WHEELCHAIR PROPULSION ON EVEN SURFACES

Manual Wheelchair Propulsion

1. Physical and Skill Prerequisites
   • Greater than normal strength of the anterior deltoids for forward propulsion, and greater than normal range of motion for shoulder external rotation for backward propulsion by pushing the tires
   • Some strength in the trapezius, the deltoids, and in the biceps, brachialis, and/or brachiaradialis for forward, backward, and turning motion
   • Some strength in the infraspinatus, teres minor for propelling a wheelchair with standard handrims, and some strength in the pectoralis major, teres major for backward propulsion of wheelchair with pegged handrims (Strength in the pectoralis major, teres major, serratus anterior, triceps, and hand musculature is not required, but is helpful for propulsion of manual wheelchair with standard handrims)
   • Some range of motion for scapula adduction, internal rotation of the shoulder, and elbow flexion and extension, for forward, backward, and turning motion. Also, some range in shoulder abduction and external rotation for wheelchair with standard handrims, and some range in shoulder flexion and extension for pegged handrims
   • Ability to maintain upright sitting position, place hands against and push and pull standard or pegged handrims, and place hands on and propel with tires.

2. Functional Skills
   • With Finger Flexors - The patient grasps the handrims and pulls forward or backward
   • Without Finger Flexors - The patient:
     • To propel forward:
       • Standard Handrim - Flexes the elbows, internally rotates the shoulder slightly, places the palms against the far back lateral surface of the handrims, stabilizes the palms (using elbow extension and combined shoulder adduction, external rotation, and flexion), and pushes until the hands are well forward
       • Pegged Handrim - Places the palms or forearms behind handrim pegs that are posterior to the buttocks, flexes the shoulder and elbow, and pulls forward on the pegs in long strokes.
     • To propel backward - Reverses the steps for forward propulsion:
       • Standard Handrim
         • Places the palms on the outer surface of the handrims, squeezes, and pulls back, or,
         • Externally rotates the shoulders, places the palms on top of the tires (just posterior to the buttocks with hands facing backward), extends the elbows, and pushes backward, or,
         • Externally rotates and elevates the shoulders, places the palms against the medial-superior surface of the tires (posterior to the buttocks), locks the elbows, depresses the scapulae, and pushes the wheels backward
       • Pegged Handrim - Internally rotates the shoulders, places the hands or forearms against the front parts of pegs that are anterior to the buttocks, and pulls back using glenohumeral extension and scapular adduction
     • To turn:
       • A long arc turn is achieved by pushing harder with one hand than the other, or, by pushing one wheel and simultaneously applying resistance to the other wheel
       • A sharp turn is achieved by pulling one wheel backward, while pushing the other wheel forward

Electric Wheelchair Propulsion requires:

• At least 3/5 strength in cervical paraspinals and 2-5/strength in trapezius for hand-controlled wheelchair (Strength in the deltoids and serratus anaterior is not required, but is helpful for hand-controlled wheelchair propulsion)
• At least 3/5 strength in cervical paraspinals, sternocleidomastoid, and trapezius for chin-controlled wheelchair, and in oral musculature for mouth- and breath- controlled wheelchair
• At least 2-5/strength for range of motion for cervical rotation, flexion, and extension for chin-controlled wheelchair
• Ability to move joystick in all directions using hand (with or without a strap), chin, or tongue motions for hand-, chin-, and mouth-controlled chairs, and to signal wheelchair by sipping and puffing using a tube in appropriate patterns for breath-controlled chair