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21 November 2015

IWRF Classifier Viola Altmann to Defend PhD on Friday

By Viola Altmann


The Paralympic Games are the third-largest sporting event in the world. A challenge to the interest of Paralympic sport is the threat for one sided and predictable outcomes, in which the least impaired athlete would have the best chance to win. To prevent this, Paralympic athletes are classified for competition based on impairment. Athletes are classified by classifiers with a medical or sport-technical background. With the increasing professionalism of Paralympic sport, development towards evidence-based classification is necessary.


Classification of trunk impairment was prioritized as the area of classification that needed improvement by athletes and stakeholders in wheelchair rugby. In this thesis the development towards evidence-based classification of trunk impairment is described, following the steps that were outlined in the Position Stand of the International Paralympic Committee.


In a first step, the existing literature about trunk impairment and the impact on wheelchair activities was assessed. Evidence was found that trunk impairment in persons with Spinal Cord Injury (SCI) does impact on reaching in a seated position and maintaining balance after a perturbation. No evidence was found for impact of trunk impairment caused by other health conditions and no evidence was found for impact on other wheelchair activities.


A new Trunk Impairment Classification system (TIC) was developed. The TIC is independent of the health condition that causes trunk impairment. Classification using the TIC results in one of four possible TIC scores (0, 0.5, 1.0 or 1.5) with the lowest score indicating the most severe trunk impairment. The inter-rater reliability was tested and was found to be sufficient. This means one athlete is allocated the same TIC score by several classifiers who apply the TIC.


After that, the construct validity of the TIC was evaluated. This means: does the TIC measure what it intends to measure? It was found that the TIC indeed measures all severity of trunk impairment. However, for moderate to mild trunk impairment and coordination impairment of the trunk, additional research is needed. Furthermore, the TIC score showed an impact on activities that determine proficiency in the collision oriented sport wheelchair rugby: acceleration to prevent a hit, impulse of a hit, and tilting the wheelchair to escape from a block by other wheelchairs.


Finally, the direct relation between trunk strength and activities in wheelchair rugby was assessed. Although a high correlation was found, no clear cut-off points were detected, except for tilting the chair. This means there was no particular value for trunk strength that indicated a clear increase or decrease in performance in all other activities than tilting the chair.


It was concluded that trunk impairment does have an impact on proficiency in wheelchair rugby and possibly on proficiency in other wheelchair sports and as such should be classified. The TIC is a scale that can measure trunk impairment, independent of a particular health condition.


Future research on classification of trunk impairment should focus on moderate to mild trunk impairment and on coordination impairment of the trunk. Furthermore, additional research is needed to determine the optimal number and boundaries of each TIC score.


Viola Altmann


On Friday, November 27th, long time Level 4 IWRF Classifier Viola Altmann will publicly defend her thesis about the impact of trunk impairment on wheelchair activities with a focus on wheelchair rugby in Leuven, Belgium. If successful she will finally earn the PhD that she has been studying and working so hard for the past several years. 


The IWRF and the global Wheelchair Rugby Family are proud of the contributions that Viola has generously shared with our sport, and wish her the very best of luck in the final stages to acquire her PhD.