Establishing the reliability of a novel battery of range of motion tests to enable evidence-based classification in Para Swimming

A Scoping Review with Bibliometric Analysis of Para-Rowing: State of the Art and Future Directions

Para-rowing is a format of rowing practiced by people with different types of disabilities, thanks to adapted equipment set-ups and regulations. Para-rowing made its debut recently at the 2008 Paralympic Games. According to the mandate of the “International Paralympic Committee”, para-rowers should be enabled to pursue sporting excellence. Therefore, rigorous research is needed in terms of well-designed, high-quality studies. To the best of our knowledge, there are no systematic appraisals of the body of scholarly evidence in the field of para-rowing. As such, a scoping review enhanced by bibliometric analyses was carried out to provide a comprehensive synthesis of knowledge related to para-rowing for the perusal of practitioners and athletes. By mining eighteen major databases, 17 studies were retained in the present review. The included studies were found to focus on a range of aspects involving health, the etiology of injuries (n = 5), psychological and physiological responses (n = 5), performance, biomechanical analysis (n = 4), and new analytical approaches for kinematic assessments and predictions of mechanical outputs in para-rowers (n = 3). The scholarly community on para-rowing consists of 78 researchers, 16 (20.51%) of whom are highly interconnected. The most prolific author was Smoljanović T., from Croatia, with three items/documents. In total, 93.6% of scholars have authored one single document. Topological features indicated a highly fragmented and dispersed, poorly connected community characterized by a high number of clusters and a low strength of connections. In terms of publication years, the first scholarly article dates back to 2008, with four articles (23.5%) published in the current year, showing an increasing interest in this para-sports discipline. Finally, gaps in current research on para-rowing were identified in terms of overlooked topics, including sports nutrition, doping, and psychological aspects in para-rowers other than those with visual impairment.

Stakeholders' Consensus to Guide the Minimum Impairment Criteria in Wheelchair Basketball

The International Paralympic Committee athlete classification code mandates sports to have defined minimum impairment criteria, describing the minimum level of an eligible impairment an athlete must possess, to be able to participate in that sport. The aim of this study was to establish stakeholders' consensus for the minimum impairment criteria in wheelchair basketball. From a pool of 48 expert stakeholders (identified via an international medical and scientific working group), 39 completed a 4-round Delphi survey. Questions were answered on the method of assessing each eligible impairment, and the level of impairment that should constitute the minimum impairment criteria. This study indicated where stakeholder consensus existed and noted that consensus was developed for impaired muscle power, impaired passive range of motion, leg length difference, hypertonia and ataxia. No consensus was found for limb deficiency and athetosis. Participants raised concerns with using subjective measurement scales for assessing certain impairments, whilst also calling for more quantitative research to be conducted into the level of impairment that should constitute the minimum impairment criteria. For these research findings to form practical minimum impairment criteria that are part of a wheelchair basketball classification system, it is required to examine their feasibility by conducting further research.

Passive drag in Para swimmers with physical impairments: Implications for evidence-based classification in Para swimming

The inherent hydrodynamic resistance force, or passive drag, of a swimmer directly influences how they move through the water. For swimmers with physical impairments, the strength of association between passive drag and swimming performance is unknown. Knowledge on this factor could improve the World Para Swimming classification process. This study established the relationship between passive drag and 100 m freestyle race performance in Para swimmers with physical impairments. Using a cross-sectional study design, an electrical-mechanical towing device was used to measure passive drag force in 132 international-level Para swimmers. There was a strong, negative correlation between normalized passive drag force and 100 m freestyle race speed in the combined participant cohort (ρ = -0.77, p < 0.001). Type of physical impairment was found to affect the relationship between passive drag and 100 m freestyle race speed when included in linear regression (R²  = 0.65, χ²  = 11.5, p = 0.025). These findings contribute to the body of evidence that passive drag can provide an objective assessment of activity limitation in Para swimmers with physical impairments. The effect of physical impairment type on the relationship between passive drag and swimming performance should be accounted for in Para swimming classification.

