Cluster analysis of impairment measures to inform an evidence-based classification structure in RaceRunning, a new World Para Athletics event for athletes with hypertonia, ataxia or athetosis

Abstract

RaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled frame that has a saddle, handle bars and a chest plate. For RaceRunning to be included as a para athletics event, an evidence-based classification system is required. This study assessed the impact of trunk control and lower limb impairment measures on RaceRunning performance and evaluated whether clusters analysis of these impairment measures produce a valid classification structure for RaceRunning.The Trunk Control Measurement Scale (TCMS), Selective Control Assessment of the Lower Extremity (SCALE), the Australian Spasticity Assessment Scale (ASAS), and knee extension were recorded for 26 RaceRunning athletes. Thirteen male and 13 female athletes aged 24 (SD=7) years participated. All impairment measures were significantly correlated with performance (rho=0.55-0.74). Using ASAS, SCALE, TCMS and knee extension as cluster variables in a two-step cluster analysis resulted in two clusters of athlete. Race speed and the impairment measures were significantly different between the clusters (p<0.001). The findings of this study provide evidence for the utility of the selected impairment measures in an evidence-based classification system for RaceRunning athletes.

To What Degree Does Limb Spasticity Affect Motor Performance in Para-Footballers With Cerebral Palsy?

“…Subsequently, Beckman et al (2016) explored the relationships between (impaired) strength and running performance in 13 participants with eligible impairments of hypertonia, athetosis and, ataxia, but they did not find significant associations between these measurements. However, other studies with para-athletes with more severe impairment related to brain injuries reported significant associations among spasticity scores and speed in Race Running, suggesting the impact of the impairment on the sport-specific performance ( van der Linden et al, 2018 , 2020 ). The significant strength of the association (i.e., trivial-to-moderate) between spasticity and the physical tests obtained in the present study suggests a low impact of lower limbs’ spasticity on sports performance in para-footballers with a high level of proficiency (i.e., international-level and GMFCS Level 1).…”

“…According to the catch presence and the degree of resistance generated during the rapid passive stretching movement, a rating ordinal score was assigned to each evaluated muscle group, where 0 indicated no spasticity or catch on rapid passive movement and four affected part(s) rigid contracture segment but moves on slow passive movement ( Love et al, 2016 ). Even though the Modified Ashworth Scale is commonly utilized for both clinical and para-sport settings, the ASAS has been used in Paralympic sports which involve participants with CP, such as Race Running ( van der Linden et al, 2020 ), Boccia ( Reina et al, 2015 ), Para-cycling ( Liljedahl et al, 2020 ), and Para-taekwondo ( Para-Taekwondo, 2021 ). Additionally, ASAS was also utilized in adults with brain injuries ( Calame and Singer, 2015 ), and showed good inter-rater reliability (weighted kappa = 0.87; ICC = 0.88) in the assessment of children with CP ( Love et al, 2016 ).…”

“…In this study, spasticity scores are reported for the hip (adductors), knee (flexors and extensors) and ankle (dorsiflexors and plantiflexors) for both the more-impaired and less-impaired sides of the body. For the statistical analysis, the muscle spasticity assessment results were summed in each principal joint to provide an overall total score, like previous procedures used in studies of the literature in evidence-based classification and para-sport ( van der Linden et al, 2018 , 2020 ).…”

“…The SEM was calculated by using the formula: SEM = . The summation of ordinal scores related to spasticity assessment was used to analyze the association with the performance of activity limitation tests, as was done in previous studies with para-athletes with brain injuries ( van der Linden et al, 2018 , 2020 ). Pearson’s correlation coefficient ( r ) analysis was used to examine the relationship between the spasticity scores and the performance in the activity limitation tests.…”

“…At present, classification methods for assessing spastic hypertonia in para-sport are based, principally, on manual testing of overreacting muscle resistance to rapid stretch generated due to increased reflex activity, where it is not possible to differentiate between neural (e.g., spasticity, hyperreflexia) and non-neural (e.g., change of muscle properties) contributors to joint resistance ( Dietz and Sinkjaer, 2007 ; de Gooijer-van de Groep et al, 2013 ). Considering that earlier investigations described the association between the level of spasticity and sport-specific performance in para-athletes with high support needs of Race Running ( van der Linden et al, 2018 , 2020 ), no study has examined the relationship of these type of impairment measures in CP para-athletes with a more functional profile (i.e., ambulatory para-athletes without mobility technical devices). Therefore, this study aimed to assess the association of clinical spasticity measurements with the performance of a sport-specific test (i.e., activity limitation testing) in CP footballers, also considering their impairment profile of spasticity (i.e., unilateral/hemiplegia or bilateral/diplegia).…”