International Paralympic Committee (IPC) and International Blind Sports Federation (IBSA) Joint Position Stand on the Sport-Specific Classification of Athletes with Vision Impairment

Periodic health evaluation in Para athletes: a position statement based on expert consensus

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes' health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete's performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement's purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE's effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete's needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete's health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

Investigating the relationship between impairment and performance in goalball: A level playing field?

Currently, all eligible goalball players compete together irrespective of their level of vision impairment, yet it remains unclear whether those with more impairment are disadvantaged during competition. Following the International Paralympic Committee's requirement for evidence-based, sport-specific classification, this study assessed whether individual goalball performance relates to the level of visual impairment. Using results from the 2016 and 2020 Paralympic Games, players' sport classes and in-competition key performance statistics (minutes played, throws per minute, goals per minute, penalties conceded per minute, blocks per minute, and goals per throw) were extracted. Players' visual acuity and visual field results were obtained through the IBSA Sport Administration System. Results showed no statistically significant differences in performance between classes. Further, there were no significant relationships between vision and performance for all six variables for female players. A small but significant positive correlation was found between visual acuity and the number of penalties conceded for male players. Collectively, the results suggest that currently eligible players compete fairly against one another during competitive goalball matches. Results provide support for the existing system of classification whereby all eligible athletes compete against each other irrespective of their level of impairment.

Athletes' Perspectives of the Classification System in Para Alpine Skiing for Those With Visual Impairment

This study explored the classification experiences and views of Para Alpine skiers with visual impairment. Data from 11  interviews were analyzed using reflexive thematic analysis to generate three themes: Suitability-The skiers questioned the suitability of the visual measurements, testing environment, and the information they received regarding classification; Exclusivity-Skiers felt certain aspects of the system remain exclusive due to the restrictions of sport classes and lack of the athlete voice; and (Dis)trust-Skiers felt distrust in those implementing the system and in other athletes due to intentional misrepresentation. Speculation surrounding this resulted in the skiers' feeling doubt in their own classification. While there is not a "one size fits all" approach to classification, understanding skiers' experiences can be a vital first step and will help to guide future research into the evolution of this sport's classification.

Profile of Athletes With a Vision Impairment: Exploring Demographics and Ocular Pathologies of Athletes in Three Paralympic Sports

OBJECTIVE

This study aimed to explore the profile of athletes with a vision impairment who compete in three Paralympic sports (goalball, vision impairment judo, and blind football).

DESIGN

Descriptive and association analyses of the vision impairment athletes' profile were conducted.

RESULTS

The typical athlete profile was a male (65.1%), aged 26-34 yrs (39.7%), from Europe (38.8%), representing a country with a high income (46.1%), and was diagnosed with a retinal-related ocular pathology (38.9%). In all three sports, the ages of the athletes were similar. In goalball, most athletes were from Europe, represented countries with a high income, and were diagnosed with retinal-, globe-, or neurological-related pathologies. In vision impairment judo, the majority of athletes were from Asia, represented countries with an upper middle income, and were diagnosed with retinal-, global-, or neurological-related pathologies. In blind football, most athletes were from Europe, represented countries with an upper middle income, and were diagnosed with retinal-, neurological-related ocular pathologies, or glaucoma.

CONCLUSIONS

The homogeneity of the athletes' profile suggests that an effort is needed to target other parts of the vision impairment population to take part in vision impairment sports. Differences in the athletes' profiles across the sports provide information that may be useful for sport-specific talent identification.

Impact of Running With and Without a Guide on Short Distance Running Performance for Athletes With a Vision Impairment

OBJECTIVE

This study aimed to investigate the difference of running with or without a guide on running performance (100, 200, and 400 m) for athletes with a vision impairment.

DESIGN

Data including athletes' and guides' sex, age, and race times were extracted from 11 elite competitions.

RESULTS

Male athletes predominantly ran without a guide (100 m = 91.4%, 200 m = 88.1%, 400 m = 84.8%), whereas female athletes mainly ran with a guide (100 m = 60.5%, 200 m = 80.0%, 400 m = 72.0%). No significant difference in 100-m race times was found between male athletes with or without a guide ( P = 0.647). For the 200 m ( P = 0.001) and 400 m ( P = 0.030), race times were significantly slower for male athletes running with a guide (mean rank 200 m = 36.80, 400 m = 33.57) compared to without a guide (mean rank 200 m = 19.43, 400 m = 21.69). Conversely, 100- ( P = 0.015), 200- ( P = 0.025), and 400-m ( P = 0.029) race times were significantly faster for female athletes with (mean rank 100 m = 18.25, 200 m = 13.71, 400 m = 11.00) compared with without a guide (mean rank 100 m = 27.74, 200 m = 22.67, 400 m = 21.69).

CONCLUSIONS

Running with a guide affects vision impairment athletes' race times. The influence of running with a guide, and the gender mix of vision impairment athlete and guide, should be considered in any research with the aim of establishing a new classification system for vision impairment athletes.

The effects of simulated vision impairment on performance in football

Footballers with vision impairment (VI) are eligible to compete in the Para sport if they meet a minimum impairment criteria (MIC) based on measures of their visual acuity (VA) and/or visual field. Despite the requirements of the International Paralympic Committee Athlete Classification Code that each sport uses an evidence-based classification system, VI football continues to use a medical-based system that lacks evidence to demonstrate the relationship between impairment and performance in the sport. The aim of this study was to systematically simulate vision loss to establish the minimum level of impairment that would affect performance in futsal. Nineteen skilled sighted players completed tests of individual technical skill and anticipation performance under six levels of simulated blur that decreased both VA and contrast sensitivity (CS). VA needed to be reduced to a level of acuity that represents worse vision than that currently used for inclusion in VI football before meaningful decreases in performance were observed. CS did not have a clear effect on football performance. These findings produce the first evidence for the minimum impairment criteria in VI football and suggest a more severe degree of impairment may be required for the MIC.

