Wheelchair Skills Training - Turning

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

Top Contributors - Naomi O'Reilly and Amrita Patro  

Turns In Place

Description and Rationale

The learner turns the wheelchair around to the left and right to face in the opposite direction, in as tight a space as possible. 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 environment may be such that the preferred direction of turn is not possible, so the learner must be capable of turning in both directions.

General Training Tips

  • The ability to turn is made easier by casters. Casters are wheels that are free to swivel around a vertical axis. The location of the casters (front vs. back) will affect the nature of the turn.
  • To make the turn as tightly as possible, the wheelchair user should pull back on one hand-rim, while pushing forward to an equivalent extent on the other. In such a case, the vertical axis of rotation for the turn is midway between the drive wheels. It may take a few cycles to complete the turn. If the arc moved through by one hand is less than that for the other hand, on completion of the turn, the wheelchair will come to rest closer to the hand that moves less.
  • It may be helpful for the learner to shuttle forward and backward – e.g. forward turn to the left, backward turn to the right, repeating as necessary – to minimize the space required, turning part of the way with each cycle. The longer the chair, the more likely it is that this will be necessary.
  • The trainer should help the learner to clearly understand the difference between the size of the turning circle (that is affected by parts, such as footrests, that stick out above the ground) and the size of the turning footprint (that only includes the chair or body parts that touch the ground). A mirror may be used to provide feedback to the learner.
  • The footrests can be moved out of the way in tight spaces to reduce the radius of the turning circle.
  • The user should be especially careful not to catch the feet on an immovable external object – if the foot stops and the chair continues to turn, a serious injury can result.

Progression: 

  • The wheelchair user should begin with small angular displacements and progress to larger ones.
  • The learner should start with a larger space in which to turn and progress to smaller ones.
  • The learner should start at a slow speed, focussing on accuracy and increase the speed as skill develops.  
  • The wheelchair user can practice on progressive smaller areas of support.
  • The wheelchair user can practice on a soft surface.
  • Small displacements do not require that the hands be repositioned on the hand-rims. 
  • The wheelchair user should then progress to larger displacements that require the hands to be repositioned, using several steps to get all the way around to 180°.
  • Some wheelchair users may be able to get all of the way around to 180°(or beyond) in a single movement (the so-called “snap turn”) by allowing the hand-rims to slide through the fingers. To prepare for a snap turn, the wheelchair user places one hand as far forward as possible on one hand-rim and the other hand as far back as possible on the other hand-rim.Then, in a single uninterrupted motion, the wheelchair user “snaps” the wheelchair around, letting the hand-rims slide through the fingers until the wheelchair reaches the desired angle. Depending upon the rolling resistance of the surface, the wheelchair may continue to spin in a circle until wheel or hand-rim friction brings the wheelchair to a stop.

Variations: 

  • Game: Ask the learner to pretend that his/her feet are the hour hand of a clock facing up from the floor and see how quickly and accurately he/she can respond to times that the trainer calls out (e.g. from a starting position of 12:00 o’clock, “turn to 3:00 o’clock”).
  • When turning around in confined spaces, it can be helpful for the wheelchair user to push or pull on external objects rather than using the hand-rims.
  • See wheelie variation later.

Turns While Moving

Description and Rationale

  • The learner turns the wheelchair to the left and right while moving forward or backward. Such moving turns are often necessary to avoid obstacles or to change direction. The amount of space needed for turning is affected by such wheelchair factors as the wheelbase (distance between the ground contact points for the front and back wheels), For most wheelchair users, turns while moving backward are usually required less often in everyday life than moving turns in the forward direction.
  • The path of the wheelchair parts (e.g. footrests) will differ depending upon the characteristics of the wheelchair. As a general rule when turning, the vertical axis for the turn is midway between the drive wheels, so the farther away from this axis that a wheelchair part or body part is, the greater the circumference through which it will swing. 
  • When turning around an object (e.g. a pylon or a corner) that the wheelchair is close to, the wheelchair user should focus on ensuring that rear wheel, specifically the contact point between the wheel and the ground, clears the obstacle. 
  • When driving a rear-wheel-drive wheelchair toward a 90°turninto a narrow opening, when space is available the wheelchair user should stay as far as possible away from the wall on which the opening is found. This is analogous to parking a car between two other cars in a crowded parking lot.
  • If the approach path is narrow but the opening is wide, approaching the corner close to the wall is preferable, watching closely that the axle of the near-side rear wheel is slightly beyond the corner before turning sharply. 
  • If maneuvering around a series of fixed obstacles (such as the pylons used in the WST) that are widely spaced, a useful strategy is to use a path that takes the drive wheels close to the obstacles. If the obstacles are closer together, the wheelchair may need to be driven farther away from each obstacle to have sufficient room in which to complete the turn.
  • 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 depends on how tight a turn is needed and safety considerations.

