Range of movement measurement tools to assess trunk function in wheelchair athletes with physical impairments


  • Marta Domínguez Díez Universidad Isabel I
  • Daniel Castillo
  • Raúl Reina
  • Jose Luis López Elvira
  • Javier Raya González




range of movement; trunk; field test; inclinometer; evidence-based classification


Introduction: Trunk function assessment is considered a key factor for the development of evidence-based classification process in wheelchair athletes. Thus, the aim of this study was to determine the intra-session reliability of two kinematic analysis tools (2D video analysis measure and an inclinometer mobile application) that could be used by classifiers to detect trunk range of movement (ROM) impairment in wheelchair athletes. Material and methods: Sixteen wheelchair athletes and six non-disabled participants (CG) were recruited for this study. Wheelchair athletes were dividing according to the origin of their eligible physical impairment in a neurological impairment group (ANI, n=7) and an impaired muscle power group (IMP, n=9). ROM was assessed in sagittal and coronal plane movements. Results: High-excellent relative intra-session reliability scores were found for trunk ROM measures for all participants (0.87 < ICC < 0.99). Significantly lower ROM values were observed in wheelchair athletes compared to CG, with the exception of the trunk flexion tilt movement measured by the 2D video analysis in the IMP group and the trunk extension tilt movement measured by the inclinometer app in the ANI group. Conclusion: 2D video analysis showed good intra-session reliability in the assessment of trunk ROM, while high intra-subject variability was observed when using the inclinometer app. The proposed tools may help classifiers to detect trunk ROM impairment at different levels in wheelchair athletes with different health conditions being the inclinometer app more interesting to detect lower back trunk impairment.


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Altmann, V. C., Groen, B. E., Hart, A. L., Vanlandewijck, Y. C., & Keijsers, N. L. W. (2018). Classifying trunk strength impairment according to the activity limitation caused in wheelchair rugby performance. Scandinavian Journal of Medicine & Science in Sports, 28(2), 649–657. https://doi.org/10.1111/sms.12921

Altmann, V. C., Groen, B. E., Hart, A. L., Vanlandewijck, Y. C., Limbeek, J. van, & Keijsers, N. L. W. (2017). The impact of trunk impairment on performance‐determining activities in wheelchair rugby. Scandinavian Journal of Medicine & Science in Sports, 27(9), 1005–1014. https://doi.org/10.1111/SMS.12720

Barbado, D., Reina, R., Roldan, A., McCulloch, K., Campayo-Piernas, M., & Vera-Garcia, F. J. (2019). How much trunk control is affected in adults with moderate-to-severe cerebral palsy? Journal of Biomechanics, 82, 368–374. https://doi.org/10.1016/J.JBIOMECH.2018.11.009

Cohen, J. (1998). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates, Publishers.

Cunha, A. B., Babik, I., Harbourne, R., Cochran, N. J., Stankus, J., Szucs, K., & Lobo, M. A. (2019). Assessing the validity and reliability of a new video goniometer app for measuring joint angles in adults and children. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2019.07.008

de Brito Macedo, L., Borges, D. T., Melo, S. A., da Costa, K. S. A., de Oliveira Sousa, C., & Brasileiro, J. S. (2019). Reliability and concurrent validity of a mobile application to measure thoracolumbar range of motion in low back pain patients. Journal of Back and Musculoskeletal Rehabilitation, 1–7. https://doi.org/10.3233/BMR-181396

Fleiss, J. L. (1986). The Design and Analysis of Clinical Experiments. New York: John Wiley and Sons.

Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando: Academic Press.

Heyrman, L., Desloovere, K., Molenaers, G., Verheyden, G., Klingels, K., Monbaliu, E., & Feys, H. (2013). Clinical characteristics of impaired trunk control in children with spastic cerebral palsy. Research in Developmental Disabilities, 34(1), 327–334. https://doi.org/10.1016/J.RIDD.2012.08.015

Hopkins, W. G. (2017). Spreadsheets for analysis of validity and reliability. Sportscience, 21, 36–44.

International Paralympic Committee (IPC). (2007). IPC classification code and international standards. Retrieved from: https://www.paralympic.org/sites/default/files/document/120201084329386_2008_2_Classification_Code6.pdf

International Paralympic Committee (IPC). (2015). IPCs´ Athletes Classification Code (Issue Bonn: IPC). Retrieved from: https://www.paralympic.org/classification-code

International Wheelchair Basketball Federation (IWBF). (2018). Official Player Classification Manual. Retrieved from: https://iwbf.org/wp-content/uploads/2020/10/Official-Player-Classification-Manual-2018.pdf

International Wheelchair Rugby Federation (IWRF). (2015). IWRF Classification Manual, 3rd edition revised 2015. Retrieved from: https://www.iwrf.com/resources/iwrf_docs/IWRF_Classification_Manual_3rd_Edition_rev-2015_(English).pdf

