The increased participation in elite wheelchair sport has provided the need to investigate the physiological requirements of wheelchair sporting competition and daily wheelchair propulsion. However, from a nutritional perspective, guidelines that have been established from the able-bodied population tend to be used by the practitioners working in disability sport and it is not known whether this information is directly transferable to the wheelchair athlete. Wheelchair sport is complex and athletes differ with respect to their sports classification based on factors relating to disability and functional capacity. Therefore, if nutritional guidance is required to optimise performance then information regarding energy expenditure (EE) in the wheelchair sports population becomes important for specific feedback. The aim of this thesis was to investigate EE in wheelchair athletes. The results from Chapter 3 found resting energy expenditure (REE) in tetraplegic athletes to be lower than that calculated using predictive equations derived from an ablebodied cohort. However, paraplegic athletes showed comparable values to those which were predicted, suggesting these equations may be of use in paraplegic athletes. Chapter 4 extended this work and found similarities in the REE of the two aforementioned cohorts. This could have been due to the similarities that were found in their total-body fat free mass (FFM). The results from Chapter 5 showed EE reduced after both a short 36 minute exposure of wheelchair propulsion and after 3 weeks of wheelchair propulsion practice in novice wheelchair users. Temporal parameters improved after the practice period, suggesting there is an association between EE and propulsion technique. Chapter 6 extended these findings with results confirming that experienced wheelchair users expended significantly less energy during wheelchair propulsion than novice individuals who had up to 3 weeks practice. It is clear that EE of daily wheelchair ambulation should not be a generic value and different levels of experience must be considered so that the nutritional needs can be tailored accordingly. Chapters 7 and 8 examined the physiological demands of elite competitive wheelchair basketball players in relation to the International Wheelchair Basketball Federation (IWBF) classification categories and identified differences in the physiological demands and physiological fitness of wheelchair basketball and tennis players. These results found that IWBF Class 3 - 4.5 (high point) players expended more energy per hour during competition than those with a lower classification (IWBF Class 1 - 2.5). However, when actual playing time was considered the low classification group showed a similar EE to the higher classification group. Furthermore, wheelchair basketball players had a higher EE per hour than wheelchair tennis players during elite competition. However, the wheelchair tennis players spent a significantly longer duration on court resulting in similar EE during a typical competition within each sport. This suggests nutritional advice should be tailored both to the duration of competitive play (where EE may be similar between sports (basketball vs. tennis)); and to training (where athletes with a higher functional capacity may have higher EE). This thesis revealed several important physiological considerations to appreciate when investigating the EE of wheelchair sportsmen and women. Findings would suggest that type of disability, wheelchair propulsion experience and sport classification are all important considerations for the accurate assessment of EE in this cohort of athletes.

Introduction: Before 2015 the hand classification in wheelchair rugby consisted of non-sport specific tests. The hand classification was not in accordance with the classification code introduced by the International Paralympic Committee in 2003. In 2015, the newly revised wheelchair rugby classification manual was released, containing the revised wheelchair rugby hand classification. Hand tests that were not functional sport-specific tests were removed from the bench test in wheelchair rugby classification. Lumbrical, interossei and thumb opposition manual muscle testing were added to the bench test in wheelchair rugby classification. On both national and international levels of classification, classifiers verbalised their uncertainty to their fellow panel members regarding their hand placement on the athlete’s hand and interpretation of the manual muscle testing of the hand that was observed and tested. This justified reliability testing of the new hand classification. Aim: The aim of this study was to determine the intra and inter-rater reliability of the manual muscle testing in the new hand classification of wheelchair rugby. Study design: This study followed a quantitative non-experimental, cross-sectional design. Method: The raters who took part in the study were active international wheelchair rugby classifiers from all over the world. The raters received an electronic questionnaire consisting of biographic information and three videos repeated two times. Each video showed an athlete’s hand being classified by a classifier. The raters had to give a manual muscle test grade for each subject (muscle) tested in each video by using tick boxes. The manual muscle test grades that could be given were: 0-1, 2, 3 and 4-5. The first three raters in each international wheelchair rugby classification level who completed the questionnaire were used for the data analysis. Data Analysis: The statistician used the two way model for the ICC in which each subject was rated by the same raters to determine the absolute agreement for each objective. The Medcalc program was used. To indicate the strength of agreement the ranges provided by Landis and Koch (1977) were used: 0.0 – 0.2 slight, 0.21 – 0.4 fair, 0.41 – 0.6 moderate, 0.61 – 0.8 substantial and 0.81 – 1.00 almost perfect. Conclusion: Raters one, two, five, seven, eight and nine’s intraclass correlation coefficient values fell between 0.81-1.00 which is descriptive of almost perfect levels of intra-rater reliability. Raters three, four and six’s intraclass correlation coefficient values fell between 0.61-0.80 which is descriptive of substantial levels of intra-rater reliability. However, none of the raters scored 100% when accuracy was determined. All three levels had intraclass correlation coefficient values which is descriptive of almost perfect levels of intra-rater reliability within each level. Level 2, 3 and 4 classifiers had intraclass correlation coefficient values between 0.81- 1.00 which is descriptive of almost perfect levels of inter-rater reliability when the manual muscle testing grades for the first and repeated videos were compared. Across all nine raters there was a high intraclass correlation coefficient value which was descriptive of almost perfect inter-rater reliability. The accuracy in each level and across all nine raters was low. Finger extensors, thumb abductor and thumb flexor showed intraclass correlation coefficient values between 0.41-0.6 which is descriptive of moderate levels of intrarater reliability. The only subjects (muscles) that were graded accurately when compared to a memorandum were subjects with a manual muscle test grade 0-1 and 4-5. Most of the accurate manual muscle test grades were for athlete two in the video footage. Athlete two was classified as having a 2.0 hand. / Dissertation (MOccThe)--University of Pretoria, 2017. / Occupational Therapy / MOccThe / Unrestricted