Research Looks at Health Outcomes from Playing Disability Sports

With all the intense banging, crashing and grabbing, it’s easy to see why wheelchair rugby was originally called murderball.  

The full-contact Paralympic sport isn’t for the foolhearted. It can leave athletes with concussions, crushed ribs, broken fingers and more. The Brain Injury Law Center in Hampton, Virginia solicits clients who’ve been injured playing wheelchair rugby and dedicates an entire page on its website to the sport.

“With the chairs making such forceful contact, athletes can experience whiplash,” said J.P. Barfield, FACSM, a recognized researcher in the field of disability and Para sport. “Unlike other sports, it’s not the player-to-player contact that causes injuries, it’s the jolt of the chair or falling out of the chair that’s problematic.”

Barfield, who recently interviewed wheelchair rugby athletes for his research project on Para sport concussions, serves as professor and chair of the Department of Applied Physiology, Health, and Clinical Sciences within UNC Charlotte’s College of Health and Human Services. 

Barfield’s research focuses on health-related and quality-of-life outcomes of sports for athletes with physical impairments. He’s published extensively on athletes with cerebral palsy, spinal cord injury, and muscular dystrophy and studies how acute responses to sport project to chronic functional changes. He’s a board member for the International Federation of Adapted Physical Activity, serving as treasurer, and is the Head of Classification for the Fédération Internationale de Powerchair Football Association (FIPFA), which is the international governing body for powerchair football (also known as powerchair soccer). 

Powerchair soccer is a sanctioned sport of the Paralympic Movement and is under review for inclusion in the summer Paralympic Games. 

Barfield travels the globe on behalf of FIPFA to classify athletes for competition.The purpose of FIPFA’s classification system is to minimize the impact of impairment on the outcome of competition, therefore the athletes who succeed in competition do so on the basis of their sporting ability. To achieve this, athletes are evaluated and put into sport classes according to the extent of activity limitation resulting from their impairment.

There are 10 eligible impairment types in Para sports, including limb deficiency, impaired muscle power and leg length difference.

As part of his research that integrates with his professional service, Barfield works with UNC Charlotte assistant professor Yinghao Pan, Ph.D., a biostatistician in the Department of Mathematics and Statistics, to set the grouping criteria for powerchair soccer classification, which is part of the requirements of the International Paralympic Committee.

Wheelchair athletes participate in study

In early January, Barfield hosted a two-day wheelchair rugby tournament in UNC Charlotte’s Belk Gym, which houses the educational spaces, labs, and offices for the Department of Applied Physiology, Health, and Clinical Sciences. The building also offers three multipurpose hardwood basketball and volleyball courts, two racquetball courts, badminton courts, locker rooms and a pool.

The annual Queen City Collision wheelchair rugby tournament is organized by Atrium Health’s Adaptive Sports and Adventures Program, which sponsors the Carolina Crash, Charlotte’s only wheelchair rugby team. Five teams, including Charlotte and Raleigh’s Sidewinders, participated in the 2025 tournament. The other three teams were from out of state.

Barfield hosted the tournament in 2024 and plans to host it in 2026 and beyond. Holding the tournament on campus provides a free and accessible facility for the games, and it gives Barfield direct access to research participants.

Over the course of this year’s tournament, Barfield and members of his research team surveyed more than 40 athletes for his study on the treatment of concussion in Para sport, which is a continuation of prior research where he looked at baseline concussion testing in this population. At the Queen City Classic wheelchair basketball tournament in Rock Hill, S.C last November, Barfield and his team interviewed 65 athletes for the study.  

To be able to access concussions, you need baseline scores and there are not a lot of baseline scores on athletes with disabilities. What Barfield did initially was establish baseline concussion test scores on a common instrument. “Now, we’re looking at how health care changes around concussion based on competition setting so that all players can access a good referral,” he said. “We’re looking at what level — grassroots, regional, national — do players feel they have adequate health care to assess and treat head injuries.”  

The goal of the research is to share with national and international organizations where there are gaps in health care services for athletes with disabilities who’ve been affected by concussions. “Do we need to find ways to get more athletic trainers at the grassroots level or is it for national tournaments? It’s educating organizations about how to update their health care policies and procedures,” Barfield said.

Working on the project with Barfield is Shelly Linens, Ph.D., clinical associate professor in the Department of Applied Physiology, Health, and Clinical Sciences, who serves as co-investigator. Linens, a leading ankle instability researcher, is also a certified athletic trainer with research experience in head injury and concussion. Other team members include four doctoral occupational therapy students from Emory & Henry University, Barfield’s former institution, and Samantha Webb, a UNC Charlotte undergraduate exercise science student who’s assisting with data collection and participant interviews.

Many research projects extend over a number of years so an issue can be studied in depth. Barfield’s projects aren’t like that. He studies people in real time at one-off sports events to develop a collection of information to make policy recommendations, for example. A lack of funding for this type of research limits how many scholars are tackling it. 

“It’s a small research community so there are far fewer studies in disability sport than able-body sport, but you have the same needs. Athletes want to learn how to get better. They want to learn how to be safe.” 

Adaptive sports on campus

Barfield’s advocacy for disability sports extends beyond his research and into his role as faculty member where he’s been working to offer opportunities on campus. 

“I foresee more adaptive sports activities on campus,” he said. “We’re working with University Recreation to identify programming that can be offered to students who use wheelchairs.”

Barfield’s Department of Applied Physiology, Health, and Clinical Sciences hosts wheelchair basketball practices for sanctioned teams in Belk Gym. The city of Charlotte has three sanctioned teams as well as youth developmental teams. These practices give students the opportunity to practice and work with wheelchair athletes.

“A lot of our students want to go into some type of health care field so exposure to people with physical impairments is a great training opportunity,” Barfield said. “During these practice sessions, our students get to see how wheelchair sports work, and get to learn more about spinal cord injuries, spina bifida and other types of physical impairments.”

Because Charlotte has rehab hospitals and an adaptive sports program, the city has a significant number of people with disabilities who want to be active but very few places where they can do that.

 “UNC Charlotte is accessible and has the know-how and space to offer opportunities to people in Charlotte with physical disabilities,” Barfield said. “It’s our duty and responsibility to provide services to everyone in our community. The city has a need for it and the University has a pathway to provide those opportunities.”