Wheelchair Skills
Original Editor - Naomi O'Reilly as part of the Wheelchair Service Provision Content Development Project
Top Contributors - Naomi O'Reilly, Uchechukwu Chukwuemeka, Jess Bell, Ewa Jaraczewska, Kim Jackson, Tarina van der Stockt, Simisola Ajeyalemi, Rucha Gadgil, Amrita Patro, Olajumoke Ogunleye and Aminat Abolade
Warning: the wheelchair skills described here come with their own risks and can be dangerous. These skills should only be attempted or practised with the assistance of trained professionals.
Introduction
Wheelchair users often have to learn to navigate challenging environments to access their homes, places of work and study and other public spaces. They might have to move over rough, sandy or muddy terrain, up and down steps and curbs or around small, cramped spaces. Because of these challenges, many wheelchair users experience reduced community mobility and participation.[1] This can have flow-on effects, including an increased risk of secondary health conditions, like cardiovascular disease and diabetes.[2]
Developing effective wheelchair skills is, therefore, imperative for wheelchair users and the World Health Organization includes training in wheelchair skills as part of their four-step approach to wheelchair service provision.[3] [4] Effective wheelchair skills training can help wheelchair users tackle obstacles independently or with assistance[5] and increase their community participation. Gaining wheelchair skills can also help to reduce pain, prevent overuse injuries and create a sense of well-being (through increased self-esteem, confidence etc.).[6]
The features of a wheelchair, including its fit and set-up, all impact how effectively a person can use their wheelchair to mobilise. Effective and safe use of a wheelchair depends on the user, as well as the wheelchair and the training given.[5][6]
General Wheelchair Safety Guidelines
The improper use of a manual wheelchair can lead to accidents, including tips and falls, acute injuries and overuse or repetitive strain injuries.[2] Because of the risk of injuries, protecting joint health is essential for optimal lifelong wheelchair mobility.[7] If you would like to read more about therapeutic strategies to protect the upper limbs specifically in spinal cord injury, please see: Positioning and General Management of Upper Limbs in Spinal Cord Injury.
The following checklist may be a useful guide for wheelchair users to ensure safety:[8]
- perform regular wheelchair maintenance to avoid wheelchair malfunctions - if there are any sign of malfunctioning (e.g., squeaking noises, brakes not working effectively during transfers), an immediate wheelchair maintenance check should be scheduled
- wear a seat belt, especially when moving on rough or uneven terrain
- remember to lock the brakes before getting in and out of the wheelchair; well-functioning brakes must lock the tyre and prevent it from turning
- it is best to remove the leg rests and place them out of the way when transferring to and from the wheelchair to prevent obstruction during the transfer
- heavy loads should not be placed on the back of a wheelchair, as this can cause the chair to tip over backwards
- keep the anti-tippers in a down position (wheels facing the ground) to prevent the wheelchair from tipping backwards
- consider attaching side guards to keep clothes away from the wheel spokes
- use headlights and flashing tail lights if you ride in the streets at night
- take extra care in rainy weather, as the wheels can lose traction on wet ground
- when traveling by vehicle, you must ensure that your wheelchair is safely and securely attached to the vehicle[9]
- if you remain seated in the wheelchair during travel in a vehicle, the wheelchair must be positioned facing forward[9]
If you would like to learn more about wheelchair maintenance activities and how often each part should be checked, please see: Manual wheelchair maintenance hands-on activity checklist.
Assessment for Manual Wheelchair Use
There is a two-way relationship between wheelchair skills and fitness; wheelchair skills facilitate greater fitness, and fitness is a prerequisite for certain wheelchair skills. Rehabilitation programmes must, therefore, address wheelchair skills training and exercise training, as neither is sufficient on its own.[10]
Assessing a patient's confidence and ability to use a manual wheelchair should be included in a rehabilitation plan.
"Confidence in one’s ability to perform a given task can be a stronger predictor of performance than the skill itself."[11]
The following assessment tools can help determine a person's skills and confidence with manual wheelchair use.
The Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M) measures a person's confidence with manual wheelchair use in six areas including: (1) negotiating the physical environment, (2) performing activities, (3) knowledge and problem-solving, (4) advocacy, (5) managing social situations, and (6) managing emotions.[12]
The Wheelchair Skills Test 4.1 is a diagnostic measure that can be used early in a rehabilitation programme to determine which skills need to be addressed during the rehabilitation process. It can also be used as an outcome measure later or at the end of the rehabilitation programme. This test assesses a wheelchair user's ability to safely and effectively complete 32 skills of varying difficulty. The patient is given a score of "pass", "fail", or "no part" for each skill - "no part" is used when skills relate to parts the person's wheelchair does not have.[13]
The Wheelchair Skills Test Questionnaire (WST-Q) Version 5.0 is a subjective, self-report version of the Wheelchair Skills Test.[14]
Wheelchair Skills
"Mobility, that is, the ability to move around in the environment, is a foundation skill, enabling engagement in essential daily activities and participation in multiple aspects of community, social, and civic life."[15]
Wheelchair users often report that curbs, uneven terrain, and travel surfaces are significant barriers to their mobility.[16] Learning how to perform certain wheelchair skills can help them negotiate these daily mobility tasks.[13]
General Rules When Teaching Wheelchair Skills
When teaching wheelchair skills, rehabilitation professionals should remember that the skills a patient must learn depend on their health condition (e.g. the level of their spinal cord injury), the environment they live in, and their personal goals. When someone is first learning wheelchair skills, it may be necessary to break tasks into smaller components. Ultimately, the long-term goal of wheelchair skills training is to optimise a person's independence.[17]
Wheelchair Handling
Folding
To transport or store a wheelchair, it needs to be folded. There are two ways that wheelchairs can be folded. A cross-folding frame folds so that both sides come together. This can be helpful as, when folded down, these wheelchairs can fit more easily into small spaces, such as the aisle of a bus or the back of a car. However, this folding mechanism can weaken, making the wheelchair feel less stable and, subsequently, more difficult to push. In rigid-frame wheelchairs, the backrest folds down, and the rear wheels come off. Having fewer moving parts increases the durability of rigid-frame wheelchairs.[5]
The following video shows how to fold a cross-folding frame wheelchair. Please click on the link under the image to watch the video on YouTube.
Lifting Wheelchairs into Cars
It is possible for individuals with sufficient upper body strength to transport their wheelchair without any specific tools or aids. To do this, they must be able to fold up their wheelchair and lift it into their car, placing it in front of the passenger seat or the backseat. Their vehicle must also be large enough to fit the wheelchair. If a wheelchair user cannot lift their wheelchair independently, they will need to ask an assistant to place their wheelchair into the car.
If you would like to see how to load a wheelchair into a vehicle and two different ways to transfer in and out of a car, please follow the links below the images.
Wheelchair Mobility
Pushing
Wheelchair users can propel their wheelchairs in different ways. Many push their wheelchair with their arms, some use their feet or one arm and one foot. Others need someone to push their wheelchair for them some or all of the time.
Pushing a wheelchair is easier when the user can comfortably reach the push rims. The rear wheel should be positioned so that when the wheelchair user holds the top of the push rim, their elbows are bent to 90 degrees. The pushing action should be long and smooth, moving from 10 or 11 o’clock to 2 o’clock.[5]
Pushing Forward
Forward rolling is an essential skill for many wheelchair activities. Each pushing cycle combines two phases (propulsion and recovery). The wheelchair user must also be able to stop.
Please follow the links under the images to see how to roll a wheelchair forward on even and uneven surfaces.
Pushing Backwards
Many wheelchair activities also require wheelchair users to roll their wheelchair backwards. Usually, backwards rolling is only used over short distances or for navigating surfaces with high rolling resistance (e.g. soft surfaces or ascending an incline using foot propulsion). Generally, you reverse the forward rolling technique to roll backwards.
Please follow the links under the images to see how to roll a wheelchair backwards unsupported and with support in a wheelie position.
