W

hen Paralympic athletes hit the swimming pool and race tracks in Rio de Janeiro, Dr. Cheri Blauwet will be there — this time, not as a competitor, but as a medical advisor tracking concussions, infections, and blindfolded collisions.

Blauwet, who’s 36, rose to fame as a wheelchair racer, scoring two Boston Marathon victories and seven Paralympic medals. Paralyzed from the waist down after a childhood farming accident, she is now an instructor at Harvard Medical School, a researcher, and a sports medicine doctor at two Boston hospitals, Brigham and Women’s and Spaulding Rehabilitation.

Blauwet plans to head to Rio in late August in a new role: heading up the medical committee that advises the Paralympic Games. The Games, which will bring 4,300 athletes to Rio from Sept. 7 to 18, feature 23 sports for people with disabilities, from powerlifting and canoe sprinting to judo for the visually impaired.

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STAT caught up with her recently for an interview.

What she’ll be doing in Rio

When she’s not watching athletes race and jump, she’ll be running an “injury and illness surveillance study” of Paralympians. During the Games, she’ll meet at 8 a.m. every day with medical staff to look for patterns from the past 24 hours.

Monitoring sports for safety

If the medical committee notices a pattern of injuries, that can prompt rule changes. In the winter sport of sled hockey, athletes, many of whom have amputations to their legs, sit on narrow sleds, using two small sticks to propel themselves on the ice. The medical committee, which Blauwet has been a member of since 2009, found a high rate of injuries to athletes’ legs. It turned out there were no rules for wearing protective gear, and no standard sled height, which made sled collisions worse. After the medical study, both of those rules changed, Blauwet said.

Injuries to watch for in Rio

Collisions in five-aside soccer, in which all of the athletes are visually impaired. To ensure an even playing field, the athletes wear blindfolds and follow the sound of a bell inside the ball. In the past, Blauwet said, the medical committee noticed a high rate of injury to athletes’ heads and necks. To prevent those injuries, athletes are supposed to yell, “Voy!” (which means “I go” in Spain, where the game was invented) as they go for the ball. But there has been “lax implementation” of that rule, Blauwet said. The medical committee is now “working with the sport to increase penalties” for athletes who omit that warning as they charge for the ball, she said.

What about doping?

Paralympians face the same doping rules as Olympians. But there are some differences, she said. Many Paralympians use catheters, so they have to put in a sterile catheter when they give a urine sample. And some visually impaired athletes run races, ride tandem bicycles — and even race downhill on skis — with the help of a sighted guide. The guide has to take the same drug tests that the athlete does. “Consider the athlete and the guide to be a unit,” Blauwet said: If they win the race, they both get a medal.

How “boosting” works

Some athletes can release a rush of adrenaline, called “boosting,” by creating a painful stimulus in a part of their body that’s paralyzed, triggering what’s known as “autonomic dysreflexia.” The most common way to create that pain is by overfilling the bladder. [Some athletes also sit on their scrotums.] Athletes can’t feel the pain, but they do get a performance boost. “It’s this niche thing that only a small subset of athletes could do,” she said — they have to have a spinal cord injury at or above thoracic vertebra six in the torso. Boosting is “hard to monitor because it’s a physiological response,” not a drug. There’s no simple test; officials monitor it by checking athletes for high blood pressure before competitions.

X-factor: concussions

“We actually don’t have good data about whether concussions are a big problem in Paralympic sports,” Blauwet said. “That is one of our biggest agenda items moving forward.” Some concussions have been reported in blindfolded soccer games, but concussions are hard to detect. “How do you diagnose a concussion? It usually involves balance testing,” she said, but those tests don’t work as well with athletes whose disabilities already affect their balance.

On Zika

While some golfers say they’re skipping the Olympics due to Zika virus fears, Blauwet said she hasn’t heard of anyone skipping the Paralympics for that reason. “They might wear long sleeves and bug spray, but they’re excited to be here.”

The competitor she’s most excited to see

Markus Rehm, a German amputee and long-jumper. Rehm tried to convince the Rio Olympics committee to let him compete, arguing that that his prosthetic limb doesn’t give him an advantage over able-bodied athletes. That effort failed, so Paralympic spectators will get to see him instead.

Most fun sport to watch

Wheelchair rugby. “It’s amazing. It really transcends disability in a lot of ways. The athletes, they’re out there playing this really rough sport. … These athletes don’t hold back. They’re out there to win.”

Her hope for Rio

“The legacy I want to leave is that we progress our knowledge around how to enable Paralympian athletes to continue competing in a safe and healthy way.” In addition to keeping them safe, she said, “we’re showing the world that these are real athletes that have trained their whole lives for this opportunity.”

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