LTA: leg, trunk, and arms
Athletes who are able to use their legs, trunk, and arms to propel the boat as well as are able to use the sliding seat. Can be further broken down into LTA-visually impaired (VI) and LTA-intellectually disabled (ID). LTA-VI is a classification of athletes whose abilities are similar to standard LTA; however, they also present with visual impairments which will be further subclassified in Table 21.2. Similarly, LTA-ID represents a subset of LTA athletes that also have concomitant intellectual disabilities
TA: trunk and arms
Athletes who are able to use their arms and trunk during the rowing process, however, are unable to use their legs or a sliding seat during the progression of the stroke. Typically athletes have good truncal control and arm function
AS: arms and shoulders
Athletes who are able accelerate the boat using primarily their arms and shoulders. These athletes have minimal to no leg and trunk function
In the classification of visually impaired athletes, placement into LTA-B1, LTA-B2, and LTA-B3 categories depends on the level of visual impairment with best correction, certified by an optometrist or ophthalmologist. Classifications for the LTA-visually impaired (VI) athletes are listed in Table 21.2 .
An athlete with a left below-knee amputation sculling with the use of her prosthetic. This athlete is classified as an LTA rower (Photo courtesy of Alan Schleier)
An athlete with a spinal cord injury (right) rowing with a non-disabled athlete (left). Note the adapted seating, which contains both a seat back and torso straps. This athlete competes within the TA classification (Photo courtesy of Alan Schleier)
Classifications for adaptive rowing for athletes with visually impairments (VI) 
No light perception in either eye to light perception, but inability to recognize the shape of a hand at any distance or in any direction
From ability to recognize the shape of a hand to a visual acuity of 2/60 and/or monocular visual field of more than 5° and less than 20°
From visual acuity about 2/60 to visual acuity of 6/60 and/or monocular visual field of more than 5° and less than 20°
Visual acuity over 6/60 and/or monocular visual field of more than 20°
There is a myriad of equipment adaptations seen in adaptive rowing. Their designs are based on goals of both improving safety and facilitating effective stroke mechanics for the athlete. Every part of a rowing setup, including the boat body itself (shell), oarlocks, footplates, and seating, may be modified. In most cases, the use of pontoons is also required to increase the stability of shells. Additional equipment involved in seating, padding and support, transfers, communication aids, and prosthetic accommodations may also be employed. There are even modifications to land-based training equipment (ergonomic rowing machines) which may be used to accommodate an individual athlete’s needs. If racing under the Fédération Internationale des Sociétés d’Aviron (FISA) rules, LTA-VI rower must wear light occluding goggles during warm-up, training, and competition.
An arm/shoulder setup for a sweep rower including fixed seat and pontoon (Photo courtesy of Alan Schleier)
Adaptive sailing has been part of the Paralympic Games since 1996 . The first occurrence consisted of one event with a mixed crew boat. It was initially contested as a demonstration event and not an official part of the games, although medals were awarded to the first Paralympic sailors. In 2000, adaptive sailing became an official part of the Summer Paralympic Games with two events being represented in Sydney. The first was a one-person keelboat using the 2.4mR and a three-person keelboat using the Sonar. The SKUD 18 class of sailing debuted in Qingdao, China, in 2008 during the Paralympic Games with 11 nations competing on the two-person keelboat .
