Expert consensus statement to guide the evidence-based classification of Paralympic athletes with vision impairment: a Delphi study

The FreiBurger: a new optotype for P300-based acuity estimation

PURPOSE

Accurate objective assessment of visual acuity is crucial, particularly in cases of suspected malingering, or when the patient's inability to cooperate makes standard psychophysical acuity tests unreliable. The P300 component of the event-related potentials offers a potential solution and even allows for the use of standard optotypes like the Landolt C. However, low-vision patients with large eccentric visual field defects often struggle to locate the Landolt C gap quickly enough for a P300 to be reliably produced.

METHODS

Addressing this challenge, we introduce a novel optotype (the "FreiBurger") with a critical detail that extends through the optotype's center. Two experiments, with 16 and 12 participants, respectively, were conducted. In the first, psychophysical acuity estimates were obtained with both the FreiBurger and the Landolt C. In the second, we tested the performance of the FreiBurger, relative to the Landolt C, in eliciting a P300 with undegraded vision, simulated low vision, and in a simulated combination of low vision and visual field constriction.

RESULTS

Comparable psychophysical acuity values (average difference 0.03 logMAR) were obtained for both optotypes. In the P300 recordings, both optotypes produced similar P300 responses under conditions of undegraded vision and low vision. However, with the combination of low vision and constricted visual field, the P300 could only be reliably obtained with the FreiBurger, while the amplitude was drastically reduced with the Landolt C (9.1 µV vs. 2.2 µV; p < 0.0005).

CONCLUSION

The new optotype extends the applicability of P300-based acuity estimation to the frequently encountered combination of low vision and constricted visual field, where Landolt C optotypes fail. Although impairments were simulated in the present study, we assume that the advantages of the new optotype will also manifest in patients with such impairments. We furthermore expect the advantages to apply to time-sensitive psychophysical examinations as well.

Expert Consensus on Classification and Performance in Paralympic Powerlifting: A Delphi Study

BACKGROUND

In Paralympic sports, classification ensures fair competition by grouping athletes based on their impairments. The International Paralympic Committee has provided scientific principles to guide evidence-based classification procedures. In Paralympic Powerlifting, athletes compete in one class, divided by sex and bodyweight categories, overlooking impairment impact on performance.

OBJECTIVE

This study aimed to establish a consensus among international Paralympic powerlifting experts regarding classification and performance issues to guide future research.

METHODS

A two-round Delphi study was conducted involving 26 experts. The study sought to identify the adequacy of the current classification and competition systems, explore the impact of various impairments, and lay the initial groundwork for a performance determinants model.

RESULTS

Experts agreed that existing classification and competition systems in Paralympic powerlifting do not align with Paralympic standards. Impairments from neurological conditions and those causing anthropometric changes were suggested to have opposing performance impacts. Initial directions for a performance determinants model were outlined, focusing on arm and bar kinematics, anthropometry, and body composition.

CONCLUSIONS

This study underscores the need for comprehensive research in Paralympic powerlifting, revealing critical discrepancies between current classification system and Paralympic standards. Insights into the multifaceted relationship between impairments and performance are provided to shape the future of Paralympic powerlifting research.

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.

Para Powerlifting Performance: A Retrospective Analysis Considering Origin of Impairment, Sport Classification, and Sex

OBJECTIVE

We analyzed the retrospective performance of para powerlifters over 8 yrs considering sex, the origin of impairment, and sport classification of para powerlifting.

DESIGN

This retrospective study analyzed data from 6791 (4613 and 2178 for male and female, respectively) individual results from 1634 athletes' performances. We collected absolute load (in kilograms), relative load (in kilogram/body mass), chronological age and origin of impairment (acquired or congenital), and sport classification (leg length difference, limb deficiency, range of movement, impaired muscle power, hypertonia, ataxia, athetosis, and short stature of para powerlifters.

RESULTS

Males were stronger than females thorough the years with acquired impairment being stronger than congenital impairment. Para powerlifters with acquired impairment were older compared with congenital impairment over the years. Acquired impairment males won 60% more medals than the congenital group. There was a significant association between competition achievement and sports class classification, with a higher number of medals for limb deficiency than other sports classes.

