T34

Diplegic - Moderate to Severe involvement. Good functional strength with minimal limitation or control problems noted in upper limbs and trunk.

Upper extremities - the upper limbs often show normal functional strength. Minimal limitation of range of movement may be present but close to normal follow through and propulsion is observed when throwing or wheeling. With hand function, normal cylindrical/spherical opposition and prehensile grasp is seen in all sports. Limitation if any is usually apparent only during rapid fine motor tasks. It must be remembered that diplegia implies that there is more spasticity in the lower than the upper extremities. Some involvement spasticity Grade 2 to 1 can be seen particularly in functional movements of the hands, arms and trunk.

Trunk - Spasticity Grade 2 to 1. Minimal limitation of trunk movements when propelling a wheelchair. In some Athletes fatigue can increase spasticity which can be overcome with proper positioning. When standing, poor balance is obvious even using assistive devices.

Lower Extremities - Moderate to severe involvement in both legs Spasticity Grade 4 to 3 usually rendering them non-functional for ambulation over long distances without the use of assistive devices.

When propelling the chair the Athlete is able to perform long and forceful strokes, with rapid grasp and release, although fine movements of the hands may be affected. During propulsion these fine movements are not essential. Strong trunk movements in forward and backward direction support the arm strokes. If these movements do not occur the trunk is well balanced and forms a stable base for the arm movements. When the wheelchair makes a curve, the trunk follows the wheelchair without disturbance of balance.