For more detailed descriptions of how to move a wheelchair forward and backward, please see: Wheelchair Skills Training - Rolling.
Turning
Turn in Place
Turning around in tight spaces is a common challenge for wheelchair users. How easily someone can turn in tight spaces depends on the type of wheelchair, its length and width, the distance between the wheels and how well the castors or steering wheels can swivel.[6]
To turn a wheelchair in place, wheelchair users hold one push rim towards the front and the other towards the back. They pull their forward hand backwards and push their backward hand forward at the same time to initiate turning.[5]
Please follow the links under the images below to see how to turn a wheelchair in place.
Moving Turns
While moving turns can be more challenging, they are often necessary to avoid obstacles or to change direction. When a wheelchair user is ready to turn, they should slow the inside wheel down and/or push harder on the outside wheel. These actions have opposite effects. Slowing the inside wheel generally slows the wheelchair and allows for a tighter turn. Pushing harder on the outside wheel speeds up the wheelchair. The user must consider safety and the type of turn required (tighter or wider) when selecting the speed of each wheel during the manoeuvre.[6]
Please follow the links under the images to see different ways to perform moving turns.
For a more detailed description of how to turn a wheelchair, please see Wheelchair Skills Training - Turning.
Moving Sideways
Wheelchair users often need to reposition their wheelchair sideways in a tight space. This allows them to get closer to or further away from objects, such as a bed or table. Wheelchair users need to be aware of the wheelchair's widest and longest points for this manoeuvre. If space is limited, they may need to move their wheelchair forward and back several times to get into the desired position, moving more to the side with each attempt.[6]
Please follow the links under the images below to see how to move a wheelchair sideways.
Negotiating Slopes
Inclines
Wheelchair users frequently encounter slopes in natural and built environments. It takes more effort to ascend steeper inclines and wheelchair users are more likely to experience problems, such as scraping their footrests or anti-tip devices, at the start of the incline.[6]
When going up a hill, wheelchair users should lean forwards to prevent their wheelchair from tipping. When first practising this technique, assistants should stand behind the patient to ensure safety. When stopping or resting, the wheelchair should be parked sideways.[5]
Please follow the links under the images below to see how to negotiate inclines in a wheelchair.
Declines
To go downhill, wheelchair users should face forwards and ensure a smooth, controlled descent. They should proceed slowly to maintain control and be prepared to stop. It is easier to maintain speed control than to regain it after losing it. By keeping their body weight back in the wheelchair, wheelchair users can maintain good traction on the rear wheels and avoid forward tips or falls as they descend a slope.[6]
As they lean back, they can let the push rim slide slowly through their hands. Experienced wheelchair users who can do a “wheelie” (i.e., balance the wheelchair on the rear wheels only) may roll down a slope on their back wheels.[5]
Please follow the links under the images below to see how to go down a slope using a standard technique and the wheelie technique.
For a detailed description of how to negotiate slopes, please see Wheelchair Skills Training - Hills & Ramps.
Wheelies
A wheelie is a useful skill for wheelchair users. With practice, they can learn to lift the castor wheels to clear small obstacles (e.g. kerbs, stones, bumps in the road). Being able to perform a wheelie has many benefits - they help to prevent forward tipping when going down a hill, they enable users to balance different items on their laps, and they can even shift the perceptions of others and build a wheelchair user's confidence.[18] Using the Wheelchair Skills Test scoring, a wheelchair user will ideally be able to perform a stationary wheelie for 30 seconds.[13]
To perform a wheelie, the wheelchair user rolls their wheelchair backwards until their hands are in the 10 o’clock position. They then push forward quickly, which lifts the castor wheels up. When first working on wheelies, it's important to have an assistant standing behind the wheelchair user.[5]
Please follow the links under the images below to see how wheelies are performed.
For a detailed description of wheelies, please see Wheelchair Skills Training - Wheelie.
Negotiating Curbs, Steps and Escalators
Curbs
Ascending Curbs
Wheelchair users can ascend curbs backwards or forwards, independently or with assistance.