CONCLUSIONS

These results demonstrate that the sex, origin of impairment, and sports classification influence performance of athletes in para powerlifting. Thus, this information can help athletes, coaches, sport managers, and sport institutions involved in the sport of para powerlifting.

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.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches

Introduction

Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings.

Methods

Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach.

Results

In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples.

Discussion

Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.

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.

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.

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.

Evidence-based classification in golf for athletes with a vision impairment: A Delphi study

Vision-impaired (VI) golf is a global para-sport currently played under several different classification systems under different bodies. This study aimed to gather expert opinion to determine whether the current classification systems are fit for the purpose intended and to identify any particular issues where VI impacts the game of golf for the disabled (G4D). A panel of 20 participants with expertise in G4D took part in a three-round Delphi study. The panel agreed that the current classification system(s) for VI golf did not or only partially fulfilled the aim to minimise the impact of VI on the outcome of competition and that there should be one, internationally recognised, classification system. It was agreed that other metrics of VI, in addition to the measurement of visual acuity (VA), need to be considered. Intentional misrepresentation of VI was identified as a cause for concern. The panel agreed that the current classification system does not fully achieve its purpose. Any changes that are made to these classification systems need to be evidence based specific to VI golf. Further research is required to determine how measures of VI affect golfing performance and whether other metrics other than VA are required.

Functional Reaction Times of a Simulated Blocking Test among Para Taekwondo Athletes

Para taekwondo is a combat sport martial art that requires fast reaction times for successful defense during fighting. The current classification system is based on the function and the effective length of the upper limbs, which affects the athlete’s ability to block. Therefore, this study aimed to investigate the differences between the different classes in the athlete’s ability to block and move around the ring. A total of 87 Para taekwondo (K42, K43, and K44) athletes’ data were analyzed. Each participant engaged in the blocking reaction time test in a fighting stance with the left leg in front, the right leg in front, and the legs parallel in random order. A foot-stepping reaction test was performed to anlyze how the athletes moved in various directions. The results indicated no significant differences between the classes for the lower body foot stepping reaction times and the upper body blocking performance times. The stimulated blocking time of the Para taekwondo athletes ranged from 0.79 to 0.97 s Furthermore, the neurological group (0.86 ± 0.09 s) was significantly slower than the amputation/dysmelia group (0.81 ± 0.07 s). We thus concluded that the neurologically impaired athletes were disadvantaged and therefore belonged in a separate class.

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.

5-A-SIDE SOCCER: PREVALENCE OF SPORTS INJURIES IN BRAZILIAN TEAM PLAYERS

ABSTRACT Introduction: 5-a-side soccer is a sports modality exclusively for athletes with vision impairment (VI) classified as blind - B1 (Blind 1) by the visual classification process. Type of impairment and high-performance training are factors that contribute to the development of sports injuries. Objective: The purpose of this study was to characterize the prevalence of sports-related injuries in visually disabled athletes of the Brazilian 5-a-side soccer team. Methods: The method was defined as a descriptive, longitudinal, epidemiological study. The sample was composed of ten male athletes, members of the Brazilian 5-a-side soccer team, including two athletes without VI and eight athletes with the B1 visual classification, who participated in competitions in 2014. The questionnaire for the data collection was based on the Sport Injuries Protocol for Paralympic Sports (PLEEP), expressing quantitative data analyzed by descriptive statistics. Results: The results showed that, in 2014, five athletes with VI had seven sports injuries, with a prevalence of 62.5%, clinical incidence of 0.87 injuries per athlete per year, and 1.4 injuries per injured athlete. The main sports injuries were muscle strain (28.6%), groin pull (athletic pubalgia) (28.6%), and shin splints (periostitis) (28.6%). All sports injuries occurred in the lower limbs, affecting legs (71.4%) and hips (28.6%). Overload was the most frequent mechanism (57%), reported after the technical kick movement and linked to the muscle imbalance between dominant and supporting lower limbs, in addition to the postural misalignment typical of people with visual impairments. Conclusions: In summary, the Brazilian 5-a-side soccer athletes presented a pattern of overload injuries resulting from the repetition of the technical kick movement, occurring predominantly in sports competitions. Epidemiological data can contribute to the development of strategies to prevent injuries in this sport. Level of evidence II, Progressive prognostic study.

