Wheelchair Skills Training - Hills & Ramps

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

Top Contributors - Naomi O'Reilly and Amrita Patro  

Ascends Inclines

Description and Rationale

The learner moves the wheelchair upinclines of different slopes. Inclines with different slopes are encountered frequently in the natural and built environments.For instance, a 5°(~1:12) grade meets the current building codes for ramps in North America. Inclines with slopes greater than the standard recommended value are encountered frequently in the natural and built environments.

General Training Tips

  • The steeper the incline, the greater is the likelihood of problems due to scraping the footrests or anti-tip devices at the transition between the floor and the lower end of the incline. 
  • Momentum can be used to ascend short inclines by approaching at speed. However, if the wheelchair user strikes the floor-ramp transition too quickly, he/she may tip the wheelchair forward or fall forward out of the wheelchair. 
  • When negotiating the incline-floor transition at the lower end, during either ascent or descent, the wheelchair user should be careful not to catch an unsupported foot, as this could lead to a hyper-flexion injury of the knee.
  • When getting the casters onto the bottom of an incline, it may be necessary to transiently tip the wheelchair (“popping” the casters, as will be described later) if the footrests are low and to reduce the sudden braking that occurs at the transition. 
  • The wheelchair user should lean forward as he/she goes up the ramp to apply more force to the hand-rims and to avoid tipping backward. The need for forward lean increases as the slope increases. In addition to a consistent forward lean, it can be helpful to lean forward a little more with each push to apply greater forces to the hand-rims. 
  • If the wheel locks are not of the retractable type, forward leaning can result in injury to the backs of the thumbs.
  • It may be necessary to use shorter propulsive strokes than on the level, to avoid rolling backward between strokes. 
  • The recovery path of the hands at the end of the propulsive stroke may be more like an arc (following the hand-rim) than a loop (below the hand-rim) for this skill.
  • If the wheelchair user gets tired part of the way up the incline, he/she should turn the wheelchair to the side and rest. This can be done without applying the wheel locks. Although it may seem counter-intuitive, the static rear stability of an occupied wheelchair is significantly lower with the wheel locks applied than not.
  • If the wheelchair starts to roll backward, instead of grasping both hand-rims (that might cause a rear tip), the wheelchair user can grab one. As the other wheel rolls backward, this will turn the wheelchair across the slope.

Progression: 

  • The learner should start with the wheelchair stationary at the lower end of the incline and progress to a moving approach.
  • The learner should start with a minimal incline and proceed to more extreme ones.

Variations: 

  • Inclines with different surfaces, such as grass, cobblestone or loose rock may be used. 
  • Stopping and turning around on the incline should be practiced.
  • Alternating hands during propulsion may help to prevent roll-back.
  • If the incline is wide enough, the learner can steer back and forth across the incline (“slalom” or “zig-zag”), to decrease the apparent slope. The more turns used, the lower is the effective slope (but the greater the distance travelled). Although a slalom path up an incline will reduce the effective slope, it will introduce an element of side-slope (dealt with more specifically later).
  • The wheelchair user may use the ramp handrails if available.
  • See wheelie variation later.

Descends Inclines

Description and Rationale

The learner moves the wheelchair down inclines of different slopes. The general rationale is as for “ascends inclines”. 

General Training Tips

  • A smooth controlled descent in the forward direction is the basic method for descending inclines. 
  • The learner should proceed slowly to maintain control and should be prepared to stop at any time. It is easier to maintain speed control than to regain it after it has been lost.
  • The wheelchair user should keep his/her weight back, to maintain good traction on the rear wheels and to avoid forward tips or falls.
  • To slow down or steer, the wheelchair user should hold the hands still ahead of top dead center (at about the 1:00 o’clock position, using the clock analogy) and let the hand-rims slide through his/her fingers. It is generally better to provide continuous friction than to use a jerky grasp-and-release method. However, the grasp-and-release method may be useful to minimize the heat that builds up through friction, grasping either with both hands at the same time or alternating from one to the other. 
  • The wheelchair user can slalom down the incline by letting the hand-rim of one wheel at a time slide through the fingers. By descending using the slalom method, the apparent slope of the incline is lessened. Also, this technique may prevent the hands from overheating due to sustained friction. Downhill-turning tendency can be used to advantage when the wheelchair user wishes to turn downhill. Leaning forward will accentuate the tendency and ease the turn.
  • As for ascending inclines, the wheelchair may be turned sideways on the incline to rest without applying the wheel locks.

