Keren Faulkner, physical therapies manager at the London and Rio Paralympic Games, speaks to Maria Whitmore about the Paralympians’ extraordinary determination, not only in the sporting arena, but in the management of their disabilities.
Sports physiotherapist Keren Faulkner has spent a lot of time working with athletes at the highest level. She was a member of the physiotherapy team at the 2004 and 2008 Olympic Games, the three most recent Commonwealth Games, and the Australian Gymnastics team from 2003 to 2009. In 2012, Keren was appointed manager of Physical Therapies at the London Paralympic Games, a role she again held at the recent Rio Games.
Her vast experience with athletes, however, didn’t prepare her for what she witnessed in Rio.
“As sportspersons, they were the most focussed, the most positive, the most independent athletes I’ve known, with no complaining, no feeling sorry for themselves,” Keren said.
The Paralympians’ extraordinary drive, she said, was very likely borne of their determination to excel in the face of adversity.
The range of disabilities and ages was broad. “Our youngest was 16, and our oldest was 74, a shooter, Libby Cosmala, who has paralpegia,” she said.
Bladder and bowel management is an added complication for athletes with degenerative diseases and certain conditions such as spinal cord injuries, in particular cauda equine syndrome (a complication from the compression of nerves at the end of the spinal cord).
“Cases like spinal cord injury, MS, which often cause weakness in the pelvic floor muscles, and cerebral palsy - whether in a wheelchair or ambulant - can cause problems with the muscles that control the bladder, bowel and pelvic floor,” Keren said.
For athletes affected by continence management issues, their toileting challenges started even before they arrived in Rio, on the 15-hour flight across the Atlantic.
“They would have had all of this planned in advance, often aiming for just one visit to the toilet,” Keren said.
A toilet stop, she explained, could involve a transfer from a regular aeroplane seat to an aisle chair - a narrow chair that can be pushed up and down the aisle - and then an awkward transfer from the aisle chair to the regular toilet seat.
“You can imagine how difficult that would be,” she said.
Although the team of physiotherapists was briefed about the athletes’ various bladder and bowel control requirements before the Games, their primary focus was sport physiotherapy, not specifically continence or pelvic floor therapies.
“But by the time we got there, all the athletes had good toileting plans in place, and were mostly independent or in need of minimal help,” Keren said.
“In many ways the athletes are more independent than people with disabilities in the wider community,” she said. “There’s this desire of really wanting to be independent.”
Further to this, the athletes’ physical training regimes, dietary and lifestyle habits contributed to their ability to manage their incontinence.
“Their strength, because they have more muscle bulk, makes them more independent with transfers on and off the toilet, and their weight management means they’re often lighter, which helps with their continence,” she said.
Keren observed that Paralympians were also more proactive in the early detection of potential health issues compared with able-bodied athletes.
“There’s a culture of monitoring and checking for problems; for example checking their urine for UTIs, which are common, particularly for athletes with spinal cord injury,” she said.
Keren singled out the Australian wheelchair rugby team, which has a reputation as a fearless group of athletes, as exemplifying the Paralympic team culture.
“The 12 athletes in the wheelchair rugby team are either quadriplegics or four-limb amputees, which means some part of each limb is amputated.”
However, these 12 Paralympians only required one carer to help with the management of their day-to-day lives outside the sports arena, she said.
Each of the Paralympians with continence management issues would have had a disciplined regime in place, she said, the majority dealing with their toileting needs independently.
“They would have been using a range of things, like leg bags or intermittent catheterisation. They would have had a bowel care plan in place in the morning, which could take up to two hours of their day,” she said.
Drug testing caused some minor problems, most often due to language barriers and cultural differences.
“Some of the officials thought that washing their hands with soap before removing their catheters for a urine sample would contaminate the samples, for example. But when we asked them to address this, they were OK,” she said.
Paralympians who required medications that were on the list of performance-enhancing drugs, were able to apply for exemptions in advance of the Games.
“This is an area that needs to be looked at, because it takes some time for these exemptions to go through. An International Paralympic Committee medical review panel is working on it,” she said.
Keren said the Paralympian team’s attitude of positivity was contagious. She said it inspired her and she hoped it would similarly affect others.
“They are so focussed. There is this amazing culture of getting the most out of every moment,” she said.
“As a group they see no barriers. Many are living with continence issues and not letting it become a barrier to their sport. Hopefully they will encourage other people to be positive too. Perhaps others see that they can achieve things in sport too.”
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