SBP determined in lab tests (218+31). Mean oxygen demand during 30 and 75 min of recreational skiing is only 45% of VO₂max while mean HR is 77% of HRmax. This departure from linearity not often seen in typical aerobic activities suggests that alpine skiing requires a combination of aerobic and anaerobic activity. Blood LA remained low during skiing suggesting that elderly skiers may govern their intensity via signals closer to VO₂ and LA compared to HR or BP.

Key points

• Recreational Alpine skiing for elderly population does not pose health risks
• Blood pressure and heart rate during recreational Alpine skiing is retain within normal limits
• Blood lactate levels remain relatively low and do not contribute to fatigue
• Oxygen uptake and blood lactate are better markers of intensity in elderly Alpine skier compared to heart rate and blood pressure.

Key words: Elderly, physiological responses, blood lactate, blood pressure     

The Waist Width of Skis Influences the Kinematics of the Knee Joint in Alpine Skiing

Recently alpine skis with a wider waist width, which medially shifts the contact between the ski edge and the snow while turning, have appeared on the market. The aim of this study was to determine the knee joint kinematics during turning while using skis of different waist widths (65mm, 88mm, 110mm). Six highly skilled skiers performed ten turns on a predefined course (similar to a giant slalom course). The relation of femur and tibia in the sagital, frontal and coronal planes was captured by using an inertial motion capture suit, and Global Navigation Satellite System was used to determine the skiers’ trajectories. With respect of the outer ski the knee joint flexion, internal rotation and abduction significantly decreased with the increase of the ski waist width for the greatest part of the ski turn. The greatest abduction with the narrow ski and the greatest external rotation (lowest internal rotation) with the wide ski are probably the reflection of two different strategies of coping the biomechanical requirements in the ski turn. These changes in knee kinematics were most probably due to an active adaptation of the skier to the changed biomechanical conditions using wider skis. The results indicated that using skis with large waist widths on hard, frozen surfaces could bring the knee joint unfavorably closer to the end of the range of motion in transversal and frontal planes as well as potentially increasing the risk of degenerative knee injuries.

Key points

• The change in the skis’ waist width caused a change in the knee joint movement strategies, which had a tendency to adapt the skier to different biomechanical conditions.
• The use of wider skis or, in particular, skis with a large waist width, on a hard or frozen surface, could unfavourably bring the knee joint closer to the end of range of motion in transversal and frontal planes as well as may potentially increase the risk of degenerative knee injuries.
• The overall results of the abduction and internal rotation in respect to turn radii and ground reaction forces indicated that the knee joint movements are likely one of the key points in alpine skiing techniques. However, the skiing equipment used can still significantly influence the movement strategy.

Key words: Abduction, inertial sensor, rotation, ski turn, three-dimensional joint movements     

A Comparison of Ground Reaction Forces Determined by Portable Force-Plate and Pressure-Insole Systems in Alpine Skiing

For the determination of ground reaction forces in alpine skiing, pressure insole (PI) systems and portable force plate (FP) systems are well known and widely used in previous studies. The purposes of this study were 1) to provide reference data for the vertical component of the ground reaction forces (vGRF) during alpine skiing measured by the PI and FP systems, and 2) to analyze whether the differences in the vGRF measured by the PI and the FP depend on a skier’s level, skiing mode and pitch. Ten expert and ten intermediate level skiers performed 10 double turns with the skiing technique “Carving in Short Radii” as High Dynamic Skiing mode and “Parallel Ski Steering in Long Radii” as Low Dynamic Skiing mode on both the steep (23 °) and the flat (15 °) slope twice. All subjects skied with both the PI and the FP system simultaneously. During the outside phase, the mean vGRF and the maximum vGRF determined by the FP are greater than the PI (p < 0.01). Additionally during the inside phase, the mean vGRF determined by the FP were greater than the PI (p < 0.01). During the edge changing phases, the mean vGRF determined by the FP were greater than the PI (p < 0.01). However, the minimum vGRF during the edge changing phases determined by the FP were smaller than the PI (p < 0.01) in the High-Steep skiing modes of Experts and Intermediates (p < 0.001). We have found that generally, the PI system underestimates the total vGRF compared to the FP system. However, this difference depends not only the phase in the turn (inside, outside, edge changing), but also is affected by the skier’s level, the skiing mode performed and pitch.

Key points

• Typically, during the steering phases of the ski turns the total vGRFs measured by the pressure-insole system were lower compared to the portable force-plate system.
• However, in some skiing modes during the edge changing phase, the pressure-insole system overestimates the total vGRF compared to the portable force-plate system.
• Differences between the forces determined by the both systems depend on the phase in the turn (inside, outside, edge changing) and are affected additionally by the skier’s level, the performed skiing mode and pitch.