To ascend a curb facing forwards, the wheelchair user tilts their wheelchair onto its back wheels while the chair is positioned against the edge of the curb. Next, they do a small wheelie forward, put the wheels down onto the curb and push forward and upwards on the wheels. If assistance is required, the assistant can pull backwards and upwards to roll the wheelchair up. Wheelchair users can assist by pushing the push rim backwards. A second assistant can assist by holding onto the wheelchair frame from the front, but NEVER onto the footrests.[5]
Please follow the links under the images below to see how to ascend curbs.
For detailed descriptions of how to negotiate curbs, go to Wheelchair Skills Training - Curbs.
Descending Curbs
Wheelchair users can also descend curbs forwards or backwards, independently or with assistance. To go forward, the wheelchair user tilts their wheelchair onto the back wheels. If required, an assistant can help the back wheels slowly roll down the step. The wheelchair user can assist by controlling the wheelchair with the push rims. If required, a second assistant can stand at the front of the wheelchair and hold the wheelchair frame, but NOT onto the footrests.[5]
Please follow the links under the images below to see how to descend curbs.
Stairs and Escalators
Going up and down stairs may be the most challenging task for wheelchair users. It usually requires the assistance of two people and task execution depends on the wheelchair setup and type and the size of the wheelchair user. To ensure the safety of everyone (wheelchair user and assistant(s)), always look for an alternative means of getting from a lower to a higher level, like a ramp or an elevator. You may also consider portable stair climbers.
If you would like to read more about navigating stairs with wheelchairs, please see Wheelchair Skills Training—Stairs.
Please follow the links under the images below for ideas on how to assist wheelchair users on stairs and to see a wheelchair user enter and exit an escalator.
Wheelchair Transfers
Being able to get in and out of a wheelchair quickly and safely, with or without assistance, helps wheelchair users in daily life. Because wheelchair users may need to transfer in and out of their wheelchair several times a day, they need an efficient method that does not use much energy. Wheelchair users can practise different transfer methods, depending on their abilities, from standing up to sliding between surfaces using a transfer or sliding board.
Wheelchairs have several features to make transfers easier. Removable armrests, or armrests which follow the line of the rear wheels, are easier for people who get in and out of their wheelchairs sideways. People who stand up to get in and out of a wheelchair may need to leave the armrests in place. People who use a stand pivot transfer to get in and out of a wheelchair may need footrests that can be moved out of the way. People who want to be able to transfer to and from the floor may prefer a wheelchair with removable footrests.
Lateral Transfer
To perform a lateral transfer, the wheelchair user must be able to lift their weight upwards by pushing with their arms. If they cannot accomplish this, they may need to use a transfer board or receive assistance from another person.
The wheelchair user positions the wheelchair close to the surface they are transferring to and applies the brakes. They then take their feet off the footrests and remove them (where applicable) to prevent obstruction during the transfer. The armrest closest to the target surface should be removed. Next, they move their body to the front of their wheelchair by lifting their buttocks and moving forward. With one hand on the target surface and the other on their wheelchair, they push up and lift their buttocks onto the target surface. If they have decreased balance, can't lift high enough or move far enough to the side, they should use a transfer board.[5]
Please follow the link under the image to see how to perform a lateral transfer.
Lateral Transfer with Transfer Board
A transfer board is a strong, thin board that essentially acts as a bridge between a wheelchair and the target surface (e.g. bed, chair, etc). Transfer boards are often used by people who are learning to transfer or who have reduced arm strength. They are useful as they tend to reduce the assistance required by a wheelchair user. When transferring with a transfer board, it's possible to transfer with one large lift or with a number of smaller lifts.[5]
"Transfer boards can be made locally from wood or plywood. They should be thin, strong and very smooth. Reduce the thickness at the edges. Suggested dimensions are 300 mm x 600 mm. The thickness of the board depends on the strength of the material, but a typical thickness is between 20 and 25 mm."[5]
To perform a lateral transfer using a transfer board, the wheelchair user must position the wheelchair close to the target surface and put the brakes on. Next, they take their feet off the footrests and move them to the side / remove them (where applicable) to prevent obstruction during the transfer. The armrest closest to the target surface should also be removed. The wheelchair user moves forward to the front of the wheelchair. They place the transfer board under their buttocks and between the wheelchair and bed. Once the transfer board is securely positioned, the wheelchair user slides along the board.[5] The assistant is in front of the user and assists with the sliding motion if needed.
