From theory to practice: Monitoring mechanical power output during wheelchair field and court sports using inertial measurement units.

An important performance determinant in wheelchair sports is the power exchanged between the athlete-wheelchair combination and the environment, in short, mechanical power. Inertial measurement units (IMUs) might be used to estimate the exchanged mechanical power during wheelchair sports practice. However, to validly apply IMUs for mechanical power assessment in wheelchair sports, a well-founded and unambiguous theoretical framework is required that follows the dynamics of manual wheelchair propulsion. Therefore, this research has two goals. First, to present a theoretical framework that supports the use of IMUs to estimate power output via power balance equations. Second, to demonstrate the use of the IMU-based power estimates during wheelchair propulsion based on experimental data. Mechanical power during straight-line wheelchair propulsion on a treadmill was estimated using a wheel mounted IMU and was subsequently compared to optical motion capture data serving as a reference. IMU-based power was calculated from rolling resistance (estimated from drag tests) and change in kinetic energy (estimated using wheelchair velocity and wheelchair acceleration). The results reveal no significant difference between reference power values and the proposed IMU-based power (1.8% mean difference, N.S.). As the estimated rolling resistance shows a 0.9-1.7% underestimation, over time, IMU-based power will be slightly underestimated as well. To conclude, the theoretical framework and the resulting IMU model seems to provide acceptable estimates of mechanical power during straight-line wheelchair propulsion in wheelchair (sports) practice, and it is an important first step towards feasible power estimations in all wheelchair sports situations.

Trunk motion influences mechanical power estimates during wheelchair propulsion.

In wheelchair sports, there is an increasing need to monitor mechanical power in the field. When rolling resistance is known, inertial measurement units (IMUs) can be used to determine mechanical power. However, upper body (i.e., trunk) motion affects the mass distribution between the small front and large rear wheels, thus affecting rolling resistance. Therefore, drag tests - which are commonly used to estimate rolling resistance - may not be valid. The aim of this study was to investigate the influence of trunk motion on mechanical power estimates in hand-rim wheelchair propulsion by comparing instantaneous resistance-based power loss with drag test-based power loss. Experiments were performed with no, moderate and full trunk motion during wheelchair propulsion. During these experiments, power loss was determined based on 1) the instantaneous rolling resistance and 2) based on the rolling resistance determined from drag tests (thus neglecting the effects of trunk motion). Results showed that power loss values of the two methods were similar when no trunk motion was present (mean difference [MD] of 0.6 ± 1.6 %). However, drag test-based power loss was underestimated up to -3.3 ± 2.3 % MD when the extent of trunk motion increased (r = 0.85). To conclude, during wheelchair propulsion with active trunk motion, neglecting the effects of trunk motion leads to an underestimated mechanical power of 1 to 6 % when it is estimated with drag test values. Depending on the required accuracy and the amount of trunk motion in the target group, the influence of trunk motion on power estimates should be corrected for.

Multi-joint isometric measurement for the evidence-based assessment of upper limb strength impairment in wheelchair athletes with different health conditions: a preliminary study.

The present study presents a novel specific multi-joint isometric test to assess upper limb strength impairment for evidence-based classification in wheelchair sports. Sixteen wheelchair athletes participated in this study and were classified according to their type of physical impairment and health condition as follows: athletes with neurological impairment (ANI, n = 5) and athletes with impaired muscle power (IMP, n = 11). In addition, six non-disabled participants formed a control group (CG, n = 6). All the participants performed the isometric propulsion strength test (IPST), evaluating pushing and pulling actions, and two wheelchair performance tests. Excellent relative intra-session reliability scores were obtained for strength values for the ANI, IMP and CG groups (0.90 < ICC < 0.99) and absolute reproducibility showed acceptable scores of SEM (< 9.52%) for IPST pushing action. The ANI had significantly lower scores in strength and wheelchair performance than the IMP and the CG, while no differences were found between the IMP and the non-disabled participants. In addition, no correlations were found for wheelchair athletes between the isometric upper limb strength measure and wheelchair performance. Our findings suggest that the IPST is a valid test for strength measurement in upper limb impairment wheelchair athletes with different health conditions, which must be used in combination with a performance test to obtain a holistic assessment of this population.

Functional and Structural Properties of Interhemispheric Interaction between Bilateral Precentral Hand Motor Regions in a Top Wheelchair Racing Paralympian.