Key words: kinetic analysis, alpine skiing, accuracy, skiing mode, pressure insole     

Muscle Activity and Morphology in Slalom Skiing by a Single-Leg Amputee Ski Racer: A Case Study of a Paralympic Athlete

The aim of this study was to clarify the characteristics of skiing by a single-leg amputee ski racer from the viewpoints of muscle activity, morphology, and the relationship between both elements through comparisons with those of a non-disabled ski racer. One elite athlete, classified as LW2 (left thigh amputation), and one non-disabled athlete, as a control, participated in this study. The cross-sectional area of thigh muscles was measured through magnetic resonance imaging. Additionally, muscle activities and joint and segment kinematics during slalom skiing were measured using electromyography and inertial measurement units, respectively. The muscle activities and joint kinematics of the amputee racer in the turn in which he performed with the inside edge of the ski were similar to those of the outside leg of the non-disabled racer over a turn. In contrast, at the turn in which the amputee racer performed with the outside edge (more difficult side), the amputee racer largely activated the biceps femoris (BF) in the first half of the turn compared to the non-disabled racer. The reason could be to control the angular momentum of the trunk during the forward tilting motion. This is because a greater activity of the BF was observed during the period in which the forward tilt of the trunk was increased, and the mean activity of the BF was the greatest during the first half of the right turn in which the range of the motion of the forward tilt was the greatest. In terms of muscle morphology of the amputee racer, a significant hypertrophy of the BF and vastus lateralis was observed compared to the non-disabled racers. The well-developed BF was considered to be related to the large activity during the turn performed with the outside edge of the ski.Key points

• An elite single-leg amputee ski racer, classified as LW2 (left thigh amputation), has a well-developed thigh muscle (vastus lateralis and biceps femoris) morphology compared to non-disabled alpine ski racers, including elite racers.
• To accomplish turns in which the amputee racer performed with the outside edge (more difficult side in terms of balance control), the amputee racer largely activated the biceps femoris in the first half of the turns. The reason could be to control the angular momentum of the trunk that occurred during the period in which the forward tilt of the trunk was increased.
• The well-developed biceps femoris of the amputee racer was considered to be related to the large activity during the turn performed with the outside edge of the ski.

Key words: Paralympic alpine skiing, electromyography, muscle cross-sectional area, magnetic resonance imaging, inertial measurement unit     

Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing

BackgroundDespite the knee extensor weakness, less attention has been paid to the evaluation of patellar tendon after total knee arthroplasty (TKA). We previously observed patellar tendon hypertrophy after TKA. The purpose of this study is to reanalyze these ultrasound data to detect whether brightness mode ultrasound imaging reflects pathological changes of the patellar tendon after TKA.MethodsTwenty-eight participants with post unilateral TKA were assigned to an intervention group or control group. The intervention group underwent a 12-week skiing program. Patellar tendon mechanical properties were obtained by combining isometric dynamometry, ultrasound imaging, and electromyography in operated knee and nonoperated knee. Luminosity ratio (LR) was measured using echo intensity in a relaxed and maximally loaded phase.ResultsBaseline comparisons revealed significant effects of the surgical side (P < .001) and loading phase (P = .017), but no interaction between leg and phase (P < .149). LR of the operated knee was significantly lower than LR of the nonoperated knee in relaxed (P < .001) and maximally loaded phases (P = .003). In addition, there was a significant correlation between LR of maximum phase and isometric knee extension torque (r² = 0.156, P = .038). However, LR was not related to patellar tendon stiffness, Young’s modulus, or strain. There was a significant time effect in knee extension torque, but no time effects on LR and tendon force.ConclusionPatellar tendon LR is decreased along with degenerative change after TKA. Ultrasound imaging provides a promising metric to acquire in vivo patellar tendon pathological assessment after TKA.     

Adolescent Athletes and the Demand and Supply of Drugs to Improve Their Performance

The aim of this study was to gather information into the principal methods and means employed to supply adolescents with doping agents and others substances used to improve their sporting performance. We conducted a nation wide study in France among adolescent athletes, using a self-completed questionnaire. Exploitable questionnaires (n = 6402) were returned, corresponding to 48.9% for the girls and 51.1% for the boys, both aged on average from 16.1 ± 2.2 years. These adolescents practise on average 10.0 ± 5.2 hours of sport per week. 21.9% participate on a national or international competition level. Of our respondents, 4.0% (95% confidence interval: 3.5% - 4.5%) say they have been enticed into using products which are prohibited for athletes. 10.3% of the adolescents say that they have received substances to improve their performance at least once from an average of two different people. It was mostly a friend, their parents and the family doctor. On average, in 33.2% of the cases, the adolescent received the product without asking for it, and in nearly half the cases (46.6%), the adolescent paid for the product. We feel that it is necessary to better understand the ways in which this black market functions: for example; the initial sources of the products sold, the number and the ‘profiles’ of the dealers, the general organisation of the market and the sums of money involved.

Key Points

• This study confirms the existence of a ‘black market’ for products to improve performance, which is directed at adolescent athletes engaged in high-level competitions.
• This market is characterized by its ease of accessibility and also the diversity of its ‘suppliers’, the two main sources being friends and parents.

