wheelchair skills program manual 5 · 1 wsp 5.0 originally approved for distribution and use:...
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Wheelchair Skills Program Manual 5.0 1
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Editorial Committee 3
R. Lee Kirby, MD, Halifax, Canada (Chair) 4
Paula W. Rushton, PhD, Montreal, Canada (Deputy Chair, Academic) 5
Cher Smith, BScOT, MSc, Halifax, Canada (Deputy Chair, Clinical) 6
François Routhier, PhD, Quebec City, Canada (Deputy Chair, French Canada) 7
8
Members (in alphabetical order) 9
Krista L. Best, PhD, Quebec, QC Canada 10
Rachel Cowan, PhD, Birmingham, AL, USA 11
Ed Giesbrecht, PhD, Winnipeg, MB, Canada 12
Alicia Koontz, PhD, Pittsburgh, PA, USA 13
Diane MacKenzie, PhD, Halifax, NS, Canada 14
Ben Mortenson, PhD, Vancouver, BC, Canada 15
Kim Parker, MASc, PEng, Halifax, NS, Canada 16
Emma Smith, PhD candidate, Vancouver, BC, Canada 17
Sharon Sonenblum, PhD, Atlanta, GA, USA 18
Amira Tawashy, MSc, Halifax, NS, Canada 19
Maria Toro, PhD, Madrid, Spain 20
Lynn Worobey, PhD, Pittsburgh, PA, USA 21
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Suggested citation: Kirby RL, Rushton PW, Smith C, Routhier F, Best KL, Cowan R, 23
Giesbrecht E, Koontz A, MacKenzie D, Mortenson B, Parker K, Smith E, Sonenblum S, 24
Tawashy A, Toro M, Worobey, L. The Wheelchair Skills Program Manual. Published 25
electronically at Dalhousie University, Halifax, Nova Scotia, Canada. 26
www.wheelchairskillsprogram.ca/eng/manual.php 27
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For further information, contact: [email protected] 29
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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TABLE OF CONTENTS 31
32
WARNINGS, DISCLAIMERS AND CONDITIONS OF USE .................................................. 6 33
ACKNOWLEDGEMENTS .......................................................................................................... 7 34
LISTS OF ABBREVIATIONS .................................................................................................... 8 35
PROLOGUE ................................................................................................................................. 9 36
1. INTRODUCTION TO THE WHEELCHAIR SKILLS PROGRAM .................................... 14 37
1.1 Scope .......................................................................................................................... 14 38
1.2 Subjects ...................................................................................................................... 14 39
1.3 Special Considerations for Caregivers ....................................................................... 14 40
1.4 The Circle of Education ............................................................................................. 15 41
1.5 Cost-Effectiveness of the Wheelchair Skills Program ............................................... 15 42
1.6 Languages ................................................................................................................... 15 43
1.7 Warnings to Subject ................................................................................................... 16 44
1.8 Wheelchair Skills Program Personnel ........................................................................ 16 45
1.9 Versions of the Wheelchair Skills Program ............................................................... 17 46
1.10 Individual Skills ....................................................................................................... 17 47
1.11 Skill Groups .............................................................................................................. 19 48
1.12 Wheelchair Skills Program Forms ........................................................................... 21 49
2. INTRODUCTION TO SAFETY ISSUES.............................................................................. 22 50
2.1 General ....................................................................................................................... 22 51
2.2 What is a Spotter? ....................................................................................................... 22 52
2.3 Who Can Function as a Spotter? ................................................................................ 23 53
2.4 Equipment and Supplies for the Spotter ..................................................................... 23 54
2.5 Obtaining the Subject’s Permission to be Spotted ..................................................... 24 55
2.6 Spotter Warnings to Subject ....................................................................................... 24 56
2.7 Ensuring Safety During Wheelchair Skills Program Activities ................................. 24 57
2.8 When the Spotter Should Intervene ............................................................................. 25 58
2.9 Extent of Spotter Intervention .................................................................................... 25 59
2.10 Stopping a Wheelchair Skills Program Session ....................................................... 25 60
2.11 Injury Determinants .................................................................................................. 25 61
2.12 Common Types of Risks and How to Prevent Them ............................................... 26 62
2.13 Dealing with Injuries ................................................................................................ 28 63
2.14 Special Considerations When the Caregiver Is Spotted ........................................... 28 64
2.15 Special Considerations for Powered Wheelchairs and Scooters .............................. 29 65
2.16 Risks Involved In Specific Skills ............................................................................. 29 66
3. INTRODUCTION TO THE ASSESSMENT OF WHEELCHAIR SKILLS ....................... .30 67
4. THE WHEELCHAIR SKILLS TEST (WST) ........................................................................ 31 68
4.1 Initial Interview .......................................................................................................... 31 69
4.2 Wheelchair and Subject Set-Up ................................................................................. 31 70
4.3 Getting Out of the Wheelchair to Accomplish a Task ............................................... 31 71
4.4 Starting Positions ........................................................................................................ 32 72
4.5Setting and Equipment Needed ................................................................................... 32 73
4.6 Indications .................................................................................................................. 36 74
4.7 Contraindications ........................................................................................................ 36 75
4.8 General Instructions to Test Subject .......................................................................... 37 76
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4.9 Feedback ..................................................................................................................... 37 77
4.10 Disclaimer re Sensitivity and Specificity ................................................................. 38 78
4.11 Use of Aids ............................................................................................................... 38 79
4.12 Scoring of Individual Skills on Capacity ................................................................. 38 80
4.13 Number of Attempts Permitted ................................................................................ 39 81
4.14 Comments ................................................................................................................ 40 82
4.15 Training Goals .......................................................................................................... 40 83
4.16 Timing ...................................................................................................................... 40 84
4.17 Rests and Breaks ...................................................................................................... 41 85
4.18 Order of Tests ........................................................................................................... 41 86
4.19 Left- Versus Right-Sided Components of Skills ...................................................... 43 87
4.20 Minimizing Ways in Which Training Can Invalidate WST Scores ......................... 43 88
4.21 Calculated Scores ..................................................................................................... 44 89
4.22 WST Test Report ...................................................................................................... 45 90
5. INDIVIDUAL SKILLS FOR THE WST ............................................................................... 46 91
5.1 Positions and Operates Controller .............................................................................. 48 92
5.2 Operates Body Positioning Options ........................................................................... 50 93
5.3 Rolls Forward Short Distance ......................................................................................... 52 94
5.4 Rolls Backward Short Distance ...................................................................................... 54 95
5.5 Stops on Command ..................................................................................................... 56 96
5.6 Turns in Place ............................................................................................................. 58 97
5.7 Turns While Moving Forward ..................................................................................... 60 98
5.8 Turns While Moving Backward .................................................................................. 62 99
5.9 Maneuvers Sideways ....................................................................................................... 64 100
5.10 Picks Object from Floor ................................................................................................ 66 101
5.11 Relieves Weight from Buttocks .................................................................................... 69 102
5.12 Performs Level Transfers .............................................................................................. 72 103
5.13 Folds and Unfolds Wheelchair .................................................................................. 75 104
5.14 Gets Through Hinged Door ....................................................................................... 78 105
5.15 Rolls Longer Distance ............................................................................................... 80 106
5.16 Ascends Slight Incline ............................................................................................... 82 107
5.17 Descends Slight Incline ............................................................................................. 84 108
5.18 Ascends Steep Incline ................................................................................................... 87 109
5.19 Descends Steep Incline ................................................................................................. 89 110
5.20 Rolls Across Side-Slope ............................................................................................ 91 111
5.21 Rolls on Soft Surface................................................................................................. 93 112
5.22 Gets Over Obstacle ................................................................................................... 95 113
5.23 Gets Over Gap ........................................................................................................... 97 114
5.24 Ascends Low Curb .................................................................................................... 99 115
5.25 Descends Low Curb .................................................................................................... 101 116
5.26 Ascends High Curb ..................................................................................................... 103 117
5.27 Descends High Curb ................................................................................................... 105 118
5.28 Performs Wheelchair-Ground Transfers .................................................................. 107 119
5.29 Performs Stationary Wheelie ...................................................................................... 109 120
5.30 Turns in Place in Wheelie Position ............................................................................. 111 121
5.31 Rolls forward and backward in wheelie position ..................................................... 113 122
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5.32 Descends High Curb in Wheelie Position .................................................................. 115 123
5.33 Descends Steep Incline in Wheelie Position .............................................................. 117 124
5.34 Ascends Stairs ............................................................................................................ 119 125
5.35 Descends Stairs ........................................................................................................... 121 126
6. THE WHEELCHAIR SKILLS TEST QUESTIONNAIRE (WST-Q) ................................. 123 127
6.1 Indications ................................................................................................................ 124 128
6.2 Contraindications ...................................................................................................... 124 129
6.3 Time Limits .............................................................................................................. 124 130
6.4 General Scoring Template for WST-Q Individual Skill Questions ......................... 124 131
6.5 Scoring Algorithm for Individual Skill Questions ................................................... 126 132
6.6 Calculated Scores ..................................................................................................... 126 133
6.7 Options for how the WST-Q may be Administered ................................................. 128 134
6.8 WST-Q Report Form ................................................................................................ 128 135
7. WHEELCHAIR SKILLS TRAINING ................................................................................. 129 136
7.1 General Background on Motor Skills Learning ...................................................... 129 137
7.2 What Is a “Motor Skill”? .......................................................................................... 129 138
7.3 The Learning Process .............................................................................................. 129 139
7.4 Assessment of Wheelchair Skills ............................................................................ 130 140
7.5 Goal Setting .............................................................................................................. 130 141
7.6 Individualize the Training Process ........................................................................... 131 142
7.7 Structure of Training ................................................................................................ 132 143
7.8 Training in Pairs or Groups ...................................................................................... 133 144
7.9 Motivation ................................................................................................................ 133 145
7.10 Demonstration ........................................................................................................ 134 146
7.11 Verbal Instructions ................................................................................................. 134 147
7.12 Focus of Attention .................................................................................................. 135 148
7.13 Imagery ................................................................................................................... 135 149
7.14 Feedback ................................................................................................................. 136 150
7.15 Specificity of Practice ............................................................................................ 138 151
7.16 Amount of Practice ................................................................................................. 138 152
7.17 Facilitate Retention ................................................................................................. 139 153
7.18 Variability of Practice ............................................................................................ 140 154
7.19 Distribution of Practice .......................................................................................... 141 155
7.20 Whole versus Part Practice ..................................................................................... 142 156
7.21 Simplification and Progression .............................................................................. 142 157
7.22 When the Caregiver is the Learner ......................................................................... 143 158
8. TRAINING OF INDIVIDUAL SKILLS OR GROUPS OF SKILLS .................................. 144 159
8.1 Positions and Operates Controller ............................................................................ 146 160
8.2 Operates Body Positioning Options ......................................................................... 150 161
8.3 Rolls Forward ................................................................................................................ 152 162
8.4 Rolls Backward ............................................................................................................. 160 163
8.5 Stops ......................................................................................................................... 163 164
8.6 Turns in Place ........................................................................................................... 166 165
8.7 Turns While Moving ................................................................................................. 170 166
8.8 Maneuvers Sideways ..................................................................................................... 174 167
8.9 Picks Objects from Floor .............................................................................................. 177 168
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8.10 Relieves Weight from Buttocks .................................................................................. 180 169
8.11 Performs Level Transfers ............................................................................................ 183 170
8.12 Folds and Unfolds Wheelchair ................................................................................ 191 171
8.13 Gets Through Hinged Door ..................................................................................... 194 172
8.14 Ascends Inclines ..................................................................................................... 198 173
8.15 Descends Inclines .................................................................................................... 202 174
8.16 Rolls Across Side-Slope .......................................................................................... 205 175
8.17 Rolls on Soft Surface............................................................................................... 208 176
8.18 Gets Over Obstacles or Gaps ................................................................................... 212 177
8.19 Ascends Curbs ........................................................................................................ 218 178
8.20 Descends Curbs ........................................................................................................... 222 179
8.21 Performs Wheelchair-Ground Transfers .................................................................. 225 180
8.22 Ascends Stairs ............................................................................................................ 229 181
8.23 Descends Stairs ........................................................................................................... 234 182
8.24 Performs Wheelie ........................................................................................................ 236 183
8.25 Performs Wheelie-Dependent Skills .......................................................................... 241 184
9. GAMES................................................................................................................................. 246 185
9.1 Line Game ................................................................................................................ 247 186
9.2 Traffic Lights ............................................................................................................ 248 187
9.3 Gears ......................................................................................................................... 249 188
9.4 What Time Is It Mr. Wolf? ....................................................................................... 250 189
9.5 Red Light, Green Light ............................................................................................ 251 190
9.6 Follow the Leader ..................................................................................................... 252 191
9.7 Trains ........................................................................................................................ 253 192
9.8 Slalom ....................................................................................................................... 254 193
9.9 Orienteering .............................................................................................................. 255 194
9.10 Go Fish ................................................................................................................... 256 195
9.11 Circle Game. ........................................................................................................... 257 196
9.12 Relay Race .............................................................................................................. 258 197
9.13 Shrinking Space ...................................................................................................... 259 198
9.14 What’s Your Clearance? ........................................................................................ 260 199
9.15 Case Open and Shut ............................................................................................... 261 200
9.16 Stormy Seas ............................................................................................................ 262 201
9.17 Simon Says ............................................................................................................. 263 202
9.18 Reverse Limbo ....................................................................................................... 264 203
9.19 Garbage-Can Basketball ......................................................................................... 265 204
9.20 Beach Ball Chaos ................................................................................................... 266 205
9.21 Horse ...................................................................................................................... 267 206
APPENDIX 1. OPTIONAL WST SKILL ORDER ................................................................. 268 207
APPENDIX 2. LESSON PLANS ............................................................................................. 269 208
APPENDIX 3. SAMPLE OUTLINE FOR A SERIES OF GROUP TRAINING SESSIONS 272 209
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WARNINGS, DISCLAIMERS AND CONDITIONS OF USE 211
212
Some of the wheelchair skills addressed in this Wheelchair Skills Program (WSP) Manual can be 213
dangerous and result in severe injury or death if attempted without the assistance of trained 214
personnel. Attempting these skills may not be appropriate for some wheelchair users or 215
caregivers. If the skills are attempted, for assessment or training purposes, one or more 216
experienced spotters should be available to intervene. The ultimate responsibility for safety 217
during the performance of wheelchair skills lies with the person performing the skills. Even if a 218
spotter acts properly, injuries can occur. Safely performing a skill in the supervised WSP context 219
provides no guarantee that the same or similar skills will be performed safely on other occasions. 220
221
The information in this WSP Manual is provided for educational purposes only. The information 222
is not intended to be and does not constitute health-care advice. Any decision concerning the 223
health, treatment and/or wheelchair of a wheelchair user or caregiver should be made in 224
consultation with a qualified health-care professional. The members of the team that developed 225
the WSP, the members of the WSP Manual Editorial Committee, Dalhousie University and the 226
Nova Scotia Health Authority are not responsible for any injuries or deaths arising from the use 227
of the WSP materials. Users of these materials assume full responsibility for their actions. 228
229
Anyone wishing to use the WSP materials may do so without permission or charge, as long as 230
they accept and comply with the Conditions of Use posted on the Wheelchair Skills Program 231
website. 232
233
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ACKNOWLEDGEMENTS 234
235
This WSP Manual and related materials have resulted from the work of many people. Those who 236
have had the greatest recent involvement constitute the members of the WSP Manual Editorial 237
Committee listed in the title page. We thank the models for the photographs and videos that 238
illustrate the WSP Manual. 239
240
The list of colleagues who have contributed and research funding agencies that have supported 241
this work since it began is extensive and continues to grow. Their names are noted in the specific 242
peer-reviewed papers that can be found on the WSP website. 243
244
This work would not have been possible without the many excellent papers, textbooks and training 245
manuals that have been published by others. Some of this literature has been acknowledged in the 246
reference sections of the published papers. 247
248
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LIST OF ABBREVIATIONS 249
250
NP Not possible 251
SCI Spinal cord injury 252
TE Testing error 253
UN United Nations 254
WHO World Health Organization 255
WSP Wheelchair Skills Program 256
WST Wheelchair Skills Test 257
WST-Q Questionnaire version of the WST 258
WSTP Wheelchair Skills Training Program 259
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PROLOGUE 261
262
In the 2008 World Health Organization (WHO) Guidelines on the Provision of Wheelchairs in 263
Less-Resourced Settings, it was estimated that there were 65 million people globally who would 264
benefit from wheelchairs but that a great many of these people did not have access to appropriate 265
wheelchairs. The prevalence of wheelchair use is rising, in part due to the aging of the 266
population. Of the wheelchairs in use in highly developed parts of the world, about 70% are 267
manual wheelchairs, with the remainder divided about equally between powered wheelchairs and 268
scooters. In less-resourced settings, almost all wheelchairs are manually propelled (either by 269
using hand-rims or an arm crank). 270
271
The wheelchair is arguably the most important therapeutic tool in rehabilitation. Research studies 272
have documented such benefits as improved mobility, improved participation, reduced caregiver 273
burden and reduced likelihood of placement in long-term-care facilities. Yet, despite the 274
importance of wheelchairs, they are far from perfect. Many wheelchairs are inappropriate for their 275
users, fit them poorly or are poorly set up. Repairs are needed often and many wheelchair users 276
suffer from acute or chronic injuries due to wheelchair use. Improvements in safety often come 277
at the expense of performance and vice versa. For instance, a highly stable manual wheelchair 278
may be less likely to tip over, but will create problems when the wheelchair user attempts to 279
unload the front wheels (casters) to overcome obstacles. Inaccessibility and societal barriers 280
restrict the usefulness of wheelchairs for many users. 281
282
The manner in which people receive wheelchairs varies widely. At the “commodity” end of the 283
spectrum, a wheelchair can be purchased without any clinical input, “over the counter” at the 284
corner drugstore or health-care dealership. Similarly, well-meaning organizations or individuals 285
may donate wheelchairs, sometimes in mass-distribution events involving 250 or more wheelchairs 286
over a few days, without adequate (or any) supporting services. 287
288
Optimally, as described by the 2008 WHO Guidelines, there is a care pathway that includes 289
assessment by professionals, the development of a wheelchair prescription with the involvement of 290
the wheelchair user and family, assistance (if needed) with the organization of funding for the 291
wheelchair, proper fitting and adjustment of the wheelchair, training of the wheelchair user and 292
caregiver in maintenance and wheelchair handling skills, and long-term follow-up for refinements, 293
routine servicing and periodic replacement. 294
295
Two important elements in this care pathway are wheelchair skills assessment and training for 296
wheelchair users and their caregivers. The WSP is a set of assessment and training protocols 297
related to wheelchair skills. Wheelchair skills assessment and training are topics that have 298
received relatively little attention until the past two decades. The accumulating body of research 299
evidence has spurred current interest in this topic. 300
301
Skill in wheelchair use is not an end in itself, it is a means to an end. In terms of the WHO’s 302
2001International Classification of Functioning, Disability and Health (ICF), wheelchair skills 303
are “activities”. The ability to perform these skills represents “capacity” and their use in 304
everyday life represents “performance”. The purpose of these activities is to overcome barriers in 305
the environment and to thereby permit the wheelchair user to fulfill his/her desired role in society 306
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(“participation”). Other target benefits of wheelchair-skills training for wheelchair users and 307
caregivers include fewer acute and overuse injuries, an improved sense of wellbeing (through 308
self-esteem, confidence and personal control, and the sense of becoming newly enabled, 309
empowered and having accomplished something of worth), improved development (of children) 310
and having fun. 311
312
In addition to or instead of learning wheelchair skills, there may be alternative ways to 313
accomplish the learner’s goals (e.g. by changing wheelchairs, by accepting the assistance of a 314
caregiver or by eliminating accessibility barriers). Alternatively, if the goal of performing a 315
wheelchair skill proves to be unrealistic, the most appropriate strategy may be to assist the 316
learner in adjusting his/her expectations to a more realistic level. 317
318
Although there are many similarities in how to best perform a skill, regardless of the 319
characteristics of the wheelchair user and the impairments that have led to wheelchair use, there 320
are also differences. What is safe and effective for a young fit woman with incomplete paraplegia 321
may be different for a middle-aged and overweight man with complete tetraplegia, and even 322
more different for the elderly foot-propelling person with a stroke. 323
324
The characteristics of the wheelchair – its features, fit and setup – can have major effects on skill 325
performance. In helping improve the safety, effectiveness and efficiency of wheelchair use, 326
service-delivery providers should try to optimize the wheelchair user (e.g. by improving fitness 327
or range of motion), to optimize the wheelchair (e.g. by moving the axles of a manual wheelchair 328
forward or adjusting the programming of a powered wheelchair) and/or to provide training. 329
330
Major independent bodies such as the United Nations (UN) 2006 Convention on the Rights of 331
Persons with Disabilities and the 2008 WHO Guidelines, have endorsed the importance of 332
wheelchair skills training. 333