Reactive Agility and Pitching Performance Improvement in Visually Impaired Competitive Italian Baseball Players: An Innovative Training and Evaluation Proposal

Visual input significantly affects kinesthesis skills and, hence, visually impaired individuals show less developed sensorimotor control, especially in an unfamiliar outdoor environment. Regular blind baseball practice can counteract such a deficit but, given the complex kinetic chain model required, a targeted workout proposal is needed to improve the main athletic gesture performance. On these premises, we investigated, for the first time, the running and pitching performance of a competitive Italian blind baseball team through quantitative tools and parameters such as Libra Easytech sensorized proprioceptive board, goniometric active range of motion, chronometric speed, and pitching linear length. Moreover, the perceived physical exertion was assessed by the Borg CR10 scale. Consequently, an adapted athletic training protocol was designed and tested on the field during the competitive season, with the aim to strengthen sport specific-gesture coordination and efficacy as well as to prevent injuries. Quantitative assessments showed an improvement in ankle stability index, bilateral upper limb and hip mobility, reactive agility, running braking phase control during second base approaching, and auditory target-related pitching accuracy along with a decrease in perceived physical exertion. This protocol might therefore represent an effective and easily reproducible training and evaluation approach to tailor management of visually impaired baseball players, and safely improve their athletic performance under the supervision of an adapted exercise specialist.

Paratriathlon Race Performance in High-Level Athletes With Visual Impairments: A Retrospective Analysis

OBJECTIVE

The aim of this study was to compare time-trial performances in elite paratriathlon athletes, according to visual classes, sex, and medal distribution.

DESIGN

The data were acquired from official books on Para Triathlon World Cups (2018-2020). The sample included 150 athletes with visual impairment, in classes: PTVI1, PTVI2, and PTVI3. One-way analysis of variance, the Student t test, and χ 2 were used to compare the performance variables and association between visual impairment classes and distribution of medals within different visual impairment classes.

RESULTS

Sex comparisons demonstrated better performance for male athletes compared with female athletes ( P < 0.05). In the sex-specific analysis, only cycling velocity was higher for female, being lower for PTVI1 compared with PTVI3 ( P = 0.012). In visual impairment class results, the first transition time was higher for PTVI1 compared with PTVI2 ( P = 0.050) and PTVI3 ( P = 0.027) and, in the second transition, higher for PTVI1 compared with PTVI2 ( P = 0.001). The χ 2 test showed a higher percentage of gold medals for PTVI3 athletes considering the whole group ( P = 0.050).

CONCLUSIONS

These results indicate that male athletes have better performance than female athletes. PTVI1 female athletes showed lower cycling velocity compared with PTVI3. Considering both male and female groups, blind athletes presented higher transition times and a lower percentage of medals.

Expert Views on Evidence-Based Classification for Goalball: A Delphi Study

Para sport classification aims to minimize the impact of impairments on the outcome of competition. The International Paralympic Committee requires classification systems to be evidence based and sport specific, yet the sport of goalball uses a structure that is not supported by evidence demonstrating its legitimacy for competition. This study aimed to establish expert opinions on how a sport-specific system of classification should be structured in the sport of goalball. Using a three-round Delphi survey, 30 international experts expressed their views across topics linked to goalball classification. Participants were divided as to whether the current system fulfills the aim to minimize the impact of impairment on competition. Most felt that less impairment should be required to compete but that the one-class structure should remain. Experts identified measures of visual function that should be considered and 15 core components of individual goalball performance. Findings constitute a crucial first step toward evidence-based classification in goalball.

It's classified: Classification, disability rights and Commonwealth Games

Sport events are often held up as opportunities to showcase excellence and further access to sport participation. The ethos of accessibility has come to the forefront of many events, but none more so than the Commonwealth Games (CG). CG uses the ethos of inclusivity to bring the Commonwealth (CW) community together and utilizes sport to celebrate, uphold and drive its vision and values: Humanity, Destiny, Equality. However there remain significant gaps in participation opportunities and the realization of equality through CG, particularly for lower resource CW nations. CG is also the only global multisport event that integrates athletes with disabilities (para sport athletes), and yet there persist significant constraints to the creation of equitable opportunities for full participation for many para sport athletes. Shalala wrote "How can you effectively achieve integration (during CG), while ensuring the gulf between the best and the rest doesn't become a seismic divide?" We echo Shalala's concerns. Through this review we intend to examine sport classification as exemplary of the opportunities and hindrances for CG to actualize their values of "equality, humanity and destiny" for para sport and athletes, specifically from developing CW nations, and guard against the growing chasm "between the best and the rest". Of significance, we consider, through a human rights lens and the concept of structural violence, the impact of sport classification on the integration of para sport and athletes at CGs, and the future of Commonwealth-wide participation and the integrated model itself.

Classification in Para skiing: do better performing skiers have better visual functions?

Introduction

Currently, Paralympic skiers with vision impairment are allocated to classes based only on their better eye static visual acuity and visual field diameter. These studies were conducted to investigate whether a broad range of visual functions were different among groups of skiers with different levels of skiing performance.

Methods

Static and dynamic visual acuities, contrast sensitivity, light and glare sensitivity, glare recovery, motion perception, and visual field were assessed binocularly in elite Para nordic (n = 26) and Para alpine skiers (n = 15) at 3 international Paralympic events. Skiing performances were calculated using modified skiing points systems based on skiers' raw race times. Clusters of skiers with similar performances were identified in each sport, and their vision and non-vision variables were compared.

