Wheelchair Skills Training - Stairs

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

Top Contributors - Naomi O'Reilly and Amrita Patro  

Ascends Stairs

Description and Rationale

The wheelchair user and the wheelchair get from the bottom of a set of stairs to the top. Although alternative means of getting from a lower to a higher level are often present (e.g. using a ramp or elevator), stairs may sometimes be the only option. 

General Training Tips

  • Alternative routes (e.g. ramps or elevators) to get to the upper level should be sought wherever possible.
  • With the exception of the initial preparation for the first step of a set of stairs and concluding the task after ascending the last step, the same technique is used for each step. 
  • Safety is of particular importance, given the consequences of a loss of control.

Out of the Wheelchair, on Buttocks: 

  • A strapped-on buttocks protector is advisable.
  • The wheelchair should be positioned next to the stairs, in a way similar to how the wheelchair would be positioned for the “performs level transfers” skill. 
  • The wheelchair user transfers from the wheelchair to a sitting position on the second or third step. The stair handrail may be used.
  • The wheelchair may be brought up to the top the stairs by the wheelchair user or by an assistant. If bringing the wheelchair up the stairs himself/herself, the wheelchair user should pull the wheelchair up by facing it downhill, and tipping it back fully. The wheelchair user should push straight down with one hand on the wheelchair’s push-handles that are resting on a step, to keep the wheelchair from rolling or sliding down the stairs.
  • For the wheelchair user to move up each step, he/she should flex the neck and hips and push down with the arms and feet to bring the buttocks up and back onto the next higher step (another example of the hips-vs.-head strategy described in the “performs level transfers” skill). Then the hands, feet and wheelchair are moved up to the next step.
  • At the top of the stairs, a stool is helpful as a half-way step to the wheelchair seat. Otherwise, this final phase is the same as for the getting from ground into wheelchair phase of the “performs wheelchair-ground transfers” skill.

Variations: 

Out of the wheelchair, on hands and knees: 

  • As for the buttocks approach above, but facing up the stairs and using a crawling action, advancing one limb at a time. A caregiver is usually needed to bring the wheelchair up the stairs.

In the Wheelchair:

  • Although this technique is not recommended for wheelchair users acting alone, because of the long-term consequences of the stresses placed on the shoulders, the following tips are provided for the exceptional wheelchair user who wishes to acquire this skill for the unusual occasion when it would be helpful.
  • The rear anti-tip devices (if any) should be repositioned to allow the rear wheels to contact the first stair and to permit the wheelchair to tip backward sufficiently.
  • The starting position is with the wheelchair userin the wheelchair, with the seat belt (if any) on.
  • The wheelchair should be backed up to the lowest step, closest to the handrail on the side of the stronger arm.
  • The wheelchair user reaches back as far as he/she can with the stronger arm and grabs the handrail with the palm facing up.
  • By pulling on the handrail, the wheelchair user tilts the wheelchair back but not beyond the wheelie balance point to avoid having the rear wheels roll forward  (submarining). 
  • The wheelchair user uses the hand on the stair handrail to pull while using the other hand on the hand-rim (starting well forward) to roll the rail-side wheel up the step.
  • Because both hands are acting on the same side of the wheelchair, the front of the wheelchair will tend to turn toward the hand-rail. The wheelchair should be squared-up (i.e. bringing both rear wheels against the step rise) before each new stair is attempted.
  • At the top of the stairs, the casters should not be brought down until there is surface to support them.

Progression:

  • It is useful to have stairs with a variety of dimensions to permit gradual progression. The wheelchair user can use a curb first, if there is a rail beside it, as an example of a single step. 

Descends Stairs

Description and Rationale

The wheelchair user and the wheelchair get from the top of a set of stairs to the bottom. The rationale is as for the “ascends stairs” skill. Although there is still a potential for injury due to a fall, descent is much less strenuous than ascent. Many wheelchair users who cannot ascend stairs independently can descend them. 

General Training Tips

To descend stairs with the occupant out of the wheelchair, on the buttocks or on hands and knees, the procedure is the reverse of the “ascends stairs” skill.

Variations:

In the Wheelchair:

  • The safest method is facing up the stairs. The wheelchair user grabs one or both stair rails, leans forward enough to keep the casters from lifting off, lowers the rear wheels down one stair, then slides the hands down the rail. 
  • If the footrests interfere with smooth progression down the stairs and they can be removed, this may be done. 
  • Another option is to face up the stairs as above, but to use one hand on the stair hand-rail and the other hand on the hand-rim of the wheelchair. This technique can prevent the tendency of the non-rail-side wheel to roll away from the stair riser.
  • See wheelie variation later.

References