Wheelchair Skills Assessment and Training

Original Editor - Lee Kirby as part of the Wheelchair Service Provision Content Development Project

Original Contributors - Lee Kirby with Paula W. Rushton, Cher Smith, François Routhier, Krista L. Best, Rachel Cowan, Ed Giesbrecht, Alicia Koontz, Diane MacKenzie, Ben Mortenson, Kim Parker, Emma Smith, Sharon Sonenblum, Amira Tawashy, Maria Toro, Lynn Worobey as part of the Wheelchair Service Provision Content Development Project

Top Contributors - Naomi O'Reilly and Amrita Patro  

Introduction

The 2008 World Health Organization (WHO) Guidelines on the Provision of Wheelchairs in Less-Resourced Settings [1] has been discussed in earlier sections of this Course. The WHO Guidelines suggest an 8-step service-delivery process that includes assessment by professionals, the development of a wheelchair prescription with the involvement of the wheelchair user and family, assistance (if needed) with the organization of funding for the wheelchair, proper fitting and adjustment of the wheelchair, training of the wheelchair user and caregiver in maintenance and wheelchair handling skills, and long-term follow-up for refinements, routine servicing and periodic replacement. The Wheelchair Skills Programis a set of protocols that deal with two of these steps, the assessment and training of wheelchair skills.[2] 

Two important elements in this care pathway are wheelchair skills assessment and training for wheelchair users and their caregivers. The Wheelchair Skills Program is a set of assessment and training protocols related to wheelchair skills.[2] There has been a growing number of peer-reviewed papers [3] about the measurement properties of the assessment methods and effectiveness of the training protocols (including two systematic reviews and meta-analyses).[4][5]

Scope

Due to constraints of time and space in this Course and the scope of practice of most physiotherapists, this page will focus on the training of manual wheelchair users using two-handed propulsion (e.g. those using wheelchairs due to spinal cord injury). Therapists interested in material beyond this scope, can use the Wheelchair Skills Program Manual [6] to complement the material presented here. The materials presented in this page of the Course here have been excerpted from Version 5.0 of the Manual.

Warning

Some of the wheelchair skills addressed in this section can be dangerous and result in severe injury or death if attempted without the assistance of one or more experienced spotters.Details about spotting can be found in Chapter 2 the Wheelchair Skills Program Manual.[6]

Assessment of Wheelchair Skills

As recommended in the WHO Guidelines, a new wheelchair user should go through an 8-step process in the course of wheelchair service delivery. One of those steps is assessment. As part of this assessment, the wheelchair skills of the wheelchair user should be assessed. This should be done at intake, as part of the prescription and fitting steps (e.g. to compare how well the wheelchair user can perform skills with a rigid vs. a folding wheelchair, or with the rear axles in more and less stable positions) and during follow-up to determine what revisions in the wheelchair are needed. 

The Wheelchair Skills Test (WST), details about which can be found in Chapters 4 and 5 of the Wheelchair Skills Program Manual,[6] is a means of assessing the capacity of wheelchair users to safely perform the skills they need in their everyday lives. There has been a growing number of peer-reviewed papers [3] about the measurement properties of the assessment methods. The following video shows a complete WST being performed by a person with s spinal cord injury. You can also read the associated WST Report Form.[7]

Information about the questionnaire version of the WST (WST-Q) can be found in Chapter 6 of the Wheelchair Skills Program Manual.[6] In addition to assessing capacity like the WST does, the WST-Q assesses confidence and performance (what the wheelchair user does do and how they do it). To better understand what can reasonably be expected of a person with spinal cord injury, you may wish to read the paper by Kirby et al. (2016). [9]

Training of Wheelchair Skills

Another WHO step is training, that includes wheelchair skills training of the wheelchair user and/or caregiver. There has been a growing number of peer-reviewed papers [3] about the measurement properties of the assessment methods and effectiveness of the training protocols (including two systematic reviews and meta-analyses).[4][5] 

The Wheelchair Skills Training Program (WSTP) combines the best available evidence on motor skills learning principles with the best available evidence on wheelchair skill techniques. The WSTP can be used during the initial provision of the wheelchair and as necessary at follow-up.