Results

Skiers in the best performing Para nordic clusters (1 and 2) had better static visual acuities (p = 0.041) and larger visual fields (p = 0.004) compared to cluster 3. In Para alpine slalom (p = 0.019), giant slalom (p = 0.019), and Super-G (p = 0.039) the average static visual acuities among the better performing clusters were significantly better compared to the worst performing cluster. In slalom, the cluster with better performance also had a significantly larger visual field (p = 0.038). In downhill, the better performance cluster demonstrated better dynamic visual acuity (p = 0.029).

Discussion

Clusters with better performing skiers appear to have better visual function in both sports. The results of this study would suggest that Para nordic and Para alpine skiers with light perception or no light perception vision should be in one class and that the skiers with quantifiable static VA should be in a different class.

Performance of Athletes With Visual Impairment in Track-and-Field Events at the Paralympic Games, From 1988 to 2016

Introduction: The Paralympic movement has grown considerably over the last decades, but few studies have analyzed the performance evolution of the best athletes with disabilities. This study examined the performance of athletes with visual impairments in track-and-field events over eight Paralympic Games (1988–2016). Method: Results in the Paralympic track-and-field events for athletes with visual impairments (and in the corresponding track-and-field Olympic events) were collected from official public websites. Results: Analysis showed that most performances at Paralympic track-and-field events increased linearly over the years, which finding contrasts with the general stagnation in Olympic events. The improvements from 1988 to 2016 in Paralympic sprinting, middle- and long-distance running, throwing, and long-jumping events were 4.0–16.3%, 3.2–16.2%, 23.0–54.2%, and 4.9–18.9%, respectively. Men had better performances than women in running, throwing, and jumping events. In general, sports classes with a less severe level of visual impairment achieved higher performance levels than those with a more severe level of visual impairment, especially men. The competition density of Paralympic track-and-field events showed modest improvements. Conclusions: This study provides evidence that the performance of track-and-field athletes with visual impairments have been improving persistently over the last eight Paralympic Games, confirming that Paralympic athletes are achieving high-level performances. Implications for Practitioners: This study will be helpful for coaches and athletes with visual impairments who are setting performance (and training) goals for the Paralympic Games and other international athletic events.

The Relationship Between Visual Function and Performance in Para Swimming

BACKGROUND

Paralympic swimmers with vision impairment (VI) currently compete in one of the three classes depending on their visual acuity (VA) and/or visual field. However, there is no evidence to suggest that a three-class system is the most legitimate approach for classification in swimming, or that the tests of VA and visual field are the most suitable. An evidence-based approach is required to establish the relationship between visual function and performance in the sport. Therefore, the aim of this study was to establish the relationship between visual function and performance in VI Para swimming. The swimming performance of 45 elite VI swimmers was evaluated during international competitions by measuring the total race time, start time, clean swim velocity, ability to swim in a straight line, turn time, and finish time. Visual function was measured using a test battery that included VA, contrast sensitivity, light sensitivity, depth perception, visual search, and motion perception.

RESULTS

Results revealed that VA was the best predictor of total race time (r = 0.40, p < 0.01), though the relationship was not linear. Decision tree analysis suggested that only two classes were necessary for legitimate competition in VI swimming, with a single cut-off between 2.6 and 3.5 logMAR. No further significant association remained between visual function and performance in either of the two resulting classes (all |rs|< 0.11 and ps > 0.54).

CONCLUSIONS

Results suggest that legitimate competition in VI swimming requires one class for partially sighted and another for functionally blind athletes.

Time-Trial Performance of Para-Cycling Athletes With Visual Impairment in Tandem Competitions: A Retrospective Analysis of 20 Yrs

ABSTRACT

Identifying performance variables associated with visual impairment classification in para-cycling is one of the steps to improve the evidence-based classification system, and consequently, bring equality in Paralympic sports. Thus, this retrospective study aimed to analyze a 1-km tandem-track race performance among para-cyclists (male and female) with different visual impairment degrees (B1, B2, and B3) and to verify the retrospective performance over 20 yrs in all sport classes. The data were extracted from 427 para-cyclists (251 male and 176 female) who competed in the Para-Cycling World Championships and Paralympic Games. The following performance variables were analyzed: time trial, velocity, pace strategies, and number of medals. A one-way analysis of variance was used to compare performance variables among athletes of different sport classes (B1, B2, and B3) and χ2 tests were implemented to test the association between sport classes and medal distribution with a level of significance set at a P value of less than 0.05. The main results revealed that partially sighted athletes exhibited better tandem-track race performance compared with blind athletes (P < 0.05). Significant associations between sport classes and medal distribution in male (P = 0.026) and female (P = 0.017) athletes were found (higher in B3 athletes). Only 23.2% of male and 41.5% of female B3 athletes were medalists, and B3 athletes performed better specifically compared with B1 in most race distances. Finally, B2 and B3 athletes showed higher performance improvements than B1 throughout 20 yrs in the male group. It was concluded that male and female visual impairment athletes who classified as B1 displayed lower tandem-track race performance and medal frequency compared with partially sighted athletes, mainly considering those in the B3 class. The competitive system for athletes with visual impairment should be improved to provide more equity in the track para-cycling events.

