1. Falling Safely -
    • Physical and Skill Prerequisites
      • Normal strength in the sternocleidomastoid and in the biceps, brachialis, and/or brachioradialis and normal range of motion in elbow flexion and extension are required; some innervation in the upper extremities and hand musculature is helpful, but not necessary to fall safely
      • Fully innervated upper extremities and normal range of motion in scapular abduction, shoulder internal rotation, and elbow flexion and extension, to block lower extremities while falling safely
      • Ability to tuck head in and hold wheels, or to tuck head in and block legs while falling backward
    • Functional Skills - Since wheelchair falls are inevitable, the patient needs to learn to fall safely, by:
      • Tucking the head and holding the wheels, so the chair's push handles take the brunt of the fall, or,
      • Tucking the head, holding one of the wheels, crossing the free arm across the legs, and grasping the opposite armrest or seat, to prevent the knees from hitting the face when the wheelchair lands
  2. Returning to Upright - The patient gets out of the chair, rights it, and transfers stays in the chair, in which case the following are required:
    • Physical and Skills Prerequisites
      • Fully innervated upper extremities and normal range of motion in scapular abduction, adduction, and upward rotation, in shoulder flexion, extension, internal and external rotation, and in elbow flexion and extension.
      • Ability to position self in chair after falling backward, and, while sitting in overturned chair, lock brakes, lift upper trunk from floor, balance on one hand, and rock chair to upright
    • Functional Skills - The patient:
      • Positions the buttocks on the seat by pulling on the wheels, grasps the legs and loops them over the front edge of the seat, locks the chair's brakes, and lifts the upper trunk by pulling on the front of the chair

      • Releases one hand, turns, places this hand on the floor directly beneath the trunk, and then balancing on the hand on the floor, releases the chair, reaches the free hand across the body, and grasps the opposite wheel

      • Bends the elbow, extends the supporting arm, and "rocks" the chair, by abruptly and forcefully pushing the extended arm against the floor (which thrusts the chair to upright), and inching the hand of the extended arm forward around the side of the chair. When the chair falls back from the forward rock, the patient balances on the supporting arm and repeats the process until the chair gradually assumes a more upright position, and, finally, a position from which it can be rocked past its balancing point to upright.

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.