Long-term motor training can cause functional and structural changes in the human brain. Assessing how the training of specific movements affects specific parts of the neural circuitry is essential to understand better the underlying mechanisms of motor training-induced plasticity in the human brain. We report a single-case neuroimaging study that investigated functional and structural properties in a professional athlete of wheelchair racing. As wheelchair racing requires bilateral synchronization of upper limb movements, we hypothesized that functional and structural properties of interhemispheric interactions in the central motor system might differ between the professional athlete and controls. Functional and diffusion magnetic resonance imaging (fMRI and dMRI) data were obtained from a top Paralympian (P1) in wheelchair racing. With 23 years of wheelchair racing training starting at age eight, she holds an exceptional competitive record. Furthermore, fMRI and dMRI data were collected from three other paraplegic participants (P2-P4) with long-term wheelchair sports training other than wheelchair racing and 37 able-bodied control volunteers. Based on the fMRI data analyses, P1 showed activation in the bilateral precentral hand sections and greater functional connectivity between these sections during a right-hand unimanual task. In contrast, other paraplegic participants and controls showed activation in the contralateral hemisphere and deactivation in the ipsilateral hemisphere. Moreover, dMRI data analysis revealed that P1 exhibited significantly lower mean diffusivity along the transcallosal pathway connecting the bilateral precentral motor regions than control participants, which was not observed in the other paraplegic participants. These results suggest that long-term training with bilaterally synchronized upper-limb movements may promote bilateral recruitment of the precentral hand sections. Such recruitment may affect the structural circuitry involved in the interhemispheric interaction between the bilateral precentral regions. This study provides valuable evidence of the extreme adaptability of the human brain.

Lesiones y enfermedades durante el campeonato sudamericano de baloncesto en silla de ruedas 2021: un estudio epidemiológico / Injuries and illnesses during the Wheelchair Basketball South America Championships 2021: an epidemiological stud

Introducción: Varias federaciones deportivas internacionales han implementado un sistema estandarizado de registro delesiones durante sus campeonatos. Sin embargo, muy pocos estudios han incorporado a deportistas con discapacidad durantelos principales campeonatos, aparte de los Juegos Paralímpicos. Por lo tanto, el objetivo de este estudio es evaluar la tasa ycaracterísticas de las enfermedades y lesiones durante el Campeonato Sudamericano de Baloncesto en Silla de Ruedas 2021. Material y método: Se solicitó a los cuerpos técnicos de los 11 equipos participantes (un total de 129 jugadores), quereportaran diariamente todas las afecciones ocurridas y sus características en un formulario estandarizado. Se calcularon lastasas de prevalencia e incidencia.Resultados: Se reportaron 108 afecciones, equivalentes a 83,7 por 100 jugadores [IC 95%: 67,9-99,5], con 8 afecciones detiempo perdido (6,2 por 100 jugadores [IC 95%: 1,9-10,5]) y un total de 74 lesiones de atención médica (57,4 por 100 juga-dores [IC 95%: 44,3-70,4]). Se informaron 15 enfermedades, y los sistemas orgánicos más afectados fueron el oftalmológico,gastrointestinal y genitourinario. Se registraron más lesiones durante los partidos (n=43). Las regiones más afectadas fueronhombro/clavícula (24,7%), mano/dedos (23,7%) y cuello/columna cervical (12,9%). Las afecciones más frecuentes fueron lascontracturas/calambres musculares (32,2%), y el mecanismo predominante fue el sobreuso (53,8%). Se reportó un 2,2% deconmociones producidas durante los entrenamientos. La mayoría de los eventos registrados fueron sin pérdida de tiempo ycon retorno a la plena participación entre cero y un día. Conclusión: El seguimiento de problemas de salud durante las competiciones es esencial para determinar los factores deriesgo de lesiones específicas del deporte, y se debe implementar un enfoque complejo para el reconocimiento de sus carac-terísticas en jugadores de baloncesto en silla de ruedas.(AU)