How Can Biomechanics Improve Physical Preparation and Performance in Paralympic Athletes? A Narrative Review

Recent research in Paralympic biomechanics has offered opportunities for coaches, athletes, and sports practitioners to optimize training and performance, and recent systematic reviews have served to summarize the state of the evidence connecting biomechanics to Paralympic performance. This narrative review serves to provide a comprehensive and critical evaluation of the evidence related to biomechanics and Paralympic performance published since 2016. The main themes within this review focus on sport-specific body posture: the standing, sitting, and horizontal positions of current summer Paralympic sports. For standing sports, sprint and jump mechanics were assessed in athletes with cerebral palsy and in lower-limb amputee athletes using running-specific prostheses. Our findings suggest that running and jumping-specific prostheses should be ‘tuned’ to each athlete depending on specific event demands to optimize performance. Standing sports were also inclusive to athletes with visual impairments. Sitting sports comprise of athletes performing on a bike, in a wheelchair (WC), or in a boat. WC configuration is deemed an important consideration for injury prevention, mobility, and performance. Other sitting sports like hand-cycling, rowing, and canoeing/kayaking should focus on specific sitting positions (e.g., arm-crank position, grip, or seat configuration) and ways to reduce aero/hydrodynamic drag. Para-swimming practitioners should consider athlete-specific impairments, including asymmetrical anthropometrics, on the swim-start and free-swim velocities, with special considerations for drag factors. Taken together, we provide practitioners working in Paralympic sport with specific considerations on disability and event-specific training modalities and equipment configurations to optimize performance from a biomechanical perspective.

Establishing the reliability of instrumented trunk impairment assessment methods to enable evidence-based classification in Para swimming

This study examined the reliability of instrumented trunk assessment methods across two experiments to develop and improve evidence-based classification in Para swimming. Trunk coordination, range of motion (ROM), and strength were assessed in 38 non-disabled participants. Each test battery was completed on two occasions to determine inter-session reliability. Intra-session reliability was also determined in Experiment Two. Absolute agreement of two-way mixed intraclass correlation coefficients (ICC 3,1) was calculated to assess reliability. Standard errors of measurement (SEMs) were also reported to facilitate comparisons between different outcomes. Trunk coordination measures had low-to-moderate reliability (inter-session ICCs = 0.00-0.60; intra-session ICCs = 0.14-0.65) and variable SEMs (5-60%). Trunk ROM demonstrated moderate-to-excellent reliability (inter-session ICCs = 0.61-0.93; intra-session ICCs = 0.87-0.95) and good SEMs (<10%). Trunk strength measures demonstrated good-to-excellent reliability (ICCs = 0.87-0.98) and good SEMs (<10%). The strength values obtained for the load cell and hand-held dynamometer (HHD) were significantly different from each other with the HHD underestimating strength. Modifications provided in Experiment Two improved the reliability of strength and ROM assessments but did not improve coordination measures. Further research involving para swimmers is required to establish the validity of the methods.

Evaluating objective measures of impairment to trunk strength and control for cross-country sit skiing

In Paralympic cross-country sit skiing, athlete classification is performed by an expert panel, so it may be affected by subjectivity. An evidence-based classification is required, in which objective measures of impairment must be identified. The purposes of this study were: (i) to evaluate the reliability of 5 trunk strength measures and 18 trunk control measures developed for the purposes of classification; (ii) to rank the objective measures, according to the largest effects on performance. Using a new testing device, 14 elite sit-skiers performed two upright seated press tests and one simulated poling test to evaluate trunk strength. They were also subjected to unpredictable balance perturbations to measure trunk control. Tests were repeated on two separate days and test–retest reliability of trunk strength and trunk control measures was evaluated. A cluster analysis was run and correlation was evaluated, including all strength and control measures, to identify the measures that contributed most to clustering participants. Intraclass correlations coefficients (ICC) were 0.71 < ICC < 0.98 and 0.83 < ICC < 0.99 for upright seated press and perturbations, respectively. Cluster analysis identified three clusters with relevance for strength and balance control measures. For strength, in upright seated press peak anterior pushing force without backrest (effect size = 0.77) and ratio of peak anterior pushing force without and with backrest (effect size = 0.72) were significant. For balance control measures, trunk range of motion in forward (effect size = 0.81) and backward (effect size = 0.75) perturbations also contributed. High correlations (− 0.76 < r < − 0.53) were found between strength and control measures. The new testing device, protocol, and the cluster analysis show promising results in assessing impairment of trunk strength and control to empower an evidence-based classification.

