Athletes with disabilities differ significantly in the degree of their disabilities that may range from mild to severe. Each doping control officer (DCO) should understand the special needs of athletes with disabilities during a sample collection session and make any modification to the notification or sample collection procedures. Any of such modification must not compromise the integrity, security or identity of the samples, and any modification should be authorized by the athlete and/or athlete representative.

 The Sample Collection Authority (SCA) has the responsibility in ensuring that the DCOs have sufficient information and sample collection equipment necessary to conduct a sample collection session with an athlete with disability.

We can divide all the modifications in two categories:

1. General Requirements and Modifications and
2. Modifications based on Disability Categories.

Regarding the general modifications, it concerns all categories of the athletes with disabilities. All aspects of notification and sample collection for athletes with disabilities shall be carried out in accordance with the standard notification and sample collection procedures unless modifications are necessary due to the athlete’s disability. Athletes with disabilities should be treated like able-bodied athletes. Assistance may be rendered when requested, but DCO should not feel obligated to act as cares for the athletes. Athletes are strongly encouraged to have an athlete representative with them.

If the DCO is unsure of the athlete’s disability, he can ask a consultation and confirmation from a classification team, so that the sample collection session could be managed appropriately. The witnessing procedure, processing procedures, and modifications made will be explained detailed to the athletes and their representatives. All modifications must be documented on the Doping Control Form, or on a Supplementary Report form.

If the athlete is unable to write, handle the Sample Collection Vessel, carry the sample, pour the sample into A and B bottles, or seal the A and B bottles, the athlete representative may perform these tasks on behalf of the athlete with his/her permission. If the athlete does not have a representative at the sample collection session, the DCO or the chaperone may perform these tasks on behalf of the athlete with the athlete’s permission. In all cases requiring assistance, the athlete representative, DCO or chaperone shall wear protective gloves while handling the sample, exercising caution not to allow the gloves come into direct contact with the sample or interior of the sample collection vessel.

Alternative sample collection equipment (such as bigger sample collection vessel) or facility can be used as required to enable the athlete to provide the sample.

Modifications to the urine sample collection procedure will be required for athletes who have: restricted mobility or coordination that prevents application of the standard sample collection procedure; visual impairment; neurological or developmental disabilities; or a catheter or condom device to allow urine production. The athlete may authorize his/her athlete representative to accompany him/her into the toilet area to observe the DCO when providing his/her sample. The athlete representative may not view the passing of the athlete’s sample unless authorized to do so by the athlete. In all cases, however, the DCO must directly observe the passing of the sample.
                When collecting blood samples from athletes, the BCO, in consultation with the athlete, shall choose the most appropriate site for venipuncture, especially if the athlete is an amputee or multiple- amputee. The athlete with one arm amputated may need help to sign the Doping Control Form, and also during the sample provision an sealing. They may have a representative present at all times.

When involving athletes in wheelchairs, quadriplegics (or tetraplegic) may require assistance to sign the notification form and will require a representative at the doping control session. Athlete unable to walk may require the use of catheter. However, some athletes may be able to provide samples normally and do not require the use of catheter.

When speaking to athletes with hearing impairment, the DCO should face the athlete and speak in a slow and clear manner so that the latter can lip-read. If necessary, a third party should be notified to relay the message in sign language.

Selecting an athlete with an intellectual disability must take care about the notification process that should take place in the presence of their representatives. There should be a representative representing the athlete throughout the procedure and fill up the Doping Control Form Boxes: Athlete’s representative and Athlete’s signature. The DCO should speak simply and clearly to the athlete so that they can understand the procedure involved in providing a sample. Athletes with cerebral palsy (CP) or an acquired brain injury do not have an intellectual disability may range from being totally independent to totally dependent on assistance from their carer. Although athletes with CP may appear to have severe physical disabilities, including the absence of coherent speech, the DCO/Chaperone should not underestimate the intelligence of the athletes as the brain is usually unaffected by this condition. If there is difficulty communicating with these athletes, DCOs should ask the carers to interpret as they should be able to interpret what their athletes are saying.

An athlete with a visual impairment should be accompanied at all times during the sample collection session by an athlete representative, preferably of the athlete’s choice. When addressing a visually-impaired, the DCO should speak to the athlete directly and not to his/her representative. The athlete should be asked if he requires any assistance with the test, especially to sign the notification form. If assistance is required, the DCO or the athlete representative may need to place the pen in his/her hand and guide his/her hand to the correct place on the form. The DCO/Chaperone may not need to guide the athlete to the Doping Control Station as not all visually-impaired athletes are totally blind. If necessary, the representative may have to be present in the sample collection area and witness the provision of the sample, with previous permission by the athlete. The athlete should be given the opportunity to inspect all selected equipment and verify certain aspects of the procedure that require visual confirmation (e.g. matching of sample code on bottle A and B to that on the box of Sample Collection Kit). The DCO and/or athlete representative should read key statements from Doping Control Form to the athlete so that he/she fully understands the requirements of the sample collection session.

Les autres is French for `the others`. It is a term used to describe athletes with range of conditions which result in locomotive disorders – such as dwarfism, multiple sclerosis and congenital deformities of the limbs – that do not fit into the traditional classification systems of the disability groups. DCOs must use their discretion and make modifications as required in accordance with the condition of the athletes.

Athletes who are using urine collection drainage systems should choose one of the following means to provide their sample:

1. If indwelling catheter or condom drainage is used, the athlete should ideally replace it with a new and unused catheter or drainage system. The urine collected in this new bag will be drained into the sample collection vessel as the sample to be processed;
2. If replacing/disconnecting the bag already in use is difficult due to the type of catheter used, the existing bag must be fully emptied to allow fresh urine to be collected. The elimination must be done under the DCO/Chaperone’s direct observation. The fresh urine collected in the bag will be drained into sample collection vessel to be processed;
3. The sample may also be taken directly from the catheter into the collection vessel. The athlete or representative, under the athlete’s instruction, may temporarily clamp off the catheter to the leg bag.

The athlete must be advised to use a clean sterile catheter if possible. It is their responsibility if they choose to reuse a non-sterile catheter and to ensure the cleanliness of the system. If the catheter is being reused, the DCO must visually inspect to ensure it contains negligible urine, and record the details in the Doping Control Form’s Comments section. If the athlete has used any product to sterilize his/her leg bag, it should be declared in the “Medical declaration” section on the Doping Control Form. The DCO should also advise the athlete that such product used is not likely to affect the analytical results of the sample.

Use of catheters and leg bags during ample collection must be documented in the Doping Control Form’s Comments section.

Of course, these rules are not exhaustive, just general guidelines and at the moment we see a lot of new categories of disabilities classifications that appear and need to be analyzed and provided with a full package of specifically developed modifications.

Mihail Grumeza