334
The Wheelchair Research Team at Dalhousie University and the Nova Scotia Rehabilitation 335
Centre (now part of the Nova Scotia Health Authority) in Halifax, Nova Scotia, Canada began in 336
the early 1980’s with a research project to determine why rehabilitation professionals were 337
observing that lightweight wheelchairs were tipping over as often as they were. This was 338
followed by a series of research studies that developed testing methods and answered questions 339
about the nature of static and dynamic stability of occupied wheelchairs. 340
341
The work on dynamic stability led to the development of the Wheelchair Skills Test (WST) in 342
1996 as a means of assessing the ability of wheelchair users to safely perform the skills they 343
need in their everyday lives. Subsequently, a questionnaire version (the WST-Q) has been added. 344
There has been a growing number of peer-reviewed papers about the measurement properties of 345
the WST/WST-Q or that have used the WST/WST-Q as outcome measures. 346
347
Having developed a useful measurement tool, it became apparent that many wheelchair users 348
could not perform all of the skills that seemed feasible and that might be helpful to them. This 349
led to the development of the Wheelchair Skills Training Program (WSTP), using the best 350
available evidence on motor skills learning principles and the best available evidence on 351
wheelchair skill techniques. Since then, there has been a growing number of peer-reviewed 352
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papers, including two systematic reviews and meta-analyses (by Tu et al. and Keeler et al.), that 353
have documented the safety and effectiveness of such training. 354
355
As noted, the WSP is a set of protocols for the assessment and training of wheelchair skills – the 356
WST/WST-Q and WSTP respectively. The WSP has expanded its scope from manual 357
wheelchairs to include powered wheelchairs and scooters (by which we mean “motorized 358
mobility scooters”), and to include caregivers in addition to wheelchair users. The WSP website, 359
materials on which are provided free of charge, had 144,955 visits from 93,373 users in 182 360
countries as of April 1, 2018. Members of the Wheelchair Research Team have provided 361
practical training on the WSP to therapists in a number of countries around the world, in both 362
highly developed and less-resourced settings. The WSP is now recognized by a variety of 363
national and international organizations. 364
365
The WSP has evolved over time, in response to research, feedback and experience with it. 366
Various iterations of the WSP – #1.0, 2.4, 3.2, 4.1, 4.2, 4.3 and 5.0 to date – have been released 367
for general use. WSP 5.0 (the basis for this WSP Manual) was originally released for use on 368
August 17, 2018. Even within the lifespan of an iteration, the WSP materials are periodically 369
updated. As such, the materials are “living” rather than fixed. If the iteration number has not 370
changed (e.g. from 4.2 to 4.3) despite an update, it is because the changes have been deemed by 371
the WSP Manual Editorial Committee to be predominantly of a minor nature. However, for 372
academic purposes, users of the WSP materials should cite the date of the iteration that they use. 373
This can be found in the footer of each page. 374
375
We had a number of goals in updating from Version 4.3 to Version 5.0, specifically: 376
1. To refine the content based on new evidence, experience and suggestions from WSP 377
users. 378
2. To broaden the scope by enhancing the caregiver elements. 379
3. To reduce the number of versions. 380
4. To simplify the administration of the WST and WST-Q. 381
5. To reduce WST and WST-Q ceiling and floor effects. 382
6. To increase WST and WST-Q sensitivity to change. 383
384
In an attempt to meet these goals, we have modified WSP Version 5.0 in the following notable 385
ways: 386
1. The skill set has evolved. We have deleted some skills (e.g. “operates battery charger”), 387
we have added skills (e.g. “rolls forward and backward in wheelie position”) and we have 388
broadened the scope of others (e.g. “performs wheelchair-ground transfers”). 389
2. The skill sets for wheelchair users and caregivers are now identical. 390
3. When a caregiver is being assessed, the scores recorded are those that include whatever 391
assistance from the wheelchair user is available. As such, there is no longer a “caregiver” 392
score, but rather a “caregiver-assisted” score whenever the “subject” of testing includes 393
the wheelchair user and caregiver acting together. 394
4. The skill sets for powered wheelchairs and scooters are now identical, with both types of 395
mobility devices being considered under the heading of “powered wheelchair version”. 396
5. The scoring for the WST and WST-Q has been modified to increase scoring sensitivity 397
and reduce floor and ceiling effects. 398
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6. The components of the individual-skill sections dealing with the WST/WST-Q and 399
WSTP have been separated. 400
7. We have eliminated skill “levels” (indoor, community and advanced) because they did 401
not apply equally well to the manual and powered wheelchair versions. 402
403
The WSP is different from most other resources on wheelchair skills in a number of ways: 404
1. It is based on the best evidence on how to perform, assess and teach wheelchair skills. 405
2. Where there are gaps in evidence, ongoing evaluation of the WSP has been initiated with 406
as much scientific rigor as possible. 407
3. The process and sequence of the training is important. 408
4. The materials are frequently updated. 409
5. The WSP deals with both assessment and training. 410
6. The WSP deals with the skills of the wheelchair user alone or in combination with a 411
caregiver. 412
7. The WSP deals with the full spectrum of wheelchair users (e.g. hand propellers such as 413
those using wheelchairs due to SCI as well as foot propellers such as those using 414
wheelchairs due to stroke or dementia). 415
8. The WSP is relevant for manual wheelchairs, powered wheelchairs and scooters. 416
9. All of the materials on the WSP website are available free of charge (“open source”). 417
418
In this WSP Manual, we have attempted to provide a wide spectrum of readers with 419
comprehensive but easily understandable materials. The target audience includes practicing and 420
student rehabilitation therapists (e.g. occupational, physical and recreational), their aids and 421
assistants, rehabilitation nurses and rehabilitation medicine physicians and residents. In addition 422
to clinicians, researchers may find the WSP Manual to be a useful resource. Additionally, 423
because the WSP Manual has been written in plain language, many wheelchair users and 424
caregivers should be able to understand the content. Because the assessment and training of 425
wheelchair skills are low-tech and the training program is high-impact, the WSP is equally 426
relevant for highly developed and less-resourced parts of the world. 427
428
As recommended in the 2008 WHO Guidelines, a new wheelchair user should go through an 8-429
step process in the course of his/her wheelchair service delivery. One of those steps is 430
assessment. As part of this assessment, the wheelchair skills of the wheelchair user should be 431
assessed. This should be done at intake, as part of the prescription and fitting steps (e.g. to 432
compare how well the wheelchair user can perform skills with a rigid vs. a folding wheelchair, or 433
with the rear axles in more and less stable positions) and during follow-up to determine what 434
revisions in the wheelchair are needed. The assessment can be performed using the WST and/or 435
the WST-Q. Another WHO step is training, that includes wheelchair skills training of the 436
wheelchair user and/or caregiver. For this training, the WSTP can be used during the initial 437
provision of the wheelchair and as necessary at follow-up. The WHO’s eight steps of wheelchair 438
service delivery need not be sequential and are often iterative. For instance, following training, it 439
may be possible to revise the wheelchair prescription and set-up. 440
441
This WSP Manual provides chapters dealing with overviews of the WSP, safety issues, the 442
assessment of wheelchair skills, the WST, the WST-Q and the WSTP. Each of the individual 443
skills that make up the WSP skill set is dealt with in detail. At the end of the WSP Manual, there 444
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is a chapter on games that can be played to reinforce learning. Finally, appendices provide some 445
options regarding the organization of training sessions for individuals or groups. 446
447
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CHAPTER 1. INTRODUCTION TO THE WHEELCHAIR SKILLS PROGRAM 448
449
1.1 Scope 450
451
The WSP is intended for manual or powered wheelchairs, operated by wheelchair users with or 452
without the assistance of their caregivers. Whenever appropriate in the WSP Manual, the word 453
“powered wheelchair” should be understood to include motorized mobility scooters (scooters). 454
Throughout the WSP Manual, to simplify descriptions, unless otherwise specified it has been 455
assumed that the wheelchair being used is one with rear-wheel drive (i.e. large diameter wheels in 456
back and smaller diameter swivel or steerable wheels in front). Other types of wheelchairs and 457
scooters can be dealt with using WSP materials, but some of the instructions and explanations may 458
need to be adapted accordingly. Wheelchair technology is diverse and is evolving at a rapid rate. 459
There may be wheelchairs that do not easily fit the categories described. In such situations, the 460
tester or trainer needs to exercise judgement regarding which skills are appropriate. For instance, 461
for power-assisted wheelchairs, a combination of skills from the manual and powered wheelchair 462
skill sets would be appropriate. 463
464
The WSP is not intended to be an adequate approach for other important wheelchair skills (e.g. 465
maintenance and repair skills), more extreme skills (e.g. some wheelchair sport activities) or 466
community-integration activities that combine a number of skills (e.g. use of accessible transport, 467
shopping). The skills chosen for inclusion in the WSP are intended to be representative of the 468
range of skills that wheelchair users and caregivers may need to regularly perform, varying from 469
the most basic to the more difficult. However, it would be impossible to be all-inclusive without 470
making the size of the WSP unmanageable. 471
472
1.2 Subjects 473
474
In the WSP Manual, the term “subject” is often used because the person who is the object of 475
testing or training may be a wheelchair user, a caregiver, a health-care student or a research 476
participant. In addition to testing or training for a wheelchair user alone, the WSP may be used to 477
assess or train the extent to which one or more caregivers and a wheelchair user can function as a 478
team; the “subject” in such situations is the blended combination of the wheelchair user and the 479
caregiver(s). If an animal (e.g. a service dog) is used to assist with a skill, the animal is 480
considered an “aid” rather than a caregiver. 481
482
1.3 Special Considerations for Caregivers 483
484
The term “caregiver” is often used in the literature. We use the term “caregiver” in the WSP 485
Manual to refer to someone other than the wheelchair user who may be involved in carrying out 486
the wheelchair skill. We intend this term to apply broadly to include formal caregivers (e.g. 487
health-care or personal-care workers who are paid for their services), informal caregivers (e.g. 488
family members or friends) and others (e.g. passersby who do not know the wheelchair user but 489
who are willing to provide assistance). The assistance provided by a caregiver may be under the 490
direction of the wheelchair user. Receiving assistance from a caregiver is often the safest and 491
most effective way to carry out an activity. 492
493
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If the usual circumstance for a skill in real life is that a wheelchair user and his/her caregiver 494
ordinarily share the duties, then “blended” wheelchair user/caregiver testing or training may be 495
the most appropriate choice, but the relative contributions of the two people involved should be 496
documented. It is not a reasonable expectation that a single caregiver could complete some skills 497
alone without special equipment or the assistance and cooperation of the wheelchair user. The 498
testing score achieved is a combination of the score of the wheelchair user and caregiver 499
functioning together (i.e. a “blended” score). The caregiver-assisted score is specific not only to 500
the wheelchair and setting (as is the case for the WST in general), but is also specific to the 501
wheelchair user and caregiver being assisted. 502
503
In addition to physical assistance, caregiver assistance may consist of no more than the presence 504
of the caregiver (e.g. for reassurance, moral support, spotting) without necessarily any cues being 505
provided. This is sometimes referred to as “standby assistance”. If a wheelchair user/caregiver 506
pair is the subject of testing, the caregiver must generally meet the same criteria used for the 507
wheelchair user (e.g. keeping the caregiver’s feet as well as the wheelchair wheels inside any 508
designated limits). Special additional caregiver considerations are noted in the later chapters on 509
individual skills. 510
511
1.4 The Circle of Education 512
513
Assessment and training are both elements in the classical circle of education. In this circle, one 514
begins with an assessment (including the WST and/or WST-Q) to identify the learner’s starting 515
point. From this, the educational objectives (goals) are identified. This is followed by the 516
curriculum (the WSTP), aimed at meeting those objectives. This is followed by another 517
assessment to confirm that the objectives have been met. If not, the cycle continues. 518
519
1.5 Cost-Effectiveness of the Wheelchair Skills Program 520
521
Although no formal studies of cost-effectiveness have yet been conducted, there is some basis 522
for believing the WSP is cost-effective. The WST requires an average of about 30 minutes to 523
conduct and the WST-Q about 10 minutes. The training studies to date suggest that significant 524
improvements in capacity can be accomplished with as few as four hours of training (although 525
many more are recommended). No equipment is required, only trained personnel. For personnel, 526
occupational or physical therapists or their assistants have the most appropriate backgrounds. 527
However, there have also been good results when using university students, research assistants or 528
peers as trainers. The potential benefits of training include reduced costs due to fewer injuries, 529
lowered caregiver needs and helping appropriate wheelchair users return to gainful employment. 530
Learning a new skill lasts a lifetime, unlike strength or endurance training that requires ongoing 531
efforts to maintain benefits. For all of these reasons, the WSP can be considered to be a cost-532
effective intervention that would compare favorably with other rehabilitation assessment 533
measures or interventions. 534
535
1.6 Languages 536
537
The WSP was originally developed in the English language. It has since been translated by a 538
team led by Francois Routhier (Deputy Chair of the WSP Manual Editorial Committee) into 539
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French (www.wheelchairskillsprogram.ca/fre). Translation into other languages is encouraged 540
and there have been some initiatives in other countries (to some of which the WSP website 541
provides links – http://www.wheelchairskillsprogram.ca/eng/links.php). Note that there is a well-542
accepted process for such translations (including, for instance, translation from English into the 543
other language, then reverse translation, and cross-cultural validation). 544
545
1.7 Warnings to Subject 546
547
Prior to beginning the initial WSP session, the subject should be warned by the WSP personnel 548
that some wheelchair skills can be dangerous and that the subject should not attempt any task 549
that he/she is not comfortable performing. Also, to avoid overuse injury, the subject should be 550
instructed to avoid overexerting him/herself in the mistaken belief that success on every skill is 551
expected. These warnings may be repeated at any time during a WSP session. If, with the 552
subject’s knowledge and permission, the rear anti-tip devices are adjusted or removed, the WSP 553
personnel should inform the subject that this has been done. 554
555
1.8 Wheelchair Skills Program Personnel 556
557
WSP personnel are important elements in testing and training. During WSP activities, the roles 558
of the tester and trainer are primarily to oversee the assessment and training of participants. The 559
spotter is the person, other than the person performing the skill, who is primarily responsible for 560
ensuring the safety of the subject from the moment the session begins until it is completed. The 561
spotter focuses on the prevention of major acute injury. Wheelchair users, caregivers, testers and 562
trainers also play roles in preventing injury. 563
564
Although it is common for the tester or trainer to simultaneously fulfill the role of the spotter, it 565
is useful to consider the roles separately. Although related, the competencies of spotters are 566
different from those of testers and trainers. If the spotter and tester or trainer roles are being 567
fulfilled by different people, and there is a difference of opinion between the WSP personnel, the 568
tester or trainer shall make the final decision, after carefully considering the opinion of the 569
spotter. For most skills, a single spotter can adequately minimize the likelihood of serious injury. 570
571
However, for some situations (e.g. a heavy or impulsive wheelchair user), one or more additional 572
spotters may be needed. If more than one spotter is used, one spotter should take the lead role. 573
Although testers and trainers need not be able to perform the physical spotter tasks themselves, 574
they should understand the spotter’s role and be able to supervise the spotter. 575
576
WSP personnel may be rehabilitation clinicians who are regularly involved in wheelchair 577
provision, but there are no minimum educational requirements. However, WSP personnel should 578
be thoroughly familiar with all elements of the WSP for which they have responsibility. WSP 579
personnel should feel free to refer to the WSP Manual whenever necessary. 580
581
Those interested in becoming WSP personnel should read this WSP Manual, study the related 582
materials, review practice materials (e.g. videos on the website), observe in-person how 583
experienced WSP personnel function and perform the activities themselves under supervision. 584
Ideally, the WSP should only be used by personnel who have been trained in its administration. 585
However, good results are possible by careful attention to the WSP Manual and other materials 586
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because the materials have been designed to be reasonably self-explanatory and to reflect normal 587
clinical practices. 588
589
Because practice outside formal training sessions can be useful, members of the rehabilitation 590
team (e.g. members of the nursing profession, personal care workers, recreation therapists, 591
volunteers, physicians) other than the primary trainer can be of assistance. Good team 592
communication among team members about a learner’s progress can help to ensure that the input 593
from multiple team members is complementary rather than conflicting. Because the principles of 594
motor skills learning used for wheelchair skills are the same as those used when learning other 595
skills (e.g. music or sport), a background in teaching such other motor skills is an asset for a 596
trainer. Similarly, experience in managing groups (e.g. coaching sports or supervising children) 597
is an asset to any trainer teaching wheelchair skills in a group setting. 598
599
Both experts and non-experts can play important roles in the training process. Wheelchair-using 600
or caregiver peers may possess or be able to acquire the necessary knowledge, skills and attitudes 601
to function as WSP personnel. Peers have a number of advantages over able-bodied personnel – 602
real-life experience with barriers, familiarity with practical solutions to common problems, 603
credibility and superior capacity to empathize with the difficulties being experienced by a 604
wheelchair-using subject. However, the peer may have limited clinical knowledge (e.g. about 605
what triggers a spasm), his/her expertise in performing wheelchair skills is likely to be highly 606
specific (e.g. a peer with SCI may have difficulty advising a person using a wheelchair due to a 607
stroke) and a wheelchair user may have difficulty spotting some skills (particularly moving 608
skills). 609
610
The personal characteristics of WSP personnel (especially trainers) are also important. Personnel 611
should be credible, friendly, supportive, non-judgemental, interested and honest. Personnel 612
should be familiar with the structure and operation of the specific wheelchair used by the subject. 613
614
1.9 Versions of the Wheelchair Skills Program 615
616
There are two versions of the WSP, one for manual wheelchairs and one for powered 617
wheelchairs (including scooters). Although there are a number of skills that apply to both manual 618
and powered wheelchairs, there are some skills that apply only to manual wheelchairs (e.g. 619
performing wheelies [balancing on the rear wheels]) and some that apply only to powered 620
wheelchairs (e.g. operating the controller). 621
622
1.10 Individual Skills 623
624
The individual skills are the units of assessment, some of which have been combined for 625
training. Table 1.1 shows which skills are included in which version of the WST. The order of 626
skills in Table 1.1 reflects the functional groupings of skills (e.g. inclines in different directions 627
and with different slopes are grouped together) and the approximate order of difficulty (although 628
this can vary depending upon the subject and wheelchair). 629
630
These skills can be put together in various combinations and permutations to allow participation 631
(e.g. going shopping, attending an educational event, performing a job). A brief description of 632
each skill and the rationale for including it in the WSP can be found in the later chapters on 633
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individual skills. In naming the individual skills, we have attempted to be as generic and 634
universal as possible. This is in recognition that the environments in which wheelchairs are used 635
vary widely around the world, although they share many common characteristics. 636
637
The WST, the WST-Q and the WSTP for each of the two versions of the WSP all deal with the 638
same set of skills, but the correspondence should not be considered exact. For instance, for the 639
“rolls forward short distance” skill, the WST by necessity deals with exact dimensions (10 m), 640
whereas the WST-Q questions are stated in more general terms because subjects may not be able 641
to easily visualize such exact distances and the WSTP involves variations that enhance learning. 642
643
Table 1.1: List of Individual Skills for WST for both Versions 644
# WST Skill Names Manual Powered
1. Positions and operates controller X 2. Operates body positioning options X 3. Rolls forward short distance 4. Rolls backward short distance 5. Stops on command 6. Turns in place 7. Turns while moving forward 8. Turns while moving backward 9. Maneuvers sideways 10. Picks objects from floor 11. Relieves weight from buttocks 12. Performs level transfers 13. Folds and unfolds wheelchair X
14. Gets through hinged door 15. Rolls longer distance 16. Ascends slight incline 17. Descends slight incline 18. Ascends steep incline 19. Descends steep incline 20. Rolls across side-slope 21. Rolls on soft surface 22. Gets over obstacle 23. Gets over gap 24. Ascends low curb 25. Descends low curb 26. Ascends high curb X
27. Descends high curb X
28. Performs wheelchair-ground transfers 29. Performs stationary wheelie X
30. Turns in place in wheelie position X
31. Rolls forward and backward in wheelie position X
32. Descends high curb in wheelie position X
33. Descends steep incline in wheelie position X
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34. Ascends stairs X
35. Descends stairs X 645
1.11 Skill Groups 646
647
Most of the individual skills can be grouped, as listed in Table 1.2 and as described below, 648
although some of these groupings only apply to manual wheelchairs. 649
650
Table 1.2: Skill Groups 651
# Group
1 How to operate the parts of the wheelchair.
2 Understanding the dimensions of the wheelchair.
3 Getting into, out of and repositioning oneself with respect to the wheelchair.
4 Moving the wheelchair around on smooth level surfaces.
5 Using the environment.
6 Skills that require leaning in the wheelchair.
7 Skills that require popping the casters briefly off the surface.
8 Skills for which balancing on the rear wheels is necessary.
9 Working with a caregiver.
652
1. How to operate the parts of the wheelchair. Wheelchairs vary widely in their components and 653
how they work. It is important that wheelchair users and caregivers learn about the structures 654
and operating idiosyncrasies of the wheelchairs they use. This includes normal daily 655
operations, transportation and storage of the wheelchair, as well as regular maintenance 656
duties. At the time of sale, new wheelchairs are usually delivered with user manuals. 657
Wheelchair users and caregivers can learn about special features of their wheelchairs by 658
studying the user manuals. If the user manual has been lost, instructions can often be found 659
on-line. Maintenance and repair issues are also usually dealt with in the user manual (e.g. 660
how to recognize when maintenance or repair are needed, how often a battery needs to be 661
charged). 662
663
2. Understanding the dimensions of the wheelchair. The dimensions of the occupied wheelchair 664
are important to understand, for instance when judging if a door is wide enough to pass 665
through, if there is enough space in which to turn around or if there is enough clearance 666
beneath the wheelchair to pass over an object on the ground. 667
668
3. Getting into, out of and repositioning oneself with respect to the wheelchair. This includes 669
transferring between the wheelchair and various other surfaces, unloading pressure-sensitive 670
body parts and changing position in the wheelchair. 671
672
4. Moving the wheelchair around on smooth level surfaces. Although the method of propulsion 673
may vary, depending upon the impairments of the wheelchair user (e.g. using two hands, one 674
hand and one foot, or power), basic propulsion includes being able to move the wheelchair 675
forward and backward, being able to turn in place or while moving, and being able to 676
maneuver the wheelchair into position (e.g. to pick something up off the ground, getting 677
close enough to a bed to make a transfer, or negotiating doors). 678
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679
5. Using the environment. Although the environment is often a barrier to activities, there are 680
times when it can be an asset, especially for manual wheelchair users. For example, a 681
wheelchair user may uses the hand rails on a ramp to pull the wheelchair up the slope. 682
683
6. Skills that require leaning in the wheelchair. The wheelchair user’s position in the wheelchair 684
has a dramatic effect on the amount of weight that is on the front versus rear wheels because 685
the wheelchair user’s trunk and upper body constitute a considerable proportion of the 686
combined mass of the wheelchair and wheelchair user. This is especially true for manual 687
wheelchairs. Leaning to alter weight distribution with respect to the wheels will affect the 688
stability of the wheelchair in a predictable way. For instance, when ascending an incline in a 689
manual wheelchair, there is a risk of the wheelchair tipping over backward. To prevent this, 690
the wheelchair user should lean forward enough to keep the front wheels on the surface. 691
692
In addition to stability, the balance of weight between the front and back wheels has an effect 693
on rolling resistance. Wheels with large diameters have lower rolling resistance, whereas 694
small-diameter wheels will tend to dig into soft surfaces. When crossing soft surfaces (e.g. 695
carpet, gravel, grass), the wheelchair user should keep his/her weight on the rear wheels to 696
the extent possible. When crossing side slopes, the tendency for the wheelchair to turn 697
downhill can be reduced by leaning away from the swivel casters. Leaning toward one side 698
can also affect the lateral stability of the wheelchair. Also, if one wheel is spinning due to a 699
lack of traction, this can often be corrected by leaning toward the spinning wheel. 700
701
7. Skills that require popping the casters briefly off the surface. There are some obstacles that 702
require that the casters clear the obstacle. These skills are most appropriate for manual 703
wheelchairs. Examples include negotiating soft surfaces, obstacles (e.g. door thresholds), 704
gaps and level changes (e.g. curbs). 705
706
8. Skills for which balancing on the rear wheels is necessary. For manual wheelchair users, the 707
full wheelie position (balancing on the rear wheels) can be used to deal with situations like 708
those described above that require the front wheels to be unloaded. However, there are some 709
desirable skills that can only be carried out by keeping the front wheels off the surface. These 710
skills include the stationary wheelie (e.g. to improve neck comfort), turning around in a tight 711
space, the forward descent of large level changes (e.g. a high curb) and the forward descent 712
of steep inclines. These skills require the ability to perform a stationary wheelie, to turn 713
around in the wheelie position, and to move forward or backward in the wheelie position. 714
Wheelie skills are impossible in most powered wheelchairs. 715
716
9. Working with a caregiver. Most wheelchair users have at least some skills that they cannot 717
safely perform themselves or that they find stressful. In such situations, the wheelchair user 718
can benefit from the assistance of a caregiver (as defined earlier). This may be in the form of 719
minimal assistance (e.g. someone standing nearby to respond to a tip), the caregiver doing 720
the task completely (e.g. ascending a curb) or the caregiver working in combination with the 721
wheelchair user. 722
723
724
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1.12 Wheelchair Skills Program Forms 725
726
The forms that facilitate the administration, recording and reporting of each of the versions of the 727
WSP can be found at www.wheelchairskillsprogram.ca/eng/manual.php. 728
729
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CHAPTER 2. INTRODUCTION TO SAFETY ISSUES 730
731
2.1 General 732
733
Wheelchair use can be dangerous. Each year, 5-18% of wheelchair users experience injuries 734
related to wheelchair use. Of the injuries that are of at least moderate severity, about two-735
thirds are related to tip-over accidents and/or falling from the wheelchair. Wheelchair users 736
and caregivers are also at risk of chronic injuries, for instance due to poor ergonomic 737
technique. 738
739
Improving a person’s wheelchair skills may not necessarily reduce the likelihood of injury. 740
Providing people with an appropriately set-up wheelchair and helping them to acquire the 741
abilities and confidence that they need to get around in their communities may, 742
counterintuitively, increase the risk of a tip or collision. 743
744
Nevertheless, the goal of wheelchair skills training is for the learner to be able to perform 745
skills safely, effectively and efficiently. Safety includes both the safety of the wheelchair user 746
and the safety of others. If there are two or more ways for a learner to perform a skill and one 747
is considerably safer to perform than the other, the trainer should encourage the learner to use 748
the safer technique. For some learners and some skills that cannot be performed in a 749
consistently safe manner, the most successful outcome of training will be if the learner 750
recognizes that the skill should not be attempted without assistance. A probationary period of 751
