FUNCTIONAL REHABILITATION: WHEELCHAIR SKILLS: TRAINING STRATEGIES: PROPEL WHEELCHAIR OVER OBSTACLES: SLOPE AND WHEELIE STRATEGIES

Propel Manual Wheelchair Over Obstacles

  1. Propel Wheelchair on a Slope
    • Up a Slope - After acquiring significant skill in wheelchair propulsion over even surfaces, the patient should be shown how to push forcefully (but not abruptly) using short strokes, reposition hands rapidly between pushes, use the hands simultaneously and symmetrically, and, if necessary and possible, flex the head and truck forward to prevent the chair from tipping backward, to ascend a ramp or other slope. The patient then begins practice on a very gentle slope, with the therapist (if necessary) giving a push and guarding the chair to prevent excessive rollback between pushes, but allowing a slight backward roll for feedback to the patient on his/her technique
    • Descend Slope on Four Wheels - The patient begins learning how to apply friction to the handrims as they slide past his/her hands to control the chair's descent, by descending gentle slopes at slow speeds, with the help of a therapist if needed. When the patient has mastered the ability to slow, stop, and turn a manual wheelchair while descending a gentle slope, he/she can begin practicing on steeper ramps and at greater speeds.

  2. Maintain Balance in Wheelie Position -
    • To begin, the therapist demonstrates the wheelchair's balance point - the point at which the chair is balanced on the rear wheels and stays in this position briefly, without any assistance form the therapist. The patient sees that the chair's balance point is further back than one would expect. The therapist then tips the patient back in the chair to this point.
    • While guarding closely, the therapist then teaches the patient how to control the chair in a wheelie position by pulling the handrims forward to tip the chair back, and pulling the handrims backward to tip the chair toward upright
    • After learning to tip the chair forward and back in a wheelie without assistance, the patient is ready to learn how to maintain the chair at the balance point, i.e. in a wheelie position. The therapist assists the patient to the balance point, spots frequently as the patient learns to maintain his/her balance, allows the chair to fall a short distance when it moves out of balance, and assures the patient that the therapist will not allow him/her to fall back onto the floor

  3. Assume Wheelie Position - After practicing and/or learning to balance the chair in a wheelie position, the patient is ready to learn to assume this position.
    • With innervated upper extremities and a lightweight chair with its axles positioned relatively anteriorly, the wheelie position is easily achieved from a stationary position. The patient grasps the handrims posteriorly (or presses in on the rims) and pulls them forward forcefully and abruptly, throwing the head back forcefully, if needed, to "pop a wheelie"
    • With impaired upper extremities, a heavy wheelchair, and/or with the chair's axles positioned relatively posteriorly, the patient grasps the handrims anteriorly, pulls backward, and then forcefully and abruptly reverses the direction of the pull, throwing the head back forcefully when the handrims are pulled forward, if needed. Safety rigging may be needed for the patient to be able to practice this skill independently.

  4. Wheelie Skills - After the patient learns to balance in and assume a wheelie position:
    • Forward - The therapist shows the patient how to glide forward in a wheelie position. With the therapist spotting, the patient then positions the chair at its balance point, tips the chair forward slightly to make the chair dip, counteracts this forward fall, and pushes forward on the handrims (allowing the handrims to slide through the hands), to propel the chair forward while in its balance point. By repeating the dip and push actions, the patient glides the chair forward in a wheelie position. With practice, the patient learns to glide smoothly, with control, and with less vertical motion of the casters. The patient progresses to varying speeds and to turning and stopping at will. Independent practice can begin when the patient has learned to Fall Safely.
    • Backward - The therapist shows the patient how to glide backward by performing the actions to glide forward in reverse. Starting in a balanced wheelie position, the patient tips the chair back slightly, counteracts the backward tilt, and pulls the handrims back to propel the chair backward.
    • Turn - The therapist shows the patient how to turn while balancing on two wheels. In a wheelie, the patient maintains the position and practices pushing one handrim forward, while pulling the other handrim back, with the therapist spotting. The patient then progresses to turning while propelling forward or backward in a wheelie, for which he/she pushes or pulls one handrim more forcefully than the other. Independent practice can begin after the patient has learned to Fall Safely.
    • Descend Slope - After learning to glide and turn in a wheelie, the patient applies light friction to the handrims, while allowing them to slide through the hands, to control the chair's descent, down gentle slopes at first. When the patient has learned to slow, stop, and turn a manual wheelchair while descending a gentle slope in the wheelie position, he/she can begin practicing on steeper ramps and at greater speeds.

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.