Duo Dance event. Picture taken by Alexander Sperl at the 2014 European Championships in Poland. Permission granted for use by the IPC
Rules and Regulations
The rules for WDS are determined by the IPWDSC and complement the rules of able-bodied dance sport as determined by the World Dance Sport Federation (WDSF). There are numerous differences and similarities between dance sport and WDS.
In WDS there are two main event categories and subgroups within each event, as defined in Table 16.1. Within each event category, there are dance subgroups and dance style regulations as listed in Table 16.1.1
Type of Wheelchair Dance Sport events (see footnote 1)
A. Conventional events
1. Single dance (one wheelchair user)
Waltz, tango, samba, rumba, or jive
2. Duo dance (two wheelchair users dance together)
Standard (waltz, tango, Viennese waltz, slow foxtrot, or quickstep) or Latin
3. Combi dance (when the wheelchair user dances with an able-bodied standing partner)
Standard or Latin (samba, cha-cha-cha, rumba, paso doble, or jive)
B. Freestyle/showdance events
1. Single dance
Any dance style
2. Combi dance
Any dance style
Rules of WDS
The rules of WDS are fully outlined by the IPC in the IPC Wheelchair Dance Sport Rules and Regulations published in August 2015 but will be summarized and reviewed here with the permission of the IPC.2
Singles participate in either the men or women’s section. Dou dance partners and combi dance partners must be made up of one man and one woman, and partners cannot change throughout a competition without certain circumstances. It is possible for Wheelchair Dance Sport athletes to dance in one section or all sections (standard, Latin, or freestyle/showdance). Most importantly, dancers must meet minimum eligibility criteria for WDS.
All movements are allowed, including lifts and acrobatics in freestyle dance, while no lifts (except of only the front wheels or short jumps) are allowed in conventional dance. Dancers are allowed to leave their wheelchairs for transitions only at the beginning or end of the dance. They may not dance on the floor without their wheelchair.
A minimum of 90 s must occur for waltz, tango, slow foxtrot, quickstep, samba, cha-cha-cha, and paso doble. A minimum of 1 min should occur for the Viennese waltz and jive. In freestyle dance presentations for singles should be between 2 min and 2 min and 30 s. However, the freestyle dance presentation for combi should meet 3 min and 30 s.
In conventional events, judging is typically based on six categories: aim (focus on the wheelchair athlete), music, movement (including balance and rhythmical control of the wheelchair), choreography, presentation, and charisma. In freestyle events, dancers perform only once, and judging is typically based on technical skills, choreography and presentation, and difficulty level.
Classification Process for Wheelchair Dance Sport Athletes
Only dancers with physical impairments of the lower limbs are eligible to participate in WDS. Most commonly the dancers that participate have cerebral palsy or spinal cord injuries. According to the WDS Classification Rules from March 2014, athletes must meet one of five lower limb impairments in order to participate.3 These include impairments in both structure and function based on the International Classification of Functioning, Disability, and Health (ICF).
The impairments include:
Hypertonia, ataxia, and/or athetosis (with a minimum of Grade 2 on lower limb Modified Ashworth Scale  (see Appendix for scale).
Impaired muscle power (with a loss of at least ten muscle strength points across the lower limbs according to the Daniels and Worthingham Scale  (see Appendix for scale).
Impaired passive range of movement of the knee or ankle.
Limb deficiency (with the minimum being the absence of ankle joint).
Leg length difference (at least 7 cm shortening of leg).
Once eligibility is determined, athletes can then be classified into two groups, Sport Class 1 (LWD 1) and Sport Class 2 (LWD 2). The sport classes are based off the scoring performance in five functional tasks as reviewed in Fig. 16.1 (see footnote 1). Couples can compete in duo dance Sport Class 1 if both athletes are in Sport Class 1 (or if the total score for the athletes is less than 30 points). Couples can compete in duo dance Sport Class 2 if they are both allocated Sport Class 2 (or if their total score is 30 points or more).
Wheelchair Dance Sport classification (see footnote 1)
Dance sport athletes can use manual or electric wheelchairs. The manual wheelchair design can vary, but it is typically five wheeled (two swivel casters in the front, two drive wheels, and one swivel caster in the back). The two swivel casters in the front are associated with a footplate to secure the dancer’s feet. The design of the wheelchair allows the dancer to have control of the chair with smooth transitions and to prevent tipping. Depending on the athlete and dance style, some athletes may have no swivel casters on the chair to allow for specific maneuvers to be incorporated into the dance.
The surface of the dance floor should be at least 250 square meters, with no side of the floor less than 10 m in length. World Championship and Regional Championship floors must be 350 square meters (see footnote 1).
Combi dance. Picture taken by Alexander Sperl at the 2014 European Championships in Poland. Permission granted for use by the IPC
Ballroom dancing requires fast as well as turns and changes of direction that require sensory stimulation, motor coordination, and creativity . WDS athletes, like able-bodied dancers, must incorporate body aspects (posture, alignment, flexibility, body control, and balance), dynamic aspects (strength and stability), and presentation aspects (confidence, style, and charisma) into a performance. Balance and strength are two of the key ways WDS athletes must use adapted mechanics compared to able-bodied dancers in order to perform.