Please follow the link under the image to see how to perform sliding board transfer.
Standing Transfers
To complete a transfer via a stand pivot transfer, the wheelchair user must stand up and distribute their weight through their legs. They may need assistance with the sit-to-stand transition or pivoting.
Please follow the link under the image below to see how to perform stand pivot transfer with assistance.
Floor Transfers
To transfer to the floor from a wheelchair, wheelchair users need strong arms and good balance. To reduce the risk of pressure injuries while sitting on the floor, they should sit on their pressure relief cushion.[5]
Wheelchair to Floor
To independently transfer from a wheelchair to the floor, wheelchair users move their body to the front of their wheelchair. They lift their feet off the footrests and position them in front, slightly to the side away from the direction they are transferring. They place one hand on the wheelchair seat and reach down to the floor with their other hand. Using their shoulders and arms, they move their buttocks down onto the floor, making sure this movement is controlled.[5]
Please follow the links under the images below to see how to perform a wheelchair-to-floor transfer. The first video shows how to transfer with assistance. The second video shows an independent transfer.
Floor to Wheelchair
To transfer independently from the floor to a wheelchair, the wheelchair user sits in front of their wheelchair. They draw their knees up close to their body. Next, they place one hand on the floor and the other on the front of the wheelchair seat. They then push down with their shoulders and arms to lift their buttocks onto the front of the wheelchair seat.[5]
Please follow the links under the images below to see different ways to perform floor-to-wheelchair transfers.
Pressure Relief Techniques
Regular pressure relief is an effective technique to prevent pressure injuries. Various techniques can help wheelchair users relieve pressure from their ischial tuberosities while sitting. The choice of technique depends on their strength and balance. There are various recommendations on the frequency of pressure relief, but collectively, clinical guidelines recommend that wheelchair users with spinal cord injuries perform pressure relief for 15–60 seconds every 15–60 minutes.[19]
Healthcare providers need to teach all wheelchair users who are at risk of developing a pressure sore at least one way to relieve pressure.
Please follow the link under the image below to learn more about pressure relief in a wheelchair.
Leaning Forward
Leaning forward is a suitable pressure relief method for most wheelchair users. Wheelchair users must have good balance and strength to perform this method independently. If they don't have adequate balance and upper body strength, this technique can be performed with assistance.[5]
Please follow the link under the image below to see how to use the leaning forward method for pressure relief in a wheelchair.
Side to Side Lean
This pressure relief method is suitable for wheelchair users with reduced strength and balance. Some wheelchair users, especially those with limited trunk control, may hook their arm over the push handle for extra support.[5]
Please follow the link under the image below to see how to perform side-to-side pressure relief in the wheelchair.
Pressure Lift
This method requires the wheelchair user to lock the wheels of their wheelchair and unbuckle their seat belt. Next, they place their hands on the armrests or the wheels (when armrests are removed) and lift their buttocks by fully extending their arms and locking their elbows. For this technique to be successful, they must completely lift their buttocks off the cushion for 15 seconds. It is recommended that the pressure lift be repeated every 15 minutes or every 30 minutes if the person can hold the position for 30 seconds. This technique can place significant strain on the shoulders, so other techniques may be preferred.[17]
Please follow the link under the image below to see how to perform pressure lifts in the wheelchair.
Resources
References
- ↑ Fasipe G, Goršič M, Rahman MH, Rammer J. Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges. Front Hum Neurosci. 2024 Jan 5;17:1331395.
- ↑ 2.0 2.1 Best KL, Rushton PW, Sheriko J, Arbour-Nicitopoulos KP, Dib T, Kirby RL, Lamontagne ME, Moore SA, Ouellet B, Routhier F. Effectiveness of wheelchair skills training for improving manual wheelchair mobility in children and adolescents: protocol for a multicenter randomized waitlist-controlled trial. BMC Pediatr. 2023 Sep 26;23(1):485.
