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Disability Sports:From Rehabilitation to Paralympics – the Evolving Nature of Classification Systems

A/Prof Jagdish MaharajDSM, DCH, MPH, MMed, FAFRM (RACP) Hon, PhD

Head of Classification, IPC Sports Technical CommitteeIPC International Classifier for Athletics and Shooting

Treasurer, Oceania Paralympic CommitteeFounding President, Fiji Paralympic Committee

•Stoke Mandeville Spinal Injury Rehabilitation

•Beginnings of Paralympic Movement

•Evolution of Classification in Paralympics•Medical Classification• Functional Classification• Sport specific Classification

•Classification research

•Future of Paralympic Classification

Overview

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Historical Profile

www.thelancet.com/neurology Published online September 7, 2016 http://dx.doi.org/10.1016/S1474-4422(16)30228-9

“a great believer in the power of sport and competitionin physical, psychological and social rehabilitation”

“a Neurologist, Spinal injury rehabilitation specialistand founding father of Paralympic Movement”

‘From Spinal Injury to the Paralympics’

AFRM e-Bulletin 23 September 2016

https://www.racp.edu.au/news-and-events/newsletters-and-communiques/afrm-e-bulletin/afrm-e-bulletin-23-september-2016

“1943 Guttmann was invited by British Government to set up spinal injuries unit at Stoke Mandeville Hospital”

1948 Wheelchair Games

On 28th July, the day of the opening of Summer London Olympics Dr Guttmann hosted sports competition for British WWII SCI veterans

1952 Dutch veterans joined in alongside the British, making it the first internationalcompetition of its kind

1960 First ‘Paralympic Games’ in Rome

• 23 countries and 400 athletes

History of Paralympic Games

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Chronology of EventsYear Event

1944Dr Ludwig Guttmann established Spinal Injuries Centre at Stoke Mandeville Hospital

1948

On 29 July, the day of the Opening Ceremony of the London 1948 Olympic Games, Dr Ludwig

Guttmann organised the first competition for 16 ex-servicemen and women wheelchair

archery, which he named the Stoke Mandeville Games

1952

Dutch ex-servicemen compete against British athletes in England and this led to the

establishment of the International Stoke Mandeville Games

1955International Committee of Sports for the Deaf (CISS) officially recognized by the IOC

1960

18 – 25 September - Rome Summer Paralympics - 400 athletes from 23 countries ; 57 events in

8 sports. These Games became known as the 1st Summer Paralympic Games and were the 9th

International Stoke Mandeville Games - followed the Rome Olympics and used same venues

1960International Stoke Mandeville Games Committee (ISMGC) established

1989 International Paralympic Committee (IPC) established

•1964 - International Sports Organization for the Disabled (ISOD)

•1982 - International Coordinating Committee of World Sports Organizations for the Disabled (ICC)

• ICC IOC cooperation 1988 Seoul Paralympics

•1989 - International Paralympic Committee (IPC)

- Global governing body of the Paralympic

Movement with Headquarters in Bonn

Forerunners of IPC

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• IWAS was formed in 2005 by a merger of the International Stoke Mandeville Wheelchair Sports Federation (ISMWSF) (which was formerly known as the International Stoke Mandeville Games Federation (ISMGF) and the International Sports Federation of the Disabled (ISOD). ISOD had been founded by the International War Veterans Association in 1964

IWAS (2005) = ISMWSF (ISMGF) (1952) + ISOD (1964)

Four International Sports Organisations for the Disabled

Medical Classification – beginning to 1980s

Consisted of –

Medical evaluation and diagnosis of impairment

As an example - low spinal cord injury and double

above knee amputee with similar activity limitation

will compete in different ‘medical’ classes

When views on disabled (patient)/athlete shifted from

a form of rehabilitation the classification system

changed from medical diagnosis to functional ability

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•Amputee

•Cerebral Palsy

•Intellectual Disability

•Wheelchair

•Visually Impaired

•Les Autres (Others)

Medical Classification- six disability groups

Classification in sports

•Paralympic Sports aims to minimise the impact of impairment on outcome of competition

•Classification groups different types and severity of impairments to allow for comparable competition

•Classification to minimise the impact characteristics such as body weight, gender & age have on outcome of competition exists in many sports

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Medical-Based Classification System

Functional Classification Systems

Evidence-Based and Sport-Specific Systems

1948 1988 1992 2003

Classification Strategy

2007 2015

Tweedy, Vanlandewijck (2011), Hart (2014), IPC (2015c), Reina (2016)

Evolution of Paralympic Games & Classification

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•Archery •Athletics • Boccia • Equestrian • Football 5-a-side • Football 7-a-side •Goalball • Judo • Para-Canoe • Para-Cycling• Para-Triathlon • Powerlifting• Rowing• Sailing

• Shooting

• Sitting Volleyball

• Swimming

• Para-Table Tennis

•Wheelchair basketball

•Wheelchair Dance

•Wheelchair Fencing

•Wheelchair Rugby

•Wheelchair Tennis

23 Summer & 5 Winter Paralympic Sports

• Alpine Skiing

• Biathlon

• Cross-Country Skiing

• Ice Sledge Hockey

• Wheelchair Curling

•Archery •Athletics • Boccia • Equestrian • Football 5-a-side • Football 7-a-side •Goalball • Judo • Para-Canoe • Para-Cycling• Para-Triathlon • Powerlifting• Rowing• Sailing

