FUNCTIONAL REHABILITATION: WHEELCHAIR SKILLS: TRAINING STRATEGIES: PROPEL WHEELCHAIR OVER OBSTACLES: CURB/UNEVEN TERRAIN STRATEGIES

  1. Curb Skills - After mastering forward propulsion over even surfaces, the patient learns curbs skills from a stationary position and with motion:

    • From Stationary Position:
      • Lift Casters from Floor - This skill is similar to Assume Wheelie Position, but the actions are performed with less force.
      • Pop Casters onto Curb - After learning to lift casters from floor, the patient practices popping the casters onto a small, 1-inch curb and then progresses to higher curbs. If the patient is likely to tip the chair over backward during independent practice, Safety Rigging can be used.
      • Position Casters at Edge of Curb - After learning to pop the casters onto a curb, the patient practices backward propulsion and turning, to position the casters right at the edge of the curb. This position maximizes the distance between the rear wheels and the curb and the momentum needed to ascend the curb. If the patient is likely to tip the chair over backward during independent practice, Safety Rigging can be used.
      • Ascend Curb - After achieving proficiency in forward propulsion and placing the casters at the edge of the curb, the patient grasps the handrims posteriorly and pulls forward with force, throwing the head and trunk forward as the chair approaches the curb to add momentum, if needed and possible. After learning to Fall Safely and acquiring some skill in negotiating curbs, the patient can practice this skill independently, starting with low, 1-inch curbs, and progressing to higher curbs.

    • With Forward Motion:
      • Lift Casters off Floor - While propelling forward, the patient grasps the handrims posteriorly and pulls them forward, forcefully and abruptly, to gain enough momentum to lift the casters. If the patient has impaired upper extremity function or a heavy wheelchair with axles located posteriorly, he/she may need to throw the head back forcefully when pulling the handrims. Patients who have had training in maintaining a wheelie position and who time the motions well will perform this skill more successfully. The patient should progress from low to higher speeds as skill improves.
      • Pop Casters onto Curb - After learning to lift the casters while propelling forward, the patient learns the timing needed to lift the chair, before the footplates hit the curb, and to lower the chair, just after it crosses the curb. The patient can begin to practice timing by popping the casters over a mark on the floor, instead of an actual curb, and then progressing to a low, 1-inch curb, and then higher curbs, as the patient's skill increases. Independent practice can begin after the patient has had sufficient practice that falling is rare, and after the patient has learned to Fall Safely.
      • Ascend Curb Using Momentum - After learning to lift the casters and after achieving some skill in popping the casters onto curb while propelling forward, the patient:
        • Approaches the curb front on, with enough speed to build sufficient momentum
        • Tilts the chair far enough back, to pop the casters onto the curb at the last moment, and
        • Lifts the casters high enough to raise them over the curb just before the rear wheels hit the curb

        Much practice is need to perfect this skill and should begin on a low, 1-inch curb, with progression to higher curbs only when the patient is ready. Frequent spotting by the therapist is needed, in the front and from behind, since an abrupt stop, caused if the casters hit the curb's vertical surface rather than lifting over it, can result in the patient being thrown from the chair, or in the chair falling over backward. Independent practice can begin after the patient has had sufficient practice that falling is rare and after the patient has learned to Fall Safely.

    • Descend Curb
      • Backing Down Curb - After learning to Propel Manual Wheelchair on Even Surfaces, the patient practices backing the wheelchair down a curb, by backing the chair just past the edge of the curb and applying a strong force to resist the chair's motion as gravity pulls it down the curb. Practice should begin on low, 1-inch curbs and can be combined with practicing curb ascent.
      • Lower Casters From Curb - After learning to turn the wheelchair in a tight arc, the patient should be able to easily learn to lower the casters down the curb by turning the chair.
      • Descend Curb in Wheelie - After learning to glide forward in a wheelie position with good control, the patient practices descending 1-inch curbs and then progresses to higher curbs.

  2. Negotiate Uneven Terrain
    • On Four Wheels - After learning to Propel Manual Wheelchair on Even Surfaces, the patient should be able to negotiate uneven terrain by pushing harder, or, by backing up from an obstacle, such as a clump of grass, and ramming it.
    • In a Wheelie - After gaining proficiency in Forward Wheelie Skills, the patient should learn to maintain the position over irregular surfaces. Independent practice should begin, after the patient has learned to Fall Safely, and in an area where assistance is available.

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.