ASSISTIVE DEVICES CLASSIFICATION ACTUAL CLASS

wheelchair Stool / chair ARW1 ARW2 ARST

bow bandaged assistant ARW1 -C Review ARST -C

bow arm splint body support / strapping

Shooting class Prosthesis block --

Leg strap

Recurve bow Compound bow Name of authorised classifiers (block capitals) PPS PRS ______other ______

______Classification N° ______M / F CLASSIFIER CLASSIFIER AR signature signature

FAMILY NAME ______

PROTEST GIVEN NAME ______

Date and time ______BIRTHDATE ______Name of classifiers on protest jury ______BIRTHPLACE ______COMMENTS: ______the following charges are upheld after protest COUNTRY ______INT’L FEDERATION ______DATE ______PLACE ______

______CLASSIFIER ATHLETE signature signature

ATHLETE signature Name------Bow Arm: R / L Full Muscle strength Coordination / ROM TRUNK BALANCE String arm: R / L R.O.M. Bow String a. Bow String a. arm arm Normal Fair Shoulder Flexion 170 Poor None HANDICAP CATEGORY Extension 40

Tetra Amputee Abduction 180 adduction 40 STANDING BALANCE Para Les Autres Int. rotation 70 Normal Fair Polio C.P. Ext. rotation 70 Poor None Spina bifida Elbow Flexion 150

Extension 10

TETRA / PARA / POLIO / SPINA BIFIDA Forearm Supination 90

Traumatic: yes no pronation 90

Wrist flexion 50 COMMENTS (description motor level) ______extension 60 ______Ulnar 40 Abduction Rad. 30 ______(description sensory level) ______Abduction Fingers Flexion 90 ______Extension 10 Spread/Closin ______g Thumb Opposition ///////////// // ______AMPUTATION Extension /////////////

congenital acquired TOTAL UPPER LIMBS Trunk Up.Abdominal ______s (describe level of amputation) ______Low.Abdomina ls Up.Extensiors ______

Low.Extensors Rotation 60 Point System Lat. flexion CEREBRAL PALSY Range of Movement: 0 - No range of movement 1 - Minimal range of movement TOTAL TRUNK 2 - 1/4 movement 3 - 1/2 movement 4 - 3/4 movement 5 - Full range of (describe type of cerebral palsy) movement Legs and Flexion 130 a) congenital ______Muscular Strength: 0 - Total lack of voluntary contraction 1 - Trace, faint hip Extension 10 contraction without any movement 2 - Poor, contraction with very weak ______Abduction 40 movement through full range of motion when gravity is eliminated 3 - Fair, contraction with movement through the complete joit range against gravity 4 - Adduction 30 Good, contraction with full range of movement against gravity and some b) acquired / date / Details ______resistance 5 - Normal, contraction of normal strength through full range of motion Internal rot 40 against full resistance ______External rot 50 Co-ordination , Spasticity, Athetosis, Ataxis: 0 - No functional movement at all 1 - Very minimal co-ordinative movement possible, non functional 2 - The Knee Flexion 150 sequence of movement is very difficoult and can only be carried out very slowly Extension 5 and unco-ordinated and/or not more than 25% range of motion by fast repetition. LES AUTRES 3 - The movements can only be carried out slowly but roughly without faults and /or not more than 50% range of motion by fast repetition. 4 - The movements are slightly unco-ordinated and/or not more than 75% range of motion by fast (describe disability)______Ankle Dorsiflexion 30 ______Plantarflexion 50 I ______

TOTAL LOWER LIMBS