Variations: 

  • If the drive wheels are uphill, they become relatively unloaded. This can cause loss of traction so that propulsion, braking and directional control become difficult. If traction is lost to the extent that the wheels spin or the wheelchair begins to slide, the wheelchair user should lean toward the affected wheels. If this is insufficient, then the wheelchair should be turned around so that the drive wheels are downhill. It is best to turn around on the level but, if that is not possible, the wheelchair user should lean uphill during the turn.
  • If the wheelchair user has weak trunk muscles and a tendency to fall forward when facing downhill on inclines, he/she may feel more comfortable descending the incline backward. When going downhill backward, the wheelchair user should lean uphill to reduce the likelihood of tipping over backward. As with any time the wheelchair is moving backward, it is important to proceed slowly with frequent shoulder checks and to avoid sudden stops that can cause rear tips.
  • The wheelchair user may use the handrails of the incline, if available.
  • See wheelie variation later.

Rolls Across Side-Slope

Description and Rationale

The learner moves the wheelchair across a slightside-slope without turning downhill or uphill significantly, then repeats the task in the opposite direction. Side-slopes (or cross-slopes) are frequently encountered in built and natural environments. Sidewalks, for instance, are usually sloped 2% (1:50) toward the street to allow water to run off. Steeper grades are also often found (e.g. where sidewalks cross driveways). The yaw axis of a wheelchair (i.e. the vertical axis around which the wheelchair turns toward the left or right) is between the drive wheels. If the combined center of gravity of the wheelchair and user is ahead of the drive wheels and more on the casters that are free to turn (as is usually the case with rear-wheel-drive wheelchairs), the wheelchair will tend to turn downhill on a side-slope (“downhill turning tendency”). 

General Training Tips

  • The extent of downhill-turning tendency is directly proportional to how far the combined center of gravity of the wheelchair and occupant is in front of the rear wheels. The person operating the wheelchair can take steps to minimize this distance by repositioning the center of gravity (e.g. by leaning, tilting or reclining). 
  • If there is room to do so on a path, the person operating the wheelchair should stay away from the downhill edge of a side-slope to avoid veering off the path.
  • To avoid turning downhill, the wheelchair user should push harder on the downhill wheel.
  • Different push frequencies may be used for the two hands. For instance, when moving across a side-slope with the right side downhill, the right hand may push 2-3 times for every 1 push on the left. 
  • When pushing longer distances, route planning can be used to avoid overuse on one side. For instance, part of the journey can be carried out on the right-hand sidewalk (where the left side is downhill) and part of the journey on the left-hand sidewalk. 
  • In some cases, the uphill hand may be used exclusively for braking (to minimize downhill-turning tendency) rather than for assisting with propulsion.
  • Shorter stokes may need to be used to keep the wheelchair moving straight.
  • On steep cross-slopes, problems (e.g. loss of uphill-wheel traction, lateral tip-over, folding of the wheelchair) may arise due to the lack of weight on the uphill wheel. These problems can be minimized by leaning uphill.
  • As noted earlier, downhill-turning tendency can be used to advantage when the wheelchair user wishes to turn downhill. Leaning forward will accentuate the tendency and ease the turn.

Progression:

Although only a 5°side-slope is mentioned specifically in the WSP Manual, for learners and wheelchairs capable of handling steeper inclines, it is reasonable to attempt these under the supervision of a trainer, even if only to help the learner recognize the limits of what is possible for him/her with that wheelchair.

Variations:

  • Slowly turning the wheelchair 360° in place on a side-slope will provide a good sense of how downhill-turning tendency affects the wheelchair at different angles. 
  • A useful learning experience to demonstrate the downhill-turning tendency is to have the wheelchair user lean forward as he/she rolls forward, to illustrate how the downhill-turning tendency increases.
  • See wheelie variation later.

References