Impaired Muscle Power

1. Definition Athletes who are diagnosed with a neuro-muscular skeletal impairment where the primary impairment is impaired muscle power affecting all four limbs and trunk that results in a permanent reduction of function. 2. Trunk Manual Muscle Test (MMT) score of Grade 3 or less in each of the following: Trunk flexors; Trunk extensors; Trunk lateral flexors; Trunk rotators. 3. Upper Limbs (Throwing & Non-Throwing Arms) Athletes must demonstrate MMT Grade 3 or less in the muscle groups producing movement around all four joints: Shoulder: flexors, extensors, abductors, internal rotators, external rotators; Elbow: flexors, extensors; Forearm: pronators, supinators (documented for overall strength); Wrist: flexors, extensors. 4. Hand Finger flexors, finger extensors, and thumb opposition are tested and documented to describe the overall strength pattern. Hand strength is not required to meet MIC, as some health conditions lead to proximal weakness first, with hand strength relatively preserved despite shoulder/elbow weakness. Examples of such conditions include Duchenne Muscular Dystrophy (DMD), Becker Muscular Dystrophy, Congenital Myopathies, and Spinal Muscular Atrophy (proximal forms).

Equivalent activity limitation to that of an Athlete with a unilateral below elbow amputation.

Total score of 30 or less (normal = 40) in one leg on the Oxford Scale.

Impaired Muscle Power – Lower Limb. Met if one lower limb meets one or more of 7 primary criteria, OR two or more of 5 secondary criteria. Primary: 1. Hip flexion loss of 3 muscle grade points (muscle grade of two). 2. Hip extension loss of 3 muscle grade points (muscle grade of two). 3. Hip abduction loss of 3 muscle grade points (muscle grade of two). 4. Hip adduction loss of 4 muscle grade points (muscle grade of one). 5. Knee extension loss of 3 muscle grade points (muscle grade of two). 6. Ankle plantar flexion loss of 3 muscle grade points (muscle grade of two). 7. At least two of the following three muscle actions must have a loss of 3 points each: Ankle Dorsiflexion, Ankle Eversion, and Ankle Inversion. Secondary (5 principal muscle actions: Hip Flexion, Hip Extension, Hip Abduction, Knee Extension, Ankle Plantar Flexion): a total loss of 6 muscle grade points in one limb across two or more of these actions, with at least two of the actions showing a loss of 2 points each.

Impaired Muscle Power – Upper Limb, eligible for all running (100m–marathon) and jumping Events. Meet one or more of the following 3 criteria: 1. Shoulder flexion loss of 3 muscle grade points (muscle grade of two). 2. Shoulder extension loss of 3 muscle grade points (muscle grade of two). 3. Elbow flexion loss of 3 muscle grade points (muscle grade of two). (Elbow extension and muscle power of the wrist and fingers are not assessed.)

Impaired Muscle Power – Upper Limb, eligible ONLY for running Events from 100m to 400m and jumping Events (meets these but not Section 2.1.6.2.1). Meet one or more of the following 2 criteria: 1. Loss of 3 muscle grade points in elbow extension (i.e., grade 2 elbow extensors). 2. A loss of 3 muscle grade points (i.e., muscle grade of 2) in wrist flexion AND wrist extension.

Unilateral upper limb Impaired Muscle Power, eligible for throwing Events (criteria differ from running/jumping Events; assessed against the throwing-specific reference ranges of movement in Table 3). Meet one or more of the following: 1. Shoulder abduction loss of 3 muscle grade points (i.e., grade 2 shoulder abductors). 2. Loss of 2 muscle grade points in BOTH elbow flexion AND elbow extension (i.e., grade 3 elbow extensors and flexors) -- both parts of this criterion must be met.