Athletes with disabilities due to spinal cord injury, brain injury, stroke, amputations, cerebral palsy, visual impairment, hearing impairment, and intellectual disability may all participate in sailing with different levels of adaptation. However, adaptive sailing itself is a multi-disability sport in which athletes with differing types of impairments can compete together on the same vessels or against one another. At the Paralympic level, three sailing classes exist: the 2.4mR, SKUD 18, and Sonar [3, 4]. These classes of adaptive sailboats are raced with 1, 2, and 3 sailors aboard, respectively. A further detail regarding the type of boats raced in each class is listed below in Table 21.5. Paralympic sailing classification is based on three factors including stability, hand function, and mobility . Athletes are ranked according to a point system awarded based on severity of disability with the lower points corresponding to severely impaired and the higher points for the less disabled. The awarded points range from 1 to 7, with 1 corresponding to the lowest level of function to 7 being the highest. Furthermore, each individual boat uses its own point system to make up a team. Athletes in a single-person boat have to meet a minimum criterion of a classification ranking 1–7. The two-person boats require one of the two sailors having a number of 1 or 2 with the other crew member having any classification from 1 to 7. Furthermore, of the 2 crew members must be female. In the three-person boat, each team of sailors is allowed a maximum of 14 points to allow for equal competition . Athletes with visual impairments have a separate classification procedure for adaptive sailing. They are placed into 1 of 3 competition rating classes based on visual acuity and field of vision . Depending on the athlete’s visual capabilities, they are placed in a sport class of 3, 5, or 7. In this system 7 indicates the highest eligible visual ability. Table 21.3 describes the classification system for the visually impaired athletes.
Classification for visually impaired athletes in adaptive sailing 
Total absence of perception of light in both eyes or some perception of the light but with the inability to recognize the form of a hand at any distance and in any direction
A visual ability to recognize the form of a hand to a visual acuity of 2/60 and/or visual field of less than 5°
A visual acuity of above 2/60 to a visual acuity of 6/60 and/or a visual field of more than 5° and less than 20°
Adaptations may include use of transfer systems, adaptive seating and support systems, communication systems, and alterations to the sailing vessel itself that may alter how the sails and/or the steering fin (rudder) are manipulated. Additional methods of increasing safety during transfers may also be employed. In addition to any access ramps, lifts, stability mats, or other equipment that will enable a disabled sailor to reach a vessel, measures should be taken to maximize safety during transfers . For instance, when a disabled sailor is boarding a vessel from a dock, it is important to remove bumpers in order to allow the boats body (hull) to be as close to the dock as possible, therefore decreasing the space a sailor must traverse to board the boat. Also, it is important remove any stray ropes (lines) from the boarding area that may present a safety hazard or otherwise interfere with transfer.
The major adaptations seen within sailing correlate with boating vessels themselves. There are a number of sailing vessels that are used in adaptive sailing, and the most commonly used vessels are included in Table 21.4.
Sailing vessels used in adaptive sailing 
A single-crew cat rigged 7′ 6″ sailing keelboat. It is regarded as a beginner’s dinghy. It can be controlled via joystick rather than a tiller and c is seated facing forward. The crew does not switch sides during a tack. Its design is composed of a low ballast and high sides, and it can be equipped with servo assist electric controls to assist with athletes with physical impairments
A single or two crew 10′ sailing keelboat. It is regarded as a beginner’s dinghy. It can have similar joystick control to Access 2.3 also with the crew facing forward. It has the same electric servo-assisted drives as Access 2.3 also is designed with a low ballast and high sides. The rigging is raised with an added jib, creating an extra sail to trim
Similar to the Access 2.3 and 303, the Liberty is long at 12′ and was designed to be faster and high pointing
A two-person lead-assisted 19′ skiff with a tube-launched asymmetrical and modern high performance stayed rig. Helmsperson can transfer manually and be steering with tillers. Otherwise helmsperson can be in a fixed seat on the centerline using a manual joystick, push/pull rods, or a servo assist joystick with full control of all functions. The forward crew can either be seated on the centerline, transferring manually, or on trapeze. It is one of the three classes of adaptive racing sailboats used in the Paralympic Games. Criteria for the SKUD 18 class require at least one member of the crew to be female
A 20′ 6″ keelboat with two mounted pivoting seats. One seat is for the helmsman and the other for the forward seated crew. It has a low freeboard and orderly side decks for easy onboarding and maneuverability. The ballast ratio and vertical center of gravity gives added stability. Equipped with self-tending jib and efficient rigging
