Nationals team pic
Disability Groups and Classifications
The majority of wheelchair athletes have suffered from spinal cord injuries. A smaller percentage of athletes also suffer from limb deficiency, amputations, or neurologic disorders such as cerebral palsy, spina bifida, post-polio syndrome, and traumatic brain injury. Regardless of the type of disability, all players in wheelchair basketball are organized by their functional ability or “volume of action.” For example, a player with a T12 complete spinal cord injury and a player with a bilateral hip disarticulation may be grouped into the same class. Classifications are not based solely on the same type of injury but rather the athlete’s functional ability to support their trunk and utilize their upper extremities  (see Fig. 12.2).
This classification system is used in an effort to ensure that the outcomes of games are determined by a player’s athletic ability and not by the level of a player’s impairment. The classification system is divided in categories from 1 to 4.5 with half point increments. In determining the difference between a class 1 and 4.5, players are viewed based upon their function, most specifically, their ability to stabilize and more especially their trunk, which is referred to as a player’s “volume of action”  (see Fig. 12.3).
The “volume of action” (Table 12.1) of a player is determined by his ability to voluntarily move in any direction and return to an upright seated position. The planes at which this is examined are the vertical plane, or rotation; the forward plane, a bending forward of the trunk toward the feet; and the sideways plane, leaning the trunk to the left or to the right. Based upon a player’s ability to perform these movements with control, they are placed into a classification as follows:
Volume of action
Volume of action
No active trunk movement in rotation, little to no controlled trunk movement in forward plane, no controlled trunk movement in sideways plane, and when unbalanced must rely on the arms to return to upright position
Has active upper trunk rotation, but no lower trunk rotation, partially controlled trunk movements in the forward plane, no controlled trunk movements in the sideways plane
Complete trunk movement in the vertical plane, complete trunk movement in the forward plane, no controlled movement in the sideways plane
Complete trunk movement in the vertical plane, forward plane and to one side but difficulty with controlled movement to the other side
Complete trunk movement in the vertical plane, forward plane and movement to both sides
Like in basketball, wheelchair basketball also utilizes five members per team on the court at a time. However, each player’s class is tallied together, so at no point can the total points of the five players on the court exceed 14 points. For example, three class 4 players, one class 2 and one class 1 player may be on this court because this would be equivalent to 14 points. Therefore the classification system emphasizes one’s skill level and capabilities instead of their disabilities .
Other rules which apply to wheelchair basketball include:
The player has a permanent severe leg disability or paralysis of the lower extremities. The eligible player may be an individual who would benefit from wheelchair basketball participation or someone who may be denied the chance to participate in basketball if it were not for the wheelchair adaption.
A wheelchair must be in use.
The chair is thought to be a part of the player. General rules of contact in regular basketball such as charging or blocking apply to wheelchair basketball.
Dribble: The player who is in possession of the ball may not push it more than twice in succession with one or both hands in either direction without tapping the ball to the floor. A traveling violation is constituted when the player takes more than two consecutive pushes. However, the player may wheel the chair and bounce the ball simultaneously just as an able-bodied player runs and bounces the ball simultaneously in a regular basketball .
Wheelchairs used in basketball are designed specifically for the sport. This is to enhance the speed, endurance, stability, agility, and ruggedness. Many variables can be modified to meet these needs.
Camber is the angle between the wheels and the vertical position. In other words, camber allows for the distance between the top and the bottom of the main wheels to be different due to a change in the wheel’s angle . Increasing the wheel camber allows for easier and faster maneuverability of the chair and can help prevent contact between wheelchairs during a match  (see Fig. 12.4).
Other adaptations which are used to increase the performance of the wheelchair include the position of the footrest, castor wheels, and seat height. Positioning of the feet underneath the seat has been shown to improve maneuverability. Castor wheels are small wheels at the front and the rear of the chair. Castor wheels at the front of the chair allow for greater stability during high speed turns, while rear castor wheels aid in preventing tipping of the chair . Seat height can also be utilized to allow for full elbow extension which can maximize a player’s push angle . Wheelchair modifications are performed based on the needs of the athlete, the athlete’s disability level, impaired hand function, and amount of trunk support required (see Fig. 12.5).
Elite wheelchair athletes will typically have extremely well designed and efficient wheelchairs to get them around the basketball court. However, the cost of these can be prohibitive for some athletes. The design of the athlete’s wheelchair can also affect the wheelchair athlete’s injury profile. Higher quality competitive wheelchairs that are low weight and have movable components which have less friction will improve the efficiency of athletes. Using a better designed wheelchair can help reduce the risks of injuries.
Medical Conditions and Injuries
While wheelchair basketball players are skilled and talented athletes, their circumstances make them more susceptible to certain types of injuries. From the use of repetitive muscle to propel a wheelchair to the effects on the cardiovascular and endocrine systems which are inherent in the spinal cord and other neurologic conditions, wheelchair basketball players are faced with a unique set of medical conditions.
