The Classification Code of the International Paralympic Committee (IPC), inter alia, mandates the development of evidence-based systems of classification. This paper provides a scientific background for classification in Paralympic sport, defines evidence-based classification and provides guidelines for how evidence-based classification may be achieved. Classification is a process in which a single group of entities (or units) are ordered into a number of smaller groups (or classes) based on observable properties that they have in common, and taxonomy is the science of how to classify. Paralympic classification is interrelated with systems of classification used in two fields: Health and functioning. The International Classification of Functioning, Disability and Health is the most widely used classification in the field of functioning and health. To enhance communication, Paralympic systems of classification should use language and concepts that are consistent with the International Classification of Functioning, Disability and Health. Sport. Classification in sport reduces the likelihood of one-sided competition and in this way promotes participation. Two types of classification are used in sport-performance classification and selective classification. Paralympic sports require selective classification systems so that athletes who enhance their competitive performance through effective training will not be moved to a class with athletes who have less activity limitation, as they would in a performance classification system. Classification has a significant impact on which athletes are successful in Paralympic sport, but unfortunately issues relating to the weighting and aggregation of measures used in classification pose significant threats to the validity of current systems of classification. To improve the validity of Paralympic classification, the IPC Classification Code mandates the development of evidence-based systems of classification, an evidence-based system being one in which the purpose of the system is stated unambiguously; and empirical evidence indicates the methods used for assigning class will achieve the stated purpose. To date, one of the most significant barriers to the development of evidence-based systems of classification has been absence of an unambiguous statement of purpose. To remedy this, all Paralympic systems of classification should indicate that the purpose of the system is to promote participation in sport by people with disabilities by minimising the impact of eligible impairment types on the outcome of competition. Conceptually, in order to minimise the impact of impairment on the outcome of competition, each classification system should: describe eligibility criteria in terms of: type of impairment and severity of impairment; describe methods for classifying eligible impairments according to the extent of activity limitation they cause. To classify impairments according to the extent of activity limitation they cause requires research that develops objective, reliable measures...

Paralympic classification systems aim to promote participation in sport by people with disabilities by controlling for the impact of impairment on the outcome of competition. Valid systems of classification ensure that successful athletes are those who have the most advantageous combination of anthropometric, physiological, and/or psychological attributes, and who have enhanced them to the best effect. Classification systems that are not valid pose a significant threat to Paralympic sport and, therefore, the International Paralympic Committee (IPC) has a Classification Code which includes policy commitment to the development of evidence-based methods of classification. The aim of this article is to provide an overview of current best practice in classification for athletes with physical impairments, and to update research advances in the area. Currently, classification has 4 stages: (1) establish whether the athlete has a health condition that will lead to one or more of the 8 eligible types of physical impairment, (2) determine whether the athlete has an eligible impairment type, (3) determine whether the impairment is severe enough, and (4) determine in what class the athlete should compete. A sequential 4-step process that outlines how to initiate and develop evidence-based methods of classification is described: (1) specification of impairment types that are eligible for the sport; (2) development of valid measures of impairment(s); (3) development of standardized, sport-specific measures of performance; and (4) assessment of the relative strength of association between measures of impairment and measures of performance. Of these, the development and reporting of valid measures of impairment is currently the most pressing scientific challenge in the development of evidence-based methods of classification.

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain.

To evaluate the validity of the ActiGraph accelerometer for the measurement of physical activity intensity in children and adolescents with cerebral palsy (CP) using oxygen uptake (VO(2)) as the criterion measure. Thirty children and adolescents with CP (mean age 12.6 ± 2.0 years) wore an ActiGraph 7164 and a Cosmed K4b(2) portable indirect calorimeter during four activities; quiet sitting, comfortable paced walking, brisk paced walking and fast paced walking. VO(2) was converted to METs and activity energy expenditure and classified as sedentary, light or moderate-to-vigorous intensity according to the conventions for children. Mean ActiGraph counts min(-1) were classified as sedentary, light or moderate-to-vigorous (MVPA) intensity using four different sets of cut-points. VO(2) and counts min(-1) increased significantly with increases in walking speed (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that, of the four sets of cut-points evaluated, the Evenson et al. (J Sports Sci 26(14):1557-1565, 2008) cut-points had the highest classification accuracy for sedentary (92%) and MVPA (91%), as well as the second highest classification accuracy for light intensity physical activity (67%). A ROC curve analysis of data from our participants yielded a CP-specific cut-point for MVPA that was lower than the Evenson cut-point (2,012 vs. 2,296 counts min(-1)), however, the difference in classification accuracy was not statistically significant 94% (95% CI = 88.2-97.7%) vs. 91% (95% CI = 83.5-96.5%). In conclusion, among children and adolescents with CP, the ActiGraph is able to differentiate between different intensities of walking. The use of the Evenson cut-points will permit the estimation of time spent in MVPA and allows comparisons to be made between activity measured in typically developing adolescents and adolescents with CP.