Two-hulled 16′ 7″ catamaran made for a two-person crew. The “trapseats” are bolted onto either side, allowing for one crew member to steer the boat with the tiller and the other to man the main sail and jib. It offers people with severe disabilities the opportunity to sail on even-terms with an able-bodied crew member. Often utilized by Special Olympic sailing programs
Norlin Mark III 2.4mRa
A 13′ 8″ single-handed dinghy that is well suited for all types of physical impairments as the sailor does not need to move about the boat. The control lines are fitted under the deck to a console directly in front of the sailor allowing for easily adjustable controls. Utilizes a hand tiller for steering and/or a foot pedal steering if required. It has no spinnaker but does use whisker pole for setting the jib downwind. It is considered one of three classes of adaptive racing sailboats in the Paralympic Games and has been used in every Paralympics since Sydney 2000
A 16′ 0″ keelboat that can be navigated by one to two crew members. It has a weighted high lift keel which makes it a very stable and safe. It can be easily trailer launched and rigged by one person adding to its easy usage and stability. It has adjustable seating and a specialized control system with optional automated systems for steering, including manual or electronic joysticks or sip and puff, automated sheeting as well as bilge pumping
A three-person 23′ keelboat with a contoured sit-in, large cockpit, and numerous configurations for adaptations. It is Bermuda rigged and has a large mainsail. It is one of three classes of adaptive racing sailboats used in the Paralympic Games and was one of the first boats sailed at the 1996 Paralympic Games. It is sailed without a spinnaker and utilizes a whisker pole to hold the jib out when running downwind
A one-design, day sailor dinghy that has a sail plan consisting of a main, jib, and spinnaker. The simple rigging and uniform wide beamed construction has made it one of the most popularized boats
A newer design keelboat that has eats, seat backs, cockpit floor, and splash rail is built into the deck mold. It can be fitted with special adaptations that are particular to any athlete-specific requirements
A 15′ single-handed vessel whose class association permits sailors with disabilities to adapt their boat to their own preferences. Modifications to seating and control line setup are nearly always allowed. A very tough and stable craft
Once aboard, a disabled sailor may utilize a number of adaptations to the cockpit environment. In terms of safety, special seating, harnesses, and/or stability straps may be used. Additional nonskid surfaces and added handles and grips may be added to the deck and cockpit surfaces to further add to sailor stability. For vessel operation, a number of adaptations may be made to equipment. For sailors with unilateral upper extremity impairments, alteration to cleats may be made for improved ability to operate one handed. Tillers, long steering bars which attach to a steering “fin” below the water known as the rudder, can be modified by alteration length or addition of rings or handles to assist a captain in steering the vessel. For those sailors with more advanced impairment of the upper extremities, joystick controls combined with electric winches and/or servo-assisted tillers may allow for both sail and rudder manipulation . In cases where sailors have very limited or absent upper extremity function, sip and puff systems similar to those used with power wheelchairs may be used to both trim (pull in/out) sails and steer the tiller . Ropes, loops, and grips are equipment that are commonly added to the vessels and employed to aid the sailors in holding on for stability.
Adaptive swimming is one of the most popular sports among disabled athletes with one of the highest participation rates. Since the first Paralympic Games in Rome, Italy, in 1960, it has remained a staple in the games drawing some of the greatest interest from participants to spectators. The 2012 Paralympic Games in London, England, saw one of the most impressive number of participants, including 148 medal events with 600 athletes, 340 of which were men and the remaining 260 being women . Competitions are held in 50-m pools and swimmers are not allowed to don prostheses or assistive devices during competitive events per Paralympics guidelines. Events are open to both male and female athletes with physical disabilities including dwarfism, amputation/limb loss, blindness/visual impairment, spinal cord injury, and other wheelchair-bound ailments, cerebral palsy, brain injury, stroke, other cognitive impairments, and Les Autres 
Adaptive swimming, like many other adaptive aquatic sports, helps to develop both strength and flexibility. Much of the stress that would be placed on athletes during participation in contact sports is reduced, producing an activity that allows for both cardiovascular and musculoskeletal conditioning without the added degradation and worsening of already present physical impairments, including no impact forces through residual limbs in athletes with amputations. Furthermore, the water’s buoyancy properties produce for an environment in which disabled swimmers are afforded the support of their body weight, without the added consequence of falling, often times helping to even the playing field among varying impairments.