Does sports-specific training improve measures of impairment developed for para sport classification? A multiple-baseline, single-case experiment

Conceptually, sports-specific training should not influence measures of impairment used to classify Para athletes. This study evaluated the extent to which measures of strength, range of movement and coordination developed for Para swimming classification changed in response to a performance-focused swimming programme. A five-phase multiple-baseline, single-case experimental research design was utilized. Three participants with cerebral palsy and high support needs completed the 64-week study, which included two 16-week performance-focused swimming training blocks. Swimming speed, isometric shoulder extension strength, shoulder flexion range of movement and upper limb coordination were monitored throughout.Interrupted Time-Series Simulation Method analysis demonstrated large, significant changes in swimming speed (m/s) during the first (d = 2.17; 95% CI 0.45-3.88; p = 0.01) and second (d = 2.59; 95% CI 1.66-3.52; p = 0.00) training blocks. In contrast, changes in strength, range of movement and coordination were predominantly trivial and non-significant. This was the first study to investigate training responsiveness of measures developed for Para sport classification. Results indicate that despite significantly improved swimming performance, impairment measures remained relatively stable, and therefore these measures of impairment may be valid for the purposes of Para swimming classification. Further research is required in elite athletes, different sports and different impairment types.

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.

Measures of impairment applicable to the classification of Paralympic athletes competing in wheelchair sports: A systematic review of validity, reliability and associations with performance

A fundamental aspect of classification systems in Paralympic sport is having valid and reliable measures of impairment. However, minimal consensus exists for assessing impaired strength, coordination and range of motion. This review aimed to systematically identify measures of upper body strength, coordination and range of motion impairments that meet the requirements for use in evidence-based classification systems in wheelchair sports. Three electronic databases were searched from 2003 until 31 August 2019 for studies that assessed upper body function of participants and used a measurement tool that assessed strength, coordination or range of motion. The body of evidence for each identified measure was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Twenty-three studies were included: ten measured strength and coordination, and six measured range of motion. There was "moderate" confidence in using isometric strength for assessing strength impairment. Tapping tasks for the assessment of coordination impairment received a "low" confidence rating. All other identified measures of coordination and range of motion impairment received a "very low" confidence rating. Several potential measures were identified for assessing upper body strength, coordination and range of motion impairments. Further research is warranted to investigate their use for classification in Paralympic wheelchair sports.

Maximal Fully Tethered Swim Performance in Para Swimmers With Physical Impairment

The assessment of swimming propulsion should be a cornerstone of Paralympic swimming classification. However, current methods do not objectively account for this component.

PURPOSE

To evaluate the swimming propulsion of swimmers with and without physical impairment using a 30-second maximal fully tethered freestyle swim test.

METHODS

Tethered forces were recorded during maximal fully tethered swimming in 80 competitive swimmers with (n = 70) and without (n = 10) physical impairment. The relationships between absolute and normalized tether forces and maximal freestyle swim speed were established using general additive models.

RESULTS

Para swimmers with physical impairment had lower absolute and normalized tether forces than able-bodied swimmers, and there were moderate positive correlations found between tether forces and sport class (τ = .52-.55, P < .001). There was a nonlinear relationship between tether force and maximal freestyle swim speed in the participant cohort (adjusted R2 = .78-.80, P < .001). Para swimmers with limb deficiency showed stronger relationships between tether force and maximal freestyle swim speed (adjusted R2 = .78-.82, P < .001) than did Para swimmers with hypertonia (adjusted R2 = .54-.73, P < .001) and impaired muscle power (adjusted R2 = .61-.70, P < .001).

CONCLUSIONS

Physical impairments affect Para swimmers' tether forces during maximal fully tethered freestyle swimming, explaining a significant proportion of their activity limitation. It is recommended that maximal fully tethered swimming be included in Paralympic swimming classification as an objective assessment of swimming propulsion.