Amputees are put into this class depending on the length of their stumps and if they play using prosthetic legs.
People in this class include Australia's Cobi Crispin, Bridie Kean, Liesl Tesch and Leanne Del Toso.
[3] Jane Buckley, writing for the Sporting Wheelies, describes the wheelchair basketball players in this classification as players having: "Normal trunk movement but some reduced lower limb function as they unable to lean to both sides with full control.
"[5] The Cardiff Celts, a wheelchair basketball team in Wales, explain this classification as, "able to move the trunk forcefully in the direction of the follow-through after shooting.
Class 4 players are able to flex, extend and rotate the trunk maximally while performing both one-handed and two-handed passes and can lean forward and to at least one side to grasp an over-the-head rebound with both hands.
Class 4 players are able to push and stop the wheelchair with rapid acceleration and maximal forward movement of the trunk.
Typical Class 4 Disabilities include : L5-S1 paraplegia, with control of hip abduction and extension movements on at least one side.
[8] 4-point players generally have the greatest number of rebounds on the court because of competitive advantage when under the basket in terms of height, stability and strength.
[9] Because of the potential for balance issues related to having an amputation, during weight training, amputees are encouraged to use a spotter when lifting more than 15 pounds (6.8 kg).
To keep their oxygen consumption rate similar to people without lower limb amputations, they need to walk slower.
[12] A1 basketball players use around 120% more oxygen to walk or run the same distance as someone without a lower limb amputation.
[13][16] A4 basketball players use around 7% more oxygen to walk or run the same distance as someone without a lower limb amputation.
People with amputations longer than 2/3rds the length of their thigh when wearing a prosthesis are generally 4.5-point players.
[21][22] The location of lesions on different vertebrae tend to be associated with disability levels and functionality issues.
[23] People with lesions at L4 have issues with their lower back muscles, hip flexors and their quadriceps.
[24] People with lesions at the L4 to S2 who are complete paraplegics may have motor function issues in their gluts and hamstrings.
The system was designed to keep out people with less severe spinal cord injuries, and had no medical basis in many cases.
[27] This class would have been IV or V.[27] In 1982, wheelchair basketball finally made the move to a functional classification system internationally.
While the traditional medical system of where a spinal cord injury was located could be part of classification, it was only one advisory component.
[21][28] The location of lesions on different vertebrae tend to be associated with disability levels and functionality issues.
[24] People with lesions at the L4 to S2 who are complete paraplegics may have motor function issues in their glutes and hamstrings.
[20] The original classification system for wheelchair basketball was a 3 class medical one managed by ISMGF.
This policy was put into place in 2014, with the goal of avoiding last minute changes in classes that would negatively impact athlete training preparations.
All competitors needed to be internationally classified with their classification status confirmed prior to the Games, with exceptions to this policy being dealt with on a case-by-case basis.
[34] Sometimes the health examination may not be done on site for amputees because the nature of the amputation could cause not physically visible alterations to the body.
[35] For wheelchair basketball, part of the classification process involves observing a player during practice or training.
[7] In Australia, wheelchair basketball players and other disability athletes are generally classified after they have been assessed based on medical, visual or cognitive testing, after a demonstration of their ability to play their sport, and the classifiers watching the player during competitive play.
[38] Cobi Crispin, Bridie Kean, Liesl Tesch and Leanne Del Toso are 4-point players for Australia's women's national team.
[41] This version is supported by the International Stoke Mandeville Wheelchair Sports Federation,[41] and played in Japan.
[42] Twin basketball has a three-point classification system based on the evaluation of the mobility of people with cervical spinal cord injuries.