Wheelchair Skills Training - Wheelie Dependant Skills
Original Editor - Lee Kirby as part of the Wheelchair Service Provision Content Development Project
Top Contributors - Naomi O'Reilly, Kim Jackson, Uchechukwu Chukwuemeka, Rucha Gadgil and Amrita Patro
Performs Wheelie-Dependent Skills
Description and Rationale
The learner performs a variety of previously discussed skills for which non-wheelie methods are available, but that can be performed (and sometimes need to be performed) in the wheelie position.[1] Once the learner has mastered the stationary wheelie, the learner should return to these skills and attempt to learn them using the wheelie position. Training these skills can improve the independence for the people using a wheelchair, improving their quality of life. [2]
General Training Tips
The training tips for the skills in this section build upon the tips presented earlier where the non-wheelie methods were described. Only aspects specific to the wheelie method will be presented here.
Rolls Forward and Backward in the Wheelie Position
Rolling forward in the wheelie position is useful when approaching obstacles for which it is advantageous to have the casters off the surface (e.g. for the descent of high curbs). Moving backwards in the wheelie position is useful in tight spaces, where it is not possible to turn around, for instance, to raise the casters over an obstacle (e.g. a stick on the ground or a towel on a bathroom floor). Also, the backward skill allows the wheelchair user to ease up to a wall or object against which he/she can lean (i.e. for the tilt-rest variation of the “relieves pressure from buttocks” skill).[1]
Moving the wheelchair forward and backwards in the wheelie position utilizes the reactive balance strategy.[3] The wheelchair user should allow the wheelchair to begin to fall (dip) slightly in the direction in which he/she wishes to move, and then roll the rear wheels in the same direction to catch up. To initiate the dip, the wheelchair user can move the head or lean slightly in the direction he/she wishes to move.[4] Alternatively, the wheelchair user can initiate the dip by pushing the wheels slightly in the opposite direction. The wheelchair user should be encouraged to take his/her time to achieve control and to move slowly. The wheelchair user should grip the wheels lightly, giving a light push and letting the hand-rims slide through the fingers. In catching up to the centre of gravity after the first dip, there is no need for the wheelchair user to catch up completely. By undershooting slightly, the wheelchair user can initiate the next dip.[4] Some wheelchair users may find it easier to move forward or backwards with one hand at a time. It is easier to begin with short steps and then proceed to longer ones.
Stops
Some highly skilled wheelchair users can induce a controlled wheelie by throwing the trunk backward while coasting quickly forward. The goal is to overshoot the balance point and then grasp the hand-rims firmly to stop the wheelchair and prevent a rear tip. With a different amount of force applied to the two hand-rims, a rapid turn can be made.
Relieves Weight from Buttocks
A wheelie can be used to achieve the tilt-rest position discussed earlier. To do so, the wheelchair user achieves the wheelie position with the back of the wheelchair facing the object that will be leaned against. The wheelchair is then rolled back in the wheelie position until the rear wheel or backrest of the wheelchair or back of the wheelchair user (for low and high objects respectively) contacts the object. Then the wheelchair is allowed to tilt back slightly further and the wheel locks are applied one at a time (or the hand-rims are held with the hands). The wheelchair user must not let go of both wheels at the same time or the rear wheels will roll rapidly forward (“submarining”) and a rear tip will occur[5][6].
Rolls on Soft Surface
If using the full wheelie position to move on a soft surface, the wheelchair user needs a strong forward “dip” to get going as was discussed earlier. If the casters touch the surface during the dip, the wheelchair user can lean forward slightly. This allows the casters to lift off further during the wheelie and provides better clearance during the dip. [7][8]
Turns in Place
Wheelchair users often encounter situations in which they need to perform a wheelie to make a tight turn. The area needed on the support surface (the “footprint”) is less in the wheelie position than when all wheels are on the surface. The learner should be careful not to let the elevated feet hit any external object. [3]
Turns while Moving Forward and Backward
These skills are similar to moving straight forward and backwards in the wheelie position except that, in correcting for the initial “dip”, the rear wheels are rolled forward or backward to different degrees. [5]
Alternatively, this skill can be broken into two components performed sequentially (e.g. rolling straight forward to a slight extent, then turning in place to a slight extent, repeating these steps) rather than simultaneously.[5]
Maneuvers Sideways
In tight spaces, the wheelie allows the wheelchair to be moved sideways by a series of forward and backwards turns. [4]
Descends Curbs
Using a wheelie to descend a curb in the forward direction allows the wheelchair user to maintain forward movement and to see any dangers that lie ahead. Also, the wheelie position prevents the footrests from making contact with the lower level, which can decelerate the wheelchair and cause a forward tip or fall from the wheelchair.[4]
If the wheelchair user descends a curb in the wheelie position, a single spotter should stand on the upper level with both hands near the push-handles to react to forward or sideways tips. A removable seat belt can prevent the wheelchair user from falling forward from the wheelchair.
The forward full-wheelie method is an excellent method for the descent of a large-level change.[9] The wheelchair user should get into the wheelie position slightly away from the edge of the level change. The wheelchair user should roll forward to the edge of the curb in the wheelie position, staying square to the edge. The “wheelie forward and backward” skill will have prepared the learner to approach the curb edge under control. After initiating the forward dip to move the rear wheels over the edge of the curb, the wheelchair user should quickly slide the hands backwards from just ahead to just behind the top dead centre of the hand rims, so that he/she can firmly grip the hand rims and pull backwards to slightly slow the descent. The wheelchair user should let the rear wheels hit the lower level before the casters. As soon as the rear wheels touch the ground, the momentum should bring the casters down to the surface, but the wheelchair user should lean forward as well. The skill should be practised first on a low curb, increasing the height of the curb as skill and confidence allow.[5]
As a variation, the wheelchair user can land on the lower level and maintain the wheelie position rather than allowing the casters to land, either maintaining balance or leaning back against the curb rise. This is useful where there is little space for the casters to land, such as on a series of widely spaced stairs.