Is the visual impairment origin a performance factor? Analysis of international-level para swimmers and para athletes

The aim of this study was to investigate the effect of congenital and acquired visual impairments on the international performance of Para swimmers and Para track and field athletes. We collected results from visually impaired Para athletes competing in Para swimming or Para athletic events at all IPC-labelled competitions between 2009 and 2019. The dataset contained 20,689 events results. Impairment origin was collected from the International Paralympic Committee (IPC) website. We separated impairment origin into two groups to distinguish those with a congenital impairment from those with an acquired impairment. In visual impairment sport classes (11-12-13), the performance level and the age performance relationship were investigated according to the impairment origin. In classes 11 and 12, peak performance was achieved earlier by male and female swimmers with a congenital impairment compared with those who had an acquired impairment (p < 0.05). No differences were present in class 13 or in any class in Para athletics (p > 0.05). A similar performance level was observed among the two sport disciplines for each class (p > 0.05). This study demonstrated that impairment origin can influence the performance pathway among visually impaired swimmers.

How wide should you view to fight? Establishing the size of the visual field necessary for grip fighting in judo

Peripheral vision is often considered vital in (combat) sports, yet most experimental paradigms (e.g., eye tracking) ignore peripheral information or struggle to make inferences about the role of peripheral vision in an in-situ performance environment. This study aimed to determine where visual information is located in the peripheral field during an in-situ combat sports task. Eight advanced judokas competed in grip-fighting exchanges while wearing a mobile eye-tracker to locate gaze direction. Three-dimensional position data of the head and hands were tracked using a VICON motion capture system. Gaze analysis through automatic feature detection showed that participants predominantly fixated on their opponent's chest. Kinematic data were used to calculate the angles between the opponent's hands and the gaze-anchor point on the chest of the opponent. Results revealed a nonlinear relationship between visual field (VF) size and visibility of the hands, with athletes needing a VF of at least 30-40 degrees radius to simultaneously monitor both hands of the opponent most of the time. These findings hold implications for the regulation of Paralympic judo for athletes with vision impairment, suggesting that a less severe degree of impairment should be required to qualify than the current criterion of 20 degrees radius.

Expert opinion on classification for footballers with vision impairment: Towards evidence-based minimum impairment criteria

In Para sport, the aim of classification is to minimize the impact of impairment on the outcome of competition. Despite requirements of the International Paralympic Committee Athlete Classification Code for classification to be evidence-based and sport-specific, sports for athletes with VI, including football, use the same generic classes across almost all sports. The aim of this study was to consult with experts to establish the needs and challenges for developing a code-compliant system of classification for VI football. A panel of 18 experts with international experience in VI football (16.8 ± 10.2 years) took part in a three-round Delphi study using online surveys. Results showed that the panel did not think that the current system completely fulfils the aim of classification. The panel identified measures of visual function they considered to be relevant but are not currently measured during classification including dynamic acuity, depth and motion perception, and contrast and light sensitivity. Moreover, they identified technical skills such as ball control, dribbling and passing, as well as perceptual-cognitive skills, as most likely to be affected by vision impairment. Findings outline the need for change and offer a framework for future research to develop an evidence-based classification for VI football.

Development of evidence-based classification for para surfers with physical impairments: A narrative review

The sport of competitive para surfing is growing internationally without established classification procedures. A classification structure is essential for equitable sport competition and worldwide sport progression. This narrative review summarizes the existing knowledge on Paralympic classification and surfing biomechanics. Its primary purpose is to describe the development of an evidence-based para surfing classification structure that follows the International Paralympic Committee (IPC) Classification Code. Two databases-PubMed and Google Scholar-were searched for three themes: "Paralympic classification", "performance determining factors in surfing", and "impact of impairments on surf performance". The IPC Classification Code and IPC regulations were obtained from the IPC website and official publications. Seventy-six relevant articles were utilized to guide the design of this preliminary para surfing classification structure. A conceptual framework on athlete characteristics, adaptive sport characteristics, and use of equipment is presented to build the essential knowledge base for continual growth of para surfing. This classification structure and conceptual framework will support para surfing sport expansion and help pave the way for its inclusion in the Paralympic Games.

How Is Jump Performance Affected in Male Athletes when Completed with a Visual Impairment?

SIGNIFICANCE

High-, long-, and triple-jump athletic events may need to consider whether it is appropriate to group vision-impaired athletes in the same classification with loss of different visual functions, and a greater emphasis may need to be placed on the visual field (VF) within the current classification system used.

PURPOSE

Athletes with vision impairment are grouped, based on their visual function, into one of three different classes (B1, B2, and B3, with B1 being the most severe). Athletes in class B2 have loss in visual acuity (VA; range, 1.50 to 2.60 logMAR) or VF (constricted to a diameter of <10°). The current study investigated how loss of different visual function (VA or VF) within the same class impacts jumping performance, a fundamental component in long-, triple-, and high-jump athletic events.

METHODS

Ten subelite male athletes (age, 21.6 ± 0.96 years; height, 178.8 ± 2.97 cm; mass, 82.2 ± 10.58 kg) with normal vision who participate in athletics were recruited. Participants completed drop jumps in four vision conditions: habitual vision condition (Full), VA no better than 1.60 logMAR (B2-VA), VF restricted to <10° (B2-VF), and VA no better than 1.30 logMAR (B3-VA).

RESULTS

Meaningful differences were observed between Full and B2-VF conditions. After rebound, vertical velocity at take-off was highest in Full condition (2.84 ± 0.35 m · s-1; 95% confidence interval [CI], 2.68 to 2.99 m · s-1) and was lowest in B2-VF condition (20% reduction; 2.32 ± 0.29 m · s-1; 95% CI, 2.16 to 2.48 m · s-1). Peak vertical jump height was highest in Full (0.42 ± 0.10 m; 95% CI, 0.38 to 0.46 m) and reduced by 40% in B2-VF (0.28 ± 0.07 m; 95% CI, 0.24 to 0.32 m). Minimal differences were found between Full and B2-VA, or B3-VA conditions.

