Yves Vanlandewijck

International Paralympic Committee position stand—background and scientific principles of classification in Paralympic sport

The Classification Code of the International Paralympic Committee (IPC), inter alia, mandates the development of evidence-based systems of classification. This paper provides a scientific background for classification in Paralympic sport, defines evidence-based classification and provides guidelines for how evidence-based classification may be achieved. Classification is a process in which a single group of entities (or units) are ordered into a number of smaller groups (or classes) based on observable properties that they have in common, and taxonomy is the science of how to classify. Paralympic classification is interrelated with systems of classification used in two fields: ▶ Health and functioning. The International Classification of Functioning, Disability and Health is the most widely used classification in the field of functioning and health. To enhance communication, Paralympic systems of classification should use language and concepts that are consistent with the International Classification of Functioning, Disability and Health. ▶ Sport. Classification in sport reduces the likelihood of one-sided competition and in this way promotes participation. Two types of classification are used in sport—performance classification and selective classification. Paralympic sports require selective classification systems so that athletes who enhance their competitive performance through effective training will not be moved to a class with athletes who have less activity limitation, as they would in a performance classification system. Classification has a significant impact on which athletes are successful in Paralympic sport, but unfortunately issues relating to the weighting and aggregation of measures used in classification pose significant threats to the validity of current systems of classification. To improve the validity of Paralympic classification, the IPC Classification Code mandates the development of evidence-based systems of classification, an evidence-based system being one in which the purpose of the system is stated unambiguously; and empirical evidence indicates the methods used for assigning class will achieve the stated purpose. To date, one of the most significant barriers to the development of evidence-based systems of classification has been absence of an unambiguous statement of purpose. To remedy this, all Paralympic systems of classification should indicate that the purpose of the system is to promote participation in sport by people with disabilities by minimising the impact of eligible impairment types on the outcome of competition. Conceptually, in order to minimise the impact of impairment on the outcome of competition, each classification system should: ▶ describe eligibility criteria in terms of: ⊳ type of impairment and ⊳ severity of impairment; ▶ describe methods for classifying eligible impairments according to the extent of activity limitation they cause. To classify impairments according to the extent of activity limitation they cause requires research that develops objective, reliable measures of both impairment and activity limitation and investigates the relative strength of association between these constructs in a large, racially representative sample. The paper outlines a number of objective principles that should considered when deciding how many classes a given sport should have: the number of classes in a sport should not be driven by the number of athletes in a sport at a single time point.

Wheelchair propulsion biomechanics: implications for wheelchair sports

AbstractThe aim of this article is to provide the reader with a state-of-the-art review on biomechanics in hand rim wheelchair propulsion, with special attention to sport-specific implications. Biomechanical studies in wheelchair sports mainly aim at optimising sport performance or preventing sport injuries. The sports performance optimisation question has been approached from an ergonomic, as well as a skill proficiency perspective. Sports medical issues have been addressed in wheelchair sports mainly because of the extremely high prevalence of repetitive strain injuries such as shoulder impingement and carpal tunnel syndrome. Sports performance as well as sports medical reflections are made throughout the review.Insight in the underlying musculoskeletal mechanisms of hand rim wheelchair propulsion has been achieved through a combination of experimental data collection under realistic conditions, with a more fundamental mathematical modelling approach. Through a synchronised analysis of the movement pattern, force generation pattern and muscular activity pattern, insight has been gained in the hand rim wheelchair propulsion dynamics of people with a disability, varying in level of physical activity and functional potential. The limiting environment of a laboratory, however, has hampered the drawing of sound conclusions. Through mathematical modelling, simulation and optimisation (minimising injury and maximising performance), insight in the underlying musculoskeletal mechanisms during wheelchair propulsion is sought. The surplus value of inverse and forward dynamic simulation of hand rim stroke dynamics is addressed.Implications for hand rim wheelchair sports are discussed. Wheelchair racing, basketball and rugby were chosen because of the significance and differences in sport-specific movement dynamics. Conclusions can easily be transferred to other wheelchair sports where movement dynamics are fundamental.

A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure

Objective: To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury. Data sources: A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009). Subjects: Hand rim wheelchair users, mainly those with spinal cord injury. Review methods: Studies’ content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman. Results: Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected. Conclusion: This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.

Physical fitness profile of elite athletes with intellectual disability

The aim of this study was to investigate the physical fitness profile of high‐performance athletes with intellectual disability (ID) in comparison with able‐bodied individuals.