Bilateral upper limb Impaired Muscle Power, eligible for throwing Events (criteria differ from running/jumping Events; both upper limbs must separately meet the MIC). Met if each upper limb meets one or more of the following seven primary criteria, OR the secondary criteria below. Primary: 1. Shoulder abduction loss of 3 muscle grade points (grade 2 shoulder abductors). 2. Shoulder horizontal flexion loss of 3 muscle grade points (grade 2). 3. Shoulder internal rotation loss of 3 muscle grade points (grade 2). 4. Shoulder external rotation loss of 4 muscle grade points (grade 1). 5. Elbow flexion loss of 4 muscle grade points (grade 1). 6. Elbow extension loss of 3 muscle grade points (grade 2). 7. Any two of the following four muscle actions each with a loss of 3 muscle grade points (grade 2): wrist flexion; wrist extension; finger extension; finger flexion. Secondary (each upper limb): a total loss of 4 points from a combination of shoulder abduction, shoulder horizontal flexion, shoulder internal/external rotation and elbow extension, with at least one of those movements having a loss of 2 points -- a loss of 1 point spread across four movements does NOT meet eligibility.

Impairment of Muscle Power that meets TWO of the following criteria in one or both limbs: 1) Hip flexion loss of 3 muscle grade points (muscle grade of two). 2) Hip extension loss of 3 muscle grade points (muscle grade of two). 3) Hip Abduction loss of 3 muscle grade points (muscle grade of two). 4) Hip Adduction loss of 3 muscle grade points (muscle grade of two). 5) Knee flexion loss of 3 muscle grade points (muscle grade of two). 6) Knee extension loss of 3 muscle grade points (muscle grade of two). 7) Ankle plantar flexion loss of 3 muscle grade points (muscle grade of two). 8) Ankle dorsiflexion loss of 3 muscle grade points (muscle grade of two). OR Back and Torso: Severely reduced mobility of a permanent nature, for example scoliosis measuring over 60 degrees curve as measured by the Cobb method. X-ray proof is necessary.

Impairment of Muscle power that meets either 1) FIVE of the following criteria in one lower limb OR 2) FOUR in one leg and TWO in the other leg: 1) Hip flexion loss of 3 muscle grade points (muscle grade of two). 2) Hip extension loss of 3 muscle grade points (muscle grade of two). 3) Hip Abduction loss of 3 muscle grade points (muscle grade of two). 4) Hip Adduction loss of 3 muscle grade points (muscle grade of two). 5) Knee extension loss of 3 muscle grade points (muscle grade of two). 6) Knee flexion loss of 3 muscle grade points (muscle grade 2). 7) Ankle plantar flexion loss of 3 muscle grade points (muscle grade of two). 8) Ankle dorsi flexion loss of 3 muscle grade points (muscle grade of two). OR Complete paraplegia L2 and below (neurological L2).

Non-playing arm: A unilateral upper limb impairment of muscle power that meets THREE of the following criteria: 1) Shoulder abduction loss of 3 muscle grade points (i.e., grade 2 shoulder abductors). 2) Shoulder forward flexion loss of 3 muscle grade points (i.e., grade 2 shoulder forward flexion). 3) Shoulder extension loss of 3 muscle grade points (i.e., grade 2 shoulder extension). 4) Loss of 2 muscle grade points in elbow flexion AND extension (i.e., grade 3 elbow extensors and flexors).

Impaired muscle power in one (1) or more limbs with at least one muscle group scoring 3 or less. Must have a cumulative deficit of at least six (6) points in muscle power testing.

Upper limb - Full loss of grip in one hand, inability to form and maintain a cylindrical grasp - Muscle Grade 0. Lower Limb - Inability to heel raise tested in single leg stance. Comparable incomplete spinal cord injury or comparable multiple impairment.

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).

A player meets MIC if they comply with one of the following criteria: A maximum of Grade 2 in at least one of the following muscle groups in either leg: Hip flexors, Hip extensors, Hip abductors, Hip adductors, Knee flexors, Knee extensors, Ankle plantarflexors, Ankle dorsiflexors. OR A maximum of Grade 3 in at least two of the following muscle groups in a single leg: Hip flexors, Hip extensors, Knee flexors, Knee extensors, Ankle plantarflexors. OR A maximum of Grade 3 in at least two of the following muscle groups across right and left legs (i.e. one in each leg): Hip flexors, Hip extensors, Knee flexors, Knee extensors, Ankle plantarflexors.

For Wheelchair Curling, only lower-limb Impaired Muscle Power is considered in Athlete Evaluation. Minimum Impairment Criteria: Loss of power in the lower limbs so that any residual power in the legs is less than a total of 40 in the manual muscle testing described in Article 3.1.2 (score for a leg with unimpaired muscle power = 80).