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SCI Forum

 

Ultralight Wheelchair Skills: From Rehab to Real World

Presented on November 8, 2011 at Harborview Medical Center, Seattle, WA

Learn the skills you need to successfully navigate your ultralight manual wheelchair in a variety of situations and environments so you can more fully participate in the activities you enjoy. In this video, physical therapist Elisa Smith, DPT, of Harborview Medical Center provides practical tips and explanations for learning and perfecting wheelchair skills, including wheelies for curbs and maneuvering in small spaces, on gravel roads, up and down hills, and more. Wheelchair users with spinal cord injuries are shown demonstrating several of these skills.
Click here to read the written report.

Caution! Consult with your physician and physical therapist before attempting any of these wheelchair skills. Always use a physical therapist or trained spotter to prevent falls while learning wheelchair skills like the ones described here.

 

Presentation time: 31 minutes. After watching, please complete our two-minute survey!

 

You can also watch this video on YouTube with or without closed-captioning.

For a complete list of our streaming videos, go to http://sci.washington.edu/info/forums/forum_videos.asp.

Report: Ultralight Wheelchair Skills: From Rehab to Real World

 

Contents

The wheelie: an essential skill

A “wheelie” is the act of balancing on your rear wheels in your wheelchair. Wheelies may look like tricks, but “they are the essential building blocks of community wheelchair skills,” said Elisa Smith, physical therapist at Harborview Medical Center. Unfortunately, many people don’t learn this skill before they are discharged home from rehab and then have few opportunities to learn them later on.

“Rehab stays now are getting so short that therapists only have time to focus on basic transfers, caregiver training and testing different chairs,” Smith said. “There isn’t much time to practice many ultralight wheelchair skills while still in the hospital.” Once patients get home, there may not be many therapists in their communities who are familiar with wheelchair skills.

“Newly injured patients often assume wheelies are simply tricks and not essential to their rehab,” Smith said. “People will say to me, ‘I don’t care about tricks right now. I just had this major tragedy in my life, and I don’t want to focus on doing stunts.’”

Other patients are just too overwhelmed and fearful in the early weeks. “They can’t imagine doing anything outside of the hospital by themselves,” Smith said. “They’ll say, ‘I’m always going to have somebody pushing my chair, so I don’t need to learn how to do this on my own,’ or ‘It seems like wheelies are impossible. I’m just getting used to a chair, and I don’t want to do anything where I’m going to put myself at risk for falling back and hitting my head or losing control of the chair.’”

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Why learn wheelies?

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Where to learn wheelies

If you didn’t learn these skills while still in rehab, or if you want to improve your skills, you can get help and information from a variety of sources, such as:

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Wheelchair skills

Following is a brief summary of the wheelchair skills and techniques presented at this forum. Watch the video (see above) to get the full descriptions and see demonstrations of these different skills.

Caution! Always use a physical therapist or trained spotter to prevent falls while learning new advanced wheelchair skills like the ones described here. A therapist also can train a family member or friend to help spot you while you are learning these skills. Spotting is especially important while you are working on getting your balance in a wheelie.

Stationary wheelie & pop-ups

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Dynamic wheelie

A dynamic wheelie is moving or propelling while balancing on your rear wheels. You can go forward, backward, turn, and pivot in place.

Practice going forward by setting up a slalom course to propel around obstacles in a wheelie.

“Reverse is the most difficult and requires a lot of practice because pulling back to go in reverse tips the chair forward out of a wheelie,” Smith said.

