Wheelchair Skills

Introduction

Many wheelchair users live and work in places where it is difficult for them to get around, for example areas where the ground is rough, sandy or muddy, or where there are steps, kerbs or small cramped spaces. Training in wheelchair skills can help wheelchair users to tackle some of these obstacles, either independently or with assistance. [1] Effective training of wheelchair skills in rehabilitation and community settings is key to increasing participation by individuals with mobility limitations and may also reduce the incidence of pain and chronic overuse injuries.

According to the Wheelchair Skills Programme "skill in wheelchair use is not an end in itself, it is a means to an end. In terms of the WHO’s International Classification of Function (2001), wheelchair skills are Activities. The ability to perform them represents “capacity” and their use in everyday life represents Performance. The purpose of these activities is to overcome barriers in the environment and to thereby permit the wheelchair user to fulfill their desired role in society (Participation). Other potential benefits of wheelchair-skills training for wheelchair users and caregivers include fewer acute and overuse injuries, an improved sense of wellbeing (through self-esteem, self-efficacy, confidence and personal control, the sense of becoming newly enabled, empowered and having accomplished something of worth), improved development (of children) and having fun. [2]

As we highlighted during assessment, the characteristics of the wheelchair - including its features, fit and setup - can have major impact on skill performance. In helping improve the safety, effectiveness and efficiency of wheelchair use, service-delivery providers should try to optimize both the the wheelchair (e.g. by moving the axles of a manual wheelchair forwards), wheelchair user (e.g. by improving strength or range of motion), and ensure optimal training. [1][2]

Wheelchair Handling

Folding

To transport or store the wheelchair, it needs to fold. Wheelchairs fold in two main ways.

  • Cross-folding frame fold so that both sides come together which can be helpful for wheelchair users needing to “squeeze” through narrow doorways or for transport, as it may fit better in the aisle of a bus, although a disadvantage can be that folding mechanism can weaken, making the wheelchair feel more unstable and more difficult to push.
  • Rigid frame wheelchairs the backrest folds down and the rear wheels come off, therefore tend to be more durable, as there are fewer moving parts.

Lifting Wheelchair Into Car

If you have enough upper body strength and an average sized vehicle, you can fold the frame and pop it right into the front of the passenger seat or in front of the backseat. If you have the ability to do that, you may be able to get your wheelchair into a car without using any tools. If you are unable to do independently you may ask an assistant to place the wheelchair into the trunk of the car.

Wheelchair Mobility

Pushing

Wheelchair users propel their wheelchair in different ways. Many wheelchair users propel the wheelchair with their arms, some wheelchair users push the wheelchair with their feet - or with one arm and one foot, and some wheelchair users need someone to push the wheelchair for them some or all of the time. Pushing the wheelchair is easier if the wheelchair user can reach the push rims comfortably and requires less effort. The rear wheel should be positioned so that when the wheelchair user holds the top of the push rim the elbow is bent at 90 degrees. Push from 10 or 11 o’clock to 2 o’clock position, using a long smooth action.[1]

Forwards

Forward rolling is a skill used during many wheelchair activities. Each pushing cycle combines two phases (Propulsion & Recovery) and also requires the wheelchair user to be able to stop.

Backwards

Backward rolling is a skill used during many wheelchair activities but normally only over short distances, except when faced with a surface with high rolling resistance (e.g. on a soft surface or ascending an incline using foot propulsion). Generally the technique used is the reverse of what is used for rolling forwards.

Turning

Turn In Place

Turning around in tight spaces is a common challenge for wheelchair users. The type of wheelchair and its dimensions affect the ease with which this skill can be performed. The ease of making a turn in a tight space depends on the overall length and width of the wheelchair, the distance between the wheels and how free the casters or steering wheels are to swivel.[2] Hold one push rim towards the front and the other towards the back. Pull the forwards hand backwards and push the backward hand forwards at the same time. [1]

Moving Turns

While moving turns can be more challenging, they are often necessary to avoid obstacles or to change direction. When ready to turn, the wheelchair user should slow down the inside wheel and/or push harder on the outside wheel. Slowing down the inside wheel results in a tighter turn, but causes the wheelchair to slow down. Pushing harder on the outside wheel causes the wheelchair to speed up. The decision on the relative speeds of the two wheels to use to make a turn depends on how tight a turn is needed and a consideration of the speed desired. [2]

Moving Sideways

Repositioning the wheelchair sideways in a tight space is commonly necessary to get closer to or farther away from objects (e.g. a bed or table). The wheelchair user needs to be aware of the widest and longest points of the wheelchair for doing this manoeuvre. If the space available is limited, the user may need to shuffle the wheelchair forwards and backwards a number of times to get into the desired position, moving more to the side with each attempt.