CONCLUSIONS

Jump performance is compromised in athletes with simulated vision impairment. However, decrements in performance seem specific to those with severely constricted VF. Those with reduced VA (in B2-VA and B3-VA classes) seem to produce performance comparable to those with normal vision.

Assessment of Visual Function and Performance in Paralympic Judo for Athletes with Vision Impairment

SIGNIFICANCE

Paralympic judo currently requires all athletes to compete against each other in one class irrespective of their level of vision impairment (VI). Recent evidence suggests that multiple classes are required to enhance fairness, yet it remains unclear how many classes are necessary and what vision tests should be used to define those classes.

PURPOSE

The aim of this study was to quantify the relationship between vision and performance in judo for individuals with VI. The results were expected to inform the development of evidence-based criteria to structure Paralympic judo competition.

METHODS

The visual function of 53 elite VI judokas was assessed using a test battery that included tests of visual acuity (VA), contrast sensitivity, light sensitivity, depth perception, motion perception, visual search, and central visual field. Performance was assessed by measuring the ratio of fights won across all competitions the participants took part in in the 2 years before and after vision testing. Pearson correlation coefficients and decision tree analyses were used to determine the relationship between vision and performance. Partial correlations were also conducted to determine the unique ability of each measure of visual function to predict judo performance.

RESULTS

Visual acuity was the best predictor of judo performance and remained the only visual function related to performance when controlling for correlations between VA and other visual functions. Decision tree analyses suggested to split athletes into two groups for more legitimate competition, using a cutoff point around 2.6 logMAR. Within each of the two resulting subgroups, no correlations remained between any of the visual functions and performance.

CONCLUSIONS

The results of this study suggest that VI judo competition should be split into separate categories for partially sighted and functionally blind athletes. The inclusion of visual functions in addition to VA does not improve the ability to predict performance in VI judo.

Psychometric Suitability of Adaptations to the Special Judo Fitness Test for Athletes With Visual Impairment

This study aimed to test the reliability, sensitivity, construct and logical validity of an adapted Special Judo Fitness Test (SJFT) for judo athletes with visual impairment . Twenty judo athletes with visual impairments performed both the adapted SJFT with tactile and sonorous stimuli (experimental conditions) and the typically administered SJFT (standard condition). We used analyses of variance (ANOVAs) with repeated-measures to compare the groups' SJFT performances, and one-way ANOVAs to compare different visual ability classes of athletes (B1, B2 and B3). We used t-tests to compare SJFT variables between elite and sub-elite groups. We set statistical significance for all tests at p < 0.05. The standard SJFT showed excellent test-retest reliability for number of throws and overall index (ICC = 0.91-0.95), and both sonorous and tactile sensitivity adaptations of the SJFT showed medium sensitivity for detecting performance changes. The number of throws and SJFT index were higher with the sonorous adaptation of the test, compared to the tactile and standard versions (p < 0.001). Athletes who were blind (B1) presented similar performances to athletes who were partially sighted (B2 and B3) only on the SJFT with the sonorous stimulus. Moreover, only the sonorous SJFT adaptation discriminated between the performances of elite and sub-elite athletes (p < 0.001). In conclusion, both SJFT adaptations showed excellent reliability and medium sensitivity on test-retest, but, only the SJFT with the sonorous stimulus seemed valid for assessing judo athletes with varying degrees of visual impairment, and only the sonorous stimulus SJFT discriminated elite from sub-elite athletes.

Topical Review: Understanding Vision Impairment and Sports Performance through a Look at Paralympic Classification

SIGNIFICANCE

To provide meaningful competition that is equitable for Paralympic athletes, classification systems are vital to determine which athletes are eligible to compete in adapted forms of sports and to group athletes for competition. Our discussion has important implications to inform how we should approach visual function assessment in sports performance. Sport participation positively benefits individuals with low vision. In particular, adapted sports exist to provide people with visual disabilities an avenue for participating in recreational activity. High-performance low-vision athletes can participate in Paralympic sports but need to be properly classified based on the severity of their vision impairment. The model for Paralympic classification was initiated by Sir Ludwig Guttmann in 1952 in a rehabilitation clinic for soldiers with spinal cord injuries. Today, the International Paralympic Committee mandates that international sports federations develop evidence-based sport-specific classification systems to ensure that eligible disabled athletes have an opportunity for meaningful competition. With the current classification system, only visual acuity and visual field measures are considered to determine an athlete's eligibility to compete, leaving room to expand our understanding of visual function requirements for individual sports. In this topical review, we discuss the origins of Paralympic sports, limitations of current classification methods, and requirements toward achieving evidence-based sport-specific evaluation systems.

Effect of vision impairment on match-related performance and technical variation in attacking moves in Paralympic judo

In Paralympic judo for athletes with vision impairment (VI judo) all eligible athletes (i.e. B1, B2 and B3 classes) compete against each other in the same competition. Evidence suggests that athletes with more impairment may be disadvantaged, but that more sensitive measures of performance are necessary to understand the impact of impairment on performance. The aim of this study was to investigate the relationship between Para sport class and technical variation, time-motion variables, and performance in Paralympic judo. All 175 judo matches from the Rio 2016 Paralympic Games were analysed across 129 competitors (82 male and 47 female). The main results indicated that athletes who demonstrated less technical variation also experienced less competitive success, with the functionally blind athletes (class B1) demonstrating less technical variation than partially sighted (class B2 and B3) athletes (p < 0.05). There was no difference in the time-motion variables between sport classes (p > 0.05). We conclude that measures of technical variation are sensitive to differences in impairment and are suitable for studies that investigate the impairment-performance relationship in VI judo. Results further confirm that some athletes with impairment are disadvantaged under the current rules of VI judo.

