Neuromuscular and Balance Performance Across the Fundamental Preparation Period in Elite Athletes with Lower Limb Deficiencies: A Retrospective Case Series

Optimizing neuromuscular strength and balance is essential for performance and injury prevention in elite Paralympic sport. However, limited evidence describes how these parameters change over time during specific phases of the training season in athletes with lower limb deficiencies. This retrospective case series aimed to describe longitudinal changes in neuromuscular and balance performance during the fundamental prepara- tion period in elite athletes using prosthetic devices. Routinely collected performance data from five international-level Paralympic athletes (Para-swimming and Para-athletics) were retrospectively analyzed across two preparatory observation windows conducted in consecutive competitive seasons. Neuromuscular performance was assessed using countermovement jump variables, while static balance was evaluated through Inertial Measurement Unit-derived sway metrics. Within-athlete changes were examined using descriptive and exploratory analyses. At the group level, changes were observed in selected neuromuscular and balance outcomes over time, including jump height and path length. Individual analyses revealed substantial inter-athlete variability in the magnitude and direction of changes across all outcomes. Overall, the findings indicate that neuromuscular and postural performance may fluctuate meaningfully during preparatory phases in elite athletes with lower limb deficiencies. This study provides exploratory insights derived from real-world training settings and highlights the value of longitudinal monitoring to support individualized performance management in Paralympic sport.