Influence of crank rate in hand cycling

PURPOSE The purpose of this study was to determine gross mechanical efficiency (ME) at different power output (PO) levels of synchronous hand cycling and to evaluate the influence of increasing PO by changing crank rate or resistance in wheelchair users with experience in hand cycling. METHODS Nine male participants with spinal cord injury randomly performed three maximal incremental hand cycling tests using a computer controlled cycle ergometer. Each test started at a PO level of 50 W with increments of 10 W. In the velocity protocol, PO was increased via crank rate while resistance was constant (VEL). In the resistance protocol PO was increased via resistance while crank rate was constant (RES). In the freely chosen frequency protocol, the participants could freely select their crank rate while resistance was automatically adjusted to obtain the desired PO (FCF). RESULTS Peak physiological responses were similar in all three tests, whereas PO max was lower in VEL compared with RES and FCF. Similar values for gross ME were found in both RES and FCF protocols, although systematically higher and increasing crank rates were adopted throughout FCF. Nevertheless, differences in gross ME at comparable relative (RES > VEL at 60 and 80% of PO range: 14.09 and 14.40% vs 13.02 and 13.11%, respectively) and absolute (RES, FCF > VEL at 90 W: 14.47, 14.47, and 13.43%, respectively) PO levels were demonstrated. CONCLUSION These results suggest that during synchronous hand cycling the freely chosen crank rate is not necessarily the most economical, that high crank rates result in a lower ME at a given PO and that freely chosen crank rates increase with increasing PO levels.

Are patients 1 year post-stroke active enough to improve their physical health?

Purpose: This study aimed to quantify physical activity one year post-stroke − by means of a multifaceted approach combining absolute, relative, and self-reported measures of physical activity (PA) − and to investigate their mutual associations. The determinants of PA were explored. Method: Daily PA was measured in 16 mildly disabled stroke patients (median RMA-GF score of 12 (IQR = 10–12.5)) using a heart rate monitor, a pedometer, the Baecke Physical Activity Questionnaire and the Physical Activity Scale for individuals with physical disabilities. Potential determinants were age, gender, functional mobility, peak exercise capacity, mood, participation and hours of daylight. Results: On average, stroke participants had a good baseline level of activity (44 ± 39 min/day spent moderate active, 6428 ± 4117 steps/day), but only three (19%) performed more than 10,000 steps/day, required for health benefits. Functional mobility, cardiorespiratory fitness, mood and participation were related to the total daily steps, but not to the time spent in moderate intense activities. Discrepancies between absolute (frequency and duration) and relative (intensity) measures of PA exist regarding the achieved quantity and its potential determinants. Conclusions: It is not only important to be active, but to be active enough to improve health. Health recommendation for stroke survivors to perform moderate intense PA needs to be translated into a pedometer-based step goal. Implications for Rehabilitation On average, stroke survivors had a good baseline level of physical activity (PA), but only some reached a level which could improve their physical health. Health recommendations for stroke survivors on amount of moderate intense PA should be translated into a pedometer-based step goal.

Boosting in athletes with high-level spinal cord injury: knowledge, incidence and attitudes of athletes in paralympic sport

Autonomic dysreflexia (AD) is unique to individuals with spinal injuries (SCI) at T6 or above and can be voluntarily induced. Although AD improves wheelchair racing performance in some athletes, it also elicits exaggerated blood pressure, which could be dangerous. The International Paralympic Committee considers AD doping and banned its use. Purpose. The purpose of this study is to evaluate AD knowledge, incidence and attitudes (KIA) of Paralympians with SCI. Methods. An existing questionnaire was modified to include questions of AD KIA, validated by three experts and piloted with a small sample. It was administered on-line, mailed to members of a scientific network and distributed during the Beijing Paralympic Games. Fisher Exact test was used to evaluate differences across gender, injury and education. Results. Of 99 participants, 54.5% had previously heard of AD while 39.4% were unaware; 16.7%, all males, had used AD to enhance performance. Participants reported that AD was (1) useful for middle (78.6%) and long distance (71.4%), marathon (64.3%) and wheelchair rugby (64.3%); (2) somewhat dangerous (48.9%), dangerous (21.3%) or very dangerous (25.5%) to health. Results were not influenced by age, injury level or injury duration. Conclusions. Findings indicate the need for educational programmes directed towards enhancing the AD knowledge of rehabilitation professionals, coaches and trainers working with SCI individuals.