Do Impairments in Visual Functions Affect Skiing Performance?

Nordic and alpine skiing-related visual tasks such as identifying hill contours, slope characteristics, and snow conditions increase demands on contrast processing and other visual functions. Prospective observational studies were conducted to assess the relationships between skiing performance and a broad range of visual functions in nordic and alpine skiers with vision impairments. The study hypothesized that contrast sensitivity (CS), visual acuity (VA), and visual field (VF) would be predictive of skiing performance. Binocular static VA, CS, light sensitivity, glare sensitivity, glare recovery, dynamic VA, translational and radial motion perception, and VF were assessed in elite Para nordic (n = 26) and Para alpine (n = 15) skiers. Skiing performance was assessed based on skiers’ raw race times. Performance on the visual function tests was compared with skiing performances using Kendall’s correlations (with and without Bonferroni–Holm corrections) and linear multivariable regressions (p < 0.05 considered significant). None of the vision variables were significantly correlated with performance in Para nordic or Para alpine skiing after Bonferroni–Holm corrections were applied. Before applying the corrections, VF extent (ρ = -0.37, p = 0.011), and static VA (ρ = 0.26, p = 0.066) demonstrated the strongest correlations with Para nordic skiing performance; in Para alpine skiing, static VA and CS demonstrated the strongest correlations with downhill (static VA: ρ = 0.54, p = 0.046, CS: ρ = -0.50, p = 0.06), super G (static VA: ρ = 0.50, p = 0.007, CS: ρ = -0.51, p = 0.017), and giant slalom (static VA: ρ = 0.57, p = 0.01, CS: ρ = -0.46, p = 0.017) performance. Dynamic VA and VF were significantly associated with downhill (ρ = 0.593, p = 0.04) and slalom (ρ = -0.49, p = 0.013) performances, respectively. Static VA was a significant predictor of giant slalom [(F(3,11) = 24.71, p < 0.001), and R of 0.87], super G [(F(3,9) = 17.34, p = 0.002), and R of 0.85], and slalom [(F(3,11) = 11.8, p = 0.002), and R of 0.80] performance, but CS and VF were not. Interestingly, static VA and CS were highly correlated in both Para nordic (ρ = -0.60, p < 0.001) and Para alpine (ρ = -0.80, p < 0.001) skiers. Of the vision variables, only static VA and VF were associated with skiing performance and should be included as the in Para nordic and Para alpine classifications. The strong correlations between static VA and CS in these skiers with vision impairment may have masked relationships between CS and skiing performance.

Evidence-based Classification in Track Athletics for Athletes with a Vision Impairment: A Delphi Study

SIGNIFICANCE

The Delphi analysis presented here highlights the need for a sport-specific evidence-based classification system for track athletics for athletes with a vision impairment (VI). This system may differ for different race distances. Further research is required to develop a useful test battery of vision tests for classification. The issue of intentional misrepresentation during classification needs particular attention.

PURPOSE

At present, athletes with VI are placed into competition classes developed on the basis of legal definitions of VI. The International Paralympic Committee Athlete Classification Code states that all sports should have their own classification system designed to reflect the (visual) demands of that individual sport. This project gathered expert opinion on the specific requirements for an evidence-based sport-specific classification system for VI track athletics and to identify any particular issues within track athletics that require further research into their impact on sport performance.

METHODS

A three-round Delphi review was conducted with a panel of 17 people with expertise in VI track athletics.

RESULTS

The panel agreed that the current classification system in VI track athletics does not completely minimize the impact of impairment on competition outcome, highlighting the need for improvements. There was clear agreement that the existing measures of vision may fail to adequately reflect the type of vision loss that would impact running performance, with additional measures required. Intentional misrepresentation, where athletes "cheat" on classification tests, remains a serious concern.

CONCLUSIONS

The panel has identified measures of vision and performance that will inform the development of an evidence-based classification system by better understanding the relationship between VI and performance in track athletics. Issues such as the use of guides and whether the current class system was equitable gave rise to differing opinions within the panel, with these varying across the different running distances.

Exploration of the minimum visual disability criteria for Para nordic and Para alpine skiing using simulated vision impairments

The International Paralympic Committee Classification Code requires sports to develop evidence-based, sports-specific classification systems. This project aimed to determine the minimum eligibility criteria for Para nordic and Para alpine skiing by simulating vision impairments and measuring the impact of the impairments on performance in twenty-two nordic (28.09 ± 9.68 years; 16 male) and eleven alpine (37.91 ± 18.9 years, 11 male) able-sighted skiers. Eight visual acuity (VA)/contrast sensitivity (CS) (Cambridge Simulation Glasses, University of Cambridge) and six visual field (VF) impairments (bespoke goggles; University of Waterloo) were simulated. VA, CS and VF were measured in each participant before they completed an on-snow session, skiing short competition-style courses with each of the 14 simulated impairments in a randomized order. Clear goggle (no impairment) trials were used as controls. Receiver Operating Characteristic (ROC) and decision tree analyses were conducted to determine the optimum VA, CS and VF cut-offs for classifying performance based on differences from baseline in real time. Moderate impairments in VA, CS and VF negatively affect skiing performance. The recommended cut-off criteria based on both analyses were VA ≥0.90 logMAR and ≤48% VF extent for nordic and VA of ≥0.60 logMAR and VF extent of ≤59.0% for alpine.