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.

Standardizing and optimizing acupuncture treatment for irritable bowel syndrome: A Delphi expert consensus study

BACKGROUND

Acupuncture has been widely utilized for irritable bowel syndrome (IBS). However, heterogeneity is large among therapeutic strategies and protocols. The aim of this study was to propose some down-to-earth recommendations and establish an optimized protocol for acupuncture practice in IBS.

METHODS

A panel of 74 traditional Chinese medicine (TCM) acupuncturists participated in clinical issue investigation. Subsequently, systematic reviews concerning acupuncture for IBS were screened within 3 databases. An initial consensus questionnaire was formed from the results of clinical issue investigation and literature review. Ultimately, a Delphi vote was carried out to determine these issues. 30 authoritative experts with extensive experience were requested to respond with agreement, neutrality, or disagreement for the items. Consensus achievement on a given item was defined as greater than 80% agreement.

RESULTS

Following a 2-round Delphi survey, there were 19 items reaching consensus; of which 5 items (26.32%) achieved thorough consensus, and significant agreement was reached for the other 14 items. These items can be classified into the 3 major domains: 1) clinical outcomes that acupuncture can bring for favorable intervention population (5 items), 2) suitable therapeutic principles and parameters of acupuncture (13 items), 3) possible adverse events in the treatment (1 item).

CONCLUSION

Without any ready-made guidelines and lacking of homogeneity in the published literatures, such expert consensus could be valuable for TCM acupuncturists in daily practice and patients with IBS to obtain appropriate and standardized acupuncture treatment. In addition, it also points out the clinical focus which need to be further explored in future trials.

Designing an internet-based intervention for improving wellbeing in people with acquired vision loss: A Delphi consensus study

PURPOSE

Vision impairment (VI) may impact a person's functional ability resulting in a loss of independence, anxiety, depression, social isolation and reduced quality of life. Caregivers also experience similar problems due to the increased burden placed on them. Support to address these difficulties encountered by those with VI and their caregivers may not always be accessible. An internet-based intervention may provide more accessible support. The aim of this study was to obtain consensus regarding the content and accessibility features required to design an internet-based intervention to promote wellbeing for people with VI and their caregivers.

METHOD

A three-round Delphi review was conducted with a panel of 30 stakeholders. Three stakeholder groups were included, namely individuals with vision loss, experts in the field of vision loss and mental health and carers of individuals with vision loss. Conceptual wellbeing ideas were examined in round 1, the intervention modules and module content were proposed in round 2 and refined in round 3.

RESULTS

Consensus of 75% or more was reached to include 18 modules into the intervention. These were divided into seven sections: understanding vision loss, emotional wellbeing, functional wellbeing, social wellbeing, physical wellbeing, wellbeing for carers and maintaining wellbeing. The accessibility features deemed most important were font size, colour and contrast options, compatibility with low vision aids and layout of the intervention.

CONCLUSIONS

The Delphi process positively informed the design of an internet-based intervention for individuals with acquired VI and their caregivers. Suggestions provided by stakeholders should now be incorporated into the intervention. Future evaluation of efficacy and cost-effectiveness of such an intervention are necessary.

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.