supervision may be appropriate before coming to a decision that a person is acceptably safe 752
to use a wheelchair independently. 753
754
Because WSP participants are assessed and trained in wheelchair skills with which they may be 755
unfamiliar, participation in assessment and training activities can be dangerous. This chapter 756
deals with issues affecting safety during these activities. The focus is on the types of risks 757
that can occur and how the spotter can minimize them without unduly interfering with the 758
activity. 759
760
Although the safety of WSP personnel (i.e. spotters, testers and trainers) and bystanders is 761
also a concern, this chapter primarily addresses the safety of the wheelchair user. There are a 762
wide range of safety concerns associated with wheelchair use (e.g. hand scrapes, overuse 763
injuries), but this chapter deals only with the major acute risks that a spotter might reasonably 764
be expected to address (e.g. wheelchair tips and falls from the wheelchair). 765
766
The best way to spot a skill may vary, depending upon the spotter, the wheelchair user, the 767
wheelchair and the setting. The material provided in the WSP Manual, although based on 768
experiences with WSP activities, represents only our consensus opinions. There is no 769
scientific evidence as yet on the best way to spot wheelchair skills. 770
771
2.2 What is a Spotter? 772
773
A spotter is a person who acts to reduce the likelihood of injury to another person who is 774
performing an activity, without unnecessarily interfering with the performance of that 775
activity. 776
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777
2.3 Who can Function as a Spotter? 778
779
The spotter may be a member of the WSP personnel. Spotter skills can also be useful as 780
wheelchair users go about their everyday activities with friends, family members and 781
caregivers. Wheelchair users may need to instruct a bystander or passerby on how to best 782
spot a skill that the wheelchair user finds difficult or hazardous. 783
784
2.4 Equipment and Supplies for the Spotter 785
786
Spotter strap. A spotter strap can be used to assist the spotter in controlling a manual 787
wheelchair during skills during which there is the risk of a rear tip or of the wheelchair running 788
away (e.g. down an incline). The necessary requirements of a spotter strap are a means of 789
attaching one end of the strap to the wheelchair, a loop or handle for the spotter’s hand at the 790
other end and sufficient tensile strength to withstand high loads (equivalent to 200 kg or more). 791
Details about one design for such a strap can be found on our website. Alternatives (e.g. a piece 792
of rope, a dog leash) are equally acceptable if they meet the criteria above. 793
794
For a wheelchair with an X-shaped cross-brace, the spotter strap is attached where the brace 795
members intersect, to avoid any lateral movement of the strap. The low attachment point of the 796
spotter strap helps to resist forward movement of the rear wheels (“submarining”) during a rear 797
tip. For a rigid-frame wheelchair, the spotter strap is placed near the midline of a lower frame 798
member or camber tube, but additional means (e.g. tape) may be needed to keep the strap from 799
sliding to one side. If a knapsack is present or if there are other wheelchair parts (e.g. to 800
provide rigidity to the backrest or to allow the backrest to be folded forward), the path of the 801
spotter strap should be as close to the backrest as possible. 802
803
The length of the spotter strap should be adjusted so that it is long enough to allow the spotter 804
to stand upright with the elbow flexed 30-60° from full extension for most skills but short 805
enough that the spotter can be sufficiently close to the wheelchair to intervene. The spotter 806
should hold the hand loop or handle with the palm up and the loop or handle across the palm at 807
the base of the fingers, not just across the fingers themselves or around the wrist. The spotter 808
strap should be held ready, but without tension in the strap, because tension can affect the 809
performance of some skills. When not in use, the hand loop or handle can be hung out of the 810
way over a push-handle or other wheelchair part. 811
812
Seat belt. For any skills during which there is a risk of the subject pitching or sliding forward 813
out of the wheelchair, a seat belt is recommended. If the subject’s wheelchair is not equipped 814
with one, a temporary one may be provided by the WSP personnel for training. The wheelchair 815
user may decline to use the seat belt, after being instructed about its availability. A seat belt 816
should not be provided by WSP personnel for WST testing purposes if the subject does not 817
ordinarily use one because this may alter the natural state that is being assessed. 818
819
First aid kit. A first aid kit should be available, in the event that an injury occurs. Also, a 820
means of communication should be available in case the WSP personnel require assistance to 821
deal with an injury. 822
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823
2.5 Obtaining the Subject’s Permission to be Spotted 824
825
Wheelchair users with advanced skills perform most of the skills in their daily lives without 826
spotters. Such users may be offended by being spotted unnecessarily. Also, they may be 827
legitimately concerned that inappropriate intervention by a spotter could interfere with the 828
performance of a skill, thereby causing injury rather than preventing it. 829
830
However, during the initial WST assessment, a spotter is mandatory, at least to the extent of 831
the spotter positioning him/herself where he/she could intervene if necessary. During 832
subsequent WSP activities, the tester or trainer may permit the subject to waive the spotter, if 833
the tester or trainer is convinced that the subject or learner will not be placed at undue risk by 834
making this decision. It is the subject’s or learner’s right to refuse to be spotted. Indeed, to 835
spot without the subject’s or learner’s permission could be considered a form of assault. 836
However, if the WSP personnel believe that the subject’s or learner’s decision to waive a 837
spotter is inappropriate, the personnel should not permit the subject or learner to participate 838
in WSP activities. 839
840
2.6 Spotter Warnings to Subject 841
842
The spotter should let the wheelchair occupant know whenever he/she is or is not in place – the 843
phrases “spotter on” and “spotter off” (with a corresponding pat on the shoulder if in a noisy 844
environment) are useful shorthand means of communicating this information, having explained 845
to the subject what the phrases mean on the first occasion that they are used. 846
847
2.7 Ensuring Safety During Wheelchair Skills Program Activities 848
849
A spotter should be present for any formal Wheelchair Skills Program activities. The tester or 850
trainer should not permit the subject or learner to attempt or complete any task that he/she has 851
reason to believe that the subject or learner will be unable to complete without risk. For some 852
skills (specified later in the chapters on individual skills), the tester or trainer should ask the 853
subject or learner about whether he/she feels able to perform the skill. For such skills, if the 854
subject or learner believes that he/she would be able to perform the skill, the tester or trainer 855
should then inquire about the intended method to be used. If an unsafe method is described, the 856
tester or trainer should not permit the attempt of that skill in the way described. Despite these 857
precautions, as a general rule, the tester or trainer should try to avoid preemptively 858
disqualifying the subject or learner and should allow him/her to attempt a skill. 859
860
Injuries can also occur between skill attempts, while the wheelchair user moves from one 861
skill site to another or even at rest (e.g. while the spotter steps away to take a phone call). It is 862
the spotter’s responsibility to pay close attention to the subject or learner both during and 863
between skill attempts. 864
865
866
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2.8 When the Spotter Should Intervene 867
868
The spotter should always intervene to prevent a complete tip of the wheelchair, a complete 869
fall from the wheelchair or a runaway. The spotter should generally not interfere with 870
minimal transient tips (self-limited by definition) that are inadvertent or may even be 871
necessary for the completion of some skills (e.g. getting up a curb). For risks other than tips 872
and falls, it is the WSP personnel’s responsibility to stop any skill attempt as soon as it is 873
clear that it is unsafe or about to become unsafe. The WSP personnel should provide 874
feedback to a subject or learner if he/she uses potentially unsafe methods. 875
876
2.9 Extent of Spotter Intervention 877
878
The spotter should not intervene to any greater extent than is necessary to ensure that a serious 879
injury is prevented. The extent of spotter intervention may consist of a warning to a subject or 880
learner to stop or change the approach being used, minor physical contact from the spotter 881
(even if the subject or learner is able to complete the trial) or full intervention (e.g. if the 882
subject or learner requires the spotter to prevent him/her from potentially injuring 883
him/herself). If there is significant intervention by WSP personnel during a session, the extent 884
of intervention and the reason for it should be recorded. A significant spotter intervention is 885
one that interferes with the skill performance. Full tips should never occur, because the spotter 886
should intervene. A skill performance is obviously unsafe if it results in a significant acute 887
injury (e.g. lacerations, sprains, strains, fractures or head injury) that interferes with test 888
continuation. Note that a spotter may occasionally intervene inappropriately. If this is a 889
minor intervention, that neither hinders nor helps the subject or learner, it can be ignored. 890
891
2.10 Stopping a Wheelchair Skills Program Session 892
893
If a subject or learner persists in potentially unsafe activities, despite the warnings of the 894
WSP personnel, the personnel should stop the session and take whatever steps are necessary 895
to ensure safety (e.g. contacting the nursing or security staff). This decision will usually be 896
made by the tester or trainer. However, the spotter (if someone other than the tester or 897
trainer) has the right to refuse to participate further, if he/she is concerned about the safety of 898
the subject, learner or personnel. 899
900
2.11 Injury Determinants 901
902
The likelihood and nature of injury varies depending on the wheelchair user and/or caregiver, 903
the wheelchair and the nature of the skill being attempted. For instance, a wheelchair user 904
who has poor vision, poor judgement or who is a risk-taker by nature is more likely to be 905
injured than one without these characteristics. Similarly, some wheelchairs are less stable 906
than others. Although this can be an advantage when attempting skills that require the casters 907
to be popped off the surface, the trade-off is that such wheelchairs are at a greater risk of an 908
unintentional rear tip. 909
910
911
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2.12 Common Types of Risks and How to Prevent Them 912
913
There are several types of common incidents that can cause injury. Those that require spotter 914
intervention and a general approach to preventing them will be described in this section. 915
Risks during specific individual skills and an approach to preventing them will be described 916
in the chapters on individual skills. Other less acute or less serious injuries (e.g. pinches, 917
scrapes and jarring) are difficult to prevent, because they occur without sufficient time for 918
intervention. These can best be dealt with by training the subject in how to avoid such risks. 919
920
Rear tips. A rear tip occurs when the pitch of the wheelchair exceeds the rear stability limit to 921
the extent that the wheelchair user cannot rescue him/herself and the wheelchair falls 922
backward. This may occur while the wheelchair is stationary or moving. If the wheelchair 923
user lets go of the rear wheels during a rear tip, the wheelchair will roll quickly forward 924
while tipping backward. The forward movement is called “submarining”. 925
926
For most skills that pose a risk of a rear tip, the spotter should be positioned behind the 927
wheelchair with one hand holding a spotter strap (if a manual wheelchair). The spotter may 928
stand in a lunge position (with the forward foot on the opposite side to the hand holding the 929
spotter strap) and close enough to the backrest so that, if the subject tips backward, the 930
spotter can rest the wheelchair on his/her forward thigh for additional support. 931
932
When using this spotting technique during a skill that requires the spotter to be elevated 933
above the subject or learner (e.g. when descending a curb or incline in the forward direction) 934
the spotter may use a longer spotter strap to reduce any forward bending that could injure the 935
spotter’s back. 936
937
If the spotter catches the subject or learner but cannot return the wheelchair to its upright 938
position, the spotter should inform the subject or learner and then slowly lower the 939
wheelchair backward to the ground. Once the wheelchair is on the ground and the subject or 940
learner is safe and as comfortable as possible, the spotter may need to seek additional help to 941
return the wheelchair to the upright position. 942
943
It is also possible to resist a rear tip from the front, for instance when practicing the stationary 944
wheelie skill. The spotter may be positioned just to the side of the front wheels with a hand 945
near the subject’s or learner’s leg or a part of the wheelchair that will not come off if 946
downward and backward force is applied to it. When a rear tip occurs, the spotter can push 947
down and backward on the leg or wheelchair part to resist the tip and forward movement of 948
the wheelchair. 949
950
For many of the skills, the rear anti-tip devices of a manual wheelchair need to be 951
repositioned or removed. While the rear anti-tip devices are inactivated, the WSP personnel 952
need to be particularly attentive to the risk of a rear tip-over. At the end of the session, the 953
WSP personnel should restore the rear anti-tip devices to their original positions, unless the 954
subject or learner has progressed to the stage where they can be abandoned. 955
956
Forward tips and/or falls. A forward tip occurs when the pitch of the wheelchair exceeds the 957
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forward stability limit to the extent that the wheelchair tips forward. This may occur while 958
the wheelchair is stationary or moving. The tip may be partial, but sufficient to allow the 959
wheelchair occupant to slide or fall forward out of the wheelchair. In some instances, such as 960
during a sudden deceleration, the subject or learner may slide or fall forward out of the 961
wheelchair without any tip. When there is a risk of a forward tip/fall and the wheelchair is 962
stationary, the spotter should be positioned in front of and just to one side of the wheelchair. 963
964
If there is a risk of a forward tip/fall and the wheelchair is moving forward, the spotter may be 965
positioned behind the wheelchair with one hand in front of (but not touching) the wheelchair 966
user’s shoulder to prevent a forward tip/fall. However, this can be distracting to the subject or 967
learner and it can be difficult to react quickly enough from this position. A seatbelt can be 968
provided by the trainer for training, but should not be provided for testing. If a second spotter is 969
available, he/she can be positioned to limit the extent of a forward tip or fall. 970
971
Sideways tips/falls. A sideways tip occurs when the pitch of the wheelchair exceeds the 972
sideways stability limit to the extent that the wheelchair tips sideways. This may occur while 973
the wheelchair is stationary or moving. The spotter should be positioned to the side to which 974
the tip/fall is expected to occur. On level changes or stairs, where a sideways tip may occur if 975
one wheel is on a higher level than the other, the spotter should position his/her hands near 976
the push-handles (if a manual wheelchair). 977
978
Combination tip/fall risks. Tips and falls do not always occur in the pure rear, forward or 979
sideways directions. For instance, when descending an incline with one footrest elevated and 980
the other lowered, a combined forward and sideways tip may occur when the lowered 981
footrest strikes the ground at the bottom of the incline-level transition. 982
983
Another combination possibility is when different risks present themselves sequentially. For 984
instance, during an attempt to get over an obstacle while moving, there is the risk of a rear tip 985
when the wheelchair user attempts to pop the casters high enough to clear the obstacle. If the 986
casters do not clear the obstacle, the sudden deceleration of the wheelchair can cause a 987
forward tip or fall. When such combination risks are present, the spotter should choose a 988
position where all risks can be minimized. This position will vary, depending upon the skill 989
being attempted and the wheelchair set-up. A seat belt or second spotter can be helpful in 990
such situations. 991
992
Runaways. A runaway occurs when the wheelchair user loses control of the wheelchair (e.g. 993
when descending an incline) and is unable to bring it to a stop. To prevent the runaway of a 994
manual wheelchair, the spotter should be positioned behind the wheelchair holding a spotter 995
strap. If the wheelchair user loses control, the spotter should pull back on the spotter strap or 996
grasp a push-handle to bring the wheelchair to a controlled stop. During the resulting 997
deceleration, the spotter should be alert to the possibility that the subject or learner may fall 998
forward out of the wheelchair, and should position the other hand on the front of the 999
shoulder. A seatbelt or second spotter can be helpful in such situations. Powered wheelchairs 1000
or scooters can also runaway if the controls are accidentally activated (e.g. by being caught in 1001
loose clothing). 1002
1003
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Injury due to contact with a wheelchair part. Pinches can occur when a part of the subject’s or 1004
learner’s body becomes caught in a wheelchair part (e.g. when opening a folded wheelchair). 1005
Injury can also occur if a body part is dragged over or rubbed against a sharp wheelchair part 1006
(e.g. the under-surface of a flipped-up footrest). Also, during some activities (e.g. curb ascent) 1007
that require the manual wheelchair user to push forcefully on the hand-rims, the backs of the 1008
thumbs may get abraded by the wheel locks. During incline descent with a manual wheelchair, 1009
the wheelchair user’s hands slowing the wheelchair by friction on the hand-rims can 1010
experience friction burns or lacerations due to sharp burrs on the hand-rims. Gloves can be 1011
used to protect the hands. 1012
1013
Injuries due to contact with the environment. When exposed parts of the wheelchair user’s 1014
body (e.g. hands, feet or head) strike or get pinched by objects in the environment (e.g. doors 1015
or walls), injury may occur. The lower limb can be injured if the wheelchair moves forward 1016
with the foot planted on the ground (e.g. at an incline-level transition, or when negotiating 1017
obstacles or level changes). Examples of injuries are hyper-flexion sprain of the knee or 1018
fracture of the tibia or femur due to the knee being forcibly flexed beyond its available range. 1019
1020
Jarring. Sudden jarring forces can be experienced when the wheelchair decelerates suddenly 1021
(e.g. when rolling into a threshold or dropping off a curb). 1022
1023
Over-exertion injuries. If subjects or learners over-exert themselves when attempting skills 1024
with which they are unfamiliar or are incapable of performing, they may experience overuse 1025
injuries (e.g. affecting the shoulder or back). Similarly, subjects or learners with limited 1026
exercise tolerance due to medical conditions (e.g. of heart or lung) may cause themselves 1027
harm by over-exertion. 1028
1029
Poor ergonomic technique. Subjects or learners are at risk of acute or chronic injuries due to 1030
poor ergonomic technique (e.g. folding the wheelchair with a bent and twisted back). 1031
1032
2.13 Dealing with Injuries 1033
1034
Despite the best precautions, injuries occasionally occur. Once a tip or fall has occurred, 1035
unless this has occurred in a dangerous location (e.g. a city street), there is usually no 1036
urgency in getting the wheelchair user back into the upright wheelchair. The WSP personnel 1037
can take the necessary time to see if the wheelchair user has been injured, to assess for 1038
wheelchair damage and to formulate a plan. The WSP personnel may need to administer first 1039
aid (e.g. cleaning and covering an abrasion). Personnel should have a plan for dealing with 1040
any emergency that is beyond their expertise. 1041
1042
2.14 Special Considerations When a Caregiver is Spotted 1043
1044
If a caregiver is the subject or learner, he/she is expected to behave in a manner that is safe 1045
for both the wheelchair occupant and him/herself. The spotter in such situations should 1046
remain close enough to intervene if the caregiver fails to exercise due caution. A spotter strap 1047
held by the spotter is not practical when spotting a caregiver, because this would interfere 1048
with the caregiver’s performance. 1049
1050
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2.15 Special Considerations for Powered Wheelchairs and Scooters 1051
1052
For powered wheelchairs (including scooters), the spotter’s primary strategy is to be in a 1053
position where the power can be turned off and, if that fails, to take over the controller (e.g. 1054
joystick). For some powered mobility devices, a remote device may be available that allows 1055
the WSP personnel or caregiver to intervene by slowing or stopping the wheelchair when a 1056
potentially dangerous situation arises. The spotter should also be alert to impending tips or 1057
falls. A spotter strap is not a practical solution. A second spotter can be helpful in such 1058
situations. 1059
1060
2.16 Risks Involved in Specific Skills 1061
1062
The nature of the skill being attempted should allow the spotter to anticipate the types of 1063
injuries that might occur. The chapters on individual skills describes the most common types 1064
of risks that should be watched for by the spotter and the usual starting position for the 1065
spotter. 1066
1067
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CHAPTER 3. INTRODUCTION TO THE ASSESSMENT OF WHEELCHAIR 1068
SKILLS 1069
1070
There are a variety of measures that can be used to assess wheelchair skills, a comprehensive 1071
discussion of which is beyond the scope of the WSP Manual. However, it may be helpful to 1072
consider the available measures as ranging along a spectrum of granularity from less to more 1073
detailed measures. 1074
1075
At the less detailed end of the spectrum, there are questionnaire-based measures. One of 1076
these, the Life Space Assessment, provides a score corresponding to being limited to the room 1077
where one sleeps, being in other rooms of the home, being outside the home, being in the 1078
neighbourhood, being outside the neighbourhood and being outside one’s town. 1079
1080
More technology-based measures at the low granularity level are data-loggers (e.g. to 1081
document the distance travelled in a day or the number of times the tilt mechanism is used) 1082
and global positioning system sensors (e.g. to document where the wheelchair travelled 1083
during the day). 1084
1085
At the very detailed level, examples are the use of instrumented rear wheels to document the 1086
forces applied to the hand-rims, the Wheelchair Propulsion Test (to assess such parameters as 1087
cadence, push efficiency), video-recordings, three-dimensional motion analysis to document 1088
the relative movement of body parts, electromyography to document muscular activity during 1089
a task and oxygen consumption studies to document the metabolic energy cost of wheeling. 1090
1091
The WST and WST-Q are measures that focus on the intermediate level of granularity. These 1092
measures test a subject’s ability to perform a representative set of skills and, in the case of the 1093
WST-Q, confidence in performing the skill and how often these skills are performed. 1094
Arguably, this intermediate level of detail is the level of greatest interest to wheelchair users, 1095
their caregivers and their health-care providers. Such details provide the data needed for 1096
intervention through a change in wheelchair type, wheelchair set-up, skills training, 1097
modification of the physical environment or provision of needed assistance. The WST and 1098
WST-Q are not intended to serve as “readiness” tests for independent wheelchair use, 1099
although they may be components of such an assessment. 1100
1101
Which of the above measure(s) should be used to assess wheelchair skills depends upon the 1102
purpose of the assessment, the measurement properties (e.g. reliability and validity) of the 1103
tool, the characteristics of the test subject, the features of the wheelchair, the propulsion 1104
method, the equipment necessary, the skill of the assessor and the time available. However, 1105
for the purpose of this WSP Manual, the emphasis will be on the WST and WST-Q. 1106
1107
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CHAPTER 4. THE WHEELCHAIR SKILLS TEST (WST) 1108
1109
The WST is a standardized evaluation method that permits a set of representative wheelchair 1110
skills to be simply and inexpensively documented. This test is intended to assess a specific 1111
subject using a specific wheelchair in a standardized manner at a specific point in time. 1112
1113
As noted earlier, the measurement properties of the WST have been studied to a moderate 1114
extent, judging by the number of peer-reviewed papers listed in the dynamic link on the 1115
website. In these studies, the WST has been found to be safe, practical, reliable, valid and 1116
useful. The WST has been used as a screening or outcome measure in a number of studies. 1117
Further study is needed to re-evaluate the measurement properties of the WST as it evolves, in 1118
different settings and with different clinical populations. 1119
1120
4.1 Initial Interview 1121
1122
Wheelchair skills assessment and training in the clinical setting usually takes place as part of 1123
a broader process. Prior to beginning testing, the tester should screen the subject for the 1124
ability to communicate and should obtain consent to proceed. If appropriate, demographic, 1125
clinical and wheelchair-related data are recorded. These data may be obtained from the 1126
wheelchair user, the caregiver and/or the health record. Forms for such documentation of 1127
important data other than wheelchair-skills data are beyond the scope of the WSP but are 1128
available on-line from other sources. 1129
1130
4.2 Wheelchair and Subject Set-Up 1131
1132
The wheelchair user and/or caregiver should be dressed and equipped as usual (e.g. wearing 1133
artificial limbs or braces) when using the wheelchair. The wheelchair should be set up as usual 1134
for that user. This is important because changes in the personal equipment or wheelchair set-up 1135
can affect how and how well the skills are performed. 1136
1137
If the wheelchair has user-adjustable features that could affect handling (e.g. rear anti-tip 1138
devices for a manual wheelchair or a more powerful controller mode for a powered 1139
wheelchair), the subject is permitted to adjust them for testing as long as the subject can do so 1140
without assistance. If tools are needed to make the adjustment, then they must be carried by the 1141
subject. The tester must not cue the test subject to make the adjustment. Having adjusted the 1142
wheelchair to accomplish a skill, unless otherwise specified, the subject may leave the 1143
wheelchair in the new configuration for the remainder of the WST. If the subject wishes to 1144
restore the wheelchair to its original configuration, he/she must do so without assistance and 1145
without cueing from the tester. When the WST is over, the tester should remind the subject 1146
about any adjustment that has been made, especially if the adjustment might affect safety. 1147
1148
4.3 Getting Out of the Wheelchair to Accomplish a Task 1149
1150
If it is possible to do so safely, a wheelchair user may get out of the wheelchair to accomplish 1151
a task or to adjust a wheelchair feature (e.g. the rear anti-tip devices). For the WST, this does 1152
not include using any sitting surface other than the ground, unless specifically noted in 1153
Chapter 5 on individual skills, because such a surface might not always be available when 1154
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such an adjustment is needed. The policy of permitting wheelchair users to get out of their 1155
wheelchairs is in recognition that many people who use wheelchairs do so in combination 1156
with walking for their mobility. 1157
1158
4.4 Starting Positions 1159
1160
Unless otherwise noted, the starting positions for each skill are as follows: 1161
Wheelchair user: The wheelchair user is seated in the wheelchair, in whatever position and 1162
state that he/she prefers. 1163
Caregiver: If a caregiver is being assessed, his/her starting position is generally standing 1164
near the wheelchair. 1165
Wheelchair: All of the wheelchair components that are usually used should be in place. The 1166
wheel locks (commonly referred to as “brakes”) may be applied or not. A rolling start is 1167
permitted (i.e. there is no need to come to a complete stop before beginning the skill 1168
attempt). When a starting position for the wheelchair is defined (e.g. relative to an obstacle), 1169
the tester may assist the subject or learner in getting into this position. The tester should be 1170
careful not to provide inadvertent cues to the subject on how to perform the skill. For 1171
instance, with a powered wheelchair that has both caregiver and user-operated controls, the 1172
tester should use the caregiver controls because they are usually out of the wheelchair user’s 1173
line of sight. If the subject expresses the wish to attempt a task by moving the wheelchair 1174
backward, the tester may assist him/her in getting into the requested starting position, but 1175
the tester must not suggest such an alternative approach. Also, when the testing 1176
instructions call for the axles of the leading wheels to be behind a starting line, the leading 1177
wheels are ones that are normally in contact with the ground (i.e. not the wheels of anti-tip 1178
devices that are usually off the ground). 1179
Tester: The starting position for the tester is initially where he/she can be well seen and 1180
heard when providing instructions for the skill. After initially communicating instructions 1181
to the subject, the tester may need to reposition him/herself where he/she will be best able 1182
to observe the skill. 1183
Spotter: The starting position for the spotter is near the wheelchair (within an arm’s reach) 1184
where he/she will be best able to respond to any safety concerns. The exact position varies 1185
with the skill being attempted, the number of spotters involved and the method being used 1186
to complete the skill. For powered wheelchairs, the spotter should be in a position where 1187
the power can be turned off or the joystick accessed. If a caregiver is being assessed, 1188
he/she is expected to behave in a manner that is safe for both the wheelchair occupant and 1189
the caregiver. The spotter in such situations should remain close enough to intervene if the 1190
caregiver fails to exercise due caution. 1191
1192
If the starting positions are different for a specific skill, this is specified in Chapter 5 on 1193
individual skills. 1194
1195
4.5 Setting and Equipment Needed 1196
1197
The test setting for the WST should be reasonably quiet, private, free from distractions and 1198
well lit. A standardized obstacle course may be used, but is not necessary. The equipment 1199
needed is described in more detail later in Chapter 5 but is summarized here in Table 4.1. 1200
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Table 4.1: Equipment Needed for Individual WST Skills* 1201
# WST Skill Names Equipment
1. Positions and operates
controller
None.