Introduction: Several international sports federations have implemented a standardized injury registration system duringtheir championships. However, very few studies have included athletes with disabilities during major competitions, apart fromthe Paralympic Games. Therefore, the objective of this study is to evaluate the rate and characteristics of illnesses and injuriesduring the 2021 South America Wheelchair Basketball Championships.Material and method: The coaching staff of the 11 participating teams (a total of 129 players) were asked to report dailyall the health problems that have occurred and their characteristics in a standardized form. Prevalence and incidence rateswere calculated.Results: In this study 108 health problems were reported, equivalent to 83.7 per 100 players [95% CI: 67.9-99.5], with 8 time-loss health problems (6.2 per 100 players [95% CI: 1.9-10.5]) and a total of 74 medical attention injuries (57.4 per 100 players[95% CI :44.3-70.4]). Were reported 15 diseases, and the most affected organ systems were ophthalmologic, gastrointestinal,and genitourinary. More injuries were recorded during matches (n=43). The most affected regions were shoulder/clavicle(24.7%), hand/fingers (23.7%) and neck/cervical spine (12.9%). The most frequent conditions were muscle contractures/cramps (32.2%), and the predominant mechanism was overuse (53.8%). 2.2% of concussions produced during training werereported. Most of the recorded events were without time loss and with return to full participation between zero and one day.Conclusion: Monitoring of health problems during competitions is essential to determine sport-specific injury risk factors,and a complex approach should be implemented for the recognition of their characteristics in wheelchair basketball players.In this way, adequate preventive measures can be developed.(AU)

Facilitation of Hand Proprioceptive Processing in Paraplegic Individuals with Long-Term Wheelchair Sports Training.

Previous studies have revealed drastic changes in motor processing in individuals with congenital or acquired limb deficiencies and dysfunction. However, little is known about whether their brains also exhibit characteristic proprioceptive processing. Using functional magnetic resonance imaging, we examined the brain activity characteristics of four individuals with congenital or acquired paraplegia (paraplegic group) who underwent long-term wheelchair sports training, when they passively experienced a right-hand movement (passive task) and when they actively performed a right-hand motor task (active task), compared to 37 able-bodied individuals (control group). Compared with the control group, the paraplegic group showed significantly greater activity in the foot section of the left primary motor cortex and in the inferior frontoparietal proprioceptive network during the passive task. In the paraplegic group, the left intraparietal sulcus region was activated during the passive task, but suppressed during the active task, which was not observed in the control group. This shows the facilitation of hand proprioceptive processing and unique usage of the intraparietal sulcus region in proprioceptive motor processing in the brains of paraplegic individuals with long-term wheelchair sports training.

Development of Tests for Arm Coordination Impairment in Paralympic Classification.

Background: In Paralympic sport, classification of impairment with the ability to detect misrepresentation of abilities is mandatory. In wheelchair rugby, there is currently no objective method to classify arm coordination impairment. In previous research, sufficient correlation between the spiral test (ST) and activity in wheelchair rugby was found in athletes with coordination impairment. However, the ST depends on maximum voluntary effort. Purpose: To assess if the ST is an objective test for arm coordination impairment, in which maximum voluntary effort can be distinguished from intentional misrepresentation. The aims of this study were to (1) assess the test-retest reliability of the ST and (2) assess if Fitts's law is applicable to the ST. Methods: Nineteen volunteers without impairments performed two sessions with three STs per arm. The STs were projected and measured on a tablet and had three different indices of difficulty based on differences in spiral width. The time to complete the spiral was measured and a penalty time was added for each time the borderline of the spiral was touched (3 s) or crossed (5 s). Results: Test-retest reliability was assessed using a Bland-Altman analysis and showed limits of agreement that were wider than the margins of 2SD from the group mean. Repeated measurement correlation coefficients between the index of difficulty according to Fitts's law and the movement time were > 0.95 (p-value < 0.001) for both test and retest. A post-hoc optimisation of penalty times revealed an optimum penalty time of 2.0 s for the dominant arm and 2.5 for the non-dominant arm for any contact with the margins of the spiral. Conclusions: The ST has sufficient test-retest reliability and Fitts's law is applicable. Therefore, it is a promising option for classification of arm coordination impairment with the option to distinguish intentional misrepresentation from maximum voluntary effort.

Impact of Sprinting and Dribbling on Shoulder Joint and Pushrim Kinetics in Wheelchair Basketball Athletes.