Jayavel, A., Misra, P., & Sivakumar, V. P. R. (2017). Reliability and validity of I handy android application on measurement of lumbar spine movement in patients with low back pain. International Journal of Clinical Skills, 11(3), 84–88. https://doi.org/10.4172/Clinical-Skills.1000118

Kallem Seyyar, G., Aras, B., & Aras, O. (2019). Trunk control and functionality in children with spastic cerebral palsy. Developmental Neurorehabilitation, 22(2), 120–125. https://doi.org/10.1080/17518423.2018.1460879

Keogh, J. W. L., Cox, A., Anderson, S., Liew, B., Olsen, A., Schram, B., & Furness, J. (2019). Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review. PloS one, 14(5), e0215806. https://doi.org/10.1371/journal.pone.0215806

Kirshblum, S. C., Waring, W., Biering-Sorensen, F., Burns, S. P., Johansen, M., Schmidt-Read, M., Donovan, W., Graves, D., Jha, A., Jones, L., Mulcahey, M. J., & Krassioukov, A. (2011). Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. The Journal of Spinal Cord Medicine, 34(6), 547–554. https://doi.org/10.1179/107902611X13186000420242

Kolber, M. J., Pizzini, M., Robinson, A., Yanez, D., & Hanney, W. J. (2013). The reliability and concurrent validity of measurements used to quantify lumbar spine mobility: an analysis of an iphone® application and gravity based inclinometry. International Journal of Sports Physical Therapy, 8(2), 129–137. http://www.ncbi.nlm.nih.gov/pubmed/23593551

Kuo, Y.-L., Tully, E. A., & Galea, M. P. (2009). Video based measurement of sagittal range of spinal motion in young and older adults. Manual Therapy, 14(6), 618–622. https://doi.org/10.1016/J.MATH.2008.12.006

Pourahmadi, M. R., Taghipour, M., Jannati, E., Mohseni-Bandpei, M. A., Ebrahimi Takamjani, I., & Rajabzadeh, F. (2016). Reliability and validity of an iPhone ® application for the measurement of lumbar spine flexion and extension range of motion. PeerJ, 4, e2355. https://doi.org/10.7717/peerj.2355

Roldan, A., Barbado, D., Vera-Garcia, F. J., Sarabia, J. M., & Reina, R. (2020). Inter-Rater reliability, concurrent validity and sensitivity of current methods to assess trunk function in boccia players with cerebral palsy. Brain Sciences, 10(3), 130. https://doi.org/10.3390/brainsci10030130

Saltan, A., & Ankarali, H. (2017). The Role of Trunk Stabilization in Functional-Classification Levels in Wheelchair Basketball. Journal of Sport Rehabilitation, 26(4), 287–293. https://doi.org/10.1123/jsr.2016-0054

Sánchez, M. B., Loram, I., Darby, J., Holmes, P., & Butler, P. B. (2017). A video based method to quantify posture of the head and trunk in sitting. Gait & Posture, 51, 181–187. https://doi.org/10.1016/j.gaitpost.2016.10.012

Santos, S. da S., Krishnan, C., Alonso, A. C., & Greve, J. M. D. (2017). Trunk function correlates positively with wheelchair basketball player classification. American Journal of Physical Medicine & Rehabilitation, 96(2), 101–108. https://doi.org/10.1097/PHM.0000000000000548

Serra-Añó, P., Pellicer-Chenoll, M., Garcia-Massó, X., Brizuela, G., García-Lucerga, C., & González, L.-M. (2013). Sitting balance and limits of stability in persons with paraplegia. Spinal Cord, 51(4), 267–272. https://doi.org/10.1038/sc.2012.148

Tweedy, S. M., & Vanlandewijck, Y. C. (2011). International Paralympic Committee position stand--background and scientific principles of classification in Paralympic sport. British Journal of Sports Medicine, 45(4), 259–269. https://doi.org/10.1136/bjsm.2009.065060

Tweedy, Sean M., Beckman, E. M., & Connick, M. J. (2014). Paralympic classification: conceptual basis, current methods, and research update. PM&R, 6(8), S11–S17. https://doi.org/10.1016/J.PMRJ.2014.04.013

Tweedy, S. M., Connick, M. J., & Beckman, E. M. (2018). Applying scientific principles to enhance Paralympic classification now and in the future: A research primer for rehabilitation specialists. Physical Medicine and Rehabilitation Clinics, 29(2), 313-332.

Vanlandewijck, Y. C., Verellen, J., & Tweedy, S. (2011). Towards evidence-based classification in wheelchair sports: Impact of seating position on wheelchair acceleration. Journal of Sports Sciences, 29(10), 1089–1096. https://doi.org/10.1080/02640414.2011.576694






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