2. Operates body
positioning options
None.
3. Rolls forward short
distance Smooth level surface 10 m long and at least 1.5 m
wide.
Starting and finish lines at 0 and 10 m.
Space at least 1.5 m before the starting line and
beyond the finish line.
A stop target (e.g. a wall or pylon) at least 1.5 m
beyond the finish line and in the line of
progression. The marker should be large enough
to be visible from the starting position.
Means (e.g. a tape measure) of measuring
distance to the nearest cm.
Means of recording time to the nearest second.
4. Rolls backward short
distance Smooth level surface 5 m long and at least 1.5 m
wide.
Space at least 1.5 m before the starting line.
Starting line 5 m from the stop target.
A stop target, at 5 m from the starting line,
should be an object at least 1.5 m wide and at
least as high as the rearmost aspect of the
wheelchair.
Means (e.g. a tape measure) of measuring
distance to the nearest cm.
5. Stops on command As for #3 and 4 with the addition of “stop
command” marks at about the half-way points.
6. Turns in place Smooth level surface.
Two 2.0-m-long lines, 90° from each other that
intersect at the starting point. Each of the 4
resulting lines running away from the starting
point should be marked at 0.75, 1.0 and 1.25 m
from the starting point.
Means (e.g. a protractor or goniometer) of
identifying the extent to which the wheelchair
has turned (to the nearest 20°).
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7. Turns while moving
forward Smooth level pathway that is 6 m long and at least
2.0 m wide.
A means (e.g. tape measure) to measure
distances.
4 pylons or equivalent (each with a base of about
10 cm and at least 10 cm high) the centers of
which are positioned in the middle of the pathway
at any or all of the following intervals separately:
0.0, 2.0, 4.0 and 6.0 m creating two
intervals of 2.0 m each.
0.0, 1.5, 3.0 and 4.5 m creating two
intervals of 1.5 m each.
0.0, 1.0, 2.0 and 3.0 m creating two
intervals of 1.0 m each.
The line connecting the first two pylons represents
the starting line for the first turn.
The line connecting the second and third pylons
represents both the finish line for the first turn and
the starting line for the second turn.
8. Turns while moving
backward
As for #7.
9. Maneuvers sideways Two lateral targets, large enough for the subject
to see, for the subject to approach. The targets
need not be identical. The target on the first side
toward which the wheelchair is to be
maneuvered can be fixed (e.g. a wall). However,
the target for the second side may need to be
movable (e.g. a pylon) because wheelchair
widths vary.
A rear barrier (e.g. a wall) that is at least 1.5 m
wide and at least as high as the rearmost aspect
of the wheelchair.
A means (e.g. tape measure) to measure
distances.
A means (e.g. a protractor or goniometer) to
measure angles.
10. Picks objects from floor Large object about the size of a cell phone.
Medium-size object about the size of a pen.
Small object about the size of a coin.
11. Relieves weight from
buttocks Means of measuring the extent of tilt or recline,
if that is the technique used by the subject.
12. Performs level transfers A transfer surface at least 1.0 m wide, at least 0.5
m deep and 45-47 cm high.
Transfer board.
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13. Folds and unfolds
wheelchair Sitting surface as for #12.
14. Gets through hinged
door Door about 81cm wide, with no resistance to
opening, preferably with a lever handle >10 cm
in length and 75-90 cm above the floor, and
preferably with no threshold.
15. Rolls longer distance A smooth level surface 50 m long and at least 1.5
m wide. Using multiple laps of a shorter distance
is permissible.
16. Ascends slight incline Incline at least 2.5 m long and at least 1.5 m wide
with a slope of 5.
17. Descends slight incline As for #16.
18. Ascends steep incline As for #16, except that the incline has a 10
slope.
19. Descends steep incline As for #18.
20. Rolls across side-slope Incline of 5, at least 2.5 m long (in the line of
progression) and at least 1.5 m wide.
Means of monitoring if any of the downhill
wheels drift or turn downhill by greater than 10
cm from the starting position.
21. Rolls on soft surface Pathway that includes a soft surface at least 2.5
m long and at least 1.5 m wide.
22. Gets over obstacle Smooth level surface 1.5 m wide, with at least 1.5
m before and after the obstacle.
Obstacle 5 cm high, 10 cm across (in the line of
progression) and at least 1.5 m wide, rectangular
in cross-section.
23. Gets over gap Smooth level surface 1.5 m wide, with at least 1.5
m before and after the gap.
The gap should be ~5 cm deep, 15 cm across (in
the line of progression)and the full width of the
path.
24. Ascends low curb Smooth level surface 1.5 m wide, with at least 1.5
m before and after the curb.
The curb should be 5 cm high.
25. Descends low curb As for #24.
26. Ascends high curb As for #24, but the curb should be 15 cm high.
27. Descends high curb As for #26.
28. Performs wheelchair-
ground transfers Smooth level surface.
29. Performs stationary
wheelie As for #6.
Means of measuring distance.
30. Turns in place in wheelie
position As for #6.
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31. Rolls forward and
backward in wheelie
position
A smooth level surface, 1.5 m wide and 2 m
long.
32. Descends high curb in
wheelie position As for #26.
33. Descends steep incline in
wheelie position As for #18.
34. Ascends stairs At least 3 stairs, with the following approximate
dimensions – 18 cm rise, 28 cm run and width of
at least 1.2 m.
Rails on both sides.
Level surface or platform at the bottom and top of
the stairs.
35. Descends stairs As for #34.
* For more detail, see the sections on the individual skills. 1202
1203
Some of the tests (e.g. “positions and operates controller”) require no equipment and can be 1204
performed anywhere. In general, the settings listed in Table 4.1 and described in Chapter 5 on 1205
individual skills should be considered as guidelines to enhance standardization, rather than as 1206
rigid constraints. Comparable challenges in the existing natural or built environment (e.g. in 1207
and around a hospital or the wheelchair user’s home), may be used. Indeed, the WST can be 1208
completed as part of a community outing. However, if the setting is materially different from 1209
the one specified, this should be noted in the Comments section of the WST Form and may 1210
preclude the WST values from being compared to those conducted in more standardized 1211
settings. 1212
1213
4.6 Indications 1214
1215
For clinical purposes, the WST can be used early in the course of a rehabilitation program as a 1216
diagnostic measure, especially to determine which (if any) skills might be addressed during the 1217
rehabilitation process (e.g. by training or equipment change). However, predicting future 1218
performance on the basis of early attempts is of limited use. The trainer should not prejudge 1219
the outcome of training. By repeating the test on completion of the rehabilitation phase (or 1220
later during follow-up), the WST can be used as an outcome measure. The WST may also be 1221
used for program evaluation, to answer research questions and to assist in wheelchair design. 1222
1223
4.7 Contraindications 1224
1225
No skill should be objectively evaluated if the subject is unwilling to attempt it or if, in the 1226
tester’s judgement, the subject or WSP personnel would be placed at undue risk during testing 1227
(e.g. due to the subject’s unstable cardiac disease, uncontrolled seizures or excessive weight). 1228
1229
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4.8 General Instructions to Test Subject 1230
1231
The paragraph below may be paraphrased or read to wheelchair-using subjects when the 1232
WST is being administered. It can be modified slightly if a caregiver is assisting or if the 1233
purpose of the WST is research. 1234
“For about the next 30 minutes, I will be asking you to perform a number of different 1235
skills in your wheelchair. The reason for this is to find out which skills you do well 1236
and which might benefit from some practice or from changes to your wheelchair. We 1237
want to see if you can perform the skill properly and safely. We do not want you to 1238
hurt yourself, but there are some mild risks involved. To reduce the chances of you 1239
hurting yourself, we will be spotting you while you try each skill. Please wait until the 1240
spotter is in position before attempting each skill. The spotter will say “spotter on” to 1241
indicate when he/she is in position to protect you and “spotter off” to indicate if 1242
he/she is no longer in position. Please do not overexert yourself. We do not expect 1243
you to be able to perform every skill. Please do not try any skill that you are not 1244
comfortable performing. If you do not understand what we are asking you to do, feel 1245
free to ask questions. There is no need to hurry; this is not a race. If you would like to 1246
take a rest or to stop at any time, feel free to tell us. Do you have any general 1247
questions now, before we begin?” 1248
1249
Instructions may include gestures for people with language disorders or be in writing for 1250
people with hearing disorders but the tester should not demonstrate the skill. When giving 1251
instructions for each skill, before moving into the best position for observing and spotting the 1252
skill (if the tester is also serving as the spotter), the tester should stand or sit to the front or 1253
side of the subject so the subject can see and hear the tester well. The tester must not instruct 1254
the subject in how to accomplish the task. If the tester asks for the task to be performed on 1255
both the left and right sides (e.g. for the “turns in place” skill) but the subject performs the 1256
skill on only one side, the tester may prompt the subject (e.g. “Now in the other direction”) 1257
without penalty. 1258
1259
4.9 Feedback 1260
1261
After the attempt, non-specific feedback may be given on how the subject did for instance, 1262
“You did well”. If the subject receives less than a full score for a skill, neither feedback on the 1263
reason for the low score nor instruction on how the skill might have been performed better 1264
should be given prior to completion of the entire WST. To do so would not affect the score 1265
for the skill already tested, but there may be other skills later in the WST that could be 1266
influenced by premature instruction. If observers (e.g. students or family members) are 1267
present during the test, they should be asked to remain silent and to refrain from providing 1268
cues or feedback. Once the entire WST has been completed, the tester may review the results 1269
with the subject and explain the reasons for reduced scores unless the WST is being 1270
administered to a research participant and the protocol precludes such feedback. 1271
1272
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4.10 Disclaimer re Sensitivity and Specificity 1273
1274
The WST is a sensitive and specific test. A change in the subject (e.g. by a reduction of 1275
spasticity), the subject’s personal equipment (e.g. removal of a prosthesis), a change in the 1276
wheelchair (e.g. by removal of rear anti-tip devices) and/or a change in the test environment 1277
(e.g. by lowering lighting conditions) may affect the test scores. The objective WST findings 1278
are sensitive to such changes and specific to the situation assessed. 1279
1280
4.11 Use of Aids 1281
1282
Aids (e.g. for reaching) are permitted if the subject carries them with him/her. An animal (e.g. a 1283
service dog) that assists with the performance of a skill is considered an aid, not a caregiver, for 1284
the purpose of the WST. 1285
1286
4.12 Scoring of Individual Skills on Capacity 1287
The tester scores the success in accomplishing each skill, using the general scale shown in 1288
Table 4.2. If there are criteria specific to individual skills, these are noted later, in Chapter 5 1289
on the individual skills in the WST. 1290
1291
Table 4.2: General Scale for WST Skill Capacity Scoring 1292
Advanced pass (Score of 3):
The subject meets all pass evaluation criteria and carries out the skill in a highly
proficient or advanced manner (e.g. using proper technique, in a tighter space, more
rapidly or more efficiently) and on the first attempt. There is no significant room for
improvement. Descriptions of proper technique can be found in the training tips
section for each individual skill in Chapter 8.
Pass (Score of 2):
The subject meets all evaluation criteria independently and safely, but imperfectly
(e.g. with difficulty, with room for improvement or requires more than one
attempt).
Partial pass (Score of 1):
The subject safely meets a majority of the evaluation criteria, but not all.
Fail (Score of 0): A fail score should be awarded if any of the following apply:
The subject does not meet a majority of the evaluation criteria.
The subject demonstrates unsafe performance on any attempt. A skill is considered
unsafe if the subject requires spotter intervention to prevent injury to the subject or
others.
The subject is considered likely to be unsafe on the basis of the subject’s description
of how a task will be attempted.
The subject is unwilling to try.
The subject has failed a prerequisite skill.
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Not Possible (NP):
The wheelchair does not have the parts to allow this skill. For instance, if a manual
wheelchair does not fold, the “folds and unfolds wheelchair” skill cannot be
tested.
Testing Error (TE):*
The tester cannot assess the skill for some reason (e.g. because a necessary item of
equipment is not available).
The skill was not sufficiently well observed to provide a score (e.g. if the skill is
being scored from videotape and the entire skill could not be viewed).
* If a correctable testing error is recognized when it occurs, the test should be repeated without 1293
penalty. If there is a minor testing error that the tester judges as not affecting his/her ability to 1294
score the test, this can be ignored. 1295
1296
4.13 Number of Attempts Permitted 1297
1298
An actual wheelchair user in real life may be safe and effective in performing a skill (e.g. 1299
getting over an obstacle), even though a few attempts may be needed. For the purposes of the 1300
WST, no additional attempt should be permitted if the first attempt was unsafe. However, if 1301
the subject does not achieve a pass score on the first attempt but is successful on an 1302
additional attempt, the subject may be awarded a pass score, but should not be awarded an 1303
advanced-pass score. 1304
1305
Additional attempts should not be considered a routine; ultimately, this is at the tester’s 1306
discretion. If an additional attempt is believed to be appropriate, the tester should provide no 1307
feedback on the reason for the failure, nor any instruction on how to perform the task, between 1308
the two attempts. The task instructions may be repeated. 1309
1310
During the course of any single attempt, a subject may use different approaches (e.g. in a 1311
manual wheelchair first attempting the “rolls on soft surface” skill forward, then backward if 1312
unable to proceed or, in a powered wheelchair, pausing to change controller settings or the 1313
degree of tilt). It is only considered an additional attempt if the subject clearly starts over with a 1314
significant pause between attempts. 1315
1316
There are some circumstances in which an additional attempt may be permitted without 1317
penalty: 1318
If the subject misunderstands the instructions. 1319
If a correctable testing error is recognized when it occurs (e.g. the spotter intervened 1320
prematurely). 1321
If a subject appears to be rushing his/her skill attempts and failing to meet test criteria 1322
because of this, on the first occasion that this occurs, the tester may permit an additional 1323
attempt and explain the importance of listening carefully to the instructions before 1324
beginning the skill attempt. 1325
1326
If a subject is unsuccessful when asked to perform a task (e.g. the “maneuvers sideways” 1327
skill) but does it correctly later, incidental to the assessment of a separate skill (e.g. the 1328
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“performs level transfers” skill), the score must not be revised. The WST requires that the 1329
subject be able to perform the skill on demand. 1330
1331
If a skill has been unsuccessful early in the attempt (e.g. being unable to go through a door in 1332
one direction), it may still be useful to allow the subject to attempt the remainder of the skill 1333
(e.g. going through the door in the other direction) as a means of seeing whether a partial-1334
pass score is warranted or identifying issues that can be dealt with later during training. 1335
1336
4.14 Comments 1337
1338
In addition to the scores for each skill, the comments add valuable qualitative data to the WST. 1339
The tester should record any comments that are appropriate (e.g. the reasons for any scoring 1340
decisions that may be useful to trainers). If there is appropriate spotter intervention during a 1341
skill attempt, the extent of the intervention and the reason for it may be recorded in the 1342
Comments section. 1343
1344
The nature of any potentially dangerous incident should be documented. Note should be made 1345
of any observations that require action (e.g. further training in alternative ways to accomplish a 1346
task or a change in equipment that might help). The WST tester should be alert to potentially 1347
correctable limiting factors in the wheelchair user’s health (e.g. limited range of motion), 1348
wheelchair (e.g. rear axles set too far back) and environment (e.g. if the WST is performed in 1349
the subject’s home, a doorway that is too narrow). Comments by the test subject may also be 1350
recorded. 1351
1352
4.15 Training Goals 1353
1354
If, at the beginning of the WST, it is decided by the tester or subject that one purpose of the 1355
assessment is to identify potential training goals then, before the assessment of individual 1356
skills, the subject should be asked if there are any specific wheelchair skills for which he/she 1357
would be interested in receiving training. Doing this before assessing the individual skills is 1358
intended to reduce the likelihood of “training to the test”. After the assessment of each skill 1359
has been completed (regardless of the scores recorded) and if an assessment of training goals 1360
is one of the purposes of the assessment, the subject may be asked whether that skill is one 1361
for which he/she would like to receive further training. On completion of the assessment of 1362
individual skills, the subject may be asked if there are any other skills on which he/she would 1363
be interested in receiving training. The quantification of goal attainment is dealt with later, in 1364
section 4.21. Goal setting is dealt with in more detail later in section 7.5. 1365
1366
4.16 Timing 1367
1368
The WST only requires the timing of 3 skills – “rolls forward short distance”, “relieves 1369
weight from buttocks” and “performs stationary wheelie”. These need only be timed to the 1370
nearest second. However, the time required to perform other individual skills, a series of 1371
skills or the entire WST can provide an additional level of sensitivity to change (e.g. due to 1372
training or the use of a different wheelchair) that clinicians or researchers may wish to use. 1373
1374
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Generally, there is no formal upper time limit for each skill or for the entire WST. This is to 1375
avoid the necessity of the tester timing every skill and to avoid having the subject feel rushed to 1376
complete the task. Although, in real life, a skill must be performed within a practical time to be 1377
useful, the definition of what such a time limit should be may vary with the circumstances. 1378
Fortunately, when administering the WST, this does not present a dilemma because the subject 1379
usually stops a task when it is taking too long. However, if a subject is persistently taking an 1380
apparently hopeless approach, the tester may gently intervene (“let’s move on to the next 1381
skill”). 1382
1383
4.17 Rests and Breaks 1384
1385
Rests are permitted during the skill attempts, unless precluded by the nature of the skill (e.g. 1386
the “performs stationary wheelie” skill). If the subject is making progress, he/she should be 1387
allowed to continue. Resting and then continuing is not considered a second attempt. For 1388
instance, a subject may get the casters up on the low curb, rest for a moment, then get the rear 1389
wheels up on the curb. It is also permissible for subjects to rest between skills. Indeed, there 1390
is no need for all of the skills to be performed on the same day. The WST is a test of 1391
individual skills, not a test of endurance. However, if the testing is conducted on more than 1392
one day, the tester should document the dates. Also, the wheelchair, its set-up and subject 1393
aids must remain the same on both test occasions if an overall score is to be valid. 1394
1395
4.18 Order of Tests 1396
1397
Tables 4.3 and 4.4 show the individual skills for the manual and powered wheelchair 1398
versions of the WST, in the same order shown earlier in Table 1.1. 1399
1400
Table 4.3: Individual Skills for the Manual Wheelchair Version of the WST 1401
# WST Skill Names
1. Rolls forward short distance
2. Rolls backward short distance
3. Stops on command
4. Turns in place
5. Turns while moving forward
6. Turns while moving backward
7. Maneuvers sideways
8. Picks objects from floor
9. Relieves weight from buttocks
10. Performs level transfers
11. Folds and unfolds wheelchair
12. Gets through hinged door
13. Rolls longer distance
14. Ascends slight incline
15. Descends slight incline
16. Ascends steep incline
17. Descends steep incline
18. Rolls across side-slope
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19. Rolls on soft surface
20. Gets over obstacle
21. Gets over gap
22. Ascends low curb
23. Descends low curb
24. Ascends high curb
25. Descends high curb
26. Performs wheelchair-ground transfers
27. Performs stationary wheelie
28. Turns in place in wheelie position
29. Rolls forward and backward in wheelie position
30. Descends high curb in wheelie position
31. Descends steep incline in wheelie position
32. Ascends stairs
33. Descends stairs
1402
Table 4.4: Individual Skills for the Powered Wheelchair Version of the WST 1403
# WST Skill Names
1. Positions and operates controller
2. Operates body positioning options
3. Rolls forward short distance
4. Rolls backward short distance
5. Stops on command
6. Turns in place
7. Turns while moving forward
8. Turns while moving backward
9. Maneuvers sideways
10. Picks objects from floor
11. Relieves weight from buttocks
12. Performs level transfers
13. Gets through hinged door
14. Rolls longer distance
15. Ascends slight incline
16. Descends slight incline
17. Ascends steep incline
18. Descends steep incline
19. Rolls across side-slope
20. Rolls on soft surface
21. Gets over obstacle
22. Gets over gap
23. Ascends low curb
24. Descends low curb
25. Performs wheelchair-ground transfers
1404
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However, during the administration of the WST, the tests may be performed in any order. For 1405
instance, it is usually practical to test the subject’s ability to fold and unfold the wheelchair 1406
after testing the ability to transfer out of the wheelchair, but before evaluating the transfer back 1407
into the wheelchair. The order of testing may also vary depending on the availability and layout 1408
of equipment and test settings. An example of an efficient optional WST for manual 1409
wheelchairs order of skills can be found in Appendix 1. 1410
1411
For highly skilled test subjects, it may even be practical to use a “top-down” approach, starting 1412
with the more advanced of similar skills. If the subject can achieve an advanced-pass score on a 1413
more difficult version of a skill (e.g. “ascends high curb”), then the same score may also be 1414
awarded for the simpler version of the same skill (“ascends low curb”). However, if the subject 1415
only achieves a lower score (e.g. a pass or partial pass) on the more difficult version of the 1416
skill, the subject should demonstrate his/her capacity on the less challenging skill. The top-1417
down order should be used with caution because a timid subject may become discouraged by 1418
an early failure and different approaches may be used for skills that differ only in their degree 1419
of difficulty. 1420
1421
4.19 Left- versus Right-Sided Components of Skills 1422
1423
In objectively evaluating skill performance, both sides are tested (e.g. turning to left and 1424
right). Although this may be redundant for subjects with symmetrical impairments (e.g. of 1425
strength or range of motion), it may be valuable for subjects with asymmetrical impairments 1426
(e.g. due to hemiplegia or amputation) or for wheelchairs with asymmetrical flaws (e.g. a 1427
bent wheel rim on one side). A left-sided skill can be performed using the right hand without 1428
penalty and vice versa. If a subject stops after performing the skill in one direction, the tester 1429
should prompt the subject (without penalty) to perform the skill in the other direction. Failure 1430
to do so constitutes a testing error by the tester. 1431
1432
4.20 Minimizing Ways in Which Training Can Invalidate WST Scores 1433
1434
There are three avoidable ways in which wheelchair skills training can have undesirable 1435
effects on WST scores: 1436
1437
Inflation of the baseline score: If the same person is serving as both the tester and trainer, 1438
he/she may be tempted to conduct testing and training together. For instance, if the 1439
subject fails the “gets over obstacle” skill, the tester/trainer may be tempted to provide 1440
instruction immediately, before continuing with the testing. However, the tester should 1441
complete as much of the pre-training WST as possible before beginning any training 1442
because the pre-training score of some skills may be artificially inflated by just having 1443
received training on a similar skill. In the obstacle-skill example, training is likely to 1444
improve the subject’s ability to perform the subsequent “gets over gap” skill. To reduce 1445
potential frustration by a subject who wants to proceed immediately with training, the 1446
tester should explain the process and indicate when training on the skills will be 1447
provided. 1448
1449
Failure to ensure skill retention: It is not unusual for a subject learning a new skill to 1450
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experience transient success during a training session (skill “acquisition”), but to be 1451
unable to perform the same skill at the next session (skill “retention”). The ultimate goal 1452
of training is that the subject will be able to perform the skill in a variety of settings at 1453
any time in the future (skill “transfer”). To ensure at least short-term retention, the post-1454
training WST (or WST-Q) should be performed at least three days after the training has 1455
been completed. 1456
1457
The “training to the test” or “specificity of training” phenomenon: If the training and 1458
testing are carried out in the same setting, it is possible that the subject may perform well 1459
in that setting, but not others. The trainer should to be aware of this phenomenon, should 1460
have the subject practice in a variety of settings (e.g. indoors and outdoors) and should 1461
vary the order of skills during practice (at least once they have been acquired and 1462
retained). This increases the likelihood that the subject will be able to transfer or 1463
