FUNCTIONAL REHABILITATION: WHEELCHAIR SKILLS: TRAINING STRATEGIES: PROPEL WHEELCHAIR OVER OBSTACLES: STAIR STRATEGIES

  1. Stair Skills

    • To Ascend/Descend on Buttocks:
      • Sit on Step or Floor and Tilt Wheelchair Back - After learning good Dynamic Balance While Sitting Propped on One Arm, patients with intact upper extremity musculature and good balance grasp and pull on a push handle to turn and tip the chair.
      • Sit on Step and Stabilize Wheelchair - After achieving good balance while Short-sitting Propped Forward on Two Arms, patients with the physical potential to ascend stairs on the buttocks, push straight down through the chair's push handle to stabilize the chair. After beginning on a low step, patients can progress to higher steps.
      • Transfer Up and Down a Step - After learning to stabilize a wheelchair, while sitting on stairs, and to perform step-high, Back Approach, Uneven Transfers from the Floor, using the head-hips relationship, patients push straight down through the push handle and transfer up or down a step. At first, the patient may push down obliquely on the push handle, causing it to slide, before pushing straight down and performing the transfer. Following practice on a low and then higher steps, the patient can practice this skill at the same time as practicing pulling the chair up or lowering the chair a step.
      • Position Buttocks and Legs While Sitting on Step - After learning to stabilize the wheelchair while sitting on a step and after achieving independence in Gross Mobility in Sitting and Leg Management on a mat, the patient with the necessary Prerequisites should be able to easily learn to position the buttocks and legs while stabilizing on a step.
      • Pull Up and Lower Wheelchair While Sitting on Step - After achieving good dynamic balance in one-hand-supported short-sitting and after learning to lean away from the chair to avoid losing his/her balance, the patient should be able to easily pull the wheelchair up a step or lower it down.
      • Pull Wheelchair to Upright While Sitting on Floor - After assuming a long-sitting position propped on one arm and achieving good balance in this position, the patient pulls on one of the push handles to right the chair.

    • To Ascend in Wheelchair:
      • Belt Self into Chair - After achieving dynamic balance and the ability to move the trunk to and from upright in a wheelchair, patients with the physical potential to ascend stairs in a wheelchair should be able to easily learn to belt themselves into a chair.
      • Lower Chair into Position to Ascend Stairs in Wheelchair - Patients with the physical potential to ascend chairs in a wheelchair should be able to easily lower the chair into positioning, beginning with small arcs of motion if necessary.
      • Reposition Hands While Sitting Tilted Back - To move the hands from one step to another while sitting a wheelchair that is tilted back, the patient must support him/herself on one hand, while moving the other hand to the next step, and the chair at the same time. Practice should begin at the base of the stairway, progress to higher steps, and then be done at the same time as pulling the chair up a step.
      • Lift Wheelchair Up a Step and Transfer Down While Sitting - For the patient who has strength, proficiency in Back Approach, Even Transfers, and the ability to reposition the hands while sitting in the chair, this skill can be practiced at the base of the stairway, by lifting up one wheel of the chair at a time and raising and lowering the chair over a single step.

    • To Descend in a Wheelchair
      • Hold Stair Handrail(s) and Lower Wheelchair - This skill is easy to learn once the patient's fear has been reduced, by the therapist's assurance of the maneuver's safety and careful spotting during practice.
      • In Wheelie Position
        • Position Wheels at Top of Step - After gaining proficiency in gliding forward, backward, and turning in a wheelie position, the patient watches the therapist demonstrate the skill and begins, if necessary, by positioning the chair on a mark on the floor, and then progressing to a low 1-inch curb, and finally to the top of a stairway.
        • Stabilize Wheelchair Against Step - After gaining proficiency in maintaining a balanced wheelie position, the patient watches the therapist demonstrate the skill, has the therapist place the chair in a wheelie with the back of the chair's wheels resting against a curb, and practices stabilizing the chair in this position by pulling back on the handrims. Practice continues with the patient lowering and raising the chair in small and then larger arcs of motion, and then positioning the chair against the curb him/herself, and finally on the bottom step of a stairway.
        • Descend Step - After learning to stabilize the wheelchair against a step and to balance, glide, and descend curbs in a wheelie position with proficiency, the patient:
          • Begins learning this skill by practicing remaining in a wheelie position, both during and after the descent, and stabilizing the chair against the curb, on low curbs and then progressively higher curbs
          • Progresses to a small flight of stairs with a small vertical rise per step, and then to longer stairways and higher steps. Independent practice remaining in a wheelie after descending can be done by patients who can independently descend a curb or step in a wheelie position.

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.