Propulsion of a wheelchair (Table 12.2) requires the use and force of multiple muscle groups in a coordinated effort. Wheelchair basketball further complicates this matter as it requires quick and repetitive motions to keep up with the pace of the game. Wheelchair propulsion can be divided into two phases: the push phase, in which active contact and propulsion of the wheels are taking place, and the recovery phase, which is characterized by arm deceleration and lifting the arm to its return .
Muscles used for wheelchair propulsion 
Clavicular head: anterior border of the medial half of the clavicle
Sternocostal head: anterior surface of the sternum, the superior six costal cartilages, and the aponeurosis of the external oblique muscle
Lateral lip of the bicipital groove of the humerus
Clavicular head: flexes the humerus
Sternocostal head: extends the humerus
As a whole, adducts and medially rotates the humerus. It also draws the scapula anteriorly and inferiorly
Third to fifth ribs, near their costal cartilages
Medial border and superior surface of the coracoid process of the scapula
Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall, raises ribs in inspiration
Spinous processes of the T2–T5 vertebrae
Medial border of the scapula, inferior to the insertion of the rhomboid minor muscle
Retracts the scapula and rotates it to depress the glenoid cavity. It also fixes the scapula to the thoracic wall
Nuchal ligaments and spinous processes of C7–T1
Medial border of the scapula, superior to the insertion of the rhomboid major muscle
Retracts and rotates the scapula, fixes the scapula to the thoracic wall
Fleshy slips from the outer surface of upper eight or nine ribs
Coastal aspect of medial margin of the scapula
Protracts and stabilizes the scapula, assists in upward rotation
Infraspinous fossa of the scapula
Middle facet of greater tubercle of the humerus
Lateral rotation of the arm and stabilizes the humerus
Supraspinous fossa of scapula
Superior facet of greater tubercle of humerus
Abduction of the arm and stabilizes the humerus; see part on controversy of action
Lesser tubercle of the humerus
Internally (medially) rotates the humerus, stabilizes the shoulder
Lateral border of the scapula
Inferior facet of greater tubercle of the humerus
Laterally rotates the arm, stabilizes the humerus
Spinous processes of the remaining thoracic vertebrae (T4–T12)
Scapular spine base
During the push phase, muscles which are actively used include the anterior deltoid, pectoralis major, supraspinatus, infraspinatus, serratus anterior, and biceps brachii. At the late recovery phase, the muscle is required to slow the extension of the arm. This action is performed by the anterior deltoid, pectoralis major, and biceps brachii. The action is then followed by these same muscles contributing to rapid shoulder flexion. The serratus anterior also contributes to shoulder stability by holding the medial border of the scapula to the rib cage. The infraspinatus and supraspinatus are required to maintain external rotation of the arm .
During the recovery phase activity of the middle/posterior deltoid, the supraspinatus, subscapularis, middle trapezius, and triceps brachii are required. The triceps function to decelerate the arm and initiate extension of the shoulder, while the middle/posterior deltoid and supraspinatus provide elevation of the arm. The trapezius provides scapula retraction during arm return. One must keep in mind, however, that depending on a player’s level of injury, the activity and utilization of certain muscle groups will vary .
Musculoskeletal injuries are the most frequent medical problem with competitive wheelchair basketball. Wheelchair basketball players are at increased risk for routine musculoskeletal injuries such as straining a muscle when compared to those of able-bodied athletes. Wheelchair athletes are at an increased risk for overuse injuries. The overuse injuries are distributed quite differently because of the use of wheelchair propulsion. The shoulder complex is the most commonly injured area, and the wrist is the second most common. The shoulder injuries could be unilateral or bilateral in location and are often considered overuse injuries but could be traumatic. A history of shoulder pain is reported in wheelchair basketball athletes, with an increasing prevalence in the proportion to the amount of trunk and upper extremity disability.
Shoulder impingement syndrome is by far the most common injury. Bicipital and rotator cuff tendinopathy in addition to tears are also common. Paraplegics are especially susceptible to rotator cuff tendinopathy, because they are more prone to internal rotation of the shoulder due to the force of the pectoralis major . The excessive internal rotation of the shoulder places the greater tuberosity under the acromion process, making impingement syndromes more likely. Furthermore, wheelchair athletes often have a protracted scapula position due to an underlying scapular dyskinesis resulting in a decreased subacromial space. The humeral head is then elevated as a result of the imbalance in muscle strength .
The scapular stabilizer muscles are the primary muscles of wheelchair propulsion. Preventive measures, strengthening, and conditioning are all beneficial to all wheelchair athletes. A rehabilitation treatment approach includes a modification of strengthening programs, proprioceptive techniques, and flexibility exercises.