FUNCTIONAL REHABILITATION: WHEELCHAIR SKILLS: WHEELCHAIR PROPULSION: OVER OBSTACLES: NARROW DOORWAYS

  1. Physical and Skill Prerequisites
    • Fully innervated upper extremities, and normal range of motion in scapular abduction, adduction, downward and upward rotation, shoulder flexion, extension, and internal rotation, elbow flexion and extension, and finger flexion, to sit on the armrest
    • Fully innervated upper extremities and normal range of motion in shoulder internal rotation, and in elbow and finger flexion, to remain on the seat
    • Ability to transfer to, maintain balance on, narrow wheelchair, and either pull doorjamb to move or propel narrowed wheelchair (all while sitting on armrest), and ability to transfer from armrest to wheelchair seat, OR,
    • Ability to narrow wheelchair by rocking and propel on even surfaces, while remaining on the seat

  2. Functional Skills
    • Sitting on the Armrest - To narrow a wheelchair to the greatest possible extent, the patient:
      • Positions the chair so the footplates extend into the doorway and the doorjamb is within reach, and then removes the foot from one footplate and folds the footplate up

      • Transfers to the seat by placing the hand toward which the transfer will be made, well forward on the armrest to leave room for the buttocks, placing the other hand, and then pushing down forcefully and throwing the head away from the armrest to achieve the transfer.

      • Maintains balance on the armrest (by propping one hand on the opposite armrest), reaches to the opposite side of the seat with the free hand, grasps the seat (or a loop, if present), and pulls the seat up forcefully and abruptly, while shifting the weight off the supporting hand, to narrow the chair. Repeated pulls will narrow the chair to the desired width.

    • Remaining on the Seat - The patient rocks the chair from side-to-side, by throwing the head to one side, while pulling up on the other side of the seat, and then vice versa, with throws and simultaneous pulls that are forceful and abrupt enough to narrow the chair.

The PoinTIS SCI Physical Therapy site of the SCI Manual for Providers is based on information in Spinal Cord Injury: Functional Rehabilitation, by M.F. Somers, Norwalk, CT, Appleton & Lange, 1992, and information in "Respiratory Rehabilitation of the Patient with a Spinal Cord Injury", by J.L. Wetzel, B.R. Lunsford, M.J. Peterson, and S.E. Alvarez, Chapter 28 in Cardiopulmonary Physical Therapy, S. Irwin and J.S. Tecklin, eds., St. Louis, Mosby, 1995, unless otherwise indicated.