Chapter 11: Wheelchairs and Wheelchair Skills

Chapter 11 presents information on wheelchairs, wheelchair skills, and therapeutic strategies for increasing independence in wheelchair skills.

INTRODUCTION

Many people with spinal cord injuries (SCIs) use wheelchairs as their sole means of locomotion. This is true even for those who learn to walk with knee-ankle-foot orthoses (KAFOs) and assistive devices during their rehabilitation. If ambulation is impaired, a wheelchair provides a faster and more energy-efficient means of mobility than does walking. Even people who have such low lesions that they retain active hip flexion and knee extension, and can walk with ankle-foot orthoses (AFOs) and assistive devices, find wheelchair mobility to be faster and to require less energy than walking.^1,2

When ambulation is impaired, an appropriate wheelchair and cushion are essential for health, functional independence, and participation in life situations. After spinal cord injury, the rehabilitation team works with the patient to select a wheelchair and cushion^a that will best meet their needs. They also work together to develop the patient's ability to function optimally with this equipment. These tasks are inextricably linked; the individual's capabilities influence the selection and adjustment of their wheelchair, and the wheelchair's characteristics, in turn, influence the skills that its user will need to develop.

This chapter presents information on wheelchair selection and adjustment, wheelchair skills, and training strategies. The descriptions of equipment, techniques, and training presented here should be used as a guide, not as a set of hard and fast rules. The equipment required and motions used to perform any functional task vary among people because of differences in body build, skill level, range of motion, muscle tone, patterns of strength and weakness, and presence or absence of additional impairments. During rehabilitation, the therapist and patient work together to determine the equipment and functional techniques that best suit that individual.

PRECAUTIONS

Falls are common among full-time wheelchair users living with spinal cord injury. Among these individuals, 64% report at least one fall in a 6-month period, and 32% report recurrent falls (more than two falls in 6 months).³ Most falls occur while transferring or propelling/driving a wheelchair.^3,4 Other factors, such as muscle weakness or spasticity, being distracted, and equipment failure, are also associated with falls.⁴ Approximately 35% of the population sustained a physical injury as a result of a fall³ and 65% reported worries about falling.⁴ Fall prevention involves a combination of providing appropriate equipment, guarding during wheelchair skill training, and educating and training to mitigate risk.

In addition to falls, risks associated with wheelchair use include pressure injury and a variety of orthopedic problems. Table 11-1 presents a summary of precautions for wheelchair use and skill training. These precautions should be taken whenever ...