Background: While wheelchair basketball is one of the most popular Paralympic sports, it eventually causes shoulder problems and pain in many athletes. However, shoulder kinetics has never been assessed during propulsion in wheelchair basketball. This study analyzes the impact of sprinting and dribbling on pushrim and shoulder kinetics in terms of external forces and net muscular moments. Methods: A group of 10 experienced wheelchair basketball athletes with various classifications performed four, 9-m sprints on a basketball court using classic synchronous propulsion, and four sprints while dribbling forward. Pushrim and shoulder kinetics were calculated by inverse dynamics, using a motion capture device and instrumented wheels. Findings: Sprinting was associated to peak shoulder load from 13 to 346% higher than in previous studies on standard wheelchair propulsion in most force/moment components. Compared to sprinting without a ball, dribbling reduced the speed, the peak external forces in the anterior and medial direction at the shoulder, and the peak net shoulder moment of internal rotation. Interpretation: The high shoulder load calculated during both sprinting and dribbling should be considered during training sessions to avoid overloading the shoulder. Dribbling generally reduced the shoulder load, which suggests that propelling while dribbling does not put the shoulder at more risk of musculoskeletal disorders than sprinting.

The Role of Diets and Dietitians for Para-Athletes: A Pilot Study Based on Interviews.

Efforts to provide nutrition support to para-athletes have not been established to date, and are far behind those established for athletes without disabilities. In the present study, we attempted to clarify the actual situation regarding dietary challenges of para-athletes. The aim of this study was to obtain clues to effective intervention methods that encourage the practice of sports nutrition. Six active elite para-athletes (30-70 years, four males) and a female physical therapist without physical disability participated in semi-structured interviews. All para-athletes had lower-limb disabilities and participated in the international wheelchair sports competitions (tennis, softball, and table tennis, with 2-26 years of player history). The interview items were on the ideal diet for improving competitive performance, evaluation of their typical diets, and the role of the dietitian as support. Responses obtained from participants were analyzed using quantitative content analysis by language analysis software. There are differences in the ideal diet based on the characteristics of the sport, but most participants believed that a nutritionally well-balanced diet with abundant vegetables was ideal for improving competitive performance. Para-athletes who use a wheelchair daily pay attention to their total calorie intake, because gaining weight is a critical issue for operating their wheelchairs and transferring themselves to and from their wheelchairs. Despite their world-class competition levels, none of them received routine dietary advice from dietitians. Some para-athletes did not even feel the need to engage with dietitians. Even for these para-athletes at a high level of competition, the "ideal diet" they considered was not always the optimal diet for improving their competitive performance. In addition, there are various barriers to practicing their optimal diet due to disability characteristics. Dietitians need to understand these barriers, their concerns and conflicts, and how to help them plan the optimal diet to improve their performance and maintain overall health.

Bioelectrical impedance vector analysis and body composition in cervical spinal cord injury: A pilot study.

Introduction: Body composition assessment in cervical spinal cord injury (c-SCI) individuals is important to monitor the fat free-mass (FFM) loss, due to immobilization, or gain, due to exercise practice. Single frequency bioelectrical impedance analysis (SF-BIA) is low in cost, simple and easy. Objectives: The aims of this study are: to evaluate the concordance between the FFM values obtained using dual X-ray absorptiometry (DXA) and the three SF-BIA previous predictive equations; and to test the applicability of the bioelectrical impedance vector analysis (BIVA). Methods: Twenty-three c-SCI males were divided into two groups: Physically active (PA; n = 13; at least 150 min/week) and non-active individuals (NPA) and were assessed by DXA and SF-BIA simultaneously. Results: FFM values were similar between groups PA and NPA. Considering all participants, FFM values obtained by Kocina and Heyward (>11%) and Sun (<15.4%) predictive equations were different when compared to DXA (p < 0.01). However, Buchholz's et al. predictive equation showed FFM values similar to DXA, but presented poor concordance (<7%, p = 0.99; concordance coefficient = 0.85). BIVA showed consistency in ellipse distribution using FFM obtained using Buchholz et al. predictive equation. Conclusions: The use of non-specific BIA equations can lead to misinterpretation in FFM values in male c-SCI individuals. Predictive equations for this group need to be developed.

Hyper-Adaptation in the Human Brain: Functional and Structural Changes in the Foot Section of the Primary Motor Cortex in a Top Wheelchair Racing Paralympian.

