Introduction: To determine if athletes with coordination impairment (CI) can continue playing wheelchair rugby (WR), while an evidence-based classification system, including impairment tests for CI is not yet available. This is a defensible practise if they show similar activity limitations as athletes with other eligible impairment types (OI) within the same sports class. Methods: Standardised activities were measured in 58 elite WR athletes; 14 with CI and 44 with OI. Wheelchair activities consisted of 20-meter sprint, 12-meter sprint with full stop, intermittent sprint (3-meter sprint, stop, 3-meter sprint, stop, 6-meter sprint with full stop), sprint-curve-slalom-curve, turn on the spot 180°, turn on the spot 90°, stop, turn 90°in the same direction, X-test (short circuit with sharp turns) without the ball. Ball activities consisted of maximal throwing distance, precision throwing short (25% of maximum throw) and long (75% of maximal throw) distance and X-test with the ball (pick-up the ball and dribble whilst pushing). Descriptive statistics were used and Spearman’s Rank correlation was assessed for athletes with CI and OI for each outcome measure. Differences between athletes with CI and OI were assessed using a Mann-Whitney U test. Results: Most activities showed a high correlation with the athlete class in both athletes with CI and athletes with OI. Furthermore, outcome measures of athletes with CI overlapped with athletes with OI in the same sports class for all activities. There was a trend for worse performance in athletes with CI in turn on the spot 90°, stop, turn 90°in the same direction, the short distance one handed precision throw (P 0.11)and in the X-test with the ball (P 0.10). Discussion: Despite the current lack of evidence based impairment tests for CI, it is a defensible practise to not exclude athletes with CI from WR with the current classification system. The trends for differences in performance that were found can support athletes and coaches in optimising performance of athletes with CI.

@en

Paralympic wheelchair athletes solely depend on the power of their upper-body for their on- court wheeled mobility as well as for performing sport-specific actions in ball sports, like a basketball shot or a tennis serve. The objective of WheelPower is to improve the power output of athletes in their sport-specific wheelchair to perform better in competition. To achieve this objective the current project systematically combines the three Dutch measurement innovations (WMPM, Esseda wheelchair ergometer, PitchPerfect system) to monitor a large population of athletes from different wheelchair sports resulting in optimal power production by wheelchair athletes during competition. The data will be directly implemented in feedback tools accessible to athletes, trainers and coaches which gives them the unique opportunity to adapt their training and wheelchair settings for optimal performance. Hence, the current consortium facilitates mass and focus by uniting scientists and all major Paralympic wheelchair sports to monitor the power output of many wheelchair athletes under field and lab conditions, which will be assisted by the best data science approach to this challenge.

@en

Within rehabilitation, there is a great need for a simple method to monitor wheelchair use, especially whether it is active or passive. For this purpose, an existing measurement technique was extended with a method for detecting self- or attendant-pushed wheelchair propulsion. The aim of this study was to validate this new detection method by comparison with manual annotation of wheelchair use. Twenty-four amputation and stroke patients completed a semi-structured course of active and passive wheelchair use. Based on a machine learning approach, a method was developed that detected the type of movement. The machine learning method was trained based on the data of a single-wheel sensor as well as a setup using an additional sensor on the frame. The method showed high accuracy (F1 = 0.886, frame and wheel sensor) even if only a single wheel sensor was used (F1 = 0.827). The developed and validated measurement method is ideally suited to easily determine wheelchair use and the corresponding activity level of patients in rehabilitation.@en

Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.@en

In wheelchair sports, the use of Inertial Measurement Units (IMUs) has proven to be one of the most accessible ways for ambulatory measurement of wheelchair kinematics. A three-IMU configuration, with one IMU attached to the wheelchair frame and two IMUs on each wheel axle, has previously shown accurate results and is considered optimal for accuracy. Configurations with fewer sensors reduce costs and could enhance usability, but may be less accurate. The aim of this study was to quantify the decline in accuracy for measuring wheelchair kinematics with a stepwise sensor reduction. Ten differently skilled participants performed a series of wheelchair sport specific tests while their performance was simultaneously measured with IMUs and an optical motion capture system which served as reference. Subsequently, both a one-IMU and a two-IMU configuration were validated and the accuracy of the two approaches was compared for linear and angular wheelchair velocity. Results revealed that the one-IMU approach show a mean absolute error (MAE) of 0.10 m/s for absolute linear velocity and a MAE of 8.1°/s for wheelchair angular velocity when compared with the reference system. The two-IMU approach showed similar differences for absolute linear wheelchair velocity (MAE 0.10 m/s), and smaller differences for angular velocity (MAE 3.0°/s). Overall, a lower number of IMUs used in the configuration resulted in a lower accuracy of wheelchair kinematics. Based on the results of this study, choices regarding the number of IMUs can be made depending on the aim, required accuracy and resources available.

@en

Athlete impairment level is an important factor in wheelchair mobility performance (WMP) in sports. Classification systems, aimed to compensate impairment level effects on performance, vary between sports. Improved understanding of resemblances and differences in WMP between sports could aid in optimizing the classification methodology. Furthermore, increased performance insight could be applied in training and wheelchair optimization. The wearable sensor-based wheelchair mobility performance monitor (WMPM) was used to measure WMP of wheelchair basketball, rugby and tennis athletes of (inter-)national level during match-play. As hypothesized, wheelchair basketball athletes show the highest average WMP levels and wheelchair rugby the lowest, whereas wheelchair tennis athletes range in between for most outcomes. Based on WMP profiles, wheelchair basketball requires the highest performance intensity, whereas in wheelchair tennis, maneuverability is the key performance factor. In wheelchair rugby, WMP levels show the highest variation comparable to the high variation in athletes’ impairment levels. These insights could be used to direct classification and training guidelines, with more emphasis on intensity for wheelchair basketball, focus on maneuverability for wheelchair tennis and impairment-level based training programs for wheelchair rugby. Wearable technology use seems a prerequisite for further development of wheelchair sports, on the sports level (classification) and on individual level (training and wheelchair configuration). @en

OBJECTIVE: The purpose of this study was to determine the effects of seat height, wheelchair mass and grip on mobility performance among wheelchair basketball players and to investigate whether these effects differ between classification levels. METHODS: Elite wheelchair basketball players with a low (n= 11, class 1 or 1.5) or high (n= 10, class 4 or 4.5) classification performed a field-based wheelchair mobility performance (WMP) test. Athletes performed the test six times in their own wheelchair, of which five times with different configurations, a higher or lower seat height, with additional distally or centrally located extra mass, and with gloves. The effects of these configurations on performance times and the interaction with classification were determined. RESULTS: Total performance time on the WMP test was significantly reduced when using a 7.5% lower seat height. Additional mass (7.5%) and glove use did not lead to changes in performance time. Effects were the same for the two classification levels. CONCLUSIONS: The methodology can be used in a wheelchair fitting process to search for the optimal individual configuration to enhance mobility performance. Out of all adjustments possible, this study focused on seat height, mass and grip only. Further research can focus on these possible adjustments to optimize mobility performance in wheelchair basketball.

@en

Purpose: To provide insight on the effect of wheelchair settings on wheelchair mobility performance (WMP). Methods: Twenty elite wheelchair basketball athletes of low (n = 10) and high classification (n = 10) were tested in a wheelchair-basketball-directed field test. Athletes performed the test in their own wheelchairs, which were modified for 5 additional conditions regarding seat height (high–low), mass (central–distributed), and grip. The previously developed inertial-sensor-based WMP monitor was used to extract wheelchair kinematics in all conditions. Results: Adding mass showed most effect on WMP, with a reduced average acceleration across all activities. Once distributed, additional mass also reduced maximal rotational speed and rotational acceleration. Elevating seat height had an effect on several performance aspects in sprinting and turning, whereas lowering seat height influenced performance minimally. Increased rim grip did not alter performance. No differences in response were evident between low- and high-classified athletes. Conclusions: The WMP monitor showed sensitivity to detect performance differences due to the small changes in wheelchair configuration. Distributed additional mass had the most effect on WMP, whereas additional grip had the least effect of conditions tested. Performance effects appear similar for both low- and high-classified athletes. Athletes, coaches, and wheelchair experts are provided with insight into the performance effect of key wheelchair settings, and they are offered a proven sensitive method to apply in sport practice, in their search for the best wheelchair–athlete combination.@en