- ↑ Wheelchair provision guidelines. Geneva: World Health Organization; 2023. Available from https://www.who.int/publications/i/item/9789240074521 (accessed 2 February 2025).
- ↑ Chase T, Mendoza K, Rager C, Stiens M, Loeser M, Stead T, Kozlowski W, Van Antwerp L, Camilleri J, O'Neil J. Skills on wheels: initial pre-post findings from a pilot study of a pediatric wheelchair skills training program. Disabil Rehabil Assist Technol. 2024 Nov;19(8):2945-2952.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 World Health Organization. Wheelchair Service Training Package - Reference Manual for Participants - Basic Level. World Health Organization, Geneva, 2012.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Kirby RL, Smith C, Parker K, McAllister M, Boyce J, Rushton PW, et al. The wheelchair skills program manual. Published electronically at Dalhousie University, Halifax, Nova Scotia, Canada. Available from: https://wheelchairskillsprogram.ca/en/ (accessed 10 February 2025).
- ↑ Field-Fote EC. Therapeutic Interventions to Improve Mobility with Spinal Cord Injury Related Upper Motor Neuron Syndromes. Phys Med Rehabil Clin N Am. 2020 Aug;31(3):437-453.
- ↑ Missouri Department of Health. Wheelchair safety and maintenance guidelines checklist. Available from https://dmh.mo.gov/media/pdf/wheelchair-safety-maintenance-guidelines-checklist (accessed 2 February 2025).
- ↑ 9.0 9.1 Hryciów Z. The safety of wheelchair occupants in motor vehicle. The Archives of Automotive Engineering.2022;97(3)
- ↑ Kirby RL, de Groot S, Cowan RE. Relationship between wheelchair skills scores and peak aerobic exercise capacity of manual wheelchair users with spinal cord injury: a cross-sectional study. Disabil Rehabil. 2020 Jan;42(1):114-121.
- ↑ Rushton PW, Miller WC, Lee Kirby R, Eng JJ, Yip J. Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study. Disabil Rehabil Assist Technol. 2011;6(1):57-66.
- ↑ Rushton PW, Miller WC, Kirby RL, Eng JJ. Measure for the assessment of confidence with manual wheelchair use (WheelCon-M) version 2.1: reliability and validity. J Rehabil Med. 2013 Jan;45(1):61-7.
- ↑ 13.0 13.1 13.2 Oyster ML, Smith IJ, Kirby RL, Cooper TA, Groah SL, Pedersen JP, Boninger ML. Wheelchair skill performance of manual wheelchair users with spinal cord injury. Top Spinal Cord Inj Rehabil. 2012 Spring;18(2):138-9.
- ↑ Giesbrecht E. Wheelchair Skills Test Outcomes across Multiple Wheelchair Skills Training Bootcamp Cohorts. Int J Environ Res Public Health. 2021 Dec 21;19(1):21.
- ↑ Charlton K, Murray C, Layton N, Attrill S. Manual wheelchair training programs: a scoping review of educational approaches and intended learning outcomes. BMC Med Educ.2025;25 (134).
- ↑ Meyers AR, Anderson JJ, Miller DR, Shipp K, Hoenig H. Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects. Soc Sci Med. 2002 Oct;55(8):1435-46.
- ↑ 17.0 17.1 Tayseer M. Wheelchair Mobility in Spinal Cord Injury Course. Plus, 2025.
- ↑ Brown M. 3 reasons you should master a wheelie in your wheelchair. 2024. Available from https://adaptdefy.com/blogs/wheelchair/3-reasons-to-master-a-wheelie-in-your-wheelchair [last access 4.02.2025]
- ↑ Hubli M, Zemp R, Albisser U, Camenzind F, Leonova O, Curt A, Taylor WR. Feedback improves compliance of pressure relief activities in wheelchair users with spinal cord injury. Spinal Cord. 2021 Feb;59(2):175-184.