generalize the skill. 1464
1465
4.21 Calculated Scores 1466
1467
The following scores can be calculated by hand (as described below) or by using software 1468
developed for the purpose. Subtracting the number of NP (not possible) scores from the 1469
denominator avoids penalizing test subjects by the inclusion of skills that would be impossible 1470
to complete. Subtracting the number of TE (testing error) scores has a similar purpose. 1471
However, there may not be more than two TE scores for a calculated score to be valid. 1472
1473
Total WST Capacity Score (%): The formula is shown below. Possible percentage scores 1474
range from 0-100%. 1475
1476
Total WST Capacity Score = sum of individual skill scores/([number of possible skills – 1477
number of NP scores – number of TE scores] x 3) X 100% 1478
1479
Goal Attainment Score (GAS) (%): Goal setting is discussed later, in section 7.5. The 1480
GAS is of use when only a limited number of skills are addressed, such as through 1481
wheelchair modifications or training. (The GAS for the WSP should not be confused with 1482
the Goal Attainment Scale for which the scoring is more complicated.) The numerator is 1483
the number of skills that are met and the denominator is the number of goals set. The 1484
formula below is based on a simple yes/no score for each skill. The GAS at baseline is 1485
0% by definition. Possible percentage scores after intervention range from 0-100%. 1486
1487
Goal Attainment Score = (number of skills met/ number of goals set) x 100% 1488
1489
Special Purpose Scores (optional): Subtotal scores may be calculated for any subset of 1490
individual skills. For instance, a score may be calculated that deals only with skills that 1491
might be appropriate for foot-propellers of manual wheelchairs. Any such modifications 1492
should be documented so that the results can be interpreted. It should be recognized that 1493
the measurement properties (e.g. reliability and validity) of such customized Special 1494
Purpose Scores may not have been documented. 1495
1496
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The calculated scores should not be used to predict the overall safety of using a wheelchair. 1497
Someone with a low total score may be very safe within his/her limits whereas someone with 1498
a high total score may be a risk-taker and more likely to get injured. However, the calculated 1499
scores can be helpful in comparing different time points (e.g. pre- vs. post-training), different 1500
wheelchairs or different populations (e.g. people with SCI vs. people with stroke). 1501
1502
4.22 WST Test Report 1503
1504
There is one WST Form for each of the two versions of the WST. The WST Form may be 1505
completed by hand or be generated by software. The completed WST Form includes 1506
identifying data, the scores for individual skills, the calculated score, comments and the skills 1507
(if any) for which the subject would be interested in receiving training. 1508
1509
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CHAPTER 5. INDIVIDUAL SKILLS FOR THE WST 1510
1511
This chapter is organized by the individual skills assessed in the WST, in the order listed in 1512
Table 1.1. For each skill in this chapter, the following headings are used: 1513
1514
Versions applicable: For which of the WSP versions (i.e. manual and/or powered 1515
wheelchairs) this skill is applicable. The corresponding skill number from Tables 4.3 and 1516
4.4 are shown in parentheses. 1517
1518
Description: A brief general description of the skill. 1519
1520
Rationale: The reason why this skill has been included in the WST skill set. 1521
1522
Prerequisites: If the ability to perform an earlier skill is necessary for this skill to be 1523
assessed. 1524
1525
Spotter considerations: If there are other than the general instructions regarding safety 1526
discussed earlier, these are mentioned here, in particular the starting position for the 1527
spotter and common risks requiring spotter intervention. These considerations are 1528
primarily for manual wheelchairs operated by their users but may be adapted for the 1529
powered-wheelchair version of the WST. 1530
1531
WST equipment: Suggested equipment (other than the wheelchair) and set-up (if any) 1532
for the WST. Equivalent alternatives may be used. Whenever a “line” is mentioned, it 1533
does not need to be an actual continuous line that is visible to the test subject. It may be 1534
some other indicator, such as a wall or a virtual line connecting two or more pylons. Note 1535
that, whenever dimensions are preceded by the words “at least” (e.g. “a path at least 1.5 1536
m wide”), the intention is to ensure that the subject has enough room, not to restrict the 1537
subject to those dimensions. 1538
1539
WST starting positions: If other than the general starting positions described earlier, the 1540
starting positions of the wheelchair user, the wheelchair and the tester are described. 1541
These positions may need to be altered, depending upon the subject’s approach to the 1542
skill. When a spotter strap is mentioned, this only applies to the version of the WST for 1543
manual wheelchairs. 1544
1545
WST instructions to subject: An example is provided of the language that the tester 1546
might use in directing the completion of the skill. Also, any actions by the tester are noted 1547
here. One or more of the following optional screening questions may be used as needed 1548
to determine: 1549
o “Does your wheelchair…?”: Whether the subject’s wheelchair has the necessary 1550
features to allow performance of this skill (if it is not obvious to the tester). 1551
o “Can you…?”: Whether the subject believes him/herself to be capable of 1552
performing the skill –This is equivalent to the capacity question used in the WST-1553
Q for this skill. If the subject answers “no”, there is no need to assess that skill 1554
and a “fail” score is awarded. If the subject answers that he/she can do part of the 1555
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skill, he/she should be given the opportunity to demonstrate the parts that he/she 1556
is capable of performing. 1557
o “How?”: How he/she ordinarily performs the skill. This may be helpful in 1558
preparing to spot the subject or allowing the tester to reach a decision that the 1559
subject’s attempt is likely to be unsafe. 1560
1561
WST Capacity scoring criteria: The evaluation criteria are noted here, including an 1562
indication if there are any beyond the general scoring criteria described earlier. 1563
Descriptions of what constitutes “proper technique” may be found in the appropriate 1564
section of Chapter 8 where training tips are provided. It is also noted here whether failure 1565
on a related easier prerequisite skill may result in an automatic fail without needing to 1566
actually attempt the skill. If a NP (not possible) score is an option because the wheelchair 1567
does not have a necessary feature (e.g. the ability to be folded), it is noted here. If there 1568
are aspects of the skill performance that are worthy of note in the Comments section, 1569
these are noted here. 1570
1571
Special considerations: If the descriptions up to this point for this skill require any 1572
special considerations, these are noted here. These might be related to the type of 1573
wheelchair being used or whether a caregiver’s assistance is being assessed. 1574
1575
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5.1 POSITIONS AND OPERATES CONTROLLER 1576
1577
Versions applicable 1578
Manual wheelchair: X 1579
Powered wheelchair: (skill #1) 1580
1581
Description 1582
The subject moves the controller (e.g. joystick) of a powered wheelchair or scooter away 1583
from its usual operating position and then returns it to its original position. The subject 1584
turns the power of a powered wheelchair or scooter on and off. The subject operates the 1585
controller of a powered wheelchair or scooter to switch between drive modes, speeds and 1586
other functions (excluding those controlling body position that are dealt with in the next 1587
skill), then returns to the original setting. 1588
1589
Rationale 1590
Moving the controller away and back is useful when the controller is in the way for some 1591
activities (e.g. approaching a table, feeding, transferring). 1592
The functions of the powered wheelchair require power. However, when the wheelchair 1593
is not being used for position changes or mobility, the power should be turned off when 1594
sitting in the wheelchair doing other activities. Otherwise, an article of clothing (e.g. the 1595
cuff of a sleeve) can catch on the joystick and unintentionally drive the wheelchair into a 1596
person or object. Turning the power off also better maintains the battery charge. 1597
Most powered wheelchairs and some scooters provide an opportunity for the user to 1598
operate the wheelchair in different modes and speeds. The controller settings that are 1599
most appropriate for driving slowly in tight quarters are different from the settings that 1600
would work best when driving longer distances outdoors or when ascending low curbs. 1601
Some powered wheelchairs use the controller to activate and use other functions (e.g. 1602
communication aids). 1603
1604
Prerequisites 1605
None. 1606
1607
Spotter considerations 1608
Spotter starting position: Beside the wheelchair, on the side of the controller in a position 1609
where it is possible to intervene. 1610
Risks requiring spotter intervention: 1611
When moving the controller away and back, the mechanisms can pinch fingers or 1612
clothing. 1613
Runaway if the subject activates the joystick unintentionally. 1614
1615
Equipment 1616
None. 1617
1618
Starting positions 1619
Wheelchair: Controller in its usual operating position and the power off. 1620
Scooter: Key in the ignition. 1621
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
1622
Instructions to subject 1623
Optional screening questions: “Does your wheelchair…?”, “Can you…?” 1624
“Move the controller out of the way, then return it to its usual position.” 1625
“Turn the power on.” 1626
“Put the wheelchair controller into each of the drive and speed settings that you can, one 1627
at a time.” For wheelchairs that have separate controls for the mode and speed settings, if 1628
the subject demonstrates one but not the other, he/she may be prompted without penalty 1629
(e.g. “Are there any other ways to adjust the speed or power of the wheelchair?”). 1630
“Put your chair back into the original drive mode/speed”. 1631
“If there are any other functions that you activate with your controller, please 1632
demonstrate their use.” 1633
“Turn the power off.” 1634
If the subject choses to demonstrate controls that are more relevant to the next skill 1635
(“operates body positioning options”), this is permitted even though the scoring will be 1636
for the next skill. 1637
1638
Capacity scoring criteria 1639
“Advanced pass”: As for the general scoring criteria. 1640
“Pass”: As for the general scoring criteria. 1641
“Partial pass”: As for the general scoring criteria. 1642
“Fail”: As for the general scoring criteria. 1643
“Not possible”: This score is not an option for this skill. 1644
“Testing error”: As for the general scoring criteria. 1645
Comments recorded: If the subject can perform some components of this skill, but not 1646
others, this should be recorded. 1647
1648
Special considerations for scooters 1649
The controller for a scooter is usually in the midline, on top of the tiller, between the two 1650
handles. For many scooters, the tiller can be unlatched and tilted toward or away from the 1651
user, to ease transferring onto and off of the scooter. 1652
There is no need for a scooter user to remove and replace the key in the ignition. 1653
Most scooters have some form of speed control on the tiller (e.g. in the form of a dial), in 1654
addition to the lever mechanism that provides moment-by-moment speed control. 1655
Some scooters have different modes or programs for different operating conditions. 1656
If the scooter has other operating features (e.g. horn, turn indicators, lights) that are 1657
controlled on the “dashboard” of the tiller, the scooter user should be able to operate them 1658
to receive a “pass” score. 1659
1660
50
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.2 OPERATES BODY POSITIONING OPTIONS 1661
1662
Versions applicable 1663
Manual wheelchair: X 1664
Powered wheelchair: (skill #2) 1665
1666
Description 1667
The subject changes body position (e.g. tilts, reclines, elevates the seat, elevates the leg-1668
rests and/or uses the sit-to-stand feature) using the available options of a wheelchair and 1669
then restores the wheelchair to the original position. 1670
1671
Rationale 1672
Powered wheelchairs and scooters capable of variable body positions or postures are used 1673
for a variety of reasons, including to assist with pressure redistribution, comfort, 1674
breathing, postural control, stability, transfers, obstacle negotiation, bladder management, 1675
tone and venous return from the legs. Not all powered wheelchairs have body-positioning 1676
options. 1677
Although some manual wheelchairs also have options for modifying body position, these 1678
will only be assessed with the skills that require changes in body position (e.g. caregiver-1679
assisted tilt as a means of relieving weight from the buttocks). 1680
1681
Prerequisites 1682
None. 1683
1684
Spotter considerations 1685
Spotter starting position: Beside the wheelchair, in a position where it is possible to 1686
intervene. 1687
Risks requiring spotter intervention: 1688
Runaway. 1689
Tips. 1690
Damage to body parts from the wheelchair mechanism or the external environment. 1691
1692
Equipment 1693
None. 1694
1695
Starting positions 1696
Wheelchair: In whatever position the person is in so as not to demonstrate the skill while 1697
getting into a standard position. 1698
1699
Instructions to subject 1700
Optional screening questions: “Does your wheelchair…?”, “Can you…?” 1701
“Show me how your wheelchair allows you to change body positions.” 1702
“Bring the wheelchair back into the original position.” 1703
If there are other positioning options that have not been demonstrated, the tester may 1704
prompt the subject without penalty (e.g. “Are there any other options that you can show 1705
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
me?”). 1706
1707
Capacity scoring criteria 1708
“Advanced pass”: As for the general scoring criteria. 1709
“Pass”: As for the general scoring criteria. 1710
“Partial pass”: As for the general scoring criteria. 1711
“Fail”: As for the general scoring criteria. 1712
“Not possible”: As for the general scoring criteria. 1713
“Testing error”: As for the general scoring criteria. 1714
Comments recorded: As for general scoring criteria. 1715
1716
Special considerations for powered wheelchairs 1717
Note that some wheelchairs have apparent controls for which the wheelchair is not 1718
actually equipped (e.g. a button labelled “tilt” when the wheelchair does not have a tilt 1719
function). 1720
1721
Special considerations for scooters 1722
Some scooters allow the seat back to be mechanically (i.e. not electronically) reclined, 1723
slid forward, slid backward and/or rotated to the side or back. If such options exist, the 1724
scooter user must be able to operate them to receive a “pass” score. 1725
1726
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.3 ROLLS FORWARD SHORT DISTANCE 1727
1728
Versions applicable 1729
Manual wheelchair: (skill #1) 1730
Powered wheelchair: (skill #3) 1731
1732
Description 1733
The subject moves the wheelchair forward a short distance on a smooth level surface and 1734
stops the wheelchair at a specified location. 1735
1736
Rationale 1737
Forward rolling is a skill used during many wheelchair activities. The short distance is 1738
intended to simulate moving about indoors or the distance involved when crossing a two-1739
lane street. Most bouts of wheelchair use (periods of wheelchair activity with intervening 1740
periods of inactivity) are relatively short but occur many times a day. While the subject is 1741
moving the wheelchair forward, he/she may need to intentionally stop at a pre-1742
determined location (e.g. next to a table). 1743
1744
Prerequisites 1745
None. 1746
1747
Spotter considerations 1748
Spotter starting position: 1749
If a manual wheelchair, the spotter should be behind the wheelchair, holding onto 1750
a spotter strap with one hand. 1751
If a powered wheelchair, the spotter should be beside the wheelchair on the side 1752
of the controller. 1753
Risks requiring spotter intervention: 1754
If a manual wheelchair, rear tip when accelerating (especially during the first 1755
push). 1756
If a powered wheelchair, runaway or collision. 1757
1758
Equipment 1759
Smooth level surface 10 m long and at least 1.5 m wide. 1760
Starting and finish lines at 0 and 10 m. 1761
Space at least 1.5 m before the starting line and beyond the finish line. 1762
A stop target (e.g. a pylon) at least 1.5 m beyond the finish line and in the line of 1763
progression. The stop target should be large enough to be visible from the starting 1764
position. 1765
Means (e.g. a tape measure) of measuring distance to the nearest cm. 1766
Means of recording time to the nearest second. Timing this skill provides a means of 1767
identifying whether the subject would be able to get across a street quickly enough to be 1768
safe (e.g. when traffic flow is controlled by lights). Although there is considerable 1769
variability, most traffic signals provide at least 30 seconds for a full cycle. 1770
1771
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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Starting positions 1772
Wheelchair: Stationary, facing the midpoint of the starting line, with the front-wheel 1773
axles behind it. 1774
1775
Instructions to subject 1776
Optional screening questions: “Can you…?” 1777
“Move the wheelchair forward and stop as close as you can to the target (indicate it).” 1778
Subjects who stop short of the 10 m finish line may be prompted, without penalty, to 1779
continue until the leading axles are over the finish line. 1780
Note: Clinicians or researchers who wish to assess propulsion in more detail than the 1781
WST requires, can use the Wheelchair Propulsion Test, by also recording the 1782
number of propulsion cycles. 1783
1784
Capacity scoring criteria 1785
“Advanced pass”: As for the general scoring criteria. 1786
“Pass”: As for the general scoring criteria. 1787
The wheelchair may gently touch the target. 1788
“Partial pass”: As for the general scoring criteria. 1789
“Fail”: As for the general scoring criteria. 1790
The subject covers < 5 m. 1791
The subject does not stop in a controlled manner. 1792
“Not possible”: This score is not an option for this skill. 1793
“Testing error”: As for the general scoring criteria. 1794
Comments recorded: Distance covered (if < 10 m), time taken (to the nearest second if > 1795
30 seconds) and final distance from the stop target (if > 10 cm). 1796
1797
Special considerations for caregivers 1798
Powered wheelchairs and scooters can be moved short distances without power, by 1799
disengaging the motors. If a caregiver uses this technique, he/she may be awarded a pass 1800
score. 1801
1802
Special considerations for manual wheelchairs 1803
An advanced score should not be awarded unless the subject uses proper propulsion 1804
mechanics (e.g. for two-hand propulsion, using long strokes and hand recovery below the 1805
hand-rims). 1806
If the subject strays too close to a wall, it is acceptable for the subject to avoid injuring 1807
his/her fingers by pushing off the wall to correct direction. 1808
1809
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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5.4 ROLLS BACKWARD SHORT DISTANCE 1810
1811
Versions applicable 1812
Manual wheelchair: (skill #2) 1813
Powered wheelchair: (skill #4) 1814
1815
Description 1816
The subject moves the wheelchair backward a short distance on a smooth level surface 1817
and stops the wheelchair at a specified location. 1818
1819
Rationale 1820
Backward rolling is a skill used during many wheelchair activities. A short distance is 1821
usually all that is necessary, unless overcoming high rolling resistance (e.g. on a soft 1822
surface or ascending an incline using foot propulsion). While the subject is moving the 1823
wheelchair backward, he/she may need to intentionally stop at a pre-determined location 1824
(e.g. next to a wall or toilet). 1825
1826
Prerequisites 1827
None. 1828
1829
Spotter considerations 1830
Spotter starting position: 1831
For a manual wheelchair the spotter may be behind the wheelchair holding onto a 1832
spotter strap (if a manual wheelchair) until close to the stop target at which point 1833
he/she should move to a position beside the wheelchair near a push-handle or 1834
beside the wheelchair near the front in position to push downward on a knee or 1835
wheelchair part. 1836
Risks requiring spotter intervention: 1837
Rear tip when stopping. 1838
Collision with fixed or moving objects. 1839
1840
Equipment 1841
Smooth level surface 5 m long and at least 1.5 m wide. 1842
Space at least 1.5 m before the starting line. 1843
Starting line 5 m from the stop target. 1844
A stop target, at 5 m from the starting line, should be an object at least 1.5 m wide and at 1845
least as high as the rearmost aspect of the wheelchair. To avoid excessive jarring if the 1846
subject fails to stop, the target should be moveable (e.g. a cardboard box) but may be 1847
fixed (e.g. a wall) if it is padded. 1848
Means (e.g. a tape measure) of measuring distance to the nearest cm. 1849
1850
Starting positions 1851
Wheelchair: The back of the wheelchair facing the midpoint of the starting line and the 1852
axles of the rear-most wheels (that touch the ground) behind the starting line. 1853
1854
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Instructions to subject 1855
Optional screening questions: “Can you…?” 1856
“Move the wheelchair backward and stop the wheelchair as close as you can to the target 1857
(indicate it) without touching it.” 1858
1859
Capacity scoring criteria 1860
“Advanced pass”: As for the general scoring criteria. 1861
“Pass”: As for the general scoring criteria. 1862
The subject looks backward over each of the shoulders at least once to monitor that 1863
the path is clear. A mirror attached to the wheelchair may be used. These two 1864
shoulder checks can be performed immediately after one another or be separated in 1865
time. 1866
The wheelchair may gently touch the target. 1867
“Partial pass”: As for the general scoring criteria. 1868
“Fail”: As for the general scoring criteria. 1869
The subject covers < 2.5 m. 1870
The subject does not stop in a controlled manner. 1871
“Not possible”: This score is not an option for this skill. 1872
“Testing error”: As for the general scoring criteria. 1873
Comments recorded: Distance covered (if < 2.5 m) and final distance from the stop 1874
target (if > 10 cm). 1875
1876
Special considerations for caregivers 1877
Powered wheelchairs and scooters can be moved short distances without power, by 1878
disengaging the motors. If a caregiver uses this technique, he/she may be awarded a pass 1879
score. 1880
1881
Special considerations for manual wheelchairs 1882
If there is a transient tip when stopping, an advanced pass should not be awarded. 1883
1884
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.5 STOPS ON COMMAND 1885
1886
Versions applicable 1887
Manual wheelchair: (skill #3) 1888
Powered wheelchair: (skill #5) 1889
1890
Description 1891
While the subject is moving the wheelchair forward or backward on a smooth level 1892
surface, he/she stops the wheelchair on command. 1893
1894
Rationale 1895
While the subject is moving the wheelchair forward or backward, he/she may need to 1896
come to a sudden stop in reaction to an unexpected event (e.g. other wheelchairs or 1897
pedestrians moving into the path) to avoid injury to him/herself or others. 1898
1899
Prerequisites 1900
“Rolls forward short distance” for the stops while moving forward. 1901
“Rolls backward short distance” for the stops while moving backward. 1902
1903
Spotter considerations 1904
Spotter: 1905
As for the appropriate shorter-distance skill (forward or backward). 1906
Risks requiring spotter intervention: 1907
As for the appropriate shorter-distance skill (forward or backward). 1908
Forward or backward tip or fall due to the sudden stop. 1909
1910
Equipment 1911
As for the “rolls forward short distance” skill, as well as a “stop command” mark at about 1912
5 m visible to the tester but not obvious to the test subject to indicate the location where 1913
the tester will ask the subject to stop. 1914
As for the “rolls backward short distance” skill, as well as a “stop command” mark at 1915
about 2.5 m visible to the tester but not obvious to the test subject to indicate the location 1916
where the tester will ask the subject to stop. 1917
1918
Starting positions 1919
As for the “rolls forward short distance” and “rolls backward short distance” skills except 1920
that, when moving forward, the tester should stand in a position that is in the subject’s 1921
view-plane but that does not indicate where the stop command will be given, for instance 1922
a short distance ahead of the stop-command line. The tester need not be in the subject’s 1923
field of view when moving backward because the subject may be looking over either 1924
shoulder while moving backward. 1925
1926
Instructions to subject 1927
Optional screening questions: “Can you…?” 1928
“Move your wheelchair forward toward the target. If I ask you to stop, please do so as 1929
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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quickly and safely as you can.” 1930
When the leading wheels (that touch the ground) reach the stop-command line, the tester 1931
should say “stop” and hold up a hand with the palm facing the subject. 1932
“Move your wheelchair backward toward the target. If I ask you to stop, please do so as 1933
quickly and safely as you can.” 1934
When the leading wheels (that touch the ground) reach the stop-command line, the tester 1935
should say “stop”. 1936
1937
Capacity scoring criteria 1938
“Advanced pass”: As for the general scoring criteria. 1939
“Pass”: As for the general scoring criteria. 1940
The subject stops in a controlled manner in both forward and backward 1941
directions without partial falls or transient tips. 1942
“Partial pass”: As for the general scoring criteria. 1943
The subject stops in a controlled manner in one direction (forward or 1944
backward) without partial falls or transient tips. 1945
The subject stops in a controlled manner in both forward and backward 1946
directions but with a partial fall and/or transient tip. 1947
“Fail”: As for the general scoring criteria. 1948
The subject fails to stop in a controlled manner in at least one direction 1949
(forward or backward). 1950
“Not possible”: This score is not an option for this skill. 1951
“Testing error”: As for the general scoring criteria. 1952
Comments recorded: The stopping distance (how far the leading wheels are from the 1953
stop-command line after the wheelchair has stopped) if > 1.0 m. 1954
1955
Special considerations 1956
None. 1957
1958
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.6 TURNS IN PLACE 1959
1960
Versions applicable 1961
Manual wheelchair: (skill #4) 1962
Powered wheelchair: (skill #6) 1963
1964
Description 1965
The subject turns the wheelchair around to the left and right to face in the opposite 1966
direction, in as tight a space as possible. 1967
1968
Rationale 1969
Turning around in tight spaces is a common challenge for wheelchair users. The type of 1970