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Indoor Skills

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Outdoor Skills

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References

  1. Wheelchair Skills Training Program.  Dalhousie University. Available at: http://www.wheelchairskillsprogram.ca/.  Accessed September 18. 2010.
  2. Anneken V, Hanssen-Doose A, Hirschfeld S, Scheuer T, Thietje R. Influence of physical exercise on quality of life in individuals with spinal cord injury.  Spinal Cord. 2010;48:319-399.
  3. Kilkens O, Post M, Dallmeijer A, van Asbeck F, van der Woude L. Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation. J Rehabil Res Dev. 2005;42:65-74.
  4. Coolen A, Kirby R, Landry J,  et al. Wheelchair Skills Training Program for clinicians: a randomized controlled trial with occupational therapy students. Arch Phys Med Rehabil. 2004;85:1160-1170.
  5. Best K, Kirby R, Smith C, MacLeod D. Wheelchair Skills Training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil. 2005;86:2316-2123.
  6. MacPhee A, Kirby R, Coolen A, Smith C, MacLeod D, Dupuis D.. Wheelchair Skills Training Program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch  Phys Med Rehabil. 2004;85:41-50.
  7. Axelson P, Chesney D, Minkel J, Perr A. The Manual Wheelchair Training Guide.  1st ed.  San Francisco, CA: PAX Press; 1998.
  8. Kirby R, Smith C, Seaman R, Macleod D, Parker K. The manual wheelchair wheelie: a review of our current understanding of an important motor skill. Disabil Rehabil: Assistive Technology. 2006;1:119-127.
  9. Bonaparte J, Kirby R, MacLeod. Learning to perform wheelchair wheelies: comparison of 2 training strategies. Arch Phys Med Rehabil. 2004;85:785-793.
  10. Bonaparte J, Kirby R, MacLeod D. Proactive balance strategy while maintaining a stationary wheelie. Arch Phys Med Rehabil. 2001;82:475-479.
  11. Kirby R, Gillis D, Boudreau A,  et al. Effect of a high-rolling-resistance training method on the success rate and time required to learn the wheelchair wheelie skill. Am J Phys Med Rehabil. 2008;87:204-211.
  12. Koshi E, Kirby R, MacLeod D, Kozey J, Thompson K, Parker KE. The effect of rolling resistance on stationary wheelchair wheelies. Am J Phys Med Rehabil. 2006;85:899-907.
  13. Kirby R, DiPersio M, MacLoed D. Wheelchair safety: effect of locking or grasping the rear wheels during a rear tip. Arch Phys Med Rehabil. 1996;77:1266-1270.
  14. Kirby R, Bennett S, Smith C, Parker K, Thompson K. Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods. Arch Phys Med Rehabil. 2008;89:2342-2348.
  15. Kwarciak A, Cooper RA, Fitzgerald SG. Curb descent testing of suspension manual wheelchairs. J Rehabil Res Dev. 2008;45:73-84.

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For further reading

  1. Newton AM, Kirby RL, Macphee AH, Dupuis DJ, Macleod DA. Evaluation of manual wheelchair skills: is objective testing necessary or would subjective estimates suffice? Arch Phys Med Rehabil. 2002;83:1295-1299.
  2. Kilkens O, Dallmeijer A, de Witte L, van der Woude L, Post M. The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil. 2004;85:424-431.
  3. Groot S, Bevers G, Dallmeijer A, Post M, van Kuppevelt H, van der Woude L. Development and validation of prognostic models designed to predict wheelchair skills at discharge from spinal cord injury rehabilitation. Clin Rehabil. 2010;24:168-180.
  4. Stanley R, Stafford D, Rasch E, Rodgers M. Development of a functional assessment measure for manual wheelchair users. J Rehabil Res Dev. 2003;40:301-308.
  5. Kilkens O, Dallmeijer A, Angenot E, Twisk J, Post M, van der Woude L. Subject- and injury-related  factors influencing the course of manual wheelchair skill performance during initial inpatient rehabilitation of person with spinal cord injury. Arch Phys Med Rehabil. 2005;86:2119-2125.
  6. Kilkens O, Dallmeijer A, Nene A, Post M, van der Woude L. The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Arch Phys Med Rehabil. 2005;86:1575-1581.
  7. Best K, Kirby R, Smith, Macleod D. Comparison between performance with a pushrim-activated power-assisted wheelchair and a manual wheelchair on the Wheelchair Skills Test.  Disabil Rehabil. 2006;28:213-220.
  8. Lighthall-Haubert L, Requejo P, Mulroy S, Newsam C, Bontrager E, Gronley J, Perry J. Comparison of shoulder muscle electromyographic activity during standard manual wheelchair and push-rim activated power assisted wheelchair propulsion in person with complete tetraplegia. Arch Phys Med Rehabil. 2009;90:1904-1915.
  9. Algood S, Cooper R, Fitzgerald S, Copper R, Boninger M. Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of person with tetraplegia. Arch Phys Med Rehabil. 2005;380-386.

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