Cardiorespiratory responses during arm ergometry, functional electrical stimulation cycling, and two hybrid exercise conditions in spinal cord injured

Purpose. The purpose of this study was to compare peak functional aerobic power (VO2 peak) across four different types of exercise: arm crank ergometry (ACE), functional electrical stimulation (FES) cycling, and two hybrid exercise conditions: FES cycling combined with ACE and FES rowing using a newly developed rowing device (ROWSTIM). Methods. Five participants (C7 – T12), four male paraplegics with neurologically complete spinal cord injury (SCI), and one male with neurologically incomplete SCI, underwent a progressive maximal peak oxygen exercise test to ascertain peak physical work capacity during arm cranking, FES cycling, FES cycling combined with arm cranking and FES rowing. Results. Metabolic variables were significantly lower for FES cycling versus ACE, FES cycling combined with ACE and FES rowing measures (P < 0.05). However there were no significant differences between ACE, FES cycling combined with ACE and FES rowing. Conclusions. Preliminary results suggest that the ROWSTIM is as effective an exercise device or training tool for persons with SCI as ACE or combined FES-cycling and ACE, and more effective than FES-cycling. A larger sample size and further technological developments of the ROWSTIM are needed to demonstrate the efficacy of rowing over other hybrid exercise modalities and ACE.

Most Essential Wheeled Mobility Skills for Daily Life: An International Survey Among Paralympic Wheelchair Athletes With Spinal Cord Injury

OBJECTIVES To create a hierarchical list of the most essential wheeled mobility (WM) skills for everyday life of wheelchair users with a spinal cord injury (SCI), and to compare perceptions of WM gained during and after clinical rehabilitation. DESIGN Cross-sectional study using survey questionnaires. SETTING The Beijing Paralympic games, at the international zone of the Olympic village and in different sports venues. PARTICIPANTS A sample of men (N=49) and women (N=30) elite manual wheelchair user athletes with SCI (paraplegia, n=64; tetraplegia, n=15). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE A survey with 24 predefined skills was distributed during the Beijing Paralympic games. Respondents were asked to rate the essentiality of each skill (1, not essential; 5, extremely essential); to state where, when, and with whom they have learned to perform each skill; and to mark the level of WM, which they gained during and after clinical rehabilitation, on 3 different WM visual analog scales (scores 1-10). RESULTS Rated as the most essential skill was transfer into and out of a car (mean ± SD, 4.7±0.7). Rated as the least essential skill was the 1-handed wheelie (mean ± SD, 1.9±1.3). Of the respondents, 57% have learned the most essential skills in clinical rehabilitation, while 40% claimed to have learned those skills afterward in a community setting. Three percent have never learned to perform the most essential skills. Of the very essential skills, 40% were self-taught. Mean score ± SD for the extent to which WM skills were gained in rehabilitation was 5.4±2.5. CONCLUSIONS The main survey outcome is a sorted list of WM skills according to their essentiality for daily life of hand-rim wheelchair users with SCI. It is recommended to incorporate the skills that were graded as very essential and extremely essential during inpatient rehabilitation and in postrehabilitation WM workshops.

Towards evidence-based classification in wheelchair sports: Impact of seating position on wheelchair acceleration

Abstract In most Paralympic wheelchair sports, active trunk range of movement is assessed by observing shoulder girdle excursion during active trunk movements and is a key determinant of an athletes class. However, to date research evaluating the impact of reduced trunk range of movement on wheelchair sports performance has not been conducted. In the present study, 15 non-disabled male participants performed two 20-s sprints on a wheelchair ergometer in each of three seating positions. Positions were typical of those used to enhance sitting stability in wheelchair sport and each impacted available trunk range of movement differently: condition-90 (seated with thighs horizontal; unrestricted range of movement) condition-45 (seated with thighs in 45°), and condition-0 (seated with hips maximally flexed; minimum range of movement). In condition-90, the trunk only actively contributed to the first push; for the remainder of the sprint, the trunk was held almost isometrically at 48.2° to the horizontal (range 42.1–56.4°). Similar patterns were observed for both condition-45 and condition-0. Compared with condition-90, participants in condition-0 had reduced capacity to accelerate of statistical (P < 0.05) and practical significance. These findings are an important initial step towards evidence-based decision making in classification. Future research should evaluate the individual and collective impact of other factors that affect the trunks contribution to wheelchair sports performance, including strapping, seating position, and impairments of trunk muscle power and coordination.