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UNDERSTANDING CLASSIFICATION

In order to match abilities across a spectrum of disability, each athlete competes in their chosen sport in a class determined by a rigorous classification system. There are many categories in Paralympic sports and, although progress has been made, it remains a confusing mix of disability categories and functional assessments to try to ensure that competitors can, as far as possible, compete on a level playing field. The best way to compare the

process is to consider weight-category sports such as boxing, which ensures that bantam weights are not pitted against super-heavyweights. But what happens when faced with multiple disabilities across a wide range of sports? Historically, the major disability

groupings (Table 3) arose from historical organisations that encouraged sport within a certain disability category, such as spinal injury or cerebral palsy. These organisations still exist and are reflected in the basic categories making up the Paralympic family of sports. Wheelchair athletes may include

people with spinal injuries, polio, high-level lower-limb amputations, cerebral palsy and other conditions that prevent ambulant participation. These classifications may ultimately evolve into a more functional or more specific descriptor of disability over the coming years. Further assessment of the athlete

takes place to look at a disability-based classification, eg. level of spinal injury or amputation and functional aspects in relation to the ability to participate in the sport. There is generally an assessment of functional sports- specific ability before full classification. Some systems, such as seen in athletics, chose a fairly disability “diagnosis”-weighted system, such as below-knee amputation or above- knee amputation, whereas disability swimming uses a more functional classification and judges how function is impaired by the disability (2). All of this contributes to a complex

but ultimately reasonably fair system, considering the constraints that are imposed on any system (Table 4). Athletes can be “Newly” (N)

classified, where they do not have an 14

TABLE 2: PARALYMPIC WINTER SPORTS

Cross-country (Nordic) skiing Downhill (Alpine) skiing Sledge hockey Wheelchair curling

TABLE 3: MAJOR DISABILITY GROUPINGS IN SPORT

Wheelchair athletes Athletes with cerebral palsy Visually impaired athletes Amputee athletes Les Autres

Athletes with intellectual impairment (currently non- Paralympic)

Deaf athletes (non-Paralympic)

TABLE 4: ISSUES TO CONSIDER WHEN DESIGNING A CLASSIFICATION SYSTEM

In designing a system, there needs to be an engagement of the general public. Without this engagement, the sport will not thrive

The classification groups should not be too broad so that the less physically able athletes within the group always struggle despite the best training and conditioning. Equally, classification should not be too narrow a class so that there are too few competitors and a logistically difficult competition to schedule

Where possible, the classification should rely on the functional ability rather than classifying by a disability label such as spinal injury or cerebral palsy. Measurements should, however, be on constants, eg. denervation to muscle group or absence of a limb, and the consequence of this disability related to the ability to perform in a specific sport. These factors should be constant and independent of any training intensity

The classification system should allow a seamless transfer from grass roots to elite sport

Consideration needs to be given to the equipment such as wheelchair or prosthesis, in order to ensure that no unfair advantage is built in. As technology advances, this becomes increasingly important

internationally recognised classification; “Review” (R) classified, where some doubt exists or the condition may change over time; or “Confirmed” (C) classified, a more robust classification allowing more certainty over the class in which the athlete competes (2).

WHAT SHOULD WE EXPECT WHEN TREATING DISABLED ATHLETES? The great worry among therapists and doctors is that injuries and illness will be very high or unduly complex in disabled athletes. In fact, injury rates are broadly comparable to those in able-bodied counterparts, at 9.1/1000 athletes (3).

Patterns of injury vary a little with the different sports, with more upper-limb injuries in people who use wheelchairs and an increase in lower- limb trauma in visually impaired athletes living and competing in unfamiliar surroundings (4). There does, however, need to be a realisation of how the injury affects the athlete as a whole. Thus, an athlete with spinal injury in a wheelchair who develops a shoulder injury may lose the ability to get out of bed or to get around in his or her wheelchair, thus becoming much more dependent than one might expect from a seemingly simple injury. Likewise, a small abrasion or ulcer at the site of a prosthetic leg may prevent an athlete from wearing the prosthesis and so limit mobility. Sometimes, treating an aspect of disability successfully can have significant consequences. Improving the range of movement and reduction in spasticity in an athlete with cerebral palsy may reduce balance or in certain circumstances even change the athlete’s classification category, making it much more difficult for him or her to compete in the new category.

THAN CLASSIFYING BY A DISABILITY LABEL. MEASUREMENTS SHOULD BE ON CONSTANTS AND THE CONSEQUENCE OF THIS DISABILITY RELATED TO THE ABILITY TO PERFORM IN A SPECIFIC SPORT. THESE FACTORS SHOULD BE CONSTANT AND INDEPENDENT OF ANY TRAINING INTENSITY

sportEX medicine 2009;42(Oct):13-19

WHERE POSSIBLE, CLASSIFICATION SHOULD RELY ON THE FUNCTIONAL ABILITY RATHER

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