Coordination Impairments

Spasticity (Hypertonia): 1. Athletes have neurological impairments affecting all four limbs and trunk (upper motor neuron pattern). 2. Spasticity present as Grade 2 on the Australian Spasticity Assessment Scale (ASAS) in at least 2 of the following joints of the throwing arm: Shoulder; Elbow & Forearm (pronation/supination); Wrist. 3. Involvement of the hand must also be present. Minimal impairment cannot be based on hand involvement alone. 4. For BC1 Footplayers: Spasticity Grade 2 on the ASAS in at least 2 of the 3 following joints: Hip; Knee; Ankle. 5. If an athlete meets the spasticity criteria in only one of the above joints in the upper or lower limb, there must be another coordination impairment present (e.g., dyskinesia) which meets the MIC for that impairment.

Ataxia: 1. Athletes have neurological impairments affecting all four limbs and trunk (upper motor neuron pattern). 2. Ataxia is present with scores of 2-3 on the Scale for the Assessment and Rating of Ataxia (SARA) in the following tests: Finger chase; Nose-finger test; Alternating hand movements; Footplayer: heel-shin slide.

Athetosis / Dystonia (Dyskinesia): 1. Athletes have neurological impairments affecting all four limbs and trunk (upper motor neuron pattern). 2. Dyskinesia is present in >10% but <50% of the duration of movement (DIS score 2) and the amplitude of involuntary movement/deviation scores 2-3 on the Dyskinesia Impairment Scale (DIS).

Spasticity = grade 2-1 on impaired side. Impairment noted on upper limb co-ordination tests compared to non-affected side. Equivalent activity limitation to below elbow amputation.

May present with Athetosis or Ataxia. Will present with Babinski, Clonus and/or Brisk/Different reflexes. Spasticity = grade 2-1 on impaired side. Ambulant without assistive devices, but will present with a limp. Single leg stance on impaired side greater than 3 sec. Able to hop on impaired side, but difficulty remaining on one spot. Side step towards impaired side more labored than intact side. Able to heel walk, approx. 2m.

The following Minimum Impairment Criteria are exactly the same for throwing as for running Events: Hypertonia (Section 2.1.1); Ataxia (Section 2.1.2); Athetosis (Section 2.1.3).

One of the following types of hypertonia must be clearly clinically detectable – i.e., grade 1 on the Ashworth scale at the wrist, elbow, shoulder, ankle, knee or hip: Spastic hypertonia (a velocity-dependent resistance to passive movement with a clasp-knife type of resistance); Rigidity (a heightened resistance to passive movement of a limb that is independent of the velocity of stretch and relatively uniform throughout the range of motion); or Dystonia (resistance to passive movement that may be focal or general, with contractions that are powerful and sustained and cause twisting or writhing of the affected areas).

To be eligible for frame running Events, the Athlete with Hypertonia must meet the following criteria: Grade 3 or higher in at least one muscle group (typically the plantar flexors); AND a total score of 10 or more in the spasticity assessment.

The following Minimum Impairment Criteria are exactly the same for throwing as for running Events: Hypertonia (Section 2.1.1); Ataxia (Section 2.1.2); Athetosis (Section 2.1.3).

To be eligible for frame running Events, the Athlete with ataxia must meet the following criteria: a total score of 7 or more; AND a score of at least 1 in the heel-shin test; AND a score of at least 1 in the standing test; AND a score of at least 2 in the gait test. (Total maximum score is 26, combining Sitting, Standing, Gait, Heel-shin and Finger-to-nose tests.)

When evaluating an Athlete the Classification Panel must be satisfied that the ataxic movement is demonstrable and clearly evident during Classification and that the observed ataxia is due to motor or sensory nervous system dysfunction. Tests that may be useful for determining this include but are not limited to: Finger-to-nose test 1; Finger-to-nose test 2; Toe-to-finger test; Heel shin test; Tandem walk; Gait.

The following Minimum Impairment Criteria are exactly the same for throwing as for running Events: Hypertonia (Section 2.1.1); Ataxia (Section 2.1.2); Athetosis (Section 2.1.3).

Clearly evident athetosis is unwanted movement and posturing that is characteristically athetoid and is observable as at least one of the following: Involuntary movement of the fingers or upper extremities despite the Athlete trying to remain still; Involuntary movement of the toes or lower extremities despite the Athlete trying to remain still; Inability to hold the body still – swaying of the body (not exacerbated by closing of the eyes); Characteristic athetoid posturing of limbs and/or trunk. The Athlete will not be eligible if athetoid movements of the face are the sole Impairment.

To be eligible for frame running Events, an Athlete with athetosis must have dyskinesia assessment scores of 2 or higher for both amplitude and duration for the active legs in both toe tapping tasks, i.e., heel-toe tapping in sitting (task D) and alternate toe tapping in supine lying (task E).

Non-playing arm: Spastic/ataxic/athetoid hemiplegia/diplegia/monoplegia with moderate involvement of upper limb but very mild involvement of lower limbs. Demonstrate a limitation in function based on spasticity, ataxia, athetosis or dystonic movements while performing during match or training. Clear evidence must include spasticity grade 1-2 in the affected upper limb. A clear difference needs to be demonstrated between active ranges of motion vs. passive. In addition, a clear difference between fast PROM against slow PROM needs to be demonstrated. All of the above, plus one of the criteria below: 1) Upper motor neuron reflex pattern must demonstrate: Clear unilateral clonus 4 beats or more; Noticeably brisk reflexes or clear difference in reflexes non-playing vs. playing arm. 2) Dysdiadochokinesia. 3) Dyssynergia and dysmetria. 4) In arm monoplegia the elbow must be involved with limitations in ROM. 5) For ataxia and athetosis, the Player must have clear signs of cerebellar dysfunction with incoordination of the upper limb.