Negotiating Slopes

Incline

Lean Forward - this helps to stop the wheelchair tipping. When practising, have an assistant stand behind for safety. To Stop or Rest - Turn the wheelchair sideways on. [1]

Decline

Lean backwards. Let the push rim slide slowly through the hands. Experienced wheelchair users who are able to do a “wheelie” (i.e. balance the wheelchair on the rear wheels only) may roll down a slope on their back wheels. This is very efficient. [1]

Wheelies

Being able to do a wheelie is very useful for a wheelchair user. The wheelchair user can lift the front wheels to clear small kerbs, stones and bumps. Roll the wheelchair backwards until hands are in the 10 o’clock position. Then push forwards quickly. The castor wheels should come up. With practice, it is possible to lift the castor wheels at the right time to clear small obstacles. Always make sure that there is an assistant standing behind the wheelchair user when they begin to practise this skill. [1]

Negotiating Curbs, Steps & Escalators

Ascending Curbs

You can go up backwards or forwards - independently or with assistance. Tilt wheelchair on to back wheels, while chair is positioned against the first step. Do small wheelie forward, put wheels down onto step and push forward and upwards on wheels. If you require assistance the assistant can pull backwards and upwards - rolling the wheelchair up. Wheelchair user can assist by pushing the push rim backwards. A second assistant can assist by holding on to the wheelchair frame from the front (not footrests).[1]

Descending Curbs

You can go down forwards or backwards. To go forwards, tilt the wheelchair on to back wheels. User can control chair independently or an assistant lets can help to let the back wheels roll down slowly, one step at a time. Wheelchair user can assist by controlling the wheelchair with the push rims. A second assistant can help by steadying the wheelchair from the front, holding on to the wheelchair frame (not footrests).[1]

Stairs & Escalators

Wheelchair Transfers

The ability to get in and out of the wheelchair easily and safely, with or without assistance, will help a wheelchair user in daily life. Getting in and out of the wheelchair is called “transferring”. Wheelchair users may need to get in and out of their wheelchair several times a day and therefore require a method which is safe, quick and does not use much energy. Wheelchair users practise different methods, depending on their abilities, some wheelchair users can get in and out of the chair by themselves, and others need help, some users can stand up to transfer, while for others this is not possible.

Wheelchair users get in and out of the wheelchair in different ways, depending on their physical ability. Different wheelchair features can make their transfers easier. Three features that can make transfers easier are: armrests, footrests, and brakes.

  • Removable armrests, or armrests which follow the line of the rear wheels, are easier for people who get in and out of their wheelchair sideways. People who stand up to get in and out of the wheelchair may need armrests to help them stand up.
  • Footrests which can be moved out of the way are helpful for people who stand up to get in and out of the wheelchair. People who want to transfer to the floor may prefer a wheelchair with removable footrests.
  • Brakes are important for all wheelchair users. They are essential for keeping the wheelchair still while the person gets in and out of the wheelchair.

Before recommending or practising a transfer with a wheelchair user you need to know whether they can transfer independently or need help.

  • For transferring independently through sitting, check that the wheelchair user can lift their weight upwards by pushing with the arms. If they cannot do this, they may needs help to transfer either through use of a transfer board or from another person.
  • For transferring independently through standing, check that the wheelchair user can stand up and take their own weight through the legs. If they cannot do this, they may need help to transfer.

Sitting Transfers

Independent

Position the wheelchair close to the bed chair, apply brakes. Take feet off and swing away or remove the footrests (where applicable) . Remove armrest closest to the bed/chair (where applicable). Push up on hands and move to the front of the wheelchair. With one hand on the bed and the other on the wheelchair, push up and lift on to the bed. If the user has poor balance or cannot lift high enough or move sideways far enough, they may do a safer transfer useing a transfer board.

Assisted with Transfer Board

A transfer board is a strong, thin board which can help to bridge the gap between the wheelchair and surface the wheelchair user is transferring to. Transfer boards are useful for wheelchair users who are learning to transfer independently, or who have limited strength in their arms. The wheelchair user can carry out the transfer in a series of small lifts, rather than one big lift. a transfer board can also reduce the assistance a wheelchair user may need. Transfer boards can be made locally from wood or plywood. They should be thin, strong and very smooth. Reduce the thickness at the edges. suggested dimensions are 300mm x 600mm. The thickness of the board depends on the strength of the material, but a typical thickness is between 20 and 25 mm.
Position the wheelchair close to bed/chair, apply brakes. Take feet off and swing away or remove the footrests (where applicable). Remove armrest closest to the bed (where applicable). Move forward. Put a transfer board under buttocks across the wheelchair and bed. User to assist as much as possible by pushing up on wheelchair and bed to take own weight. Assistant stands behind user, and moves user’s buttocks over to the bed (where assistance required).