wheelchair and its dimensions affect the ease with which this skill can be performed. The 1971
environment may be such that the preferred direction of turn is not possible, so the 1972
subject must be capable of turning in both directions. 1973
1974
Prerequisites 1975
None. 1976
1977
Spotter considerations 1978
Spotter starting position: Near the wheelchair. 1979
Risks requiring spotter intervention: No common risks. 1980
1981
Equipment 1982
Smooth level surface. 1983
Two 2.0-m-long lines, 90° from each other that intersect at the starting point. Each of the 1984
4 resulting lines running away from the starting point should be marked at 0.75, 1.0 and 1985
1.25 m from the starting point. (These anchoring locations can be used to conceptualize 1986
concentric circles with diameters of 1.5, 2.0 and 2.5 m.) 1987
Means (e.g. a protractor or goniometer) of identifying the extent to which the wheelchair 1988
has turned (to the nearest 20°). 1989
1990
Starting positions 1991
Powered and manual wheelchairs should be positioned with the mid-point between the 1992
drive wheels directly over the starting point and the wheelchair in line with one of the 1993
two intersecting lines. 1994
Scooters should be positioned with the mid-point between the rear and front wheels 1995
directly over the starting point and the wheelchair in line with one of the two intersecting 1996
lines. 1997
1998
Instructions to subject 1999
Optional screening questions: “Can you…?” 2000
“Keeping the wheelchair in as tight a space as possible, turn the wheelchair around until 2001
you are facing in the opposite direction.” 2002
If the subject has turned, but has not yet turned fully, he/she may be prompted, without 2003
penalty, to continue. 2004
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
After the initial turn in one direction, if necessary, the wheelchair should be repositioned 2005
before the turn in the other direction. 2006
“Now turn the chair in the other direction.” 2007
2008
Capacity scoring criteria 2009
“Advanced pass”: As for the general scoring criteria. 2010
“Pass”: As for the general scoring criteria. 2011
Angle reached > 160 in both directions. 2012
Turning diameter ≤ 1.5 m. 2013
“Partial pass”: As for the general scoring criteria. 2014
Angle reached ≥ 90 in one or more direction. 2015
“Fail”: As for the general scoring criteria. 2016
Angle reached < 90. 2017
Turning diameter > 2.5 m. 2018
“Not possible”: This score is not an option for this skill. 2019
“Testing error”: As for the general scoring criteria. 2020
Comments recorded: After each turn, the tester notes the angle reached (if ≤ 160), 2021
the turning diameter (if > 1.5 m), displacement in any direction from the starting point 2022
(if > 0.5 m) and, if three-point turns (e.g. forward to one side, followed by backward 2023
turn to other side, repeated as necessary) are used, the number of steps. 2024
2025
Special considerations for caregivers 2026
The caregiver’s feet should be considered equivalent to a wheel touching the ground for 2027
the purpose of identifying the turning diameter. 2028
2029
Special considerations for manual wheelchairs 2030
Performing the skill in the wheelie position is considered an advanced version of the skill. 2031
See also, skill #30. 2032
2033
Special considerations for scooters 2034
Because of the way that scooters turn, three-point turns will usually be necessary. 2035
2036
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.7 TURNS WHILE MOVING FORWARD 2037
2038
Versions applicable 2039
Manual wheelchair: (skill #5) 2040
Powered wheelchair: (skill #7) 2041
2042
Description 2043
The subject turns the wheelchair to the left and right while moving forward through 2044
progressively smaller openings. 2045
2046
Rationale 2047
Moving turns are often necessary to avoid obstacles or to change direction. The amount 2048
of space needed for turning is affected by such factors as the type of wheelchair, the 2049
wheelbase (distance between the ground contact points for the front and back wheels), the 2050
overall length of the wheelchair and the freedom of the steering wheels to turn. 2051
2052
Prerequisites 2053
None. 2054
2055
Spotter considerations 2056
Spotter starting position: Behind the wheelchair, holding onto a spotter strap (if a manual 2057
wheelchair), unless the subject has safely performed the “rolls forward short distance” 2058
and “stops on command” skills, in which case the spotter needs only to be nearby. 2059
Risks requiring spotter intervention: 2060
Rear tip when accelerating, especially during the first push. 2061
2062
Equipment 2063
Smooth level pathway that is 6 m long and at least 2.0 m wide. 2064
A means (e.g. tape measure) to measure distances. 2065
4 pylons or equivalent (each with a base of about 10 cm and at least 10 cm high) the centers 2066
of which are positioned in the middle of the pathway at any or all of the following intervals 2067
separately: 2068
0.0, 2.0, 4.0 and 6.0 m creating two intervals of 2.0 m each. 2069
0.0, 1.5, 3.0 and 4.5 m creating two intervals of 1.5 m each. 2070
0.0, 1.0, 2.0 and 3.0 m creating two intervals of 1.0 m each. 2071
Note: Alternatively, if a pathway 11 m long is available, 8 pylons may be positioned in the 2072
middle of the pathway at 0.0, 2.0, 4.0, 6.0, 7.5, 9.0, 10 and 11.0 m, creating two 2073
intervals each of 2.0, 1.5 and 1.0 m. 2074
The line connecting the first two pylons represents the starting line for the first turn. 2075
The line connecting the second and third pylons represents both the finish line for the first 2076
turn and the starting line for the second turn. 2077
2078
Starting positions 2079
Wheelchair: Facing the midpoint of the starting line for the first turn, with the front-2080
wheel axles behind it. 2081
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
2082
Instructions to subject 2083
Optional screening questions: “Can you…?” 2084
“Move the wheelchair forward around each of the pylons (indicate them) without 2085
touching them.” The tester may walk through the pylons to illustrate the path to be taken. 2086
The intervals may be tested in any order. 2087
Subjects who stop short of the final finish line may be prompted, without penalty, to 2088
continue. 2089
2090
Capacity scoring criteria 2091
“Advanced pass”: As for the general scoring criteria. 2092
The turns through the pylons spaced 1.0 m apart are successfully completed. 2093
If a subject is successful at the 1.0 m intervals, there is no need to assess the 2094
1.5 or 2.0 m intervals. 2095
“Pass”: As for the general scoring criteria. 2096
The turns through the pylons spaced 1.5 m apart are successfully completed. 2097
The pylons may be touched but not significantly displaced. 2098
If a subject is successful at the 1.5 m intervals, there is no need to assess the 2099
2.0 m intervals. 2100
“Partial pass”: As for the general scoring criteria. 2101
The turns through the pylons spaced 2.0 m apart are successfully completed. 2102
“Fail”: As for the general scoring criteria. 2103
Does not complete the turns through the pylons spaced 2.0 m apart. 2104
“Not possible”: This score is not an option for this skill. 2105
“Testing error”: As for the general scoring criteria. 2106
Comments recorded: If three-point turns (e.g. forward to one side, followed by 2107
backward turn to other side, repeated as necessary) are used for any interval, this 2108
should be noted. 2109
2110
Special considerations for caregivers 2111
The feet of the caregiver must remain within the defined space. 2112
2113
Special considerations for manual wheelchairs 2114
Part or all of the skill may be performed in the wheelie position. 2115
2116
Special considerations for scooters 2117
The length of a scooter and the limitations on how far the steering wheel(s) can be turned 2118
may require that a three-point turn be used. There is no scoring penalty for using such a 2119
turn, as long as the other criteria are met. 2120
2121
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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5.8 TURNS WHILE MOVING BACKWARD 2122
2123
Versions applicable 2124
Manual wheelchair: (skill #6) 2125
Powered wheelchair: (skill #8) 2126
2127
Description 2128
The subject turns the wheelchair to the left and right while moving backward. 2129
2130
Rationale 2131
As for the “turns while moving forward” skill although, for most wheelchair users, such 2132
turns are usually required less often in everyday life than moving turns in the forward 2133
direction. 2134
2135
Prerequisites 2136
None. 2137
2138
Spotter considerations 2139
Spotter starting position: Behind the wheelchair, holding onto a spotter strap (if a manual 2140
wheelchair), unless the subject has safely performed the “rolls backward short distance” 2141
and “stops on command” skills, in which case the spotter needs only to be nearby. 2142
Risks requiring spotter intervention: 2143
Rear tip when stopping. 2144
Collision. 2145
2146
Equipment 2147
As for the “turns while moving forward” skill. 2148
2149
Starting positions 2150
Wheelchair: The back of the wheelchair facing the starting line, with the rear-wheel axles 2151
behind it. 2152
2153
Instructions to subject 2154
Optional screening questions: “Can you…?” 2155
“Move the wheelchair backward around each of the pylons (indicate them) without 2156
touching them.” 2157
Subjects who stop short of the final finish line may be prompted, without penalty, to 2158
continue. 2159
2160
Capacity scoring criteria 2161
As for the “turns while moving forward” skill. 2162
2163
Special considerations for caregivers 2164
As for the “turns while moving forward” skill. 2165
2166
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Special considerations for manual wheelchairs 2167
As for the “turns while moving forward” skill. 2168
An advanced-pass score should not be awarded if the wheelchair transiently tips 2169
backward when stopping. 2170
2171
Special considerations for scooters 2172
As for the “turns while moving forward” skill. 2173
2174
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.9 MANEUVERS SIDEWAYS 2175
2176
Versions applicable 2177
Manual wheelchair: (skill #7) 2178
Powered wheelchair: (skill #9) 2179
2180
Description 2181
The subject maneuvers the wheelchair sideways to the left and right. 2182
2183
Rationale 2184
Repositioning the wheelchair sideways in a tight space is commonly necessary to get 2185
closer to or farther away from objects (e.g. a window, bed or table). 2186
2187
Prerequisites 2188
None. 2189
2190
Spotter considerations 2191
Spotter starting position: Near the wheelchair. 2192
Risks requiring spotter intervention: No common risks. 2193
2194
Equipment 2195
Two lateral targets, large enough for the subject to see, for the subject to approach. The 2196
targets need not be identical. The target on the first side toward which the wheelchair is 2197
to be maneuvered can be fixed (e.g. a wall). However, the target for the second side may 2198
need to be movable (e.g. a pylon) because wheelchair widths vary. 2199
A rear barrier (e.g. a wall) that is at least 1.5 m wide and at least as high as the rearmost 2200
aspect of the wheelchair. 2201
A means (e.g. tape measure) to measure distances. 2202
A means (e.g. a protractor or goniometer) to measure angles. 2203
2204
Starting positions 2205
Wheelchair: 2206
The rear-most part of the wheelchair should be positioned as close as possible to 2207
the rear barrier. 2208
The first lateral target should be at least 0.5 m lateral to the widest part of the 2209
wheelchair. For manual wheelchairs, the widest aspect of the wheelchair will 2210
usually be the rear-wheel hand-rim; for powered wheelchairs, this will usually be 2211
the drive wheels themselves. 2212
The second lateral target should be placed on the other side of the wheelchair. It 2213
may be necessary to wait until the subject has moved toward the first target before 2214
placing the second target, so as not to limit the subject’s freedom to maneuver. 2215
2216
Instructions to subject 2217
Optional screening questions: “Can you…?” 2218
“Get this wheel (indicate the one closest to the first target) as close as you can to this 2219
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
target (indicate it), using as little forward-backward space as possible and ending facing 2220
forward as you are now.” 2221
If the wheelchair is close to the desired finish position, but not quite there (too far away 2222
or at too great an angle), it is permissible to prompt the subject, without penalty, (e.g. 2223
“Can you get a little closer?” or “Can you straighten out the wheelchair?”). 2224
Repeat toward the other side. The finish position for the movement to the first side is the 2225
starting position for the movement to the other side. 2226
2227
Capacity scoring criteria 2228
“Advanced pass”: As for the general scoring criteria. 2229
“Pass”: As for the general scoring criteria. 2230
The subject must meet the criteria in both directions. 2231
Lateral distance (between the widest aspect of the wheelchair and the lateral 2232
barrier) ≤ 10 cm. The wheelchair may touch the target. 2233
Angle between wheelchair and the lateral barrier ≤ 20 º. 2234
“Partial pass”: As for the general scoring criteria. 2235
Lateral distance ≤ 25 cm. 2236
Angle ≤ 45 º. 2237
The subject meets the pass criteria in one direction, but not the other. 2238
“Fail”: As for the general scoring criteria. 2239
Lateral distance > 25 cm. 2240
Angle > 45 º. 2241
Forward distance (farthest forward from the rear barrier that the front wheels 2242
have moved during the maneuver) > 2.5 m. 2243
“Not possible”: This score is not an option for this skill. 2244
“Testing error”: As for the general scoring criteria. 2245
Comments recorded: On completion of each sideways maneuver, the tester should 2246
note the lateral distance (if > 10 cm), the angle between wheelchair and the lateral 2247
barrier (if > 20 º), the forward distance (if > 2.5 m) and, if using a series of forward 2248
and backwards turns, the number of steps required. 2249
2250
Special considerations for caregivers 2251
If a caregiver chooses to perform the skill from behind the wheelchair, the caregiver 2252
represents the “rearmost aspect of the wheelchair”. 2253
2254
Special considerations for manual wheelchairs 2255
Most subjects will use to-and-fro motions (as in parallel parking a car), but “bunny 2256
hopping” or rocking (from the wheels on one side to those on the other) is permitted. 2257
2258
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.10 PICKS OBJECTS FROM FLOOR 2259
2260
Versions applicable 2261
Manual wheelchair: (skill #8) 2262
Powered wheelchair: (skill #10) 2263
2264
Description 2265
The subject picks objects up from the floor and passes them to the tester. 2266
2267
Rationale 2268
Objects that need to be picked up from the floor or ground vary from those as small and 2269
light as a coin or a piece of paper to those as bulky and heavy as a young child. 2270
2271
Prerequisites 2272
None. 2273
2274
Spotter considerations 2275
Spotter starting position: Near the wheelchair, on the side toward which the subject leans 2276
(if any). 2277
Risks requiring spotter intervention: 2278
Forward or sideways tip or fall when reaching, leaning or standing up. 2279
Forward fall or tip due to standing on a footrest. 2280
2281
Equipment 2282
Large object about the size of a cell phone (about 6 cm wide, 13 cm long and 1 cm thick). 2283
Medium-size object about the size of a pen (about 6 cm in length and 1 cm in diameter). 2284
Small object about the size of a coin (about 2-3 cm in diameter and 2 mm thick). 2285
The tester places the objects in a line with the large object at one end and the small object 2286
at the other end, each about 0.5 m from the medium-size object in the middle. 2287
2288
Starting positions 2289
Wheelchair: At right angle to the line, facing the medium-size object with the front-wheel 2290
axles about 0.5 m away. 2291
2292
Instructions to subject 2293
Optional screening questions: “Can you…?” If showing the objects to the subject, the 2294
tester should show the largest object first. If the subject answers “no” about the largest 2295
object, there is no need to proceed to the smaller objects. 2296
“Pick the three objects (indicate them) up from the floor and pass them to me, one at a 2297
time. You may move your wheelchair.” 2298
When the subject is ready to pass each object to the tester, the tester should position 2299
his/her hand at about the subject’s waist height and within an arm’s reach of the subject. 2300
2301
Capacity scoring criteria 2302
“Advanced pass”: As for the general scoring criteria. 2303
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
The subject successfully picks up and passes all three objects. 2304
“Pass”: As for the general scoring criteria. 2305
The subject successfully picks up and passes two of the objects. 2306
The subject may use either hand. 2307
The subject may pick up more than one object at a time. 2308
The subject may pass more than one object to the tester at a time. 2309
A reaching aid may be used, if it is carried by the subject. 2310
If the subject chooses to remove or reposition parts of the wheelchair (e.g. the 2311
footrests) to improve the reach, this is permitted as long as the subject can 2312
remove and replace the parts independently. After completing the skill, the 2313
subject may be prompted, without penalty, to restore the wheelchair to its 2314
original state. 2315
A wheelchair with a seat-height-variation feature may be used, as long as the 2316
subject can operate it independently. 2317
The subject may get out of the wheelchair to perform this skill. 2318
If the wheelchair user chooses to stand to accomplish the task, he/she need not 2319
apply the wheel locks and/or clear the footrests away if he/she can perform 2320
the tasks safely. 2321
If the subject drops an object while picking it up or passing it, but then 2322
successfully retrieves it, this is considered a second attempt. 2323
“Partial pass”: As for the general scoring criteria. 2324
The subject successfully picks up and passes one object. 2325
“Fail”: As for the general scoring criteria. 2326
“Not possible”: This score is not an option for this skill. 2327
“Testing error”: As for the general scoring criteria. 2328
Comments recorded: As for general scoring criteria. 2329
2330
Special considerations for caregivers 2331
When bending or stooping to pick up an object, the caregiver may place the non-reaching 2332
hand on the wheelchair for balance. 2333
2334
Special considerations for powered wheelchairs 2335
The power may be on or off. However, the spotter should intervene and award a fail score 2336
if he/she is concerned that the subject is about to move the wheelchair in a way that 2337
appears likely to result in the fingers being run over by the wheels. 2338
If a powered-wheelchair user chooses to stand, an advanced-pass score should not be 2339
awarded if the power is not turned off. 2340
2341
Special considerations for scooters 2342
Scooter users often get out of their scooters to pick up objects. This is safer than leaning 2343
from the seat, due to the high center of gravity of most scooters and the possibility of a 2344
sideways tip. 2345
If a scooter user chooses to stand, an advanced-pass score should not be awarded if the 2346
power is not turned off. 2347
When bending or stooping to pick up the object, the scooter user may place the non-2348
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
reaching hand on the wheelchair for balance. 2349
2350
69
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.11 RELIEVES WEIGHT FROM BUTTOCKS 2351
2352
Versions applicable 2353
Manual wheelchair: (skill #9) 2354
Powered wheelchair: (skill #11) 2355
2356
Description 2357
The subject relieves weight from both buttocks, although not necessarily at the same 2358
time. 2359
2360
Rationale 2361
Weight relief is important for comfort and the prevention of pressure sores. Although 2362
research-based recommendations are evolving, for the purposes of the WST, complete 2363
unloading for a duration of 15 seconds is considered representative of the subject’s 2364
capability. 2365
2366
Prerequisites 2367
None. 2368
2369
Spotter considerations 2370
Spotter starting position: Near the wheelchair, on the side toward which the subject leans 2371
(if any). 2372
Risks requiring spotter intervention: Forward or sideways tip or fall when leaning. 2373
2374
Equipment 2375
Means (e.g. an inclinometer) of measuring the extent of tilt or recline, if that is the 2376
technique used by the subject. 2377
2378
Starting positions 2379
Wheelchair user: In the wheelchair, sitting upright. 2380
2381
Instructions to subject 2382
Optional screening questions: “Can you…?” 2383
“Demonstrate how you relieve weight from your buttocks. Hold your position until I tell 2384
you to stop.” 2385
The tester tells the subject to stop after 15 second. 2386
If a subject chooses to lean to one side, the tester may prompt the subject “Now to the 2387
other side” without penalty. 2388
2389
2390
70
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Capacity scoring criteria 2391
“Advanced pass”: As for the general scoring criteria. 2392
“Pass”: As for the general scoring criteria. 2393
The subject relieves ≥ 90% weight from the buttocks. For the purpose of the 2394
WST, this is considered to be the case if the tester is able to easily slide a hand 2395
between pressure-sensitive areas (the “sitting bones” and “tailbone”) and the 2396
wheelchair seat or cushion. However, placing a hand into the pressure-2397
sensitive areas is ordinarily not required for the WST and this should only be 2398
done with the permission of the subject. The tester must make his/her best 2399
judgment about the extent of the pressure relief achieved. 2400
Weight is significantly relieved for ≥ 15 seconds. 2401
It is permissible for the wheelchair user to lean to one side at a time, to lean 2402
forward with the elbows or chest resting on the thighs, to stand up or to bridge 2403
(lifting the buttocks by extending the legs, pushing the feet on the footrests or 2404
floor) to relieve pressure. 2405
If the subject leans, he/she must recover independently (e.g. using push-2406
handles or armrests). 2407
If the wheelchair user chooses to stand to accomplish the task, he/she need not 2408
apply the wheel locks and/or clear the footrests away. 2409
If the subject uses tilt or recline, a pass may be awarded if the extent of the tilt 2410
or recline is ≥ 45°. 2411
If the subject is using a positioning belt that is tight enough to prevent 2412
effective weight relief, it should be undone or loosened. After the weight-2413
relief maneuver, it should be reapplied or tightened. 2414
If the subject’s wheelchair is fitted with an alternating pressure cushion, a pass 2415
may be awarded if the tester is convinced by palpation that there is adequate 2416
relief under the pressure points. 2417
“Partial pass”: As for the general scoring criteria. 2418
If the subject relieves weight from the buttocks but < 90%. 2419
If the subject relieves weight from the buttocks but for < 15 seconds. 2420
If the subject uses tilt or recline, the extent of the tilt or recline must be ≥ 45°. 2421
The subject transiently tips the wheelchair while leaning. 2422
The subject uses the “push-up” technique. The push-up method, applying 2423
forces to the armrests or seat to lift the buttocks straight up, requires more 2424
force than most of the alternative methods. Over time, this may have adverse 2425
effects on the wheelchair user’s wrists and shoulders. Also, this technique is 2426
difficult to maintain for the recommended 15 seconds. 2427
“Fail”: As for the general scoring criteria. 2428
“Not possible”: This score is not an option for this skill. 2429
“Testing error”: As for the general scoring criteria. 2430
This score should be awarded if the tester is uncertain about the extent of weight 2431
relief and the subject refuses to permit the tester to perform a manual check. 2432
Comments recorded: As for general scoring criteria. 2433
The tester should record the method used by the subject. 2434
If the subject chooses to lean forward to relieve weight from the buttocks, the 2435
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
tester should note if the direction of caster trail is suboptimal (i.e. rearward trail). 2436
The tester should note the tilt or recline angle if the subject uses these methods. 2437
2438
Special considerations for caregivers 2439
The caregiver is only expected to assist the wheelchair user into and out of the weight-2440
relieving position and to prevent any tips or falls. 2441
2442
Special considerations for powered wheelchairs 2443
If a powered-wheelchair user chooses to stand to achieve pressure relief, an advanced-pass 2444
score should not be awarded if the power is not turned off. 2445
2446
Special considerations for scooters 2447
If a scooter user chooses to stand to achieve pressure relief, an advanced-pass score should 2448
not be awarded if the power is not turned off. 2449
2450
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.12 PERFORMS LEVEL TRANSFERS 2451
2452
Versions applicable 2453
Manual wheelchair: (skill #10) 2454
Powered wheelchair: (skill #12) 2455
2456
Description 2457
The wheelchair user transfers from the wheelchair to another surface that is about the 2458
same height as the wheelchair seat and back again. 2459
2460
Rationale 2461
A level transfer is a commonly used skill to move between the wheelchair and a chair, 2462
bed, tub, toilet, car or other surface. The average wheelchair user spends about 10 hours 2463
per day in his/her wheelchair and performs about 8 transfers a day, but the range is high. 2464
A greater number of transfers per day increases the likelihood of overuse injury to the 2465
upper limbs. Proper technique is advisable as a means of reducing overuse and 2466
minimizing pain during transfers. The level wheelchair transfer should only be 2467
considered a representative transfer. More difficulty may be experienced when 2468
transferring to and from other surfaces or heights. 2469
Note: Clinicians or researchers who wish to assess transfers in more detail than the WST 2470
requires can use the Transfer Assessment Instrument. 2471
2472
Prerequisites 2473
None. 2474
2475
Spotter considerations 2476
Spotter starting position: 2477
Usually in front of the wheelchair and slightly to one side, close enough to 2478
catch the subject if he/she falls and to prevent the wheelchair from rolling or 2479
sliding away or tipping. 2480
The spotter may ask the subject where it would be best to stand, given the 2481
subject’s previous experiences. 2482
Risks requiring spotter intervention: 2483
Forward or sideways tip or fall when reaching or standing. 2484
Rear tip when sitting back down in the wheelchair after a standing-pivot or 2485
crouching transfer. 2486
Fall between the wheelchair and bench if the wheelchair rolls or slides away. 2487
In the course of a standing pivot or crouching transfer, a fall due to tripping 2488
over the footrests. 2489
2490
Equipment 2491
Bench or equivalent with a padded flat surface, no backrest and no armrests. The sitting 2492
surface should be at least 1.0 m wide, at least 0.5 m deep and 45-47 cm high. 2493
Transfer board (a piece of wood or plastic with bevelled edges). 2494
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
2495
Starting positions 2496
Wheelchair user: Seated in the wheelchair, and oriented in the chair as if he/she is ready 2497
to propel the chair (e.g. feet on footplates, if used). 2498
Wheelchair: Facing the bench and at least 0.5 m from it. 2499
2500
Instructions to subject 2501
Optional screening questions: “Can you…?” 2502
"Transfer from the wheelchair to the bench (indicate it).” 2503
If, during the transfer, the subject is sitting on the target surface with part of the transfer 2504
