Concussions in high profile athletes attract worldwide attention and potentially large court settlements, but no one takes much notice when it happens to a Para athlete, say the authors.
"For the Para athlete, the International Paralympic Committee's (IPC) term for a sportsperson with an impairment, the concussion debate struggles to garner attention," they write.
Para athletes are just as vulnerable to concussion as any able bodied sportsman/woman, and there are several competitive sports, which, due to the speed of play, impact potential, and lack of protective equipment, make them particularly vulnerable, say the authors.
These include road cycling, ice sledge hockey, and alpine downhill skiing, but also less obvious sports, such as wheelchair track racing.
At the Sochi Paralympic Games in 2014, poor snow conditions meant that 60% of alpine skiers were unable to complete the course, and 37% of sit-ski competitors sustained an injury: in one in 20 cases this was to the head and neck.
During the London 2012 Paralympic Games, football five a side for the visually impaired clocked up the highest number of injuries, with those to the head and neck accounting for a quarter of the total.
Over one season 6% of American wheelchair basketball players said they had been concussed, but nearly half didn't report it for fear of being taken out of competition -- a similar proportion to able bodied athletes -- but it shows the importance of raising awareness of the issues to ward off potentially longer term harm, say the authors.
This was again brought to the fore during the 2016 Rio Paralympic Games where team doctors reported 10 "significant" head and face injuries, yet despite the suspicious nature of these injuries, gleaned from video footage of the events, none was reported as concussion.
Yet there is no dedicated guidance on the management of concussion in Para sports, and the current concussion assessment tool (SCAT5) has not been adapted for use in Para athletes either, the authors point out.
This is particularly important for Para athletes, because elements of SCAT5 aren't suitable for competitors who are paraplegic, amputees, or those with known communication difficulties or cognitive impairments.
And while sport-specific risk factors for concussion have been identified, prompting recognition of the issues by International Federations, "there is no mandate for change," highlight the authors.
"It is time for the clinical and research community to put their heads together -- figuratively -- to help address this important but poorly understood issue," they write.
And they conclude: "For this to be successful, urgent focus on Para athletes is needed within the broader academic and public discourse on concussion. No longer a population on the sidelines, Para athletes deserve our attention, focus and resources. The time is now."
British Journal of Sports Medicine