Chapter 7 of the Wheelchair Skills Program Manual [6] provides a practical overview of the motor skills learning literature, addressing such topics as goal setting, demonstration, the structure of practice sessions, the focus of attention, the use of imagery, the nature and timing of feedback, skill segmentation, progression from simple to more complex versions of skills and steps that can be used to facilitate skill retention and transfer. However, for the purpose of this Course, we will focus on technique, that is how best to train manual wheelchair users to perform specific skills or groups of skills including;

Basic Skills

  1. Pressure Relief
  2. Rolling
    • Forwards
    • Backwards
    • Roll on Soft Surface
  3. Stopping
  4. Turning
    • Turn in Place
    • Turn While Moving
    • Maneuvers Sideways
  5. Transfers
    • Level Transfer

Intermediate Skills

  1. Fold & Unfold Wheelchairs
  2. Going Through Doorways
  3. Obstacles
  4. Hills and Ramps
    • Ascends Inclines
    • Descends Inclines
    • Rolls Across Side-Slope
  5. Curbs
    • Ascends Curbs
    • Descends Curbs

Advanced Skills

  1. Transfers
    • Wheelchair to Ground
  2. Picking Up Objects
  3. Stairs
    • Ascends Stairs
    • Descends Stairs
  4. Wheelie
  5. Wheelie Dependant Skills

Resources

Training Manual

Wheelchairs Skills Program Manual - Version 4.3

Forms

Wheelchair Skills Test (WST) Form;

Wheelchair Skills Test Questionnaire (WST-Q)

References

  1. World Health Organization (WHO) Guidelines on the Provision of Wheelchairs in Less-Resourced Settings. Available at: www.who.int/disabilities/publications/technology/wheelchairguidelines/en/2008.
  2. 2.0 2.1 Wheelchair Skills Program. Available at: www.wheelchairskillsprogram.ca.
  3. 3.0 3.1 3.2 Dynamic link to PubMed-cited Publications about the Wheelchair Skills Test and Wheelchair Skills Training Program. Available at: www.wheelchairskillsprogram.ca/eng/publications.php.
  4. 4.0 4.1 Tu C-J, Liu L, Wang W, Du H-P, Wang Y-M, Xu Y-B, Li P. Effectiveness and Safety of Wheelchair Skills Training Program in Improving the Wheelchair Skills Capacity: A Systematic Review. Clin Rehabil. 2017;31:1573-1582.
  5. 5.0 5.1 Keeler L, Kirby RL, Parker K, McLean KD, Hayden J. Effectiveness of the Wheelchair Skills Training Program: A Systematic Review and Meta-analysis. Disability and Rehabilitation: Assistive Technology 2018:https://doi.org/10.17483107.2018.1456566 (Epub ahead of print).
  6. 6.0 6.1 6.2 6.3 6.4 Kirby RL, Rushton PW, Smith C, Routhier F, Best KL, Cowan R, Giesbrecht E, Koontz A, MacKenzie D, Mortenson B, Parker K, Smith E, Sonenblum S, Tawashy A, Toro M, Worobey, L.Wheelchair Skills Program Manual. Available at: https://wheelchairskillsprogram.ca/wp-content/uploads/2018/03/The_Wheelchair_Skills_Program_Manual.March_7_2016.pdf
  7. WST Video and WST Report Form for a person with a spinal cord injury. See Example 7 at https://wheelchairskillsprogram.ca/en/skill-tests/.
  8. Wheelchair Skills Program. Manual Wheelchair Skills Tests - Example 7 Spinal Cord Injury. Available from: https://youtu.be/PRWp9bCIj-g[last accessed 30/10/17]
  9. Kirby RL, Worobey LA, Cowan R, Presperin Pedersen J, Heinemann AW, Dyson-Hudson TA, Shea M, Smith C, Rushton PW, Boninger ML.Wheelchair Skills Capacity and Performance of Manual Wheelchair Users with Spinal Cord Injury.Arch Phys Med Rehabil. 2016;97:1761-9.