board under him/her, it is permissible to prompt the subject, without penalty, to “move 2505
the transfer board away from you”. 2506
“Transfer back into the wheelchair.” 2507
After transferring back into the wheelchair, the subject may be prompted, without 2508
penalty, to restore the wheelchair to its original condition (e.g. “Is your wheelchair ready 2509
to go?”), but without itemizing specific deficiencies. 2510
2511
Capacity scoring criteria 2512
“Advanced pass”: As for the general scoring criteria. 2513
“Pass”: As for the general scoring criteria. 2514
The wheelchair user is able to independently and safely set up the wheelchair 2515
for the transfer, transfer to and from the target surface and restore the 2516
wheelchair to its operational condition. 2517
The transfer is not considered complete until the subject is off the transfer 2518
board, if one is used. 2519
If the wheelchair user’s arm is secured to an arm support he/she must 2520
independently release and later replace his/her arm in the original position and 2521
state. 2522
The wheel locks (if any) need not be used as long as the wheelchair does not 2523
roll away significantly. 2524
The subject need not clear the footrests if the transfer can be effectively and 2525
safely completed without doing so. After transferring back into the 2526
wheelchair, the footrests and feet should be as they were prior to the transfer. 2527
If a positioning belt is intended for independent use and is fastened around the 2528
wheelchair user at the beginning of the test, then the subject is expected to be 2529
able to undo it and fasten it again after transferring back into the wheelchair. 2530
If the wheelchair is equipped with a positioning belt, but the wheelchair user 2531
is not using it, the subject is not required to be able to use it. 2532
If the subject needs to reposition the unoccupied wheelchair between the 2533
transfer out of the wheelchair and the transfer back into it, the subject must do 2534
so him/herself. 2535
“Partial pass”: As for the general scoring criteria. 2536
The subject is successful in transferring out of the wheelchair, but not back 2537
into it. 2538
“Fail”: As for the general scoring criteria. 2539
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
If the subject is the wheelchair user and the wheelchair has a rear-closing seat 2540
belt or other restraint that is not intended for independent use, a fail score 2541
should be awarded. 2542
“Not possible”: This score is not an option for this skill. 2543
“Testing error”: As for the general scoring criteria. 2544
If a subject routinely uses a transfer board but one is not available at the time 2545
of testing, a TE score should be awarded. 2546
Comments recorded: 2547
The transfer method used (e.g. sideways vs. standing-pivot transfer). 2548
If, during a sideways transfer, the buttocks scrape significantly over the rear 2549
wheel or wheel-lock extension. 2550
If the lower limbs scrape over a footrest to a significant extent. 2551
If, during a standing-pivot or crouch transfer, a 270° turn is used instead of 2552
using the shortest possible rotation. 2553
2554
Special considerations for caregivers 2555
The caregiver may receive physical assistance from the wheelchair user in performing the 2556
skill because it is not a reasonable expectation that a single caregiver could carry out this 2557
skill alone without additional equipment. 2558
The caregiver may use a transfer belt, as long as it is carried by the wheelchair user or 2559
caregiver. 2560
2561
Special considerations for powered wheelchairs 2562
The controller may be on or off. Although the transfer is likely to be safer with the power 2563
off, the subject may need to move the wheelchair during the transfer and may not be able 2564
to control the power when out of the wheelchair. 2565
If the wheelchair seat can be swivelled to the side or back, this may be done. 2566
2567
Special considerations for scooters 2568
If the scooter seat can be swivelled to the side or back, this may be done. 2569
2570
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.13 FOLDS AND UNFOLDS WHEELCHAIR 2571
2572
Versions applicable 2573
Manual wheelchair: (skill #11) 2574
Powered wheelchair: X 2575
2576
Description 2577
The subject folds or takes apart the unoccupied wheelchair to make it as small and light 2578
as possible, and then restores it to its original condition. 2579
2580
Rationale 2581
For transport or storage, the size or weight of the wheelchair may need to be reduced. 2582
This can be done by folding the wheelchair. Removal of the rear wheels or other parts is a 2583
useful way to further diminish the size and weight of the wheelchair. Although, in 2584
everyday life, wheelchair users may not need to break their wheelchairs down 2585
completely, for the purposes of the WST, this is required. For the purposes of the WST, 2586
this skill is considered “not applicable” for powered wheelchairs and scooters, even 2587
though some parts of some models may be readily foldable or removable. 2588
2589
Prerequisites 2590
None. 2591
2592
Spotter considerations 2593
Spotter starting position: 2594
Near the subject, on the side toward which the subject leans (if any). 2595
Risks requiring spotter intervention: 2596
Forward fall while reaching. 2597
Pinching fingers between folding or rotating parts. 2598
Injury to lower leg or foot due to dropping or rotating wheelchair parts. 2599
2600
Equipment 2601
Surface for the subject to sit on (e.g. the one used for the “performs level transfers” skill), 2602
if needed. 2603
2604
Starting positions 2605
Wheelchair user: Seated or standing near the wheelchair. 2606
Wheelchair: In the same position and condition as it is immediately after the wheelchair 2607
user has transferred out of it. This skill is usually assessed with the “performs level 2608
transfers” skill, while the wheelchair user is out of the wheelchair. For a wheelchair with 2609
a spotter strap around a cross-brace, the strap may be removed by the tester, to permit the 2610
wheelchair to fold fully. 2611
2612
2613
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Instructions to subject 2614
Optional screening questions: “Does your wheelchair…?”, “Can you…?” 2615
“Fold the wheelchair as tightly as you can or take it apart as completely as possible, as 2616
if you were going to store it.” 2617
If the wheelchair is incompletely folded or taken apart, it is acceptable to prompt the 2618
subject without penalty (e.g. “Can you get it a little tighter or smaller?” or “What if it 2619
was still too big or heavy?”) but the tester must not suggest the solution. 2620
“Put the wheelchair back together and open it so that you can get back into it.” 2621
If the wheelchair is incompletely restored to its original condition, it is permissible, 2622
without penalty, to cue the subject by inquiring “Is the wheelchair in the same condition 2623
that it was in before you folded it?” but the tester must not suggest the solution. 2624
2625
Capacity scoring criteria 2626
“Advanced pass”: As for the general scoring criteria. 2627
“Pass”: As for the general scoring criteria. 2628
If the subject has removed some wheelchair parts (e.g. an armrest or footrest) 2629
as part of the transfer out of the wheelchair and restores the wheelchair to its 2630
original state after transferring back into it, the tester may also consider these 2631
actions as part of the “folds and unfolds wheelchair” skill. 2632
The wheelchair is folded or taken apart such as to reduce the dimensions of the 2633
wheelchair as much as possible without tools. 2634
If wheelchair components or accessories (e.g. cushion, rigid seat, backrest, 2635
knapsack, armrests, footrests, clothing guards) need to be removed to achieve 2636
the smallest and lightest condition, this should be done. 2637
For a rigid wheelchair with a backrest that folds forward, the backrest canes 2638
and the seat rails should be as close to parallel with each other as is 2639
mechanically possible. 2640
The rear wheels should be removed if this can be done without tools (i.e. if 2641
they are of the quick-release type). 2642
For the unfold component of the skill, the wheelchair should be opened fully. 2643
After putting the rear wheels back on the frame, the subject should check that 2644
they are firmly in place by pulling on them. 2645
“Partial pass”: As for the general scoring criteria. 2646
The subject is successful in folding and unfolding the wheelchair but neglects 2647
to remove and replace all components. 2648
The subject is successful in folding the wheelchair, but not unfolding it. 2649
The subject opens the wheelchair in a way that precludes normal use of the 2650
wheelchair (e.g. putting a contoured cushion in backward, tangling a seatbelt 2651
strap in a way that will cause it to rub on a wheel, or failing to get the seat rails 2652
properly into the rail saddles). The tester should intervene and ask the subject 2653
to correct the problem before the wheelchair user gets back into the wheelchair 2654
(to avoid the necessity of a second transfer to correct the problem). 2655
“Fail”: As for the general scoring criteria. 2656
The subject does not know that the wheelchair folds or can otherwise be 2657
reduced in size or weight. 2658
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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“Not possible”: As for the general scoring criteria. 2659
The wheelchair cannot be folded or reduced in size or weight in any way. 2660
“Testing error”: As for the general scoring criteria. 2661
If the subject cannot achieve the “performs level transfers” skill out of the 2662
wheelchair, the “folds and unfolds wheelchair” skill cannot be tested. The 2663
tester is not required to assist the wheelchair user out of the wheelchair but a 2664
caregiver (if available) may do so to allow the “folds and unfolds wheelchair” 2665
skill to be tested. 2666
Comments recorded: As for general scoring criteria. 2667
2668
Special considerations 2669
None. 2670
2671
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.14 GETS THROUGH HINGED DOOR 2672
2673
Versions applicable 2674
Manual wheelchair: (skill #12) 2675
Powered wheelchair: (skill #13) 2676
2677
Description 2678
The subject opens, passes through and closes a hinged door that opens away from the 2679
subject, then repeats the task in the opposite direction (with the door opening toward the 2680
subject). 2681
2682
Rationale 2683
Wheelchair users frequently encounter such hinged doors or gates. Although there are 2684
many door types, the hinged door is considered a representative skill. 2685
2686
Prerequisites 2687
None. 2688
2689
Spotter considerations 2690
Spotter starting position: Near the wheelchair, on the side toward which the subject leans 2691
(if any). 2692
Risks requiring spotter intervention: 2693
Rear, forward or sideways tip or fall due to reaching and pulling on the door 2694
handle. 2695
Pinching the fingers between the door and the frame. 2696
Scraping the hands between the door frame and the wheelchair. 2697
2698
Equipment 2699
Door about 81cm wide, with no resistance to opening, preferably with a lever handle >10 2700
cm in length and 75-90 cm above the floor, and preferably with no threshold (because the 2701
ability to get over an obstacle is evaluated separately later). 2702
There should be enough space (preferably at least 1.5 m2), before and after the door as 2703
well as on the side of the door that opens, to allow the subject to maneuver. 2704
2705
Starting positions 2706
Wheelchair: Facing the mid-point of the closed door with the front wheels about 0.5 m 2707
from it. 2708
2709
Instructions to subject 2710
Optional screening questions: “Can you…?” 2711
"Open the door, move the wheelchair through it and close the door behind you.” 2712
“Now, go back through the door the other way.” 2713
The order of performing the two components of this skill test is not important. 2714
If the subject leaves the door ajar, he/she may be prompted, without penalty, to finish 2715
closing it. 2716
79
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
2717
Capacity scoring criteria 2718
“Advanced pass”: As for the general scoring criteria. 2719
Meets the criteria for a pass score but also the additional criteria below. 2720
“Pass”: As for the general scoring criteria. 2721
The skill in each direction is completed when the door closes firmly. 2722
“Partial pass”: As for the general scoring criteria. 2723
The subject is successful in one but not both directions. 2724
The subject is able to open the door in both directions, but fails to close it. 2725
The subject is able to pass through the door and close it in both directions, but 2726
not open it. 2727
“Fail”: As for the general scoring criteria. 2728
A finger pinch seems likely between the door and the frame. The spotter should 2729
intervene to prevent injury. 2730
“Not possible”: This score is not an option for this skill. 2731
“Testing error”: As for the general scoring criteria. 2732
Comments recorded: As for general scoring criteria. 2733
2734
Special considerations for manual wheelchairs 2735
The subject may use the door-frame to assist in passing through the door. 2736
2737
80
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.15 ROLLS LONGER DISTANCE 2738
2739
Versions applicable 2740
Manual wheelchair: (skill #13) 2741
Powered wheelchair: (skill #14) 2742
2743
Description 2744
The subject moves the wheelchair a longer distance on a smooth level surface. This may 2745
be done in the forward or backward direction. 2746
2747
Rationale 2748
The ability to manage longer distances allows wheelchair users to get around in the 2749
community (e.g. getting from a parking lot to an office or getting around inside a store). 2750
Subjects who are able to move their wheelchairs short distances may not be able to roll 2751
longer distances due to the additional endurance or attention required. 2752
2753
Prerequisites 2754
The “rolls forward short distance” skill is a prerequisite if this skill is carried out in the 2755
forward direction and the “rolls backward short distance” skill is a prerequisite if this 2756
skill is carried out in the backward direction. 2757
2758
Spotter considerations 2759
Spotter: If the subject has already safely performed the appropriate shorter-distance skill 2760
(forward or backward) and “stops on command” skill, the spotter need only be nearby. 2761
Risks requiring spotter intervention: 2762
As for the appropriate shorter-distance skill (forward or backward) and the “stops 2763
on command” skill. 2764
Rear, forward or sideways tip or fall due to a sudden stop or turn. 2765
Because speeds are usually faster if the skill is being performed in an open space, 2766
the higher momentum can cause greater injury or damage if there is a collision with 2767
a fixed or moving obstacle. 2768
2769
Equipment 2770
A smooth level surface 50 m long and at least 1.5 m wide is ideal. Using multiple laps of 2771
a shorter distance is permissible, but it is preferable for the straight stretches to be at least 2772
10 m in length, to minimize the number of turns. A curved path may be used. 2773
If the space to be used requires laps to and fro through the same space, a pylon at the end 2774
of each lap is a helpful guide for the subject to turn around. 2775
Space at least 1.5 m before the starting line and beyond the finish line. 2776
2777
Starting positions 2778
Wheelchair: Leading wheel axles facing the starting line and behind it. 2779
2780
Instructions to subject 2781
Optional screening questions: “Can you…?” 2782
81
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Move the wheelchair to the finish line (indicate it or the number of laps and the pylons if 2783
used).” 2784
Note: Clinicians or researchers who wish to assess propulsion in more detail than the 2785
WST requires can use the Wheelchair Propulsion Test, by also recording the time 2786
taken and the number of propulsion cycles. 2787
2788
Capacity scoring criteria 2789
“Advanced pass”: As for the general scoring criteria. 2790
“Pass”: As for the general scoring criteria. 2791
As for the “rolls forward short distance” or “rolls backward short distance” 2792
skill depending upon the direction of travel. 2793
The subject needs to avoid any contact with fixed or moving obstacles that 2794
he/she encounters, by stopping, slowing down and/or changing direction. 2795
“Partial pass”: As for the general scoring criteria. 2796
The subject covers ≥ 25 m. 2797
“Fail”: As for the general scoring criteria. 2798
An automatic “fail” score is awarded if the subject has failed the “rolls 2799
forward short distance” skill if a forward propeller or if the subject has failed the 2800
“rolls backward short distance” skill if a backward propeller. 2801
The subject covers < 25 m. 2802
“Not possible”: This score is not an option for this skill. 2803
“Testing error”: As for the general scoring criteria. 2804
Comments recorded: As for general scoring criteria. 2805
2806
Special considerations for powered wheelchairs 2807
If there are potential hazards (e.g. people or wheelchairs emerging from office doorways 2808
or intersecting hallways), an advanced-pass score should not be awarded if the subject is 2809
driving the wheelchair too quickly. 2810
2811
Special considerations for scooters 2812
If there are potential hazards (e.g. people or wheelchairs emerging from office doorways 2813
or intersecting hallways), an advanced-pass score should not be awarded if the subject is 2814
driving the scooter too quickly. 2815
2816
82
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.16 ASCENDS SLIGHT INCLINE 2817
2818
Versions applicable 2819
Manual wheelchair: (skill #14) 2820
Powered wheelchair: (skill #15) 2821
2822
Description 2823
The subject moves the wheelchair from a level surface up a slight incline to another level 2824
surface. 2825
2826
Rationale 2827
Inclines with different slopes are encountered frequently in the natural and built 2828
environments. For instance, a 5 (~1:12) grade meets the current building codes for ramps 2829
in North America. 2830
2831
Prerequisites 2832
None. 2833
2834
Spotter considerations 2835
Spotter starting position: Behind the wheelchair, holding onto a spotter strap (if a manual 2836
wheelchair). 2837
Risks requiring spotter intervention if moving forward up the incline: 2838
Rear tip when initially accelerating. 2839
Forward tip or fall due to deceleration when striking the lower floor-incline 2840
transition. 2841
Hyper-flexion injury of the lower limb at the lower floor-incline transition if the 2842
foot catches on the ground. 2843
Rear tip while ascending the incline. 2844
2845
Equipment 2846
Incline with a slope of 5, at least 2.5 m long and at least 1.5 m wide. 2847
A lip and a handrail on both sides of the incline are desirable to prevent injuries although 2848
the handrails should not be used during the performance of the skill. 2849
The incline should end at the upper end on a level surface or platform that is large enough 2850
to allow wheelchairs of all types, caregivers and WST personnel to turn around on safely 2851
(2.0 m2 or more is recommended). A lip around the open edges of the platform is 2852
recommended. 2853
There should be little or no lip at the lower junction of the floor and incline. The ability to 2854
overcome such obstacles is tested elsewhere. 2855
2856
Starting positions 2857
Wheelchair: On the level at the bottom of the incline, with the leading wheels of the 2858
wheelchair facing the incline and at least 0.5 m away. Some subjects may prefer to start 2859
farther away if they wish to use momentum to get up the ramp. This is the subject’s 2860
choice but the tester should not suggest this solution. 2861
83
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
2862
Instructions to subject 2863
Optional screening questions: “Can you…?” 2864
“Move the wheelchair up the ramp.” 2865
If the subject attempts to perform the skill using the ramp handrails he/she may, without 2866
penalty, be instructed not to use this method for the purposes of the test. 2867
2868
Capacity scoring criteria 2869
“Advanced pass”: As for the general scoring criteria. 2870
“Pass”: As for the general scoring criteria. 2871
The subject may use any type of propulsion, in the forward or backward 2872
direction. 2873
The end of the skill occurs when all wheelchair parts are completely off the 2874
incline at the top. 2875
The subject or wheelchair may make contact with the ramp lips or rails 2876
without penalty. 2877
“Partial pass”: As for the general scoring criteria. 2878
The subject does not ascend at least 2.0 m. 2879
The subject successfully handles a slope of lesser degree (e.g. if a 2.5 slope is 2880
available). 2881
“Fail”: As for the general scoring criteria. 2882
A wheel moves outside the lateral boundaries of the incline. 2883
“Not possible”: This score is not an option for this skill. 2884
“Testing error”: As for the general scoring criteria. 2885
Comments recorded: 2886
The footrests or rear anti-tip devices make enough contact with the surface at the 2887
lower transition to significantly interfere with progression. 2888
A transient wheelchair tip occurs. 2889
2890
Special considerations 2891
None. 2892
2893
2894
84
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.17 DESCENDS SLIGHT INCLINE 2895
2896
Versions applicable 2897
Manual wheelchair: (skill #15) 2898
Powered wheelchair: (skill #16) 2899
2900
Description 2901
The subject moves the wheelchair from a level surface down a slight incline to another 2902
level surface, stopping part-way. 2903
2904
Rationale 2905
As for the “ascends slight incline” skill. In addition, being able to stop during incline 2906
descent is valuable for safety and demonstrates control. 2907
2908
Prerequisites 2909
None. 2910
2911
Spotter considerations 2912
Spotter starting position: 2913
If the wheelchair is to move forward down the incline, the spotter should be behind 2914
the wheelchair, holding onto a spotter strap (if a manual wheelchair) with one hand 2915
and holding the other hand in front of the wheelchair user’s shoulder. 2916
If using two spotters, one spotter should be behind the wheelchair, holding onto a 2917
spotter strap and the second spotter should be in front of and beside the wheelchair 2918
to resist a forward tip or fall. 2919
Risks requiring spotter intervention: 2920
Rear tip if performed in the wheelie position. 2921
Forward tip or fall due to deceleration when stopping or when striking the lower 2922
incline-floor transition. 2923
Hyper-flexion injury of the lower limb at the lower incline-floor transition due to 2924
catching the foot on the ground. 2925
Runaway leading to collision or tip-over. 2926
Hand injuries to the wheelchair user due to friction burns or lacerations due to 2927
hand-rim irregularities if the wheelchair is allowed to descend too rapidly. 2928
Thumb injury on the wheel locks if the wheelchair user grabs the hand-rims when 2929
they are rolling too quickly because the hands can get pulled forward into the 2930
wheel locks by the wheels. 2931
2932
Equipment 2933
As for the “ascends slight incline” skill. 2934
2935
2936
85
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Starting positions 2937
Wheelchair: All wheels are on the level surface at the top of the incline with the leading 2938
wheels of the wheelchair facing the incline and at least 0.5 m away. 2939
2940
Instructions to subject 2941
Optional screening questions: “Can you…?” 2942
“Move the wheelchair down the ramp under control, stopping about half-way down.” 2943
After the stop: “Carry on to the bottom and stop when you are off the ramp.” 2944
If the subject attempts to perform the skill using the ramp handrails, he/she may, without 2945
penalty, be instructed not to use this method for the purposes of the test. 2946
2947
Capacity scoring criteria 2948
“Advanced pass”: As for the general scoring criteria. 2949
“Pass”: As for the general scoring criteria. 2950
The end of the skill occurs when all wheelchair parts are completely off the 2951
incline at the bottom and the wheelchair has been brought to a controlled stop. 2952
The subject must come to a complete stop part-way down the incline. 2953
The subject or wheelchair may make contact with the ramp lips or rails 2954
without penalty. 2955
“Partial pass”: As for the general scoring criteria. 2956
The subject does not descend at least 2.0 m under control. 2957
The subject descends the full incline under control but does not come to a 2958
complete stop part-way down the incline. 2959
The subject successfully handles a slope of lesser degree (e.g. if a 2.5 slope is 2960
available). 2961
“Fail”: As for the general scoring criteria. 2962
A runaway requires the spotter’s intervention. 2963
A wheel moves outside the lateral boundaries of the incline. 2964
“Not possible”: This score is not an option for this skill. 2965
“Testing error”: As for the general scoring criteria. 2966
Comment recorded: 2967
The footrests or rear anti-tip devices make enough contact with the surface at 2968
the lower transition to significantly interfere with progression. 2969
2970
Special considerations for caregivers 2971
For a caregiver of a powered wheelchair user, disengaging the motors and letting the 2972
wheelchair roll down the ramp is not considered a safe method so a fail score should be 2973
awarded. 2974
2975
Special considerations for manual wheelchairs 2976
“Advanced pass”: As for the general scoring criteria. 2977
If the subject performs the skill in the wheelie position, an advanced pass may be 2978
warranted but the wheelie method is not necessary. 2979
“Pass”: As for the general scoring criteria. 2980
“Partial pass”: As for the general scoring criteria. 2981
86
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Fail”: As for the general scoring criteria. 2982
The handrails of the ramp are grasped. 2983
Comments recorded: 2984
The subject uses the wheel locks to limit the speed of the wheelchair (e.g. by 2985
partially or repeatedly applying them). 2986
The subject drags the feet to slow the wheelchair. 2987
A foot catches on the floor as the wheelchair continues to move forward, without 2988
injury. 2989
The subject sustains mild friction burns of the hands. 2990
There is minor thumb injury on the wheel lock because the hand gets pulled 2991
forward into the wheel lock by the wheel. 2992
2993
87
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.18 ASCENDS STEEP INCLINE 2994
2995
Versions applicable 2996
Manual wheelchair: (skill #16) 2997
Powered wheelchair: (skill #17) 2998
2999
Description 3000
The subject moves the wheelchair from a level surface up a steep incline to another level 3001
surface. 3002
3003
Rationale 3004
As for the “ascends slight incline” skill. Inclines with slopes greater than the standard 3005
recommended value are encountered frequently in the natural and built environments. 3006
The appropriate technique for a steep incline may differ somewhat from that used for a 3007
lesser slope. 3008
3009
Prerequisites 3010
“Ascends slight incline” skill. 3011
3012
Spotter considerations 3013
As for “ascends slight incline” skill. 3014
3015
Equipment 3016
As for “ascends slight incline” skill, except that the incline has a 10 slope. 3017
3018
Starting positions 3019
As for “ascends slight incline” skill. 3020
3021
Instructions to subject 3022
As for “ascends slight incline” skill. 3023
3024
Capacity scoring criteria 3025
“Advanced pass”: As for the general scoring criteria. 3026
As for the “ascends slight incline” skill. 3027
“Pass”: As for the general scoring criteria. 3028
As for the “ascends slight incline” skill. 3029
“Partial pass”: As for the general scoring criteria. 3030
As for the “ascends slight incline” skill. 3031
“Fail”: As for the general scoring criteria. 3032
As for the “ascends slight incline” skill. 3033
An automatic fail score can be awarded if the subject has failed the “ascends 3034
slight incline” skill. 3035
