A Fair Provision Of Lower-Limb Prostheses Technology For Paralympic Level Running

BRYCE T.J. DYER BA (Hons), MSc

INTRODUCTION

Within sport, there is a constant need to make sure that a competition is as fair as possible between its participants. When applied to disability sport, it is unclear how the lower-limb prostheses (LLP) technology is currently perceived (and in light of future innovations) whether it should be regulated in terms of its performance.

With regards to athletes with a lower-limb amputation who run, research has shown that the technological performance varies between the type of LLP used by an athlete (Nolan 2008) and that the optimised use of these will require it to be ‘tuned’ for their best performance (Buckley 1999). This potentially would allow some athletes to have a mechanical ergogenic advantage over others within an event. In addition, it has been suggested that the use of sports technology requires an ‘ethical foundation’ to ensure a positive and fair environment is created (Freeman 1991). By creating a symbiosis between these two areas, a holistic and pragmatic insight into the use of disability sports technology (that is fair to all of the athletes) would be created.

This qualitative investigation will create a set of values to form the foundation for the design of a series of biomechanical/structural characteristic driven assessments. This assessment is the first of a three stage project which investigates disability sports LLP inclusion/assessment.

References:

Buckley, J., 1999. Sprint Kinematics of Athletes with Lower Limb Amputations, Arch Phys Med Rehabil, Vol. 80, May, 501-508.Dalkey, N., 1969. An Experimental Study of Group Opinion: The Delphi Method, Futures, 2/3, 27-37.Freeman, W., 1991. Sport and Technology: Ethics on the Cutting Edge. Paper Presented at: Sport Philosophy Academy Session. San Francisco: USA.Nolan, L., 2008. Carbon Fibre Prostheses and Running in Amputees: A Review, Foot and Ankle Surgery, 14, 125-129.

PHASE 1: RESULTS• A list of 17 common ethical/fairness themes were generated by the expert panel at round 1. Some of these issues included : cost and access to LLP technology, the wellbeing of the user, ethos of the sport, manipulation of the LLP, and individual/external perception of the LLP.

• 16 closed ended questions in round 2 (based upon round 1’s themes) saw 7 areas obtain the expert panels consensus in the range of 70-90%.

• Upon further refinement of the questions, 3 further areas obtained expert panel consensus of 70-85% in round 3.

• Panelist participation levels from round to round were 100% at round 1 (22), 91% at round 2, (20) and 100% at round 3 (20).

•This has allowed the formulation of a statement of fairness to be created which states the role, ability, and place that the LLP has within lower-limb disability running.

PHASE 2: (aimed completion late 2009)

Having established an ethical foundation, a series of biomechanical/structural assessments are being developed that:

•Allow a lower-limb uni-lateral amputee to be regulated on an individual basis but promote an equity in technology performance contribution employed across an elite field.•Allow the same advantage/disadvantage tuning rate for all competitors.•Would be applicable within a major events infrastructure and should not inhibit participation levels.

1

PHASE 1: CONCLUSIONS

The expert stakeholder panel obtained high levels of consensus and agreed that:

•The lower-limb running prosthesis is a restorative (not enhancement) form of equipment in nature and should be treated as such.

•Increased legislative control and performance limitations should be imposed on the lower-limb prostheses to maintain a fair environment within the specific running discipline.

•A lower-limb prostheses performance should be set by the individuals own physical abilities that they have obtained under naturally generated means rather than a blanket specification.

PHASE 1: METHOD1

SpectatorsPractitioners

AcademicsAthletes

22 Participants undertook a 3 round Delphi Technique process (Dalkey 1969). This involved anonymous participation of an broad interest expert panel and a controlled and structured iterative process of ‘rounds’ to obtain shared consensus in developing/incomplete areas of knowledge.

A first round open ended question phase was implemented to obtain opinion on the role, perceived limitations and stakeholder understanding of unfairness.

Rounds 2-3 involved closed ended question based decision-making by the experts on the raised themes of round 1.

Consensus was defined as a 70% level of agreement between the experts and the absence of a change in opinion between the iterative rounds.

Qualitative open coding and analysis took place after round 1. Likert scales and resulting Mode scores were used to establish consensus levels in rounds 2 and 3.

Stage 1: 3 Open ended questions posed to panel members separately.

Stage 2: Closed end Likert scales (non neutral) questions released to panel.

Stage 3: Round 2 repeated (but with questions modified based on round 2 feedback).

DELPHI EXPERT STAKEHOLDER PANEL

THE SPORTS THE SPORTS TECHNOLOGY TECHNOLOGY

PROVISIONPROVISIONRELATIONSHIPRELATIONSHIP

FAIRNESSPROSTHESES

PERFORMANCE

Establish the Ethical Foundation

Derive Assessment for LLP23 Applied Case Studies1

Phases 1-3 for Research Project