The physical characteristics underpinning performance of wheelchair fencing athletes: A Delphi study of Paralympic coaches

Wheelchair fencing (WF) is a Paralympic sport which is practised by athletes with physical disabilities and is classified into three categories according to the degree of activity limitation the impairment causes in the sport. All Paralympic sports are requested to develop their own evidence-based classification system to enhance the confidence in the classification process; however, this is yet to be achieved in WF. Research within WF is scarce; therefore, the aim of this study was to reach expert consensus on the physical characteristics that underpin performance of athletes competing in the sport as this is known as one of the initial steps required to achieve an evidence-based classification system. Sixteen Paralympic WF coaches were invited to take part in a three-round Delphi study, with experts drawing consensus on qualities of speed, strength, power, flexibility and motor control of the trunk and fencing arm being associated with increased athletic success. The required qualities of the non-fencing arm led to diverging opinions across the expert panel. This study provides clear guidance of the physical qualities to be developed to maximize athletic performance while also providing the initial framework to guide future WF classification research.

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.

Using Decision Trees to Support Classifiers' Decision-Making about Activity Limitation of Cerebral Palsy Footballers

This study aimed (1) to determine the appropriateness of using decision trees as a classification tool for determining the allocation of sport classes of para-footballers with "moderate vs. mild" cerebral palsy (CP) profiles of spastic diplegia/hemiplegia and ataxia/athetosis based on observational outcomes by international classifiers, and (2) to identify what key observational features were relevant to discriminating among different impairment levels. A sample of 16 experienced international classifiers from five world regions participated in this study, observing activity limitation of a final sample of 21 international CP footballers when performing 16 gross-motor and sports-specific tests for balance (n = 3), coordination (n = 5), running, accelerations and decelerations (n = 3), jumping (n = 4), and change of direction ability (n = 1). For the overall sample (336 observations), the model included eight decision nodes and 24 branches with 17 leaves, including side-step, side-stepping, and triple hop as the tests with the best sensitivity (precision = 67.0%). For those with spastic diplegia (64 observations: Two nodes, six branches with five leaves), the range of motion in the side-step test and the balance in the tandem walk tests correctly classified 89.1% of the observations. In those with athetosis and ataxia (96 observations), the model included five nodes, 15 branches, and 11 leaves (176 observations, precision = 86.5%). For those with spastic hemiplegia, a model containing two nodes, six branches, and five leaves had 90.9% accuracy, including observational features of balance in the side-step test and symmetry in the side-stepping test. The observational tool used in this study, based on the impact of specific impairment measurements of hypertonia, athetosis, and ataxia, can be used to determine which assessments are more appropriate for discriminating between functional profiles in para-footballers with CP.

Do visual fields need to be considered in classification criteria within visually impaired shooting?

Classification within the sport of vision impairment (VI) shooting is based upon the athlete's visual function. This study aimed to determine whether more than one class of competition is needed within VI shooting on the basis of visual field loss. Qualification scores of 23 elite athletes were obtained at World Championship events in prone and standing shooting disciplines. Visual field data were obtained from classification data and from assessment at events. A standardized scoring protocol determined whether athletes had function (≥10 dB) or no function (<10 dB) at locations between 0-60 degrees eccentricity along 10 meridia. Visual field function was not associated with shooting performance in prone or standing disciplines (p > 0.05). Having measurable visual field function beyond 30 degrees made no difference to athletes' ability to shoot competitively in prone (p = 0.65) or standing disciplines (p = 0.47), although a potential impact on qualification was observed in the standing discipline. There was no evidence that loss of visual field function at any specific location adversely affected ability to shoot competitively. There is currently no evidence to consider visual fields in classification within prone or standing VI shooting, although further research is needed as the sport grows.

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.

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.

Acupuncture Therapy for Cognitive Impairment: A Delphi Expert Consensus Survey

Background

Current research evidence challenges clinical decision-making when acupuncture is taken into consideration in the treatment of cognitive impairment (CI). Aiming to provide some viable recommendations for acupuncture practitioners in dealing with actual clinic issues, an expert consensus study was conducted.

Methods

A clinical question investigation among 47 acupuncturists yielded 24 initial items. Subsequently, systematic reviews on acupuncture for CI were searched within three online databases. A panel of 30 authoritative experts were requested to respond with agreement, neutrality, or disagreement for each item. Consensus establishment was defined as the percentage of agreement on a given item >80%.

