Athletes with Cerebral Palsy (CP-ISRA)

CLASS 1	CLASS 2	CLASS 3	CLASS 4
CLASS 5	CLASS 6	CLASS 7	CLASS 8

CLASS 1

A Class 1 athlete has severe quadriplegia (tetraplegia). Spasticity Grade 4 to 3+, with or without athetosis, or with poor functional range of movement and poor functional strength in all extremities and trunk OR the with severe athetoid with or without spasticity with poor functional strength and control. Dependent on electric wheelchair or assistance for mobility. Unable to functionally propel a wheelchair.

Lower Extremities:
Considered non-functional in relation to any sport due to limitation in range of movement strength and/or controL Involuntary movement would not change this classification.

Trunk Control:
Static and dynamic trunk control very poor or non-existent. Severe difficulty adjusting back to mid-line or upright position when performing sports movements.

Upper Extremities:
Severe limitation in functional range of movement makes this the major factor in all sports, and reduced throwing motion with poor follow-through is evident. Opposition of thumb and one finger may be possible allowing athlete to grip.

A Class 2 athlete has severe to moderate quadripleia (tetraplegia). Spasticity Grade 3+ to 3, with or without athetosis. Severe athetoid or tetraplegic with fair function in less affected side. Poor functional strength in all extremities and trunk but able to propel a wheelchair.

Lower Extremities:
A demonstrable degree of function in one or both lower limbs allowing propulsion of the wheelchair automatically qualifies individual as a Class 2 lower, unless the classification team determines that the upper limb function is more efficient. Class 2 lower athletes can sometimes ambulate.

Trunk Control:
Static control is fair. Dynamic trunk control is poor as demonstrated by the obligatory use of upper extremities and/or head to assist in returning to the midline (upright position).

Upper Extremity: Hand:
Severe to moderate involvement. Spasticity Grade 3. If hand and arm function is described as in Class 1 then lower extremity will determine whether Class 2 is more appropriate.

A Class 2 athlete often has a cylindrical or spherical grasp, and demonstrate sufficient dexterity to manipulate and throw a balL but will exl~ibit poor grasp release. Throwing motions must be tested for effects on hand function. Wheelchair propulsion with upper extremities is also demonstrable. Active range of motion is moderately to severely impaired, thus hand function is the key.

CLASS 3

A Class 3 athlete has moderate (asymmetric or symmetric) quadriplegia or severe hemiplegia. Use of wheelchair with almost full functional strength in dominant upper extremity. Can propel a wheelchair independently.

Lower Extremities:
Spasticity is a Grade 3 to 4. Some demonstrable function can be observed during transfer. May be able to ambulate with assistance or assistive devices.

Trunk Control:
Fair trunk control is shown when pushing wheelchair, but forward trunk movement is often limited by extensor tone during forceful pushing. Some trunk movement can be noted also in throwing for postural correction, but throwing motions are mostly from the arm. This is a major factor in non-ambulatory capability. Rotation is limited or non-existent. Spasticity is Grade 2 to 3+.

Upper Extremlties:
Moderate limitation. Spasticity Grade 2 to 3+ in dominant arm shown as limitation in extension and follow-through.

Hand Function:
Rapid grasp and release hand movements are usually slow and laboured. Dominant hand may demonstrate cylindrical and spherical grasp, but release of objects is noticeably less than a Class 4 athlete.

CLASS 4

A Class 4 athlete has moderate to severe Diplegia. Good functional strength, with minimal limitation or control problems in upper limbs and trunk.

Lower Extremlties:
Moderate to severe involvement in both legs. Spasticity Grade 3 to 4 rendering them non functional for ambulation over long distances without the use of assistive devices. A wheelchair is usually the choice for sport.

Trunk:
Minimal limitation of trunk movements. Spasticity Grade 1 to 2 when wheeling and throwing. In some athletes, fatigue can increase spasticity, which can be overcome with proper positioning. When standin6 poor balance is obvious even using assistive devices.

Upper Extremities:
The upper extremities often show normal functional strength. Minimal limitation of range of movement may be present but a normal follow-through and propulsion is observed when throwing or wheeling.

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 should be remembered that diplegia implies that there is more spasticity in the lower than the upper extremities. Some involvement Spasticity Grade 2 can be seen on close examination, particularly in functional movements of the hands, arms and trunk.

CLASS 5

A Class 5 athlete has symmetric or asymmetric moderate diplegia. The individual may require the use of assistive devices in walking but not necessarily when standing or throwing. A slight shift of centre of gravity leads to loss of balance.

Lower Extremities:
Spasticity is Grade 3. Involvement of one or both legs which may require assistive devices for walking. A Class 5 athlete may have sufficient function to run on the track. If function is insufficient Class 4 may be more appropriate.

Balance:
Usually has normal static balance but exhibits problems in dynamic balance, e. g. attempting a spin or throwing forcefully.

Upper Extremities:
This is an area where variation occurs. Some moderate to minimal limitation in upper extremities ca often be seen, particularly when throwing but strength is within normal limits.

Hand Function:
Normal cylindrical/spherical opposition and prehensile grasp and release in the dominant hand is seen in all sports.

CLASS 6
Not available at the moment.

CLASS 7

The Class 7 athlete is ambulatory with hemiplegia. The individual has Spasticity Grade 2 to 3 in one half of the body. They walk without assistive devices but often with a limp due to spasticity in the lower limb. Good functional ability in dominant side of the body.