Progression: 

  • The learner should start with small changes of direction (e.g. around widely spaced pylons) and progress to more closely spaced ones. 
  • When beginning training around full 90°corners, learners may find it easier to break a turn down into its segments – driving straight, turning, then driving straight again, rather than following a smooth curved path. 

Variations:

  • Three-point turns (e.g. using an opening like a doorway to turn around and go back in the opposite direction) can be carried out by making the first turn into the opening while moving forward, followed by a backward turn in the opposite direction. 
  • Alternatively, the initial turn into the opening can be backward (after rolling past the opening), followed by a forward turn in the opposite direction.
  • When using the moving-turns skill in real-life settings, the learner should obey the rules of the road at corners – he/she should slow down if the path around the corner cannot be seen, he/she should stay to the right or left (whichever is the convention in the country in which the training is taking place) and he/she should not cut the corner.
  • While coasting forward in a straight line, the wheelchair user can experiment with the effect that rotating the outstretched arms from side to side has on direction – for instance, swinging the arms counterclockwise causes the wheelchair to turn clockwise.
  • The fixed environment can be used to assist with turning. Timing, intensity, direction and location of the forces applied to a fixed object such as a wall are important features of success. Using the environment minimizes the need to slow down. 
  • In the “drag” turn, the wheelchair user drags a hand, in a rear position, along the wall to turn toward the wall and around the corner. If the learner is having difficulties, the skill can be simplified by segmenting the skill, for instance having the trainer push the wheelchair forward toward the corner while the wheelchair user has the wall-side hand in the ready position and the opposite hand on the lap.
  • In the “push-off” turn, the wheelchair user uses a hand, in a forward position, to push away from the wall. 
  • See wheelie variation later.

Manoeuvres Sideways

Description and Rationale

The learner maneuvers the wheelchair sideways to the left and right parallel to an object (e.g. a window, bed or table). Repositioning the wheelchair sideways in a tight space is commonly necessary to get closer to or farther away from objects.

General Training Tips

  • The learner needs to be aware of the widest and longest points of the wheelchair as well as the footprint created by the wheels on the floor. 
  • If the space available in a real-life situation is limited, the learner may need to shuttle the wheelchair forward and backward a number of times to get into the desired position, moving more to the side with each attempt. 

Progression: 

  • The learner should start with ample forward-backward room in which to maneuver and gradually decrease the space. 
  • The learner should start with small sideways steps and progress to larger ones.
  • The learner should start at a slow speed, focussing on accuracy (staying within any designated boundaries), increasing the speed within the limits of accuracy. 

Variations:

  • The learner may mimic parallel parking a car, pulling forward ahead of the target opening, then backing into the opening.
  • An alternative for the wheelchair user with good upper-body strength and co-ordination is to use the “bunny-hop” method. To do so, the wheelchair user hops the rear wheels to the side by shifting the body weight in the desired direction and pulling up on the rear wheels to have them move in the same direction. Although there remains some controversy regarding this, it seems that the head should move initially in the direction intended, then in the opposite direction while moving the hips over (analogous to the head-vs.-hips method used in the sideways transfer discussed later). The wheels do not need to get fully off the ground to be successful. The bunny hop is most useful when space is very limited (e.g. when very close to a wall). Initially, the wheelchair user can get used to just hopping up and down, with no sideways movement. If the hands holding onto the hand-rims are not at the top dead center, the rear wheels will rotate when they become unloaded. This can be prevented by applying the wheel locks.
  • A similar effect can be created by rocking the wheelchair from side to side, although the wheelchair may move forward as well as to the side. The wheelchair user should lean hard in the direction that he/she wishes to move and return more gently to the upright position.
  • The learner may use the sideways-maneuvering technique to negotiate to the other side of two barriers with a space between them (e.g. two concrete bolsters in a parking lot) that is too narrow to drive straight through but is low enough from the ground to allow clearance between the wheels. It may be possible to move one pair of wheels through the gap at a time, transiently straddling the obstacles with one pair of wheels on either side of the obstacles and the wheelchair parallel with the obstacles. 
  • The learner may perform the basic sideways-maneuvering skill or the bolster variation of it in the wheelie position.

References