FUNCTIONAL REHABILITATION: WHEELCHAIR SKILLS: TRAINING STRATEGIES: PROPEL WHEELCHAIR OVER OBSTACLES: NARROW DOORWAY STRATEGIES

  1. Narrow Doorways -

    • Transfer to Armrest - After achieving independence in even and slightly uneven transfers without a sliding board and proficiency using the head-hips relationship to move the buttocks, the patient:
      • Watches as the therapist demonstrates transferring to an armrest, and
      • With spotting from the therapist and cushions on the seat to reduce the distance of the transfer, at first, pushes down hard on the wheelchair seat, throws the head and upper trunk down and to the side with force, and lifts the buttocks onto the armrest.

    • Maintain Balance on Armrest - After achieving good dynamic balance in Short-sitting Propped Forward on One Extended Arm, the patient sits on an armrest, with one hand on each armrest, shifts his/her weight to the arm on the armrest opposite the buttocks, lifts the other hand, and practices maintaining balance in this position with the free arm reaching in all directions. This skill should be practiced following practice in transferring to the armrest, at first, and then following practice narrowing the chair, as proficiency increases.

    • Narrow Wheelchair, Pull Doorjamb, and Propel Narrowed Chair While Sitting on Armrest - After learning to maintain balance while sitting on an armrest, the patient:
      • Watches as the therapist demonstrates narrowing the chair, and then, with spotting from the therapist, practices pulling forcefully and abruptly upward on the wheelchair seat (while maintaining balance) and shifting his/her weight off the supporting arm with each pull. Practice of this skill can begin with the patient opening an already narrowed chair.
      • Maintains balance on the narrowed chair, propped on one arm, and practices, with spotting from the therapist, grasping the doorjamb and pulling the chair through the doorway.

    • Transfer from Armrest to Wheelchair Seat - After achieving proficiency in even and slightly uneven transfers, without a sliding board, and in using the head-hips relationship to move the buttocks, the patient can usually transfer from the armrest to the seat after a brief period of practice with spotting from the therapist.

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.