Chapter 9: Interventions to Improve Manual Wheelchair Skills

INTRODUCTION

For individuals who use a manual wheelchair as their primary means of locomotion, such as individuals with spinal cord injuries, the ability to propel and maneuver over and around various obstacles and terrains in their home and community is essential for functional independence, community participation, and quality of life.^1,2 Optimal wheelchair configuration, which allows for the ideal rider positioning, and appropriate technique while performing these skills is important for energy efficiency, injury prevention, and safety. To propel a manual wheelchair independently in the home and community environments, riders need to be able to perform basic wheelchair mobility skills, such as propulsion, door management, emergency egress, and wheelies, and be able to ascend and descend steep hills, ramps, and curbs. Therapists play a vital role in employing appropriate teaching strategies to promote motor learning of these skills.

WHEELCHAIR CONFIGURATION

Wheelchairs are sized and configured differently for part-time users and full-time users. For those who will use it for more than intermittent transport, the wheelchair should be correctly measured for seat width, seat depth, backrest height, and footrest length. When used for full-time mobility, the individual’s wheelchair should be custom specified.³ After sizing, the configuration should be determined, as it establishes the dynamic stability of the wheelchair and the rider. The configuration required depends on the rider’s body functions and structures, activity, and participation.⁴

If the user spends some period of time ambulating, the wheelchair should be configured to make sit-to-stand transfers easier to accomplish. In this case, the wheelchair is best configured with swing-away or flip-up footrests to allow the feet to be positioned with knee flexion and an anterior tibial inclination. Often, a slightly higher seat height is also advantageous for the transfer. If the part-time rider will be propelling the wheelchair with his or her feet, the seat needs to be lower to the ground with a slightly shorter seat depth. The footrests should be removable and set slightly shorter than the user’s legs to allow ground clearance when in use. A wheelchair that will be frequently pushed by a caregiver should include push handles, be set up with a slightly longer wheelbase, and have larger casters. This wheelchair may also have a higher backrest with a posterior bend in the canes (vertical tubular bars supporting the backrest) to create a slight recline to allow better posture and comfort for the rider.

The wheelchair that will be propelled by the rider independently for community mobility should be set up for optimal push ...