Knowing how to properly work with a wheelchair is the key to getting the right one for you.
The importance of having the right wheelchair to someone with spinal-cord injury/disease can never be overstated. The key to getting that wheelchair is learning the ins and outs of operating one.
A trained person with a properly fitted wheelchair can attain high levels of mobility. Many people can achieve a level of proficiency to allow them years of safe and efficient community mobility. One of the key factors is having an ultralight wheelchair and to have it properly fitted to the user.
Propelling a wheelchair is like any other motor-learning task; it takes practice to make perfect. But, once learned, it can help users preserve their arms, participate in a wide variety of activities and propel through diverse terrains.
There are many challenges to propelling a wheelchair. The first things to start with are going straight, stopping and turning.
The goal is to learn to propel with long smooth strokes and to contact the pushrim at a speed just greater than that of the wheel. This helps to reduce stroke frequency, peak force and impact spike; these are all factors associated with injuries to the wrist and shoulder.
Another tip is not to apply excessive force while grasping the pushrims. Just enough grip force should be applied to keep the hands from slipping. The stroke should start about top-dead-center of the wheel and sweep about 70 degrees (Figures 1 & 2). Longer strokes are fine; in fact, wheelchair racers push over a stroke angle of greater than 120 degrees.
Learning to perform a "wheelie" is often an essential skill for using a manual wheelchair.
When braking, it’s best to slightly drag the hands along the pushrims and come to a gentle stop. The more pressure applied, the faster you will stop.
There are two easy methods to turn:
(1) If there is a wall or some solid object on the inside of the turn, simply place a hand on the wall and use it to pull the chair around the curve (Figures 3 & 4).
(2) The second approach is to drag the hand on the pushrim on the inside of the turn and push with the hand on the outside of the turn.
It’s important to pay extra attention to the additional stress on the arms during starts, stops and turns. A sharp turn can be made by pulling backward with one hand and pushing forward on the other. The rule of thumb is to be smooth.
Up & Down
When going up slopes or on soft surfaces, it is often necessary to shorten the stroke to generate enough power.
In such cases, it’s often better to shorten the stroke and maintain the same stroke frequency but go a bit slower to keep from overloading the arms. When going up a slope, always lean forward. This helps to keep the chair from tipping and provides more power to the pushrims.
When going down, lean backward or use a “wheelie” to keep your body from falling forward and losing balance. Exercise caution at the beginning and ending of a ramp as that is where tips and falls commonly occur. You can smooth the transition by popping a wheelie just before the intersection to smooth the abruptness of the transition (Figures 5 & 6).
Cross-slopes are common outdoors in order to help water flow toward drains. However, for wheelchair users it can cause considerable strain on the low side arm. As with slopes, it’s best to lean into the cross-slope. If the user’s center of gravity is close to the rear axles, the effect of cross-slope is reduced.
A way to overcome cross-slopes is to push in a wheelie. However, you must make the tradeoff on whether it’s easier to push in a wheelie or to stay on all four wheels and lean into the cross-slopes.
Not a Trick
Wheelies are a fundamental skill for manual wheelchair users and often are the defining skill for many tasks, such as negotiating curbs, popping over obstacles, and adjusting posture.
There are three basic wheelies in progression of difficulty:
(1) Lifting the front casters and setting them down
(2) Balancing on the rear wheels while stationary
(3) Balancing on the rear wheels while moving
If the chair is well matched to the person, it takes little effort to wheelie. Wheelies aren’t tricks, they’re tools used nearly every day to roll around in a world full of big and small obstacles to wheelchair users.
Learning a wheelie is best done with an assistant. The simplest way to learn is to reduce the degrees of freedom; in other words, simplify the movement.
This can be accomplished by using a couple of blocks of wood or two bricks to keep the wheels from rocking (Figure 7). Once in place, when the user pushes forward on the pushrims, the casters will lift off the floor. As the person keeps pushing, the casters will eventually rise until the person reaches his/her balance point.
The user should have time to feel comfortable balancing at this point and be able to steadily hold the chair at the balance point for several seconds. Once mastered, the chocks can be removed and the process repeated.
It’s best to start with the wheelchair positioned on a soft mat, which can provide some protection in a fall and makes it easier to learn. A spotter should use a strap or even a bedsheet to catch the user in case he/she loses balance.
After learning to balance in a wheelie, the user should attempt to move forward while maintaining a wheelie, all the while being spotted.
It’s best to take small strokes and to maintain contact with the pushrims. The front-end will fall a little bit as one moves forward, and rise as the user takes the next stroke. It requires some practice but can be mastered by many.
Once someone can safely and independently control a wheelie, he/she can learn to ascend and descend curbs.
For more information, visit herl.pitt.edu.