Disability and rehabilitation on the move: mobility, exercise and sports for people with physical disabilities

The ability to move is central for people to function in society and enjoy quality of life. Moving is a precondition to functioning but also a purpose of its own, as people purposefully engage in physical activities and sports. Human Movement Sciences is an interdisciplinary field of study, focusing on all aspects of movement and applying knowledge to many different fields of practice. Such an interdisciplinary approach clearly fits the challenges of rehabilitation of those with physical disabilities. Movement related problems are predominantly multidimensional and can be expressed at different levels of functioning. Solving these problems rely on collaboration of scientists and medical professionals who are able to merge their expertise on movement systems and who are able to work across different levels of functioning. Such experts are invited each four years to join a state-of-the-art congress on mobility, exercise and sports in the Netherlands. In this three-day event, “human movement” is the central theme. Current issues of human movement in the context of mobility, physical exercise and leisure to elite sports in people with disabilities are presented and discussed, not restricted to a specific disability but to the general population of people with physical disabilities.

This special issue provides an overview of the central theme of the meeting and the issues addressed. In the first paper, De Groot et al. [1] elaborated on Human Movement Sciences as a field of study to address issues in Disability and Rehabilitation. It also defines the concepts “Mobility”, “Exercise”, and “Sports” and reviews current developments within each concept. Following that overview, a collection of keynote and highlight papers is presented, ordered according to the levels of the ICF classification, building from the level of body structures and functions towards activities and participation. This will demonstrate the variation of approaches and topics joined in this meeting to address and progress the advances in disability, rehabilitation, exercise and sport.

Three contributions focus specifically on body structures and functions for movement. Being confronted with physical disability requires re-learning of motor skills given new bodily constraints. Newell [2] contrast principles of re-learning in functional recovery and normal motor learning, indicating how changing constraints induce individual differences. Autonomous control of the cardiovascular system is the focus in the contribution of West and Krassioukov.[3] They address difference in autonomous cardiovascular control among athletes with a spinal cord injury, which impact sports performance but are not yet incorporated in sports classification. Finally, Dallmeijer et al. [4] explored muscle strength in relation to mobility capacity in children with cerebral palsy. Although intuitively such a relation might seem trivial, their results provide insight in the strength of this relation and indicate the muscle groups that could be the primary target for training strength and improving mobility.

The basic activity of ambulation as well as the more complex activity of playing golf and adapted wheelchair sports in general are discussed in subsequent contributions focusing on the level of activities. Identifying, explaining, and reducing increased metabolic demands in ambulation for people after lower-limb amputation has received broad attention in science and clinical practical. Czerniecki and Morgenroth [5] challenge the ecological validity of current approaches to assess metabolic demands in ambulation and the current evidence on the effects of amputation level and etiology and prosthetic components. They propose to define new paradigms to assess the relation between metabolic cost and functional mobility. Focusing on a much more specific activity, Stoter et al. [6] explore the relation between physical impairments and skills in golf. They propose a conceptual framework, conform IPC regulations, and a scientific agenda to develop a classification system for golfers with physical disabilities. Taking a broader perspective on adapted sports, Perret [7] reviews scientific literature on optimization of elite adapted wheelchair sports performance. While noticing that scientific evidence is scarce in comparison to able-bodied sports, he outlines advances related to performance enhancement through wheelchair equipment and physiological adaptations.

Mobility, exercise, and sports are vehicles for participation in society. How this can be promoted and implemented during and after rehabilitation is an important topic. Psychosocial factors and impact related to exercise and sports, as well as ethical considerations towards adapted sports were given specific attention during the congress and can be found in this special issue. Rimmer and Lai [8] present the Transformative Exercise Framework to support people with disabilities to transition from being patient to participant and from perceiving exercise as a mode of rehabilitation into means for wellness. Hoekstra et al. [9] described the current state of affairs regarding integration of sports and physical activity in rehabilitation care in the Netherlands, indicating that promising steps are being made but also indicating room for improvement. Martin Ginis et al. [10] signified the role of psychosocial factors for engaging in leisure time physical activities. Physically less disabled individuals can have lower levels of activity compared to physically more disabled peers when their perception of their capacity and attitude towards activities are not adequately developed. While psychosocial factors can impede sport and activity participation, Richardson et al. [11] demonstrated that reversely participating in sports can positively affect psychosocial well-being. Moreover, they show how sports can affect perception of disability within the cultures of developing countries. As a final contribution to the conference and this special issue, McNamee [12] engaged in a philosophical debate, evaluating the values of Paralympism and Paralympic sports: i.e., Courage, Determination, Inspiration and Equality. These values are not self-evident and can be challenged from philosophical and ethical perspectives. However, this will not challenge the value of mobility, exercise and sports for people with disabilities as highlighted in this special issue.