The aim of this study was to develop and describe a wheelchair mobility performance test in wheelchair basketball and to assess its construct validity and reliability. To mimic mobility performance of wheelchair basketball matches in a standardised manner, a test was designed based on observation of wheelchair basketball matches and expert judgement. Forty-six players performed the test to determine its validity and 23 players performed the test twice for reliability. Independent-samples t-tests were used to assess whether the times needed to complete the test were different for classifications, playing standards and sex. Intraclass correlation coefficients (ICC) were calculated to quantify reliability of performance times. Males performed better than females (P 

@en

Performance in wheelchair court sports is to a large extent determined by the wheelchair mobility performance, the performance measure for the wheelchair-athlete combination. So far, wheelchair mobility performance is mostly utilized as concept, rather than a well quantified measure. However, in order to gain insight in the interaction between athlete, wheelchair and sport, it should be an objective and well quantified outcome that is easily measured. An inertial sensor-based “Wheelchair Mobility Performance Monitor” (WMPM) was developed that met the demands of objective quantification of mobility performance in an easy to use manner. This WMPM is believed to be a valuable tool for wheelchair court sports practice and research. All research done with the WMPM showcases its opportunities and commenced the unravelling of the complex interactions between athlete, wheelchair and sport. It will be a matter of time before the use of the WMPM will be common practice in wheelchair sports and sports research.@en

Objectiev:
This study aimed to investigate which characteristics of athlete, wheelchair and athlete-wheelchair interface are the best predictors of wheelchair basketball mobility performance.

Design:
Sixty experienced wheelchair basketball players performed a wheelchair mobility performance test to assess their mobility performance. To determine which variables were the best predictors of mobility performance, forward stepwise linear regression analyses were performed on a set of 33 characteristics, including ten athlete, nineteen wheelchair and four athlete-wheelchair interface characteristics.

Results:
Eight of the characteristics turned out to be significant predictors of wheelchair basketball mobility performance. Classification, experience, maximal isometric force, wheel axis height and hand rim diameter - which both interchangeable with each other and wheel diameter - camber angle, and the vertical distance between shoulder and rear wheel axis – which was interchangeable with seat height - were positively associated with mobility performance. The vertical distance between the front seat and the footrest was negatively associated with mobility performance.

Conclusion:
With this insight, coaches and biomechanical specialists are provided with statistical findings to determine which characteristics they could focus on best to improve mobility performance. Six out of eight predictors are modifiable and can be optimized to improve mobility performance. These adjustments could be carried out both in training (maximal isometric force) and in wheelchair configurations (e.g. camber angle).@en

Purpose:
Classification is a defining factor for competition in wheelchair sports, but it is a delicate and time-consuming process with often questionable validity.1 New inertial sensor based measurement methods applied in match play and field tests, allow for more precise and objective estimates of the impairment effect on wheelchair mobility performance. It was evaluated if these measures could offer an alternative point of view for classification.

Methods:
Six standard wheelchair mobility performance outcomes of different classification groups were measured in match play (n=29), as well as best possible performance in a field test (n=47).

Results:
In match-results a clear relationship between classification and performance level is shown, with increased performance outcomes in each adjacent higher classification group. Three outcomes differed significantly between the low and mid-class groups, and one between the mid and high-class groups. In best performance (field test), a split between the low and mid-class groups shows (5 out of 6 outcomes differed significantly) but hardly any difference between the mid and high-class groups. This observed split was confirmed by cluster analysis, revealing the existence of only two performance based clusters.