The majority of the same rules apply for Paralympic swimming that apply to non-disabled competitions. Similar to non-disabled races, swimmers may begin races by standing on a platform and diving into the pool. Other athletes however may start in the water if their impairment limits them from standing and/or diving. Some strict rules do apply to adaptive swimmers who present with certain impairments. One such rule is no butterfly stroke or diving at the start of the race for persons with atlantoaxial instability. Similar to this, no diving is allowed for athletes if they have any sort of shunt in place. Furthermore, athletes who present with open wounds must be excluded from all competition as the risk for infection and further bodily harm is too great.
An adaptive swimmer classification may vary for different swimming strokes as their physical impairments may alter the way in which they are able to perform the certain strokes. However, unlike any other Paralympic sport, swimming is the only sport that combines varying impairments, including conditions of limb loss, cerebral palsy, spinal cord injury, Dwarfism, and other disabilities, across classes. The classification system allows for swimmers with certain impairments to compete against those with similar levels of function. Those with physical disabilities are placed in categories between 1 and 10, with 1 representing the most severely disabled. Blind and visually impaired swimmers are altogether categorized into a separate classification within categories 11, 12, or 13. Category 11 is relegated for athletes who are totally blind, while those in category 13 have severe visual impairment but are not completely blind. Swimmers with intellectual disabilities fall into class or category 14. In the adaptive swimming classification system, the prefix S denotes the class for freestyle, backstroke, and butterfly, while SB denotes the class for breaststroke, and SM represents the class for individual medley [6, 7]. Table 21.5 outlines the different classifications among disabled swimmers.
S1 SB1 SM1
Swimmers in this sport class have a significant loss of muscle power or control in their legs, arms, and hands. Some athletes also have limited trunk control, as it may occur with tetraplegia. These impairments may be caused by spinal cord injuries or polio. Swimmers in this class usually use a wheelchair in daily life
S2 SB1 SM2
Swimmers in this sport class are able to use their arms with no use of their hands, legs, or trunk or have severe coordination problems in four limbs. As in sport class S1 SB1 SM1, athletes mostly only compete in backstroke events
S3 SB2 SM3
This sport class includes athletes with amputations of all four limbs. Swimmers with reasonable arm strokes but no use of their legs or trunk and swimmers with severe coordination problems in all limbs are also included in this sport class
S4 SB3 SM4
Swimmers who can use their arms and have minimal weakness in their hands but cannot use their trunk or legs. Athletes with amputations of three limbs also swim in this sport class.
S5 SB4 SM5
Swimmers with short stature and an additional impairment, with loss of control over one side of their body (hemiplegia) or with paraplegia, compete in this sport class
S6 SB5 SM6
This sport class includes swimmers with short stature, amputations of both arms, or moderate coordination problems on one side of their body
S7 SB6 SM7
This profile is designated for athletes with one leg and one arm amputation on opposite sides, double leg amputations, or a paralysis of one arm and one leg on the same side. Moreover, swimmers with full control over arms and trunk and some leg function can compete in this class
S8 SB7 SM8
Swimmers who have lost either both hands or one arm are eligible to compete in this sport class. Also, athletes with severe restrictions in the joints of the lower limbs could compete in this sport class
S9 SB8 SM9
Athletes in this sport class swim with joint restrictions in one leg, double below-the-knee amputations, or an amputation of one leg
S10 SB9 SM10
This class describes the minimal impairments of eligible swimmers with physical impairment. Eligible impairments would be the loss of a hand or both feet and a significantly limited function of one hip joint
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