• Shooting

• Sitting Volleyball

• Swimming

• Para-Table Tennis

•Wheelchair basketball

•Wheelchair Dance

•Wheelchair Fencing

•Wheelchair Rugby

•Wheelchair Tennis

Tokyo 2020 - 22 Summer Paralympic Sports

• Badminton• Para-Taekwondo

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IPC Athlete Classification Code

•New version published in 2015

• Core document for Athlete Classification

• Sets International Standards to be adhered to by IPC, IFs,

NPCs, NFs, LOCs, athletes, coaches and officials.

•Guidelines for all classification processes for all IPC Sports

• Sets timelines for competition organisers

•Outlines responsibilities for all levels of the IPC family

Classification Code

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1. Impaired muscle power

2. Impaired passive range of movement

3. Limb deficiency

4. Leg length difference

5. Short stature

6. Hypertonia

7. Ataxia

8. Athetosis

9. Visual impairment

10. Intellectual impairment

Ten Eligible Impairments for IPC Sports

•Medical Model• Bench Testing

• Manual Muscle Testing

• Joint ROM

• Amputation

• Limb Length

• Impairment

• Vision Impaired

Classification systems process

Sport Functional

Model

Observation of

athlete in training

Looks at specific

sport functions

E.g. W/Basketball

Hybrid Bench Test

Functional sports specific observation

E.g.

Athletics, Shooting, Swimming, Wheelchair Rugby, etc.

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1. Does the athlete have an eligible impairment for this sport?

2. Does the athlete’s eligible impairment meet the minimum impairment criteria (MIC) of the sport?

3. Which sport class describes the athlete’s activity limitation most accurately?

NE, CNC, R or FRD (Review), (C) Confirmed

Three steps of Classification

• Archery – W1-2

• Athletics – T/F11-13, T/F20, T/F32-38,

T/F40-41, T/F42-47, T51-54, F51-57, T/F61-64 (new)

• Boccia – BC1-4

• Paracanoe – KL1-3

• Cycling – H1-5, T1-2, bicycle – C1-5, TB

• Equestrian – Ia, Ib, II, III, IV

• Football 5-a-side – B1

• Football 7-a-side – FT5-8

• Goalball – B1-3

• Judo – B1-3

• Sailing – Sport class 1-7

• Shooting – SH1, SH2, SG-U, SG-L, SG-S, (SHVI)

Paralympic Summer Sports Classes

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Scientific background

10.2 Classification Research

10.2.1 International Sport Federations must develop sports-specific Classification Systems through multidisciplinary scientific research. Such research must be evidence-based and focus on the relationship between Impairment and key performance determinants. Athlete input must be solicited to assist in research and improvement in Classification Systems.

10.2.2 Classification research must comply with internationally recognised ethical standards and research practices.

Evidence-based Classification

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In January 2013 the IPC Governing Board approved the

concept of Classification Research & Development Centres,

which aims ”to develop methods of evidence-based

classification systems through a strategic long-term research

and development program that will guide the sport-specific

classification procedures for sports on the Paralympic Games

programme, and to develop assessment tools and methods”

IPC Classification Research

IPC signed agreements with three universities that became

official IPC Classification Research & Development Centres

University of Queensland (Brisbane, Australia)

Catholic University of Leuven (Belgium)

Free University of Amsterdam (Netherlands)

IPC Classification Research Centres

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Classification Research

Evidence Based Classification

Current research at University of Queensland

Standardized objective measurements

London to Rio to Tokyo

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•Current Classes SH1 & SH2

•Participate in Pistol & Rifle events

Classifications under development • Clay Target Para Trap introduced 2017

Classes SG-U, SG-L, SG-S for review in 2 years

• Visual Impaired Shooting Classification – coming soon

IPC Para Shooting Sport

Assessment of a “Classification Model”

for Athletes with motor impairment competing in

Clay Target Shooting (CTS)

Project Index & Outcome:

1. Background of Para CTS

2. Literature review of physiology and biomechanics of shooting sports

3. 3D Kinematics analysis of 5 able-bodied

4. Motor impairment score and performance score

5. Proposal of classification model

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VI Shooting Classification Research

Medical-Based Classification System

Functional Classification Systems

Evidence-Based and Sport-Specific Systems

1948 1988 1992 2003

Classification Strategy

2007 2015

Evolution of Paralympic Games & Classification

2018

Future of Classification

IF & NPC meeting July 2018

IPC Membership Gathering & IPC Governing Board

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Rapid pace of development in technology, training methods and medical advances

• Harmonisation of Classification• Classifier education• Code interpretation & compliance• Resources

• Optimization of athlete evaluation• Bring classification to athletes

• How, where, when and by whom• Creating the right environment

• Accessible to general public

Future of Classification

Must be -

sport specific evidence-based

Must have -

objective measurement methods

Should it be conducted during competition as now?

or

Should it be ‘laboratory’ based out of competition?

Within Universities / institutions?

Thank you