Key words: Doping in sport, adolescents, enticement, black market     

Adaptation of Insulin Clearance to Metabolic Demand Is a Key Determinant of Glucose Tolerance

With the development of insulin resistance (IR), there is a compensatory increase in the plasma insulin response to offset the defect in insulin action to maintain normal glucose tolerance. The insulin response is the result of two factors: insulin secretion and metabolic clearance rate of insulin (MCR_I). Subjects (104 with normal glucose tolerance [NGT], 57 with impaired glucose tolerance [IGT], and 207 with type 2 diabetes mellitus [T2DM]), divided in nonobese and obese groups, received a euglycemic insulin-clamp (40 mU/m² ⋅ min) and an oral glucose tolerance test (OGTT) (75 g) on separate days. MCR_I was calculated during the insulin-clamp performed with [3-³H]glucose and the OGTT and related to IR: peripheral (glucose uptake during the insulin clamp), hepatic (basal endogenous glucose production × fasting plasma insulin [FPI]), and adipocyte (fasting free fatty acid × FPI). MCR_I during the insulin clamp was reduced in obese versus nonobese NGT (0.60 ± 0.03 vs. 0.73 ± 0.02 L/min ⋅ m², P < 0.001), in nonobese IGT (0.62 ± 0.02, P < 0.004), and in nonobese T2DM (0.68 ± 0.02, P < 0.03). The MCR_I during the insulin clamp was strongly and inversely correlated with IR (r = −0.52, P < 0.0001). During the OGTT, the MCR_I was suppressed within 15–30 min in NGT and IGT subjects and remained suppressed. In contrast, suppression was minimal in T2DM. In conclusion, the development of IR in obese subjects is associated with a decline in MCR_I that represents a compensatory response to maintain normal glucose tolerance but is impaired in individuals with T2DM.     

Automated Identification and Evaluation of Subtechniques in Classical-Style Roller Skiing

The aims of the present study were (1) the development of an automated system for identifying classical-style ski subtechniques using angular rate sensors, and (2) the determination of the relationships among skiing velocity, ski course conditions, and ski subtechniques using a global navigation satellite system (GNSS) and the developed automated identification system. In the first experiment, the performance of a male cross-country skier was used to develop an automated system for identifying classical-style ski subtechniques. In the second one, the performances of five male and five female college cross-country skiers were used to validate the developed identification system. Each subject wore inertial sensors on both wrists and both roller skis, a small video camera on the helmet, and a GNSS receiver. All subjects skied a 6,900-m roller ski course using the classical-style at their maximum speed. The adopted subtechniques were identified by the automated method based on the data obtained from the sensors, and also by visual count from a video recording of the same ski run. The results showed that the automated identification method could be definitively used to recognize various subtechniques. Specifically, the system correctly identified 9,307 subtechnique cycles out of a total of 9,444 counted visually, which indicated an accuracy of 98.5%. We also measured the skiing velocity and the course slope using the GNSS module. The data was then used to determine the subtechnique distributions as a function of the inclination and skiing velocity. It was observed that male and female skiers selected double poling below 6.7° and 5.5° uphill, respectively. In addition, male and female skiers selected diagonal stride above 0.7° and 2.5° uphill, and below 5.4 m/s and 4.5 m/s velocity, respectively. These results implied that the subtechnique distribution plot could be used to analyze the technical characteristics of each skier.

Key Points

• The automatic identification method, which utilizes data obtained by small and light inertial sensors, could be used to recognize subtechniques of classical-style roller skiing with a high accuracy of 98.5%.
• The skiing velocity was measured using a small DGNSS module at all over the course, which made it possible to evaluate the technical features of skiers together with the results of the automatic identification.
• However, there were limitations in the automatic identification during the start phase, the downhill, and the transition period between subtechniques.

Key words: GPS/GNSS, cross-country skiing, inertial sensor, angular rate     

The Paralympic athlete: a systematic review of the psychosocial literature

Background: There is a lack of knowledge of the psychosocial wellbeing and attributes of Paralympic athletes. Such knowledge may reveal what contributes to exceptional performance. Objectives: To systematically review the literature on psychosocial wellbeing and attributes of the Paralympic athlete. Study Design: Systematic literature review. Methods: Five key databases that index psychosocial literature were searched: CINAHL, ISI Web of Science, MEDLINE, PsycINFO and SportsDiscus. Results: Sixteen papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, sample characteristics, outcome assessment and outcomes examined. The emerging thematic areas are 1) participation, motivations and goals; 2) mental imagery; 3) stress and coping; 4) personality; 5) attitudes towards other disabled-bodied athlete groups; 6) knowledge and attitudes towards doping; and 7) transitions to retirement. Conclusions: Relative to the biomechanical aspects of the Paralympian, the psychosocial literature remains limited and diffuse. Nonetheless an understanding of the psychosocial profile of these athletes complements the extant physiological and technological knowledge in enabling a holistic view of what contributes to the successful Paralympic athlete and may facilitate the team working to optimize performance and wellbeing in these high-performing individuals. Clinical relevance An understanding of the psychological profile of the Paralympic athlete complements the extant physiological and technological knowledge in enabling a holistic view of what contributes to the successful athlete and may facilitate optimizing performance and wellbeing.