Results

Following a 2-round Delphi survey, there were 21 items reaching consensus and three items resulting in no consensus; of which 10 items reached 90∼100% agreement, and 80∼90% expert agreement was achieved for 11 items. These items could be roughly categorized into six domains: (1) therapeutic effects of acupuncture, (2) therapeutic principles, (3) acupoint selection and combination, (4) acupuncture parameters, (5) considerable combined therapies, and (6) possible adverse events.

Conclusion

Without ready-made guidelines, this expert consensus may be conducive to guide acupuncturists in implementing clinical acupuncture practice for CI. Moreover, given the lack of high-quality research evidence and plenty of unresolved clinical issues in this field, it is of necessity to carry out more studies to better clarify the treatment algorithm.

Minor effect of inaccurate fixation on VEP-based acuity estimates

PURPOSE

VEP-based estimation of visual acuity may be used in cases of suspected malingering to objectify subjective complaints. In such an application, a lack of cooperation needs to be expected. The same may apply to young children with suspected functional impairments. In the present study, we assessed how inaccurate fixation affects the acuity estimates obtained with a VEP technique.

METHODS

VEP-based acuity estimates were obtained by stimulating with a series of different check sizes using a 'stepwise sweep' protocol. Sixteen participants were tested with normal and degraded vision under five different fixation conditions (central fixation and eccentric fixation at top, bottom, right, and left edge of the stimulus area).

RESULTS

The majority of individual acuity estimates with eccentric fixation differed by less than 0.1 logMAR from central fixation, and almost all estimates differed by less than 0.3 logMAR. Median estimates with eccentric fixation differed only slightly (up to 0.08 logMAR) and, except for top fixation with normal vision, non-significantly. However, data quality was lower with eccentric fixation, which increased the probability that no acuity estimate could be derived from the recording.

CONCLUSION

VEP-based acuity estimates are relatively insensitive to eccentric fixation. Unnoticed deviations from central fixation in routine applications will probably be smaller than in the present study and will have even less impact on the outcome.

Towards developing a test of global motion for use with Paralympic athletes

The Paralympic classification system for visual impairment only assesses static visual acuity and static visual field despite many Paralympic sports being dynamic in nature. As a first step towards determining whether motion perception tests should be used in Paralympic classification, we assessed whether motion coherence thresholds could be measured when visual acuity or visual fields were impaired at levels consistent with the current Paralympic classification criteria. Visual acuity and visual field impairments corresponding to Paralympic classification criteria were simulated in normally sighted individuals and motion coherence thresholds were measured. Mild-to-moderate visual acuity impairments had no effect on motion coherence thresholds. The most severe Paralympic class of acuity impairment (≥2.6 logMAR) significantly elevated thresholds. A trend towards superior motion coherence thresholds in the peripheral visual field compared to the central visual field was also present. Global motion perception appears to be measurable under simulated visual impairments that are consistent with the Paralympic classification. Poorer global motion perception was found for visual acuities >2.6 logMAR and visual fields <10° in diameter. Further research is needed to investigate the relationship between global motion perception and sports performance in athletes with real visual impairment.

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

Classification is a defining characteristic of para-sports whereby eligible athletes are allocated a sport class to compete against others with similar activity limitations. To account for the unique characteristics of each sport, para-sports should develop their own classification system using evidence that demonstrates the impact of impairment on performance in that sport. Although the move towards sport-specific classification has progressed in sports for athletes with physical and intellectual impairments, sports for athletes with vision impairment (VI) continue to use the same three classes irrespective of the sport, with classes delineated by legal definitions of low vision and blindness. The aim of this joint International Paralympic Committee/International Blind Sports Federation (IPC/IBSA) Position Stand is to provide guidance for how evidence-based sport-specific classification should be achieved in VI sports. It does so by outlining three conceptual research models (correlation, simulation, and component analysis) that can be used to establish both the minimum impairment required to compete plus the appropriate number of sport classes and their inclusion criteria. The present evaluation of vision relies on measures of visual acuity and field, but new criteria may require a sport-specific combination of additional measures of visual function (e.g. contrast, motion, and light sensitivity) to better account for the impact of VI on sport performance. Moreover, the test procedures used during athlete evaluation (e.g. whether to evaluate both eyes individually or together) should be chosen to better represent the habitual viewing situation experienced in that sport. The development of sport-specific criteria should enhance the legitimacy of competition and encourage increased grassroots participation in VI sports.