Recall that balance requires a complex interaction between the visual, vestibular, and nervous system . Able-bodied dancers maintain balance within the complexity of their dance by adjusting their legs, pelvis, and trunk quickly and subtly before the onset of arm movements . They rely on muscle synergy patterns that occur milliseconds before movements. Such whole body reactions support limb movements without excessive disturbance to the center preventing the appearance of swaying or instability . WDS athletes, who cannot use their lower limb movements for balance, must instead maintain balance with their wheelchair, trunk, and upper body. In order to accomplish balance, like many of the wheelchair sports and especially important for dancers, proper alignment of center in the wheelchair with seat positioning, wheel alignment, and hand rim configurations are key [6, 7]. Trunk strength is then heavily needed not only for creating stability during arm movements but also for maintaining posture throughout the performance and in deceleration .
Similar to the able-bodied dancer, upper body strength is also very important for WDS athletes for maintaining contact with their dance partner, performing arm and hand positions, and controlling their chair . In contrast to the able-bodied dancer, the wheelchair dancer is unable to use the whole body kinetic chain in maintaining contact with their partner, and this may lead to greater eccentric load on the upper body making the wheelchair athlete more prone to upper body injury . The WDS athlete must also propel the wheelchair in a controlled and stylistic fashion as they will be judged on their ability to control chair movements (see footnote 2). Shoulder strength and range of motion is key in all of these movements. For example in order to lift the front of the chair in a dance, wheelchair users rely heavily on shoulder flexors and internal rotators to generate the greatest force, while elbow flexors are required to control the shoulder efforts and maintain balance within the chair . Improper technique and training could lead to injury of these muscles affecting not only performance but also everyday function in these athletes.
Combi dance with an example of posture, balance, and technicality of the dancing. Picture taken by Alexander Sperl at the 2014 European Championships in Poland. Permission granted for use by the IPC
Common Injuries and Injury Prevention
There is unfortunately no specific incidence data on WDS injuries, but literature is available from able-bodied dance sport and other wheelchair athletes. Therefore, common wheelchair athlete injuries will be reviewed first and compared to that of able-bodied dance sport. Figure 16.2 reviews the common injuries reported in wheelchair athletes without sport specification.
Common wheelchair sport injuries
Common Wheelchair Athlete Injuries
Upper Limb Injuries
In general for wheelchair sports, upper limb injuries are most commonly reported. A 1991 study reported injuries commonly occurred in the hand (20%), followed then by the shoulder (15.5%), fingers (11.1%), and arm (10%) . Another study, looking at only wheelchair athletes in track and field, wheelchair basketball, quad rugby, fencing, table tennis, tennis, and volleyball, similarly demonstrated soft tissues injuries commonly occurring in the shoulder (18%), followed by the arm (12%) and the wrist (12%) . The general consensus within the adaptive sport literature is that injuries most commonly involve the shoulder, ranging between 15  and 72% with the highest incidence in female wheelchair basketball players [14–16]. In those with arm injuries, the most likely diagnosis was muscle strains (52%), tendinopathy (30%), bursitis (15.6%), and contusions [12, 13]. Interestingly, a 2012 Summer Paralympic study, which included all adaptive athletes (wheelchair and non-wheelchair users), determined that irrespective of impairment type, the upper limb accounted for 50.2% of all injuries, with shoulder being most common (17.7%), followed by the wrist/hand (11.4%) and elbow (8.8%) [17, 18].
In wheelchair athletes, it appears chronic injuries (35–60%) may be more likely than acute, but this could be sport and study specific depending on the definition of acute versus chronic and methods to collect data [19–21]. Upper limb nerve entrapments are also common, specifically median mononeuropathy (50%) at the wrist and ulnar neuropathy (25%) at the wrist .
While the shoulder may be the most common site of reported pain in wheelchair athletes, the actual site of pathology in one study was determined to be the cervical and thoracic spine (59 and 8%, respectively), suggesting common referral of pain to the shoulder . This stresses the importance of a thorough physical examination.
Soft Tissue Injuries
Soft tissue injuries are often reported to include sprains, strains, and tendinopathies of the shoulder, elbow, arm, and hand, as well as blisters (74%) abrasions (68%), lacerations (12%), and decubitus ulcers (8.9%) . Another study reported blisters and skin lacerations accounting for up to 35% of reported injuries . Recall that the likely mechanism of blisters, abrasions, and lacerations (when there is not a collision involved) is contact of the hand or wrist with the chair rim. Since these may require minimum medical care, they may even be under reported .
Lower Extremity Injuries
The lower extremity incidence of injury is less common than the able-bodied population in wheelchair athletes . Lower extremity fractures are more common in high speed adaptive sports with collision like wheelchair basketball, rugby, and softball  than would likely occur in Wheelchair Dance Sport.