The human brain has the capacity to drastically alter its somatotopic representations in response to congenital or acquired limb deficiencies and dysfunctions. The main purpose of the present study was to elucidate such extreme adaptability in the brain of an active top wheelchair racing Paralympian (participant P1) who has congenital paraplegia (dysfunction of bilateral lower limbs). Participant P1 has undergone long-term wheelchair racing training using bilateral upper limbs and has won a total of 19 medals in six consecutive summer Paralympic games as of 2021. We examined the functional and structural changes in the foot section of the primary motor cortex (M1) in participant P1 as compared to able-bodied control participants. We also examined the functional and structural changes in three other individuals (participants P2, P3, and P4) with acquired paraplegia, who also had long-term non-use period of the lower limbs and had undergone long-term training for wheelchair sports (but not top athletes at the level of participant P1). We measured brain activity in all the participants using functional magnetic resonance imaging (MRI) when bimanual wrist extension-flexion movement was performed, and the structural MRI images were collected. Compared to 37 control participants, participant P1 showed significantly greater activity in the M1 foot section during the bimanual task, and significant local GM expansion in this section. Significantly greater activity in the M1 foot section was also observed in participant P4, but not in P2 and P3, and the significant local GM expansion was observed in participant P2, but not in P3 and P4. Thus, functional or structural change was observed in an acquired paraplegic participant, but was not observed in all the paraplegic participants. The functional and structural changes typically observed in participant P1 may represent extreme adaptability of the human brain. We discuss the results in terms of a new idea of hyper-adaptation.

A Model of Perfectionism, Moral Disengagement, Altruism, and Antisocial and Prosocial Behaviors in Wheelchair Athletes.

Two forms of perfectionism were examined in the present study to see whether they predicted prosocial and antisocial behaviors in sport through moral disengagement and altruism in a sample of 327 wheelchair basketball and rugby athletes (M = 33.57 years, SD = 10.51; 83% male). Using structural equation modeling, the following significant direct and indirect effects were found. First, perfectionistic strivings positively predicted perceived prosocial behaviors and altruism. Second, perfectionistic concerns negatively predicted altruism and prosocial behaviors and positively predicted moral disengagement. Third, antisocial behaviors were positively predicted by moral disengagement and altruism. Furthermore, perfectionistic concerns indirectly predicted antisocial behaviors positively through moral disengagement and negatively through altruism. Finally, perfectionistic strivings positively predicted antisocial behaviors through altruism. Results provided partial support for the role of perfectionism in predicting prosocial and antisocial behaviors through moral disengagement among athletes with a disability.

Interpreting the tilt-and-torsion method to express shoulder joint kinematics.

BACKGROUND: Kinematics is studied by practitioners and researchers in different fields of practice. It is therefore critically important to adhere to a taxonomy that explicitly describes positions and movements. However, current representation methods such as cardan and Euler angles fail to report shoulder angles in a way that is easily and correctly interpreted by practitioners, and that is free from numerical instability such as gimbal lock. METHODS: In this paper, we comprehensively describe the recent Tilt-and-Torsion method and compare it to the Euler YXY method currently recommended by the International Society of Biomechanics. While using the same three rotations (plane of elevation, elevation, humeral rotation), the Tilt-and-Torsion method reports humeral rotation independently from the plane of elevation. We assess how it can be used to describe shoulder angles (1) in a simulated assessment of humeral rotation with the arm at the side, which constitutes a gimbal lock position, and (2) during an experimental functional task, with 10 wheelchair basketball athletes who sprint in straight line using a sports wheelchair. FINDINGS: In the simulated gimbal lock experiment, the Tilt-and-Torsion method provided both humeral elevation and rotation measurements, contrary to the Euler YXY method. During the wheelchair sprints, humeral rotation ranged from 14° (externally) to 13° (internally), which is consistent with typical maximal ranges of humeral rotation, compared to 65° to 50° with the Euler YXY method. INTERPRETATION: Based on our results, we recommend that shoulder angles be expressed using Tilt-and-Torsion angles instead of Euler YXY.

Analyzing Intra-Cycle Velocity Profile and Trunk Inclination during Wheelchair Racing Propulsion.