Kinetics of Muscle Damage Biomarkers at Moments Subsequent to a Fight in Brazilian Jiu-Jitsu Practice by Disabled Athletes

Purpose: Evidence indicates that muscle injury caused by exercise can lead to functional, biochemical, and clinical damage. These outcomes encompass an intrinsic potential to understand the real magnitude of interpretation of classic signs in sport environments and to monitor athletes, contributing to specific actions. However, little or no research has explored the general behavior of the variables presented in response to paradesportivo Brazilian jiu-jitsu. The objective of this study was to investigate the physiological behavior through clinical, functional, and metabolic outcomes in the moments following a simulated fight. Methods: Six disabled athletes, male Brazilian jiu-jitsu practitioners (34-44 years old), were included. The participants had their outcomes analyzed individually and the variables studied were correlated. It is noteworthy that participants I and II are professional athletes with world titles. The ethics committee involving human beings of the Federal University of Mato Grosso (register no. 2.997.241) accepted the study. The participants attended the collection site four times, with a 24-h interval between sessions, characterizing the following moments: pre-exertion, and post-exertion, 24, 48, and 72 h after the simulated fight. Data collected were muscle pain, perception of recovery, muscle strength, and blood samples for creatine kinase (CK) and lactate dehydrogenase (LDH) analysis. The variables described were measured at all collection moments. The data were presented in individual raw values of each participant, with Spearman correlation analysis to verify the relationship between variables and moments. Results: The outcomes demonstrated that the CK and LDH activity was higher of high-performance parathletes (I and II) and the reported muscle pain was lower. The fight did not influence maximal isometric strength levels in either participant. In addition, regarding delayed effects, the participants reported peak pain, CK, LDH, and decreased perception of recovery within 24 h. However, it was found that, at 72 h, all values had recovered, close to baseline levels. Conclusion: The presented outcomes provide parameters and suggest a safe scenario based on the intensity and volume commonly adopted in this sports parade modality where the level of effort recommended during combat does not seem to cause deleterious damage.

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 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.

The Level of Vision Necessary for Competitive Performance in Rifle Shooting: Setting the Standards for Paralympic Shooting with Vision Impairment

The aim of this study was to investigate the level of vision impairment (VI) that would reduce performance in shooting; to guide development of entry criteria to visually impaired (VI) shooting. Nineteen international-level shooters without VI took part in the study. Participants shot an air rifle, while standing, toward a regulation target placed at the end of a 10 m shooting range. Cambridge simulation glasses were used to simulate six different levels of VI. Visual acuity (VA) and contrast sensitivity (CS) were assessed along with shooting performance in each of seven conditions of simulated impairment and compared to that with habitual vision. Shooting performance was evaluated by calculating each individual’s average score in every level of simulated VI and normalizing this score by expressing it as a percentage of the baseline performance achieved with habitual vision. Receiver Operating Characteristic curves were constructed to evaluate the ability of different VA and CS cut-off criteria to appropriately classify these athletes as achieving ‘expected’ or ‘below expected’ shooting results based on their performance with different levels of VA and CS. Shooting performance remained relatively unaffected by mild decreases in VA and CS, but quickly deteriorated with more moderate losses. The ability of visual function measurements to classify shooting performance was good, with 78% of performances appropriately classified using a cut-off of 0.53 logMAR and 74% appropriately classified using a cut-off of 0.83 logCS. The current inclusion criteria for VI shooting (1.0 logMAR) is conservative, maximizing the chance of including only those with an impairment that does impact performance, but potentially excluding some who do have a genuine impairment in the sport. A lower level of impairment would include more athletes who do have a genuine impairment but would potentially include those who do not actually have an impairment that impacts performance in the sport. An impairment to CS could impact performance in the sport and might be considered in determining eligibility to take part in VI competition.