Impairment Groups in Para Sport

Para sport recognises seven eligible impairment types, defined by the International Paralympic Committee (IPC). Five are physical impairments. Impaired muscle power means a reduced ability to generate force, as after a spinal cord injury or poliomyelitis. Impaired passive range of movement means a permanently restricted range at one or more joints. Limb deficiency and/or limb length difference means the total or partial absence of a limb, or anatomically irregular limb dimensions, from a cause such as amputation, dysmelia or a congenital difference, and it includes leg length difference and arm length difference. Short stature means a reduced standing height from congenitally or developmentally shortened bones of the limbs and sometimes the trunk. Coordination impairments are a single category covering three movement disorders that arise from the central nervous system: hypertonia or spasticity, an increase in muscle tension with reduced ability to stretch a muscle; motor ataxia, a lack of coordination of movement; and dyskinesia, meaning involuntary movements such as athetosis, dystonia and chorea. The remaining two types are vision impairment, affecting the eye, the optic nerve or pathways, or the visual cortex, and intellectual impairment, a restriction in intellectual functioning and adaptive behaviour originating before adulthood.

Each impairment must arise from an underlying health condition, and the same condition can cause different impairments in different people. Cerebral palsy, for example, may present as a coordination impairment such as hypertonia, ataxia or dyskinesia, while a spinal cord injury may cause impaired muscle power and impaired passive range of movement. Recognising which eligible impairment an athlete has is the starting point for classification, because eligibility depends on having one of these defined types rather than simply on having a disability or a diagnosis.

Classification is the system that makes para sport fair, and it works in four stages. First, an underlying health condition is confirmed from diagnostic information. Second, that condition must lead to one of the seven eligible impairment types. Third, the impairment must meet the sport's minimum impairment criteria, meaning it must be severe enough to affect that sport, because a very mild impairment may not qualify in a given sport. Fourth, eligible athletes are allocated a sport class, which groups them so as to minimise the impact of impairment on the outcome of that sport's activities, together with a sport class status that indicates whether and when they may need to be seen again.

Several features are worth understanding. Classification is sport-specific, and each international federation decides which of the eligible impairments it includes, so an impairment eligible in one sport may not feature in another. Sport classes are based on the impact of the impairment on that sport's activities, such as running, propelling a wheelchair or throwing, rather than on the diagnosis alone or on current sporting performance. The sport class status, recorded as confirmed, review, or review with a fixed review date, sets out any need for re-evaluation, which may follow a progressive or fluctuating condition, maturation in a younger athlete, or a change in a sport's rules. This evidence-based, sport-specific approach aims to keep competition meaningful and fair.

The medical care of para athletes varies with the impairment and its underlying condition, and several issues recur. Athletes with a spinal cord injury, particularly those with higher-level lesions, are prone to impaired temperature regulation, pressure injuries over insensate areas, and autonomic dysreflexia, a dangerous surge in blood pressure triggered by a stimulus below the level of injury, which is covered in detail on its own page. A specific and serious concern in susceptible athletes is boosting, the deliberate induction of autonomic dysreflexia to raise blood pressure and enhance performance, which is dangerous and is prohibited. Athletes with limb deficiency need attention to the residual limb and, where used, to the fit and skin interface of prosthetics, and wheelchair athletes are prone to shoulder overuse from propulsion, both of which are addressed on their dedicated pages.

Other groups have their own considerations. Athletes with cerebral palsy and a coordination impairment need management of tone, movement and musculoskeletal problems, and attention to how these change with fatigue. Athletes with vision impairment need safe training environments and, in many sports, sighted guides, while athletes with intellectual impairment need clear communication and appropriate support. Themes such as bone health, thermoregulation and the prevention of overuse injury recur across several groups but are not universal, so care is matched to the individual, and a general medical review does not overlook ordinary health problems simply because an athlete has an impairment. The overarching principle is individualised care that understands the underlying condition, anticipates its specific risks, and enables safe, high-level performance.

• •There are seven eligible impairment types: five physical (impaired muscle power, impaired passive range of movement, limb deficiency and/or limb length difference, short stature, and coordination impairments) plus vision impairment and intellectual impairment.
• •Coordination impairments are a single category covering hypertonia or spasticity, motor ataxia and dyskinesia (such as athetosis, dystonia and chorea).
• •Each impairment must arise from an underlying health condition; the same condition (for example cerebral palsy) can cause different impairments.
• •Classification has four stages: confirming an underlying health condition, confirming an eligible impairment, meeting the sport's minimum impairment criteria, and allocating a sport class and sport class status.
• •Classification is sport-specific and minimises the impact of impairment on the outcome; sport class status (confirmed, review, or review with a fixed review date) sets out any re-evaluation.
• •Athletes with spinal cord injury, especially higher-level lesions, are prone to impaired thermoregulation, pressure injuries and autonomic dysreflexia; boosting (deliberately inducing autonomic dysreflexia to enhance performance) is dangerous and prohibited.