The efforts and philosophy of Sir Ludwig Guttman flourish in the present day. Recognized as the founder of the paralympic movement, he first recognized the therapeutic benefit of organized competitive sport in the lives of individuals with physical challenges, and his initiatives culminated in the Stoke Mandeville Games on July 1948, held in Aylesbury, England. The games since have grown to a global level, in the form of the Paralympics, which now occur every four years in the same country, as often as possible as the able-bodied Olympics (Table 1).<sup>33 Reynolds J., Stirk A., Thomas A. , et al. Paralympics—Barcelona, 1992 Br J Sports Med 1994 ;  28 : 14-17  [cross-ref]

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Like the Olympics, these games are the pinnacle of international elite competition. Even more gratifying, however, is the fact that the growth of these games reflects an increased awareness of the abilities of people with physical challenges and increasing opportunities for youth to participate at recreational, local, and regional levels. The enormous increase in sporting opportunities for the individual with a disability has nourished an increasing number of participants in sports events such as wheelchair track and field, swimming, horseback riding, and wheelchair basketball. For example, in Canada, since 1976, through the energies of Dr. Robert Jackson in Toronto there has been an explosion in the quantity of sporting events for participants with disabilities, and also a proliferation in the variety of events available (Table 2).

Although the value of this increased participation is priceless, one should appreciate that, similar to the athlete without a disability, with greater participation and competition come the unique injuries and health issues of this population. This article provides an overview of the health problems that youth with disabilities may encounter during sporting activities and an approach to managing some of these issues. The article is divided into three main sections: the value of sport and its particular influence on the development of children and youth with physical challenge; the preparticipation evaluation; and the medical and orthopedic concerns of the wheelchair athlete, amputee, and child with special sensory impairment.