Wheelchair Skills
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Introduction[edit | edit source]
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]
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[edit | edit source]
Folding[edit | edit source]
Lifting[edit | edit source]
Wheelchair Mobility[edit | edit source]
Pushing[edit | edit source]
Pushing correctly requires less effort. Push from 10 or 11 o’clock to 2 o’clock position, using a long smooth action.[1]
Forwards[edit | edit source]
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.
Propulsive Phase: To propel the wheelchair straight forwards, the wheelchair user should grasp the hand-rims and push evenly with both hands. They should not wrap the thumbs around the hand-rims, but point them forward. Where the wheelchair user has trunk control they should lean forward as the arms are extended, to get more contact time between the hands and the hand-rims and to reduce the chance of a rear tip. To minimise shoulder strain and be mechanically efficient, the wheelchair user should try to push with long, slow strokes, allowing the wheelchair to coast where possible. Hand positions can be illustrated by having the wheelchair user imagine the right rear wheel as the face of a clock; the initial and final contact positions for the wheel might then be referred to as 11:00 and 2:00 O’ Clock. This “three- hour time period” corresponds to a contact angle of 90°. Although it is possible to coast for several meters from a single push, a cadence of about 1 push per second is commonly used, at least in part to maintain directional control.
Recovery Phase: After releasing the hand-rims at the end of the propulsive phase, the arms can be allowed to swing in a pendular fashion back towards where the propulsive phase will begin for the next propulsive cycle. This allows the hands to make initial contact with the hand-rims while moving upward, reducing impact.
Stopping: How hard the hand-rims are gripped determine the rate of slowing and therefore control stopping. The hand-rims should run through the wheelchair user’s hands. During the coast and stop, the hands are in the 1:00 o’clock position.
Backwards[edit | edit source]
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.
Propulsive Phase: To propel the wheelchair straight backward, the wheelchair user should reach forward, grasp the hand-rims and pull evenly backwards. Unlike forward rolling, it is not easy to coast backwards without deviating to one side or the other. Therefore, the length of the strokes is usually shorter when rolling backwards.
Turning[edit | edit source]
Turn In Place[edit | edit source]
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[edit | edit source]
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[edit | edit source]
Negotiating Slopes[edit | edit source]
Incline[edit | edit source]
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]
https://youtu.be/353XfUoTn7c https://youtu.be/tDkcc96OO3Y
Decline[edit | edit source]
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]https://youtu.be/7DzjDFZ4Cfs https://youtu.be/BOAOQj86wI4 https://youtu.be/Sqkof8ry7GQ https://youtu.be/hNUdoX3drAw https://youtu.be/e8EbuilTGJ0
Wheelies[edit | edit source]
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[edit | edit source]
Ascending[edit | edit source]
Descending[edit | edit source]
Negotiating Steps[edit | edit source]
Ascending[edit | edit source]
With Assistance[edit | edit source]
Go up backwards. Tilt wheelchair on to back wheels, positioned against the first step. Assistant pulls 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[edit | edit source]
With Assistance[edit | edit source]
Go down forwards. Tilt the wheelchair on to back wheels. Assistant lets 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]
Independently[edit | edit source]
Wheelchair Transfers[edit | edit source]
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”.
Sitting Transfers[edit | edit source]
Independent[edit | edit source]
Assisted with Transfer Board[edit | edit source]
Standing Transfers[edit | edit source]
Independent[edit | edit source]
Assisted with Transfer Board[edit | edit source]
Floor Transfers[edit | edit source]
Pressure Relief Techniques[edit | edit source]
Leaning Forward[edit | edit source]
Side to Side Lean[edit | edit source]
Pressure Lift[edit | edit source]
References[edit | edit source]
- ↑ 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
- ↑ 2.0 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.