The analysis of intra-cycle velocity profile of manual wheelchair (MWC) users has been used to highlight the significant role of trunk inertia in propulsion biomechanics. Maximal wheelchair linear velocity has previously been observed to be reached after the release of the handrims both during sports activities and daily life propulsion. This paper provides a combined analysis of linear velocity and trunk kinematics in elite wheelchair racing athletes during straight-line propulsion at stabilized speeds. MWC and trunk kinematics of eight athletes (level: 7 elite, 1 intermediate; classification: T54 (5), T53 (2) and T52 (1)) were monitored during 400 m races using inertial measurement units. An average propulsion cycle was computed for each athlete. The main finding of this article is the difference in propulsion patterns among the athletes, exhibiting either 1, 2 or 3 peaks in their velocity profile. A second peak in velocity is usually assumed to be caused by the inertia of the trunk. However, the presence of a second velocity peak among more severely impaired athletes with little to no trunk motion can either be associated to the inertia of the athletes' arms or to their propulsion technique.

Increased serum levels of brain-derived neurotrophic factor following wheelchair half marathon race in individuals with spinal cord injury.

Objective: Brain-derived neurotrophic factor (BDNF) has beneficial effects on metabolism as well as the peripheral and central nervous systems. The aim of this study was to assess the response of serum BDNF concentration ([BDNF]s) to wheelchair half marathon race in individuals with spinal cord injury (SCI).Design: Prospective observational study.Setting: The 34th Oita International Wheelchair Marathon Race in Japan.Participants: Nine cervical SCIs (CSCI) and 8 thoracic and lumber SCIs (LSCI) male athletes. Interventions: Wheelchair half-Marathon Race.Outcome measures: [BDNF]s, plasma concentrations of adrenaline ([Ad]p), noradrenaline ([Nor]p), and cortisol ([Cor]p), hematocrit, and platelet count were measured the day before, immediately after, and an hour after the race.Results: [BDNF]s increased significantly immediately after the race in both groups (CSCI; P = 0.0055, LSCI; P = 0.0312) but returned to the baseline levels at one hour after the race. However, [BDNF]s immediately and one hour after the race were significantly higher in LSCI than in CSCI (immediately after the race; P = 0.0037, 1 h after the race; P = 0.0206). Hematocrit and platelet count remained unchanged throughout the study. In LSCI, [Ad]p, [Nor]p and [Cor]p increased significantly immediately after and one hour after the race, compared with the baseline values (P < 0.05). On the other hand, these variables remained unchanged throughout the study in the CSCI.Conclusions: [BDNF]s increased significantly from the baseline in both LCSI and CSCI but was higher in LSCI than in CSCI immediately after and one hour after the race.

Associations between wheelchair user's shoulder pain index and tendinitis in the long head of the biceps tendon among female wheelchair basketball players from the Japanese national team.

BACKGROUND: Among injuries in wheelchair athletes, shoulder injury is the most common. An easy and valid assessment tool is required to monitor the shoulder status in wheelchair athletes anytime. The present study aimed to investigate the association of wheelchair user's shoulder pain index (WUSPI) with physical examinations for tendinitis in the long head of the biceps tendon (LHBT) and range of motion (ROM) of shoulder movements among female wheelchair basketball players from the Japanese national team. METHODS: A total of 21 female players (mean age, 32.0 ± 7.9 years) participated in this study. LHBT tendinitis was assessed using findings of tenderness in the bicipital groove point (TBGP) and speed test. Shoulder ROMs were evaluated in three movements-namely, abduction, flexion, and extension. RESULTS: The mean total WUSPI score was 9.55 ± 13.35 points. The players were more likely to experience shoulder pain during activities related to wheelchair pushing and object lifting. A higher total WUSPI score was strongly and moderately associated with positive findings of TBGP (effect size r = 0.82) and speed test (r = 0.49), respectively. Furthermore, the total WUSPI score was significantly associated with limited ROM in shoulder abduction (r = 0.47) and flexion (r = 0.43). Receiver operating characteristic analysis showed that the total WUSPI score had a significant area under the curve (AUC) for positive findings of TBGP (AUC = 0.98), speed test (AUC = 0.83), and limited ROM in abduction (AUC = 0.84). When optimal cut-points were set by the Youden index, total WUSPI scores of 4.1 points (sensitivity = 1.00, specificity = 0.92), 11.3 points (sensitivity = 0.80, specificity = 0.81), and 3.3 points (sensitivity = 1.00, specificity = 0.65) were recommended for screening positive findings of TBGP, speed test, and limited ROM in abduction, respectively. CONCLUSION: TBGP, which is a major finding of LHBT tendinitis, was strongly associated with the total WUSPI score in physical examinations. Hence, pain assessed by WUSPI could reflect the presence of LHBT tendinitis. The WUSPI is a superior tool for monitoring the shoulder status of wheelchair basketball players.

