Expert Consensus to Guide the Classification of Paralympic Swimmers With Vision Impairment: A Delphi Study

The International Paralympic Committee requires their member sports to develop a classification system that is sport-specific, meaning that the specific ‘class’ in which an athlete competes should be suitable for the degree to which the athlete’s impairment affects performance in that particular sport. However, swimmers with vision impairment (VI) currently compete in classes that were developed on the basis of legal definitions of blindness, failing to consider how vision impacts swimming performance. The aim of this study was to establish expert guidance on the specific requirements for a sport-specific system of classification for VI swimming. A three-round Delphi review was conducted with a panel of 16 people with expertise in VI swimming either as an athlete, coach, administrator, or scientist. There was clear consensus (86%) among the panel that the current classification system used for VI swimming fails to fulfill the aim of minimizing the impact of VI on the outcome of competition. Particularly, the panel agreed that there are a range of aspects of visual function (e.g., depth perception and contrast sensitivity) that are important for optimal swimming performance, yet are not assessed using the current classification system. The panel also identified nine performance components of a swimming race that are mostly likely to be affected by VI. Interestingly, these were spread across all four major segments (start, clean swim, turn, and finish), and weren’t necessarily those performance determinants generally used by performance analysts and coaches. There was also strong agreement that the age at which VI is acquired will substantially impact the ability of a swimmer to reach their full potential in the pool. The main implication is that changes are required to the way that swimmers with VI are classified for para-sport competition. Clear guidance has been provided for how to further the development of an evidence-based classification system

Detecting Cheating when Testing Vision:Variability in Acuity Measures Reveals Misrepresentation

SIGNIFICANCE In certain scenarios, it is advantageous to misrepresent one's ability and "cheat" on vision tests. Our findings suggest that increased variability when testing visual acuity holds promise as a novel means to help detect this cheating and may generalize to other subjective tests of visual function. PURPOSE People who cheat on vision tests generally do so to make their vision appear better than it actually is (e.g., for occupational or driving purposes). However, there are particular settings in which it is advantageous for their vision to appear to be worse than is the case (e.g., to qualify for benefits available to people with low vision). Therefore, a method to help detect cheating in these scenarios is desirable. The aim of this study was to investigate whether the intentional underrepresentation of vision could be detected when testing visual acuity. METHODS We tested the visual acuity of 13 participants with simulated vision impairment using the Berkeley Rudimentary Vision Test. Participants were tested in an honest condition when providing their best effort and in a cheating condition when attempting to make their visual acuity appear to be markedly worse. We also tested visual acuity of 17 participants with a wide range of vision impairments. RESULTS Participants were successfully able to "cheat" on the tests; however, their responses were significantly more variable when cheating (P <.001). Although the variability in visual acuity was larger in individuals with actual vision impairment compared with those providing honest answers with simulated impairment (P <.01), their responses remained significantly less variable than those for individuals in the cheating condition (P =.01). CONCLUSIONS The variability in the estimations of vision provides a promising novel means of detecting the intentional underrepresentation of vision and could help to minimize the chance of successfully cheating on tests of vision

Cardiovascular disease risk after spinal cord injury: The role of autonomic dysfunction

Cardiovascular disease (CVD) is the leading cause for mortality and morbidity after spinal cord injury (SCI) with an earlier onset and more rapid progression compared to the general population. Lifestyle changes after injury have been suggested to be the main contributor to CVD risk, but I proposed that the issue is more complicated. Although less well-known, autonomic function is affected by SCI, in addition to motor and sensory dysfunction. Cardiovascular autonomic dysfunction is a particular concern in individuals with high lesions (above T5) due to the possible disruption of descending spinal sympathetic pathways to the heart and main vascular resistance bed. In this thesis, I propose that cardiovascular autonomic impairment plays a role in the elevated CVD risk. The thesis starts with an evaluation of the prevalence and progression of cardiovascular dysfunction after SCI. Then, the contribution of autonomic dysfunction on CVD risk is investigated. In addition, markers for obesity-related CVD risk specific to individuals with SCI and ECG markers for cardiac arrhythmias in relation to autonomic impairments are explored. Prevalence of cardiovascular dysfunction was found not to improve over time after injury and it was highest in those with lesions above T5. The second study showed that autonomic dysfunction contributes to overall CVD risk and specifically to glucose intolerance, either directly or through an interaction with physical activity levels. The data showed that waist circumference is the best marker for obesity considering ability to detect adiposity and CVD risk, and practicality of use. A specific cut-off for waist circumference was found to be lower compared to the general recommendations. The final study showed increased values for the ECG markers Tpeak-Tend variability, P-wave variability and QTVI, only in those with impairments to descending cardiac sympathetic pathways. The ECG characteristics may be indicative of susceptibility to cardiac arrhythmia related to autonomic dysfunction. Implications of these findings are that management of cardiovascular autonomic dysfunction should remain a priority into the chronic phase of injury, not merely due the direct impact on quality of life, but also due to its contribution to the elevated cardiovascular disease risk after SCI