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

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Disability Sports: From Rehabilitation to Paralympics the Evolving Nature of Classification Systems A/Prof Jagdish Maharaj DSM, DCH, MPH, MMed, FAFRM (RACP)

Committee Founding President, Fiji Paralympic Committee Overview Stoke Mandeville Spinal Injury Rehabilitation Beginnings of Paralympic Movement Evolution of

1 Disability Sports: From Rehabilitation to Paralympics the Evolving Nature of Classification Systems A/Prof Jagdish Maharaj DSM, DCH, MPH, MMed, FAFRM (RACP) Hon, PhD Head of Classification, IPC Sports Technical Committee IPC International Classifier for Athletics and Shooting Treasurer, Oceania Paralympic Committee Founding President, Fiji Paralympic Committee Overview 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 1

Hospital a great believer in the power of sport and competition in physical, psychological and

Paralympic Movement www.thelancet.com/neurology Published online September 7, 2016 http://dx.doi.

1016/s1474-4422(16)30228-9 History of Paralympic Games 1948 Wheelchair Games On 28 th July, the day

2 Historical Profile AFRM e-bulletin 23 September 2016 From Spinal Injury to the Paralympics Guttmann was invited by British Government to set up spinal injuries unit at Stoke Mandeville Hospital a great believer in the power of sport and competition in physical, psychological and social rehabilitation a Neurologist, Spinal injury rehabilitation specialist and founding father of Paralympic Movement Published online September 7, History of Paralympic Games 1948 Wheelchair Games On 28 th 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 international competition of its kind 1960 First Paralympic Games in Rome 23 countries and 400 athletes 2

Chronology of Events Year Event Dr Ludwig Guttmann established Spinal Injuries Centre at Stoke Mandeville Hospital 1944 1948 On 29 July, the day of the Opening Ceremony of the London 1948 Olympic

athletes in England and this led to the establishment of the International Stoke Mandeville Games International Committee of Sports for the Deaf (CISS) officially recognized by the IOC 1955 1960 18

3 Chronology of Events Year Event Dr Ludwig Guttmann established Spinal Injuries Centre at Stoke Mandeville Hospital 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 International Committee of Sports for the Deaf (CISS) officially recognized by the IOC September - Rome Summer Paralympics 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 International Stoke Mandeville Games Committee (ISMGC) established International Paralympic Committee (IPC) established Forerunners of IPC International Sports Organization for the Disabled (ISOD) International Coordinating Committee of World Sports Organizations for the Disabled (ICC) ICC IOC cooperation 1988 Seoul Paralympics International Paralympic Committee (IPC) - Global governing body of the Paralympic Movement with Headquarters in Bonn 3

Four International Sports Organisations for the Disabled IWAS (2005) = ISMWSF (ISMGF) (1952) + ISOD (1964) IWAS was formed in 2005 by a merger

Games Federation (ISMGF) and the International Sports Federation of the Disabled (ISOD).

evaluation and diagnosis of impairment As an example - low spinal cord injury and double above knee amputee with similar activity limitation

4 Four International Sports Organisations for the Disabled IWAS (2005) = ISMWSF (ISMGF) (1952) + ISOD (1964) 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 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 4

Medical Classification - six disability groups Amputee

Impaired Les Autres (Others) Classification in sports

body weight, gender & age have on outcome of competition

impact of impairment on outcome of competition Classification

5 Medical Classification - six disability groups Amputee Cerebral Palsy Intellectual Disability Wheelchair Visually Impaired Les Autres (Others) Classification in sports Classification to minimise the impact characteristics such as body weight, gender & age have on outcome of competition exists in many 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 5

6 Evolution of Paralympic Games & Classification Classification Strategy Medical-Based Classification System Functional Classification Systems Evidence-Based and Sport-Specific Systems Tweedy, Vanlandewijck (2011), Hart (2014), IPC (2015c), Reina (2016) 6

23 Summer & 5 Winter Paralympic Sports Archery Athletics Boccia Equestrian Football 5-a-side Football 7-a-side Goalball Judo Para-Canoe Para-Cycling Para-Triathlon Powerlifting Rowing Sailing

Sledge Hockey Wheelchair Curling Tokyo 2020-22 Summer Paralympic Sports Archery Athletics Boccia Equestrian Football 5-a-side Football 7-a-side Goalball Judo Para-Canoe Para-Cycling Para-Triathlon

7 23 Summer & 5 Winter Paralympic Sports 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 Alpine Skiing Biathlon Cross-Country Skiing Ice Sledge Hockey Wheelchair Curling Tokyo Summer Paralympic Sports 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 Badminton Para-Taekwondo 7

IPC Athlete Classification Code Classification Code New version

International Standards to be adhered to by IPC, IFs, NPCs, NFs,

Guidelines for all classification processes for all IPC Sports

8 IPC Athlete Classification Code 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 8

Ten Eligible Impairments for IPC Sports 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.

9 Ten Eligible Impairments for IPC Sports 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 Classification systems process Medical Model Bench Testing Manual Muscle Testing Joint ROM Amputation Limb Length Impairment Vision Impaired 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. 9

10 Three steps of Classification 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 Paralympic Summer Sports Classes 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) 10

1 International Sport Federations must develop sports-specific Classification Systems through multidisciplinary scientific research.

11 Scientific background Evidence-based Classification 10.2 Classification Research 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 Classification research must comply with internationally recognised ethical standards and research practices. 11

IPC Classification Research In January 2013 the IPC Governing Board approved the concept

evidence-based classification systems through a strategic long-term research and

sports on the Paralympic Games programme, and to develop assessment tools and methods

became official IPC Classification Research & Development Centres University of

12 IPC Classification Research 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 Centres 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) 12

13 Classification Research Evidence Based Classification Current research at University of Queensland Standardized objective measurements London to Rio to Tokyo 13

14 IPC Para Shooting Sport 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 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 14

Classification Classification Strategy 1948

15 VI Shooting Classification Research Evolution of Paralympic Games & Classification Classification Strategy Medical-Based Classification System Functional Classification Systems Evidence-Based and Sport-Specific Systems 2018 Future of Classification IF & NPC meeting July 2018 IPC Membership Gathering & IPC Governing Board 15

Future of Classification Rapid pace of development in technology, training methods and medical advances Harmonisation of Classification Classifier

whom Creating the right environment Accessible to general public Must be - sport specific evidence-based Must have - objective measurement methods

16 Future of Classification 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 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 16

In November 2016 the International Paralympic Committee (IPC) began the role out of a rebrand of Para sport terminology across all sports.

1 Terminology Guide Introduction In November 2016 the International Paralympic Committee (IPC) began the role out of a rebrand of Para sport terminology across all sports. Paralympics New Zealand (PNZ)