The interaction between wheelchair configuration and wheeling performance in wheelchair tennis: a narrative review.

The number of wheelchair tennis players is rising internationally, yet from a scientific perspective little is known about wheelchair tennis performance. Wheelchair tennis is more complex compared to other wheelchair court sports, due to the wheelchair/racket interaction. The purpose of this narrative review was to gain insight into the influence of wheelchair configuration, i.e., the individual set-up of a wheelchair, on wheelchair tennis performance, more specifically on wheelchair mobility performance and propulsion technique. Wheelchair propulsion while holding a racket has had little attention in both the wheelchair mobility performance and wheelchair propulsion technique area. It is shown that the propulsion technique and wheelchair mobility performance are negatively affected by the racket. Based on the current literature, the influence of wheelchair configuration on wheeling performance in wheelchair tennis can mainly be described from a broader wheelchair court sport perspective, due to the lack of specific publications about wheelchair tennis. In the future more research should be conducted on wheeling performance and wheelchair configuration in wheelchair tennis, to attain a more proper scientific foundation for optimising wheelchair tennis performance.

Objective Measurement of Ball-Handling Proficiency in Wheelchair Sports: A Systematic Review.

Background: In Paralympic sports, classification of athletes based on the impact of impairments on the ability to perform is needed, to prevent a one-sided and predictable outcome of the competition in which the least impaired athlete has the best chance to win. Classification is developing from expert opinion based to evidence based. In wheelchair court sports, there is evidence to support the impact of impairment on wheeled mobility, but not on ball handling. To assess the impact of impairment on the ability to perform ball-handling activities, standardised tests for ball handling are needed. Purpose: To assess if reliable and valid standardised tests for the measurement of ball-handling proficiency in a wheelchair or able-bodied court sports exist; to assist in the development of Evidence-Based Classification (EBC) in wheelchair court sports according to the guidelines of the International Paralympic Committee (IPC). Methods: The review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) statement. Search terms used were "wheelchair," "ball," "ball sports," "test," and "performance." Databases searched were Medline, Embase, PubMed, and Sport Discus. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Twenty-two articles were included. Foundational Movement Skills in ball-handling proficiency were assessed. Tests for throwing maximal distance showed sufficient reliability and validity. Precision in throwing showed low-to-moderate reliability and conflicting results in validity. Throwing techniques differed between studies. Dribbling the ball showed high reliability, but conflicting results in validity. Conclusions: Tests for throwing maximal distance, throwing precision, and dribbling the ball can be used in standardised tests for activity limitation in wheelchair court sports. However, tests need to be adapted and standardised and then reassessed for reliability and validity in athletes with and without arm impairment.

Wearable Wheelchair Mobility Performance Measurement in Basketball, Rugby, and Tennis: Lessons for Classification and Training.

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).

Correlation between sleep and psychological mood states in female wheelchair basketball players on a Japanese national team.

[Purpose] Although some studies suggest the importance of getting adequate sleep for enhancing mood, there is not yet sufficient evidence on the relationship between sleep and mood states in athletes, especially for athletes with physical disability. The purpose of this study is to reveal relationships between sleep and psychological mood states in female wheelchair basketball players. [Subjects and Methods] Seventeen female wheelchair basketball players (30.9 ± 9.4 years old) on a Japanese national team participated. Sleep states were assessed with the Pittsburgh Sleep Quality Index (PSQI), and mood states with the Japanese version of the Profile of Mood States short form (POMS-SF). Spearman's rank correlations were computed. [Results] The mean PSQI score was 5.4 ± 2.6 points, and 9 athletes (52.9%) exceeded the cutoff point (5.5) for insomnia. Higher sleep efficiency (rS=0.58), fewer sleep disturbances (rS=-0.58), and lower total PSQI score (rS=-0.51) were significantly correlated with higher vigor. Lower likelihood of daytime dysfunction was also significantly correlated with lower tension (rS=0.50). [Conclusion] Vigor was the mood state most frequently correlated with sleep variables. Because vigor is a known key psychological factor in optimal performance, the findings are valuable for wheelchair basketball players.