Lower Extremities:
Hemiplegia Spasticity Grade 2 to 3. Dominant side has better development and good follow-through movement in walking and running. Moderate to minimal athetoids do not fit into this class.

Upper Extremities:
Arm and hand control is only affected in the non-dominant side. There is good functional control on the dominant side.

CLASS 8

The Class 8 athlete has minimally affected diplegia/hemiplegia and/or minimally affected athetosis. Spasticity Grade is 1 to 2. They are able to run and jump freely without a limp, without modifications of footwear or orthoses. They may have minimal loss of function caused by incoordination, usually seen in the hands, perhaps a slight loss of coordination in one leg or minimal shortening of the achilles tendon.

Athletes with Spinal Cord Lesion, Spina Bifida and Polio (ISMWSF)

CLASS 1A

Lower cervical medullar lesions between C4 and C6 with involvement of all four members. Non-functional triceps muscles (test= 0 to 3).

CLASS 1B

Lower cervical medullar lesions (up to C7) with involvement of all four members. Triceps good or normal (test = 4 or 5). Poor flexion and extension of the wrist (test = 0 to 3).

CLASS 1C

Lower cervical medullar lesions (up to C8) with involvement of all four members. Triceps good or normal (test = 4 to 5). Good or normal function of wrist extensors and flexors (test = 4 or 5). Poor functioning of the interossei and lumbricales of the hand (test = O to 3).

CLASS 2

Thoracic medullar lesions from T1 to T5. Involvement of the trunk and lower extremities. No use of aWominal muscles. No sitting balance.

CLASS 3

Thoracic medullar lesions from T6 to T10. Involvement of the abdomen and lower extremities. Good upper abdominal muscles. No use of lower abdominal muscles. No use of lower trunk extensors. Slight capacity to maintain sitting balance.

CLASS 4

Thoracic and lumbar medullar lesions from T6 to T10. Involvement of the lower extremities. Good spina dorsal abdominal muscles and extensors. Fair hip flexors and abductors. Good sitting balance.

*Lower Extremity Test: traumatics from 1 to 20 points, non-traumatics from 1 to 15 points.

CLASS 5

Lumbar medullar lesion at LA or L5. Involvement of the lower extremities. Good sitting balance. Good abdominal muscles.

*Lower Extremity Test: traumatics from 21 to 40 points, non-traumatics from 16 to 35 points.

CLASS 6

Sacrum medullar lesion from S1 to S3, involvement of one lower extremity or slight involvement of both lower extremities.

*Lower Extremity Test: traumatics from 41 to 60 points, non-traumatics from 36 to 50 points.

*Note: Lower Extremity Tests indude testing of muscles involved in: Hip Flexion and Extension, Hip Abduction and Adduction, Knee Flexion and Extension, Ankle Plantar Flexion and Dorsi Flexion. Points are based on a 0 to 5 scale: 0 to 3 being an non-working muscle, 4 is working with resistance, and 5 represents a normal functioning muscle.

CLASS 2

From the ability to recognize the form of a hand to a visual acuity of 2/60 and/or a visual field of less than 5 degrees.

CLASS 3

From a visual acuity of above 2/60 to a visual acuity of 6/60 and/or a visual field or more than 5 degrees and less than 20 degrees.

All classifications must be made by measuring the best eye and to the highest possible correction. This means that all athletes who use contact lenses or correcting glasses normally must wear them during classification, whether or not they intend to use them during competition.

Les Autres (ISOD)

This classification system includes all motor disabilities except amputees, medullar lesions and cerebral palsy.

CLASS l

These are athletes with severe involvement of all four extremities.

Examples:
Severe cases of multiple sclerosis.
Muscular dystrophy.
Juvenile rheumatoid arthritis with contractions, etc.

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CLASS 2

Athletes with severe involvement of three or all four extremities whose limitations are less severe than those of Class 1.

Examples:
Severe hemiplegia.
Paralysis of one extremity with deformation of two other extremities.
Less severe cases of multiple sclerosis and comparable diseases.

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CLASS 3

Athletes with limited functioning of at least two extremities.

Examples:
Hemiparesis.
Hip and knee stiffness in one member with deformation of one arm.

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CLASS 4

Athletes with limited functioning in two or more extremities. These limitations must be less than in Class 3.

Examples:
Contractions or ankylosis/orthodesis in the joints of one member with limited functioning in the other.

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CLASS 5

Athletes with limited functioning of at least one extremity or comparable disability.

Examples:
Contractions of ankylosis of hip or knee joint.
Paresis in one arm.
Cyphoscoliosis.

CLASS 6

Athletes with slight limitations

Examples:
Arthritis and osteoporosis.
Ankylosis of the knee.

Double AK - Both legs amputated above the knee

CLASS 2

Single AK - One leg amputated above the knee.

CLASS 3

Double BK - Both legs amputated below knee.

CLASS 4

Single BK - One leg amputated below the knee.

CLASS 5

Double AE - Both arms amputated above or through the elbow joint.

CLASS 6

Single AE - One arm amputated above or through the elbow joint.

CLASS 7

Double BE - Both arms amputated below the elbow, but through or above the wrist joint.

CLASS 8

Single BE - One arm amputated below the elbow, but through or above the wrist joint.

CLASS 9

Combinations of amputations of the upper and lower extremities.