ASSISTIVE DEVICES CLASSIFICATION ACTUAL CLASS wheelchair Stool / chair ARW1 ARW2 ARST compound bow release aid 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 pronation 90 Traumatic: yes no 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 ///////////// TOTAL UPPER LIMBS congenital acquired 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 movement through full range of motion when gravity is eliminated 3 - Fair, ___________________________________________ Abduction 40 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 .