Seasonal Changes in Breathing Pattern, Trunk Stabilization, and Muscular Power in Paralympic Swimmers

The purpose of this study was to monitor the changes in breathing pattern, trunk muscle stabilization, and upper-body muscular power in Paralympic swimmers throughout a competitive season over three time points: October (T1), March (T2), and August (T3). Six top-level Paralympic swimmers voluntarily participated in this study. The Friedman test, the Bonferroni-Dunn multiple comparison post hoc analysis, and Kendall's W concordance coefficient for the measure of effect were used. A significant difference was found in the breathing pattern, trunk stability, and upper-body power variables from the T1 to T3 season (p < .05). However, no significant changes were found in the T2 season. A long-term assessment of these fitness parameters may be of practical importance for better tailoring the training programs of top-level Paralympic swimmers.

Conceptual model of sport-specific classification for para-athletes with intellectual impairment

The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.

Modelling the age-related trajectory of performance in Para swimmers with physical, vision and intellectual impairment

This study is the first to provide information on the age-related trajectories of performance in Para swimmers with physical, vision and intellectual impairment. Race times from long-course swim meets between 2009 and 2019 were obtained for Para swimmers with an eligible impairment. A subset of 10 661 times from 411 Para swimmers were included in linear mixed effects modelling to establish the relationship between age and performance expressed relative to personal best time and world record time. The main findings were: (a) age has the most noticeable influence on performance between the ages of 12-20 years before performances stabilize and peak in the early to late twenties, (b) women have faster times relative to personal best and world record time than men during early adolescence and their performances stabilize, peak and decline at younger ages, and (c) Para swimmers from different sport classes show varying age-related trajectories in performance after maturation and when training-related factors are more likely to explain competitive swim performance. The results of this study can guide talent identification and development of Para swimmers at various stages of their career and help to inform decision-making on the allocation of sport class and sport class status in Para swimming classification.

Perspectives of a new sport-specific Para Shooting classification system for athletes with vision impairment

The International Paralympic Committee (IPC) and individual sports federations have established the need to develop evidence-based systems of classification for athletes with vision impairment (VI) that may differ depending on the visual demands of each sport. As a consequence, research has been conducted that led to a new classification system for athletes competing in VI shooting. The purpose of this study was to canvas the experiences of key stakeholders (athletes, coaches and classifiers) when the new system of classification was implemented. Twenty-eight participants (17 athletes, 7 coaches and 4 classifiers) completed a questionnaire to rate their experiences of the previous and new classification systems and were interviewed to gain richer insights into their opinions. It was apparent that the changes to the classification system were not adequately communicated to the athletes in particular, and that the classifiers may require a better understanding of the principles of evidence-based classification. The new system was perceived to be significantly more specific for VI shooting and intentional misrepresentation was observed to be significantly less likely than when using the old system. This research provides valuable insights into both the positive and negative experiences of key stakeholders experiencing change in a classification system.

Rifle Shooting for Athletes With Vision Impairment: Does One Class Fit All?

Revised evidence-based classification criteria introduced for shooting for athletes with vision impairment (VI shooting) suggest that athletes with impaired contrast sensitivity (CS) and visual acuity (VA) should be eligible for inclusion in the sport but should all eligible athletes compete against each other in the same "class" or is more than one class necessary? Twenty-five elite VI shooting athletes took part in the study. Two measures of visual function were assessed under standardized conditions: VA (using an ETDRS logMAR letter chart, and/or a BRVT chart) and CS (using both a Pelli-Robson chart and a Mars number chart). Shooting performance, in both prone and standing events, was measured during an international VI shooting competition. Fourteen of the 25 athletes had measurable VA, and for CS, 8 athletes had measurable function with the Pelli-Robson chart and 13 with the Mars chart. The remaining athletes had function not numerically measurable by the charts and were considered to have no residual vision. There was no indication that shooting performance varied with visual function, and individuals that had residual vision had no advantage over those without vision for either prone or standing shooting. The modifications made to VI shooting, including the use of auditory tones to guide the gun barrel, appear to have successfully rendered the sport equitable for all eligible athletes. Only one class is necessary for athletes. An improved method of measuring CS in athletes with profound VI would be advantageous.

The Effect of Vision Impairment on Competitive and Technical-Tactical Performance in Judo: Is the Present System Legitimate?

In judo competition for visual impairment, athletes of different classes compete against each other in the same category; B1 athletes are totally blind, whereas B2 and B3 athletes are partially sighted. To test for potential competition disparities due a single category of athletes, this study aimed to compare competitive and technical-tactical performance in visually impaired judo athletes with different degrees of visual impairment. The authors analyzed 340 judo matches from the 2012 and 2016 Paralympic Games. The scores, penalties, efficiency index, and types of medals were examined, as well as the technical variation and temporal structure. The main finding was that blind judo athletes presented lower scores (p < .05; effect size [ES] = 0.43-0.73), medals (p < .05), and efficiency (p < .05; ES = 0.40-0.73); different patterns of play; and a shorter time to lose than partially sighted athletes (p = .027; ES = 0.10-0.14). However, the penalties were similar between classes (p > .05; ES = 0.07-0.14). The odds ratio of a winning medal was 3.5-8 times less in blind athletes than in partially sighted athletes (p < .01). In conclusion, blind judo athletes presented lower competitive and technical-tactical performance than athletes with some residual functional vision. These findings provide support for the development of new evidence-based criteria for judo classification based on vision impairment.

