2021 will be looked back on as the year that the COVID19-delayed sporting events from the previous year came back to life across the (northern hemisphere) summer. As part of the Tokyo Paralympic games, there was a first for football with the Blind Football (“Football 5-a-side”) tournament at the Paralympics, the first international football competition to be held with Temporary Concussion Substitutes.

Whilst there has been considerable discussion regarding the introduction of Temporary Concussion Substitutes in mainstream football1, the “IBSA Blind and Partially Sighted Football Temporary Concussion Substitution Policy” came into effect in May 2021 during the build-up to the Paralympic Games2. This Temporary Concussion Substitution (TCS) policy was adapted from a similar approach pioneered in Cerebral Palsy football3 and ensures that in the event of a head injury, a substitute can enter the field of play- regardless of how many substitutions a team has left.

The thought process behind the introduction of this rule change was simple. Blind Football has one of the highest injury rates in all Paralympic Sports4 with many of the injuries sustained being head injuries. Given the nature of the sport (i.e. all players being registered blind), the likelihood of contact with other players is high, and thus attempts need to be made to best manage these head injuries when they do arise.

As part of the build-up to the Paralympics, we held a webinar with all of the medical staff who were due to attend the Tokyo Paralympic Games with their respective Blind Football squads. This webinar outlined the TCS policy to all in attendance and gave all medical staff the chance to discuss the policy and ask any questions they had regarding this. The beginning of the tournament has seen the TCS policy implemented on the first day of the tournament, and more detailed analysis on the policy is planned, including qualitative studies to understand more about any barriers/challenges to the policy (from the perspective of players, medical staff, and referees).

The introduction of the TCS Policy is aligned with recent efforts to understand more about concussions in Para Sport. This year saw the publication of the 1st Position Statement on Concussion in Para Sport5 which resulted from world expects in Para sport and concussion coming together to discuss the unique challenges of managing concussion in Para athletes. This Position Statement will be highlighted to the medical staff at the Paralympic Games during the Educational Symposium held in Toyko to help disseminate the information to the key stakeholders (namely clinicians working in Para Sport). The Concussion in Para Sport group who came together to write this Position Statement hope to build on the existing knowledge base in this area in coming years- watch this space!

Dr Osman Ahmed

Dr Richard Weiler




Richard Weiler


  4. Derman W, Runciman P, Schwellnus M, et a. High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. British Journal of Sports Medicine. 2018 Jan;52(1):24-31.
  5. Weiler R, Blauwet C, Clarke D, et al. Concussion in para-sport: the first position statement of the Concussion in Para Sport (CIPS) Group. British Journal of Sports Medicine, Published Online First: 09 April 2021. doi: 10.1136/bjsports-
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