Conclusion:
The use of inertial sensor technology to get objective measures of wheelchair mobility performance, combined with a standardized field-test, brought alternative views for evidence based classification. The results of this approach provided arguments for a reduced number of classes in wheelchair basketball. Future use of inertial sensors in match play and in field testing could enhance evaluation of classification guidelines as well as individual athlete performance.@en

Increased professionalism in wheelchair sports demand a more precise and quantitative measure of individual wheelchair mobility performance, to allow it to be an evaluation measure of wheelchair setting or training optimization. This research describes the application of an inertial sensor based method for measuring wheelchair kinematics and a factor analysis based selection of outcomes best describing wheelchair mobility performance. This set of kinematic outcomes was analysed for sensitivity towards wheelchair performance differences due to competition level and classification of the match data of 29 wheelchair basketball athletes. The method proved sensitive and is believed to provide a solid basis for a kinematics based definition of wheelchair mobility performance in sports.@en

Quantitative assessment of an athlete׳s individual wheelchair mobility performance is one prerequisite needed to evaluate game performance, improve wheelchair settings and optimize training routines. Inertial Measurement Unit (IMU) based methods can be used to perform such quantitative assessment, providing a large number of kinematic data. The goal of this research was to reduce that large amount of data to a set of key features best describing wheelchair mobility performance in match play and present them in meaningful way for both scientists and athletes. To test the discriminative power, wheelchair mobility characteristics of athletes with different performance levels were compared. The wheelchair kinematics of 29 (inter-)national level athletes were measured during a match using three inertial sensors mounted on the wheelchair. Principal component analysis was used to reduce 22 kinematic outcomes to a set of six outcomes regarding linear and rotational movement; speed and acceleration; average and best performance. In addition, it was explored whether groups of athletes with known performance differences based on their impairment classification also differed with respect to these key outcomes using univariate general linear models. For all six key outcomes classification showed to be a significant factor (p<0.05). We composed a set of six key kinematic outcomes that accurately describe wheelchair mobility performance in match play. The key kinematic outcomes were displayed in an easy to interpret way, usable for athletes, coaches and scientists. This standardized representation enables comparison of different wheelchair sports regarding wheelchair mobility, but also evaluation at the level of an individual athlete. By this means, the tool could enhance further development of wheelchair sports in general.@en

Short sprints are important components of most wheelchair court sports, since being faster than the opponent often determines keeping ball possession or not. Sprinting capacity is best measured during a field test, allowing the athlete to freely choose push strategies adapted to their own wheelchair setting, physical ability, classification and speed changes during a sprint. The key test outcome is sprint duration, but there are various ways to accomplish the same sprint time. So can different push strategies be identified in a wheelchair sport and how do they relate to athlete level/classification and wheelchair configuration? These relationships were investigated by field tests of 30 male wheelchair basketball athletes during a 12 meter sprint in their own wheelchair. A recently developed method for ambulatory measurement was used to calculate wheelchair kinematics [1], providing outcomes on displacement, speed, acceleration and pushes. Additionally maximal isometric push force was recorded and rear seat height was noted. Within the measured athletes, internationals were expected to be faster due to a better physical training status and technique, allowing them to sprint with fewer (but more powerful) pushes. Likewise, athletes of higher classification were expected to be faster due their superior physical capacity, but the effect on the number of pushes used was not that evident. Video analysis was added to validate push detection of the ambulatory measurement system. Mutual correlations and competition level differences of sprint characteristics were calculated. General Linear Models (GLM) were drawn to determine the effect of competition level and classification on sprint time and number of pushes. In the overall dataset sprint characteristics did not correlate significantly with classification, but if split by competition level, there were significant correlations with sprint time (r=-0.715, p=0.006) and number of pushes (r=-0.647, p= 0.017) in the national level athletes. Sprint time, number of pushes and isometric push force differed significantly between national and international level wheelchair basketball athletes. Competition level showed to be a significant (p

@en