The Development of Evidence-Based Classification of Vision Impairment in Judo: A Delphi Study

Objective: Most para-sports group athletes into "classes" to compete against others with similar activity limitations. Judokas with vision impairment (VI) instead all compete in the same class irrespective of their level of impairment. There is considerable controversy whether this approach represents a legitimate way to structure judo competition. The aim of this study was to establish expert opinion on the requirements for an evidence-based classification system for VI judo. Methods: A panel of 18 athletes, coaches, and administrators participated in a three-round Delphi review process. Expert opinions were canvased for a large range of issues related to classification in judo. Between rounds, results were summarized and further questions were asked on topics where consensus was not reached across experts. Results: The panel expressed that: (i) blind and partially sighted athletes should not compete against each other in the same class; (ii) additional measures of visual function might be needed to accurately evaluate an athlete's impairment; (iii) the minimum impairment criteria (MIC) should represent a more severe level of impairment to ensure that all those included possess a level of VI that indeed decreases performance in judo; and (iv) legitimate competition could be undermined by some athletes intentionally underperforming on classification tests. The panel identified six additional measures of visual function which are not currently measured but are likely to impact judo performance, and six aspects of judo performance which are most likely impacted by VI. Conclusion: Experts in the field of VI judo expressed a need to change the manner in which VI judokas are classified. This study outlines a model for establishing the impairment-performance relationship and guides the development of evidence-based classification for VI judo.

Expert Consensus to Guide the Classification of Paralympic Swimmers With Vision Impairment: A Delphi Study

The International Paralympic Committee requires their member sports to develop a classification system that is sport-specific, meaning that the specific ‘class’ in which an athlete competes should be suitable for the degree to which the athlete’s impairment affects performance in that particular sport. However, swimmers with vision impairment (VI) currently compete in classes that were developed on the basis of legal definitions of blindness, failing to consider how vision impacts swimming performance. The aim of this study was to establish expert guidance on the specific requirements for a sport-specific system of classification for VI swimming. A three-round Delphi review was conducted with a panel of 16 people with expertise in VI swimming either as an athlete, coach, administrator, or scientist. There was clear consensus (86%) among the panel that the current classification system used for VI swimming fails to fulfill the aim of minimizing the impact of VI on the outcome of competition. Particularly, the panel agreed that there are a range of aspects of visual function (e.g., depth perception and contrast sensitivity) that are important for optimal swimming performance, yet are not assessed using the current classification system. The panel also identified nine performance components of a swimming race that are mostly likely to be affected by VI. Interestingly, these were spread across all four major segments (start, clean swim, turn, and finish), and weren’t necessarily those performance determinants generally used by performance analysts and coaches. There was also strong agreement that the age at which VI is acquired will substantially impact the ability of a swimmer to reach their full potential in the pool. The main implication is that changes are required to the way that swimmers with VI are classified for para-sport competition. Clear guidance has been provided for how to further the development of an evidence-based classification system.

The Perception of Deceptive Information Can Be Enhanced by Training That Removes Superficial Visual Information

The ability to detect deceptive intent within actions is a crucial element of skill across many tasks. Evidence suggests that deceptive actions may rely on the use of superficial visual information to hide the basic kinematic information which specifies the actor's intent. The purpose of this study was to determine whether the ability of observers to anticipate deceptive actions could be enhanced by training which removes superficial visual information. Novice badminton players (n = 36) were allocated to one of three groups who performed perceptual training over 3 days, with the efficacy of training assessed using tests of anticipatory skill conducted at pre-test, post-test, and a 1-week retention test. During training, participants watched a series of non-deceptive badminton shots performed by actors, with the footage manipulated to display either (i) low spatial-frequency information only (low-SF training group; blurring to remove superficial information); (ii) high spatial-frequency information only (high-SF training group; an 'edge detector' to highlight superficial information); or (iii) normal vision (normal-SF group). Participants were asked to anticipate the direction of the shuttle when footage was occluded at the moment of racquet-shuttle contact. In the post-test, response accuracy (RA) when viewing deceptive trials was higher for the low-SF training group when compared to the normal-SF (control) training group (p = 0.005), with the difference retained in the retention test (p = 0.020). High-SF training resulted in greater performance at post-test (p = 0.038) but not retention (p = 0.956). The analysis of gaze provided some explanation for the findings, with the low-SF training group spending more time after training fixating on the location of racquet-shuttle contact than did the normal training group (p = 0.028). The findings demonstrate that training which conveys only the basic kinematic movements visible in low-SF information may be effective in learning to 'see-through' deceptive intent.

Contrast Sensitivity Is a Significant Predictor of Performance in Rifle Shooting for Athletes With Vision Impairment

Purpose: In order to develop an evidence-based, sport-specific minimum impairment criteria (MIC) for the sport of vision-impaired (VI) shooting, this study aimed to determine the relative influence of losses in visual acuity (VA) and contrast sensitivity (CS) on shooting performance. Presently, VA but not CS is used to determine eligibility to compete in VI shooting.

Methods: Elite able-sighted athletes (n = 27) shot under standard conditions with their habitual vision, and with their vision impaired by the use of simulation spectacles (filters which reduce both VA and CS) and refractive blur (lenses which reduce VA with less effect on CS). Habitual shooting scores were used to establish a cut-off in order to determine when shooting performance was ‘below expected’ in the presence of vision impairment. Logistic regression and decision tree analyses were then used to assess the relationship between visual function and shooting performance.

Results: Mild reductions in VA and/or CS did not alter shooting performance, with greater reductions required for shooting performance to fall below habitual levels (below 87% of normalized performance). Stepwise logistic regression selected CS as the most significant predictor of shooting performance, with VA subsequently improving the validity of the model. In an unconstrained decision tree analysis, CS was selected as the sole criterion (80%) for predicting ‘below expected’ shooting score.

Conclusion: Shooting performance is better predicted by losses in CS than by VA. Given that it is not presently tested during classification, the results suggest that CS is an important measure to include in testing for the classification of vision impairment for athletes competing in VI shooting.