Ascends Inclines
For the ascent of very steep inclines, some wheelchair users will go up backward The uphill movement is initiated by allowing the wheelchair to fall (“dip”) partially backwards, followed by a strong pull backward on the hand-rims to re-achieve balance a short distance up the slope. [9]
Descends Inclines
Descending a steep incline in the forward direction in the wheelie position lessens the problem of loss of traction (affecting braking and control) when the uphill wheels become unloaded. This technique also reduces the likelihood of forward tips or digging the footrests into the floor at the transition between the bottom of the incline and the level surface. For very steep inclines, this technique may be the only way to get down the incline without tipping over.[9] [7]
The wheelchair user usually achieves the wheelie position on the level at the top of the incline. Then he/she moves forward onto the incline. Moving forward and backwards in the wheelie position will already have been practised. When initially moving onto the incline, the wheelchair user may be startled to feel as though the wheelchair is tilting farther backwards. Once on the incline, facing downhill, the wheelchair user should let the hand rims run smoothly through the hands to control the wheelchair’s speed, direction and pitch angle.
Letting the hand-rims run more quickly through the hands will allow the wheelchair to pitch (tilt) farther back. Slowing the rate at which the hand rims slide through the fingers will cause the wheelchair to pitch forward. The learner should have the casters touch down shortly after the rear wheels reach the level surface at the bottom of the incline.[9]
When stopped facing downhill in the wheelie position, the sensation is similar to that felt while leaning back on a barrier, as when learning the balance phase of the “performs stationary wheelie”.
A variation is for the learner to achieve wheelie take-off while on the incline and facing downhill. This is useful when an unexpected obstacle is encountered. If the wheelchair user is facing downhill, more force is needed for take-off (because the wheelchair is pre-tilted in the wrong direction) and the wheelchair may accelerate rapidly downhill.
On steep or slippery inclines, or if the wheelchair has too much rear stability, there may not be enough rear-wheel traction to allow wheelie take-off while facing downhill. In such situations, the wheelchair can be turned so that it is facing across the hill or even uphill. This will place more weight on the rear wheels and avoid runaway. Once in the wheelie position, a wheelie turn-in-place will allow the wheelchair user to proceed down the incline.
Rolls Across Side-Slope
In the wheelie position facing across a slope, there is no downhill-turning tendency, because the centre of gravity is between the rear wheels.
Descends Stairs
In the full wheelie position, the wheelchair user can descend forward, one step at a time. This is possible if there is an adequate horizontal distance (“run”) on each step. [10]
At least two spotters should be involved. One or two spotters should be below the wheelchair with the hands near a fixed front part of the wheelchair to resist tipping or runaway. The uphill spotter should be above the wheelchair with the hands near the push-handles to react to forward, backward or sideways tips or runaway.
The wheelchair user drops down one step at a time for the “descends high curb in wheelie position” skill. The difference is that the casters cannot land after the rear wheels do. The wheelchair user instead balances on the rear wheels or, more simply, allows the wheelchair to tilt back after the rear wheels land on the step such that the rear wheels push against the step rise (analogous to the “tilt rest” version of the “relieves weight from buttocks” skill) before proceeding to the next step. This should be practised on a single curb first.[7]
References
- ↑ 1.0 1.1 Kirby RL, Kirby RL, Smith C, Seaman R, Macleod DA, Parker K. The manual wheelchair wheelie: a review of our current understanding of an important motor skill. Disability and Rehabilitation: Assistive Technology. 2006 Jan 1;1(1-2):119-27.
- ↑ Fliess-Douer O, Vanlandewijck YC, Van Der Woude LH. Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury. Archives of physical medicine and rehabilitation. 2012 Apr 1;93(4):629-35.
- ↑ 3.0 3.1 Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Archives of physical medicine and rehabilitation. 2005 Dec 1;86(12):2316-23.
- ↑ 4.0 4.1 4.2 4.3 Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disability and Rehabilitation: Assistive Technology. 2017 Jan 2;12(1):28-38.
- ↑ 5.0 5.1 5.2 5.3 Kirby RL, Worobey L. Training Manual and Power Wheelchair Mobility and Maintenance Skills. InSeating and Wheeled Mobility (pp. 433-462). Routledge.
- ↑ Buning ME. Wheelchairs and Transportation. InSeating and Wheeled Mobility 2024 Jun 1 (pp. 385-395). Routledge.
- ↑ 7.0 7.1 7.2 WHEELCHAIRS M. Wheelchair Skills. Spinal Cord Injuries-E-Book: Management and Rehabilitation. 2008 Jan 28:351.
- ↑ Sol ME, Verschuren O, de Groot L, de Groot JF, Fit-For-the-Future!-consortium. Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise. BMC pediatrics. 2017 Dec;17:1-8.
- ↑ 9.0 9.1 9.2 9.3 Gollan E, Wilson T. Functional independence. Rehabilitation in Spinal Cord Injuries. 2020 Feb 1:112.
- ↑ Sawatzky B, Hers N, MacGillivray MK. Relationships between wheeling parameters and wheelchair skills in adults and children with SCI. Spinal Cord. 2015 Jul;53(7):561-4.