Standing Transfers

Floor Transfers

This transfer requires the wheelchair user to have strong arms and good balance.Wheelchair users at risk of developing a pressure sore should always sit on their pressure relief cushion when sitting on the floor.

Wheelchair to Floor

Sit at the front of the wheelchair. Lift feet off the footrests in front of you and slightly to the side (away from the direction you are transferring). Place your cushion on the floor. With one hand on the wheelchair seat; reach down to the floor with the other hand. Using the shoulders and arms, move the buttocks down on to the cushion you have placed on the floor in a controlled movement.

Floor to Wheelchair

Sitting in front of the wheelchair, draw the knees up close to the body. Look down and keep looking down throughout the lift. Place one hand on the floor and one hand on the front of the wheelchair seat. Push down with the shoulders and arms to lift buttocks up and on to the front of the wheelchair seat. Sit back into the wheelchair and reach down to pick up wheelchair cushion.Shifting your weight to one side, push the wheelchair cushion in place.

Pressure Relief Techniques

Regular pressure relief can be effective in preventing pressure sores. Wheelchair users can relieve pressure from the seat bones while in their wheelchair. How they do this will vary, depending on how much strength and balance they have. Wheelchair service personnel need to teach all wheelchair users who are at risk of developing a pressure sore at least one way to relieve pressure.

Leaning Forward

A method suitable for most wheelchair users. Independent: for people with good balance and strength. With assistance: For people with poor balance and strength.

Side to Side Lean

A method suitable for wheelchair users with limited strength and balance. Some wheelchair users, especially those with limited trunk control, may hook their arm over the push handle for extra support.

Pressure Lift

Resources

Wheelchair Skills: SCI Empowerment Project

Learn the correct technique for navigating curbs, bumpy terrain, ramps, potholes, and tight spaces in your manual wheelchair from these short videos. Funding for the SCI Empowerment Project and videos was provided by the Craig H. Neilsen Foundation.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 World Health Organization. Wheelchair Service Training Package - Reference Manual for Participants - Basic Level. World Health Organization, Geneva. 2012
  2. 2.0 2.1 2.2 2.3 Kirby RL, Smith C, Parker K, McAllister M, Boyce J, Rushton PW, Routhier F, Best KL, Mortenson B, Brandt A. The Wheelchair Skills Program Manual. Published electronically at Dalhousie University, Halifax, Nova Scotia, Canada. www.wheelchairskillsprogram.ca.
  3. Lori Colwill. Getting into Car from Wheelchair. Available from: https://youtu.be/LIWEaWf3UAs[last accessed 30/06/18]
  4. Wheelchairs Rock. Wheelchair Transfers to Car. Available from: https://youtu.be/AaxcAOWMzks[last accessed 30/06/18]
  5. Wheelchair Skills Program. Vehicle Loading. Available from: https://youtu.be/I2d8LGl5m0U[last accessed 30/06/18]
  6. Wheelchair Skills Program. Tilt Rest in a Manual Wheelchair Available from: https://youtu.be/NDkZ8L4okvU[last accessed 30/06/18]
  7. Wheelchair Skills Program. Wheelies, Stationary 6 - Proactive Balance Strategy. Available from: https://youtu.be/YzYeOwwPdqs[last accessed 30/06/18]
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  9. Wheelchair Skills Program. Level Changes, Ascent 7. Available from: https://youtu.be/LeBmD1YExHo[last accessed 30/06/18]
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  14. Wheelchair Skills Program. Level Changes, Descent 6. Available from: https://youtu.be/osv1MI36Fw4[last accessed 30/06/18]
  15. Craig Hospital. Wheelchair Skills: Two Person Assist Going Up and Down Stairs. Available from: https://www.youtube.com/watch?v=4Y2imvo2uUA[last accessed 30/06/18]
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  18. Wheelchair Skills Program. Stair Descent 1. Available from: https://youtu.be/_ZZHaeyA1KA[last accessed 30/06/18]
  19. Wheelchair Skills Program. Escalator 1. Available from: https://youtu.be/J-s3pSidlXw[last accessed 30/06/18]
  20. Wheelchair Skills Program. Escalator 3. Available from: https://youtu.be/75BEZRNSmpk[last accessed 30/06/18]