The following four criteria should apply: (1) Spastic/ataxic/athetoid hemiplegia/diplegia/quadriplegia with marked involvement of lower limb but with no or only mild impairment of upper limbs. (2) Demonstrate a limitation in function based on spasticity, ataxia, athetosis or dystonic movements while performing during match or training. The Player walks or runs with a limp due to spasticity in the lower limb. (3) Clear evidence must include spasticity grade 2-3 in the affected lower limb. A clear difference needs to be demonstrated between active ranges of motion vs. passive. In addition, a clear difference between fast PROM against slow PROM needs to be demonstrated. (4) The Player has difficulty walking on his heel on the impaired side and has significant difficulty with hopping and balancing and side stepping on the impaired leg or side. Plus ONE of these signs: 1) Upper motor neuron reflex pattern must be demonstrated (one of the following signs): Positive unilateral Babinski. Clear unilateral clonus four beats or more. Noticeably brisk reflexes or clear difference in reflexes left vs. right leg. 2) Irregular migrating contraction (chorea) and/or writhing movements (athetoid). 3) Leg length difference and/or difference of muscle bulk of more than 2 cm. 4) Dysmetria and/or dyssynergia.

Spastic/ataxic/athetoid hemiplegia/diplegia/quadriplegia with severe involvement of lower limb but with no or mild involvement of upper limbs or trunk. Demonstrate a limitation in function based on spasticity, ataxia, athetosis or dystonic movements on the legs requiring the use of assistive devices in walking. A shift of centre of gravity may lead to loss of balance e.g. attempting to pivot or stop and start. Clear evidence must include spasticity grade 3 on the legs usually rendering them non-functional for ambulation over a long distance without the use of assistive devices.

Hypertonia/Spasticity Hypertonia must be present at least one (1) long bone joint in at least one (1) limb with a minimum Modified Ashworth Scale score of two (2). Where dystonia is present variability in Modified Ashworth Scale score is acceptable. Hypertonia must impact on climbing ability. Motor Ataxia Athletes must demonstrate an observable moderate-level involvement in one (1) or mild-level involvement in at least two (2) limbs. Ataxia must impact on climbing ability. Dyskinesia Athletes must demonstrate an observable moderate-level involvement in one (1) or mild-level involvement in at least two (2) limbs. Dyskinesia must impact on climbing ability.

Spasticity grade 1 in the affected arm or leg plus clear neurological signs to demonstrate Upper Motor Neuron lesion such as: Positive unilateral or bilateral Hoffman/Babinski; Noticeably brisk reflexes or clear differences in reflexes left versus right.

Occasional and mild or subtle signs of Ataxia (reference to SARA scale).

Occasional Dyskinesia signs with mild or subtle intensity or amplitude of movement (reference to DIS Scale). Unilateral or bilateral (symmetrical/asymmetrical)

An Athlete will be allocated a total point score for the Physical Assessment (based on individual point scores awarded in the Physcial Assessment tests). An Athlete must lose a minimum of fifteen (15) points in the Physical Assessment (scoring resulting from Sections 4-7 of this Appendix) to continue to the Technical Assessment. If fifteen (15) points are not lost after the Physical Assesement the Athlete must be allocated Not Eligible (NE) and the Technical Assessment will not be conducted. If following the Technical Assessment, the Athlete loses less than fifteen (15) points, the Athlete is deemed Not Eligible (NE).

To be eligible, an athlete must have spastic or rigid hypertonia, or dystonia. An athlete meets MIC if they comply with the following criteria: Minimum Grade 1 on the Ashworth Scale in one of the following: Hip adductors, Hip extensors, Hip flexors, Knee flexors, Knee extensors, Ankle plantarflexors, Ankle dorsiflexors.

Ataxia is to be assessed using the Scale for the Assessment and Rating of Ataxia (SARA). An athlete meets MIC if they comply with the following criteria: A minimum score of 2 on the SARA in each of i) Gait, ii) Stance and iii) Heel-shin slide.

Athetosis is to be assessed using the Dyskinesia Impairment Scale. A Player meets MIC if they comply with the following criteria: A minimum Grade 1 Duration and Amplitude on the DIS for both i) Standing and ii) Heel-toe raising.

For Wheelchair Curling, only lower-limb Hypertonia is considered in Athlete Evaluation. Minimum Impairment Criteria: Hypertonia in the both lower limbs graded using the modified Ashworth Scale at grade 3 or grade 4 across 2 or more of the large joints (hip, knee, ankle) in each leg, or all 3 joint in one leg.

For Wheelchair Curling, only lower-limb Ataxia is considered in Athlete Evaluation. Minimum Impairment Criteria: Score of 2 or less (normal = 6) on the coordination tests defined in Article 3.2, Appendix One.

For Wheelchair Curling, only lower-limb Athetosis is considered in Athlete Evaluation. Minimum Impairment Criteria: Score of 2 or less (normal = 6) on the coordination tests defined in Article 3.2, Appendix One.