“Not possible”: This score is not an option for this skill. 3036
“Testing error”: As for the general scoring criteria. 3037
Comments recorded: 3038
88
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
As for the “ascends slight incline” skill. 3039
3040
Special considerations 3041
As for the “ascends slight incline” skill. 3042
3043
89
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.19 DESCENDS STEEP INCLINE 3044
3045
Versions applicable 3046
Manual wheelchair: (skill #17) 3047
Powered wheelchair: (skill #18) 3048
3049
Description 3050
The subject moves the wheelchair from a level surface down a steep incline to another 3051
level surface, stopping part-way. 3052
3053
Rationale 3054
As for the “descends slight incline” skill. 3055
3056
Prerequisites 3057
“Descends slight incline” skill. 3058
3059
Spotter considerations 3060
As for “descends slight incline” skill. 3061
3062
Equipment 3063
As for “ascends steep incline” skill. 3064
3065
Starting positions 3066
As for “descends slight incline” skill. 3067
3068
Instructions to subject 3069
As for “descends slight incline” skill. 3070
3071
Capacity scoring criteria 3072
“Advanced pass”: As for the general scoring criteria. 3073
As for the “descends slight incline” skill. 3074
“Pass”: As for the general scoring criteria. 3075
As for the “descends slight incline” skill. 3076
“Partial pass”: As for the general scoring criteria. 3077
As for the “descends slight incline” skill. 3078
“Fail”: As for the general scoring criteria and the “descends slight incline” skill. 3079
An automatic fail score should be awarded if the subject has been awarded this 3080
score on the “descends slight incline” skill. 3081
“Not possible”: This score is not an option for this skill. 3082
“Testing error”: As for the general scoring criteria. 3083
Comments recorded: As for general scoring criteria. 3084
3085
Special considerations for caregivers 3086
As for the “descends slight incline” skill. 3087
3088
90
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Special considerations for manual wheelchairs 3089
As for the “descends slight incline” skill. 3090
3091
91
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.20 ROLLS ACROSS SIDE-SLOPE 3092
3093
Versions applicable 3094
Manual wheelchair: (skill #18) 3095
Powered wheelchair: (skill #19) 3096
3097
Description 3098
The subject moves the wheelchair across a slight side-slope without turning downhill or 3099
uphill significantly, then repeats the task in the opposite direction. 3100
3101
Rationale 3102
Side-slopes (or cross-slopes) are frequently encountered in built and natural 3103
environments. Sidewalks, for instance, are usually sloped 2% (1:50) toward the street to 3104
allow water to run off. Steeper grades are also often found (e.g. where sidewalks cross 3105
driveways). The yaw axis of a wheelchair (i.e. the vertical axis around which the 3106
wheelchair turns toward the left or right) is between the drive wheels. If the combined 3107
center of gravity of the wheelchair and user is ahead of the drive wheels and more on the 3108
casters that are free to turn (as is usually the case with rear-wheel-drive wheelchairs), the 3109
wheelchair will tend to turn downhill on a side-slope (“downhill turning tendency”). If 3110
the combined center of gravity of the wheelchair and user is behind the drive wheels (as 3111
is usually the case with front-wheel-drive wheelchairs), the wheelchair will tend to turn 3112
uphill on a side-slope (“uphill turning tendency”). 3113
3114
Prerequisites 3115
None. 3116
3117
Spotter considerations 3118
Spotter starting position: 3119
Slightly behind and downhill from the wheelchair. 3120
Risks requiring spotter intervention: 3121
Sideways tip or fall downhill. 3122
3123
Equipment 3124
Incline of 5, at least 2.5 m long (in the line of progression) and at least 1.5 m wide. 3125
Starting and finish lines perpendicular to the line of progression. 3126
At least an extra 1.5 m before the starting line and beyond the finish line. 3127
Means of monitoring if any of the downhill wheels drift or turn downhill by greater than 3128
10 cm from the starting position. The slope-level transition can be used, or any line 3129
parallel to it. 3130
3131
Starting positions 3132
Wheelchair: With the wheel locks off, and all wheels on the sloped surface, oriented in 3133
the line of progression across the slope. The downhill drive wheel is positioned 10 cm up 3134
the slope from the line used to detect if the wheelchair has turned downhill. The axles of 3135
the leading wheels must be behind the starting line. The casters should be trailing 3136
appropriately for the direction of travel so that there is no initial deflection of the 3137
92
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
wheelchair due to the casters realigning themselves. If the subject wishes to perform the 3138
skill in the backward direction, the tester may assist the subject in getting the wheelchair 3139
into position to do so. 3140
3141
Instructions to subject 3142
Optional screening questions: “Can you…?” 3143
“Move the wheelchair straight across the slope to the finish position (indicate it)." 3144
“Now do the same thing in the other direction.” 3145
3146
Capacity scoring criteria 3147
“Advanced pass”: As for the general scoring criteria. 3148
“Pass”: As for the general scoring criteria. 3149
The skill may be performed in the forward or backward direction. 3150
The leading wheels cross the finish line. 3151
No downhill wheel crosses the line 10 cm downhill from the starting position. 3152
“Partial pass”: As for the general scoring criteria. 3153
The subject covers < 2 m in both directions. 3154
The subject is successful in one direction, but not the other. 3155
“Fail”: As for the general scoring criteria. 3156
“Not possible”: This score is not an option for this skill. 3157
“Testing error”: As for the general scoring criteria. 3158
Comments recorded: As for general scoring criteria. 3159
3160
Special considerations for caregivers 3161
The caregiver’s feet need not remain above the line being avoided because the 3162
caregiver’s usual position relative to the wheelchair is slightly downhill to the 3163
wheelchair. 3164
3165
Special considerations for manual wheelchairs 3166
An advanced-pass score may be awarded if the subject performs the skill in the wheelie 3167
position but the wheelie position is not necessary for an advanced-pass score. 3168
3169
Special considerations for powered wheelchairs 3170
A front-wheel-drive wheelchair will tend to self-steer uphill instead of downhill, but there 3171
is no penalty for this if the wheelchair is able to complete the distance in the space 3172
available without any downhill wheel (e.g. a rear caster) in contact with the surface 3173
moving below the line. 3174
3175
93
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.21 ROLLS ON SOFT SURFACE 3176
3177
Versions applicable 3178
Manual wheelchair: (skill #19) 3179
Powered wheelchair: (skill #20) 3180
3181
Description 3182
The subject moves the wheelchair a short distance on a soft surface. 3183
3184
Rationale 3185
There are many types of soft surfaces (e.g. carpet, dirt, grass, gravel, sand or snow) that a 3186
wheelchair user may encounter. Propulsion is more difficult on such surfaces (increased 3187
rolling resistance) because the wheels tend to sink into the surface, especially wheels that 3188
are narrow or of small diameter. 3189
3190
Prerequisites 3191
None. 3192
3193
Spotter considerations 3194
Spotter starting position: Behind the wheelchair, holding onto a spotter strap with one 3195
hand (if a manual wheelchair). 3196
Risks requiring spotter intervention: 3197
Rear tip when accelerating. 3198
Overuse injury due to the additional forces needed. 3199
3200
Equipment 3201
Pathway that includes a soft surface at least 2.5 m long and at least 1.5 m wide. 3202
There should be an additional 1.5 m of soft surface before the starting line and 1.5 m 3203
beyond the finish line. 3204
A gym mat (5 cm thick) is often used indoors as an example of a soft surface because it is 3205
readily available and easy to keep clean. Outdoor examples of soft surfaces include gravel, 3206
sand or grass. 3207
Note: Some sand and gravel pits have lips that make it difficult to get into and out of 3208
them. It is the 2 m of soft surface that is the focus of this skill, not the entry and 3209
exit. 3210
3211
Starting positions 3212
Wheelchair: Fully on the soft surface with the leading wheel axles behind the starting 3213
line. If the subject wishes to perform the skill in the backward direction, the tester may 3214
assist the subject in getting the wheelchair into position to do so. 3215
3216
3217
94
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Instructions to subject 3218
Optional screening questions: “Can you…?” 3219
“Move the wheelchair to the finish position (indicate it).” 3220
3221
Capacity scoring criteria 3222
“Advanced pass”: As for the general scoring criteria. 3223
“Pass”: As for the general scoring criteria. 3224
The leading wheel axles are moved beyond the finish line. 3225
All techniques are permitted, such as forward or backward approaches. 3226
During the course of any single attempt, a subject may use different approaches. 3227
“Partial pass”: As for the general scoring criteria. 3228
“Fail”: As for the general scoring criteria. 3229
“Not possible”: This score is not an option for this skill. 3230
“Testing error”: As for the general scoring criteria. 3231
Comments recorded: As for general scoring criteria. 3232
3233
Special considerations for manual wheelchairs 3234
The wheelchair user may use the feet. 3235
Examples of advanced technique include popping the casters slightly off the soft surface 3236
and moving the wheelchair well forward with each propulsion cycle. Alternatively, an 3237
advanced-pass score may be awarded if the subject performs the skill in the wheelie 3238
position. 3239
3240
Special considerations for powered wheelchairs 3241
The wheelchair user may use the wheelchair’s body positioning options (e.g. tilt, recline, 3242
leg-rest elevation) to reduce the weight on the smaller wheels. 3243
3244
95
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.22 GETS OVER OBSTACLE 3245
3246
Versions applicable 3247
Manual wheelchair: (skill #20) 3248
Powered wheelchair: (skill #21) 3249
3250
Description 3251
The subject moves the wheelchair over an obstacle. 3252
3253
Rationale 3254
Wheelchair users often encounter obstacles (e.g. door thresholds) of various sizes and 3255
shapes that they may not be able to simply roll over. Alternative strategies may be 3256
needed. For example, a manual wheelchair user might need to pop the casters over the 3257
obstacle whereas a powered wheelchair user might need to change the mode setting to 3258
one with more power. 3259
3260
Prerequisites 3261
None. 3262
3263
Spotter considerations 3264
Spotter starting position: 3265
If using a single spotter, he/she should be behind the wheelchair, holding onto a 3266
spotter strap with one hand (if a manual wheelchair) and holding the other hand in 3267
front of the wheelchair user’s shoulder. 3268
If using two spotters (as is recommended), the second spotter should stand to one 3269
side of the level change. 3270
Risks requiring spotter intervention: 3271
Rear tip when accelerating to pop casters from the surface (if a manual 3272
wheelchair). 3273
Forward tip or fall if the casters strike the obstacle. 3274
3275
Equipment 3276
Path on a smooth level surface that is at least 1.5 m wide, at least 3 m long before the 3277
obstacle (for subjects who use a moving approach) and at least 1.5 m after the obstacle. 3278
Obstacle 5 cm high, 10 cm across (in the line of progression) and at least 1.5 m wide, 3279
rectangular in cross-section (i.e. a vertical front face without a bevel). 3280
The obstacle should be secured to sufficiently withstand horizontal forces. 3281
The obstacle may be free-standing or braced across a doorway. 3282
3283
Starting positions 3284
Wheelchair: Facing the obstacle with the leading wheels at least 1.5 m from it. 3285
3286
Instructions to subject 3287
Optional screening questions: “Can you…?” If the subject answers “no”, the tester 3288
should repeat the question regarding an obstacle lower in height. 3289
96
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Get your wheelchair over the obstacle.” 3290
3291
Capacity scoring criteria 3292
“Advanced pass”: As for the general scoring criteria. 3293
A moving approach to the obstacle is used. 3294
“Pass”: As for the general scoring criteria. 3295
All parts of the wheelchair must pass beyond the obstacle. 3296
“Partial pass”: As for the general scoring criteria. 3297
At least the casters are over the 5-cm-high obstacle. 3298
The subject is successful on a lower obstacle (e.g. 2.5 cm high), if one is 3299
available. 3300
“Fail”: As for the general scoring criteria. 3301
“Not possible”: This score is not an option for this skill. 3302
“Testing error”: As for the general scoring criteria. 3303
Comments recorded: As for general scoring criteria. 3304
3305
Special considerations for caregivers 3306
A caregiver may request assistance from the wheelchair user during this skill, in the form 3307
of having the wheelchair user lean backward or forward at the caregiver’s direction, to 3308
facilitate the different stages of the skill. 3309
3310
Special considerations for manual wheelchairs 3311
The wheelchair user is permitted to use his/her feet or stand up to get over the obstacle. 3312
3313
Special considerations for powered wheelchairs 3314
The wheelchair user may use the wheelchair’s body positioning options (e.g. tilt, recline, 3315
leg-rest elevation) to reduce the weight on the smaller wheels or to clear the footrests. 3316
If the subject approaches the obstacle with excessive speed, leading to unnecessary 3317
jarring and potential loss of control, an advanced-pass score should not be awarded and a 3318
comment should be recorded. 3319
3320
Special considerations for scooters 3321
If the subject approaches the obstacle with excessive speed, leading to unnecessary 3322
jarring and potential loss of control, an advanced-pass score should not be awarded and a 3323
comment should be recorded. 3324
3325
97
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.23 GETS OVER GAP 3326
3327
Versions applicable 3328
Manual wheelchair: (skill #21) 3329
Powered wheelchair: (skill #22) 3330
3331
Description 3332
The subject moves the wheelchair over a gap across the line of progression. 3333
3334
Rationale 3335
A gap in surface support is a commonly encountered barrier (e.g. due to a rut in the road, 3336
a water channel or a space between a subway platform and a subway train). Gaps that 3337
only affect one wheel at a time are not usually major obstacles. In this section, only gaps 3338
that are as wide as the wheelchair will be considered. Small-diameter wheels (such as 3339
casters) can drop into such gaps, causing a sudden deceleration that can tip the 3340
wheelchair over forward or lead to the wheelchair user falling out of the wheelchair. 3341
Even if no tip or fall occurs, it can be difficult to get the wheelchair out of the gap. 3342
3343
Prerequisites 3344
None. 3345
3346
Spotter considerations 3347
Spotter starting position: 3348
If using a single spotter, he/she should be behind the wheelchair, holding onto a 3349
spotter strap with one hand (if a manual wheelchair) and holding the other hand in 3350
front of the wheelchair user’s shoulder. 3351
If using two spotters (as is recommended), the second spotter should stand to one 3352
side of the gap. 3353
Risks requiring spotter intervention: 3354
Rear tip when accelerating to pop casters from surface (if a manual wheelchair). 3355
Forward tip or fall if the casters drop into the gap. 3356
3357
Equipment 3358
Path on a smooth level surface that is at least 1.5 m wide, at least 3 m long before the gap 3359
(for subjects who use a moving approach) and at least 1.5 m after the gap. 3360
The gap should be ~5 cm deep, the full width of the path and 15 cm across (in the line of 3361
progression). 3362
If a gap is not readily available, one can be easily simulated. For instance, two folding 3363
tables (with the legs folded), two wooden platforms or two gym mats can be put close 3364
together. 3365
3366
Starting positions 3367
Wheelchair: Leading wheels at least 1.5 m in front of the gap. 3368
3369
Instructions to subject 3370
98
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Optional screening questions: “Can you…?” If the subject answers “no”, the tester 3371
should repeat the question regarding a gap with smaller dimensions. 3372
“Get your wheelchair over the gap (indicate it).” 3373
3374
Capacity scoring criteria 3375
“Advanced pass”: As for the general scoring criteria. 3376
A moving approach to the obstacle is used. 3377
“Pass”: As for the general scoring criteria. 3378
The task is over when all components of the wheelchair are on the level 3379
surface beyond the gap. 3380
“Partial pass”: As for the general scoring criteria. 3381
At least the casters get beyond the gap. 3382
A partial-pass score may be awarded if the subject is successful over a gap 3383
with smaller dimensions (e.g. 7.5 cm in the line of progression or only 2.5 cm 3384
deep), if one is available. 3385
“Fail”: As for the general scoring criteria. 3386
“Not possible”: This score is not an option for this skill. 3387
“Testing error”: As for the general scoring criteria. 3388
Comments recorded: As for general scoring criteria. 3389
3390
Special considerations for caregivers 3391
As for “the gets over obstacle” skill. 3392
3393
Special considerations for manual wheelchairs 3394
As for “the gets over obstacle” skill. 3395
3396
Special considerations for powered wheelchairs 3397
As for “the gets over obstacle” skill. 3398
3399
99
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.24 ASCENDS LOW CURB 3400
3401
Versions applicable 3402
Manual wheelchair: (skill #22) 3403
Powered wheelchair: (skill #23) 3404
3405
Description 3406
The subject gets the wheelchair up a low curb. 3407
3408
Rationale 3409
Level changes (e.g. curbs, home entries, uneven sidewalk sections) are common obstacles 3410
in the natural and built environments. The ability to manage low curbs is useful but 3411
practice on low curbs also provides an opportunity to hone techniques that will be needed 3412
for higher curbs. 3413
3414
Prerequisites 3415
None. 3416
3417
Spotter considerations 3418
Spotter starting position: 3419
For this and later curb-handling and stairs skills, a spotter strap is of little use if a 3420
sideways tip or fall occurs. 3421
If using a single spotter, he/she should be behind the wheelchair, with both hands 3422
close to the push-handles (if any) or close to the backrest components to best 3423
guard against a sideways tip if one wheel goes up the curb before the other. If 3424
there are no push-handles, some other fixed portion of the wheelchair or the 3425
wheelchair user may be used. 3426
If using two spotters (as is recommended), the second spotter should stand to one 3427
side of the level change. 3428
Risks requiring spotter intervention: 3429
Rear tip when accelerating to pop casters from surface (if a manual wheelchair). 3430
Forward tip or fall if the casters strike the curb. 3431
Sideways tip if one wheel gets up onto the upper level before the other. 3432
3433
Equipment 3434
Path on a smooth level surface that is at least 1.5 m wide and at least 3 m long before the 3435
curb (for subjects who use a moving approach). The pathway on the upper level leading 3436
away from the curb edge should be at least 1.5 m wide and at least 1.5 m long. 3437
The curb should be 5 cm high. 3438
The nosing of the curb should be gently rounded. 3439
Bracing a simulated curb (e.g. a wooden platform or folded table) against a solid object 3440
(e.g. a wall) or weighting it is usually needed to prevent it from moving when it is struck 3441
by the wheelchair. 3442
3443
Starting positions 3444
100
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Wheelchair: All wheels are on the level surface below the curb, facing the curb and at 3445
least 1.5 m from it. 3446
3447
Instructions to subject 3448
Optional screening questions: “Can you…?” 3449
“Get the wheelchair up on the curb.” 3450
3451
Capacity scoring criteria 3452
“Advanced pass”: As for the general scoring criteria. 3453
A moving approach to the obstacle is used. 3454
“Pass”: As for the general scoring criteria. 3455
The task is complete when all wheels are on the upper surface, with the 3456
wheelchair user seated upright in the wheelchair. 3457
The subject may remove the footrests and reposition the rear anti-tip devices 3458
but must do so independently. 3459
The wheelchair user may get out of the wheelchair to accomplish the task. 3460
Curb-climbing aids may be used if the wheelchair is equipped with these 3461
devices, but the subject must be able to activate and inactivate the aids 3462
independently. 3463
“Partial pass”: As for the general scoring criteria. 3464
If moving forward, the subject gets the casters, but not the rear wheels, up 3465
onto the upper level. 3466
If moving backward, the subject gets the rear wheels, but not the casters, up 3467
onto the upper level. 3468
The subject successfully ascends a smaller level change (e.g. 2.5 cm high), if 3469
one is available. 3470
“Fail”: As for the general scoring criteria. 3471
“Not possible”: This score is not an option for this skill. 3472
“Testing error”: As for the general scoring criteria. 3473
Comments recorded: As for general scoring criteria. 3474
3475
Special considerations for caregivers 3476
As for the “gets over obstacle” skill. 3477
If a caregiver uses poor ergonomic technique (e.g. lifting rather than rolling the 3478
wheelchair up onto the upper level), no more than a pass score should be awarded. 3479
3480
Special considerations for manual wheelchairs 3481
As for the “gets over obstacle” skill. 3482
3483
Special considerations for powered wheelchairs 3484
As for the “gets over obstacle” skill. 3485
3486
101
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.25 DESCENDS LOW CURB 3487
3488
Versions applicable 3489
Manual wheelchair: (skill #23) 3490
Powered wheelchair: (skill #24) 3491
3492
Description 3493
The subject gets the wheelchair down a low curb. 3494
3495
Rationale 3496
As for the “ascends low curb” skill. 3497
3498
Prerequisites 3499
None. 3500
3501
Spotter considerations 3502
Spotter starting position: 3503
If the wheelchair user uses the forward direction, simply rolling off the low curb, 3504
the spotter may simply stand on the lower level close enough to intervene if the 3505
wheelchair tips forward or the wheelchair user falls from the wheelchair. 3506
If the task is performed forward in the wheelie position, the spotter should be behind 3507
the wheelchair, with one hand close to each push-handle (if a manual wheelchair) to 3508
best avoid a sideways tip if one wheel descends before the other. If a second spotter 3509
is available, he/she should be on the lower level. 3510
If the wheelchair user uses the backward technique, the spotter should be standing 3511
on the lower level with the hands positioned near the push-handles (if a manual 3512
wheelchair). 3513
Risks requiring spotter intervention: 3514
Forward tip or fall from the wheelchair if the task is performed by rolling forward off 3515
the curb. 3516
Rear tip if performed in the backward direction. 3517
Rear tip if performed forward in the wheelie position. 3518
Sideways tip if one wheel drops off the upper level before the other. 3519
3520
Equipment 3521
As for the “ascends low curb” skill except, because many subjects can descend level 3522
changes from a higher level than they can ascend, some alternative means (e.g. an 3523
incline) of getting to the upper level is recommended. 3524
3525
Starting positions 3526
Wheelchair: All wheels are on the level surface above the curb edge, facing the edge, 3527
with the leading wheels at least 0.5 m away from it. 3528
3529
Instructions to subject 3530
Optional screening questions: “Can you…?” 3531
102
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Get the wheelchair down to the lower level.” 3532
3533
Capacity scoring criteria 3534
“Advanced pass”: As for the general scoring criteria. 3535
Descending forward in the wheelie position or using the moving transient-3536
caster-pop technique generally warrant an advanced-pass score but these 3537
methods are not necessary for this score. 3538
“Pass”: As for the general scoring criteria. 3539
The task is complete when all wheels are on the lower level, the wheelchair 3540
user is seated upright in the wheelchair and the wheelchair is free to roll away 3541
(i.e. not hung up on the footrests or rear anti-tip devices). 3542
The wheelchair user may get out of the wheelchair to accomplish the task. 3543
The subject may remove the footrests and reposition the rear anti-tip devices 3544
but must be able to do so independently. 3545
“Partial pass”: As for the general scoring criteria. 3546
The subject successfully descends a smaller level change (e.g. 2.5 cm high), if 3547
one is available. 3548
“Fail”: As for the general scoring criteria. 3549
“Not possible”: This score is not an option for this skill. 3550
“Testing error”: As for the general scoring criteria. 3551
Comments recorded: As for general scoring criteria. 3552
3553
Special considerations for caregivers 3554
A caregiver of a manual wheelchair user may request assistance from the wheelchair user 3555
during this skill if performed in the backward direction, in the form of having the 3556
wheelchair user lean forward then backward at the caregiver’s direction, to facilitate the 3557
different stages of the skill. 3558
3559
103
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.26 ASCENDS HIGH CURB 3560
3561
Versions applicable 3562
Manual wheelchair: (skill #24) 3563
Powered wheelchair: X 3564
3565
Description 3566
The subject ascends a high curb. 3567
3568
Rationale 3569
As for the “ascends low curb” skill. Although curb cuts (“pedestrian ramps”) are now 3570
commonplace in many parts of the world, curbs or large level changes are still commonly 3571
encountered. This skill is not applicable for most powered wheelchairs and scooters 3572
because of the difficulty and danger involved. 3573
3574
Prerequisites 3575
“Ascends low curb” skill. 3576
3577
Spotter considerations 3578
As for the “ascends low curb” skill. 3579
3580
Equipment 3581
As for the “ascends low curb” skill except the curb is 15 cm high. 3582
3583
Starting positions 3584
As for the “ascends low curb” skill. 3585
3586
Instructions to subject 3587
Optional screening questions: “Can you…?” 3588
“Get the wheelchair up on the curb.” 3589
3590
Capacity scoring criteria 3591
“Advanced pass”: As for the general scoring criteria. 3592
As for the “ascends low curb” skill. 3593
“Pass”: As for the general scoring criteria. 3594
As for the “ascends low curb” skill. 3595
“Partial pass”: As for the general scoring criteria. 3596
As for the “ascends low curb” skill. 3597
The subject successfully performs the skill using a 10 cm curb (if one is 3598
available). 3599
“Fail”: As for the general scoring criteria and the “ascends low curb” skill. 3600
An automatic “fail” score should be awarded if the subject has failed the 3601
“ascends low curb” skill. 3602
“Not possible”: This score is not an option for this skill. 3603
“Testing error”: As for the general scoring criteria. 3604
104
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Comments recorded: As for general scoring criteria. 3605
3606
Special considerations 3607
As for the “ascends low curb” skill. 3608
3609
105
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.27 DESCENDS HIGH CURB 3610
3611
Versions applicable 3612
Manual wheelchair: (skill #25) 3613
Powered wheelchair: X 3614
3615
Description 3616
The subject gets the wheelchair down a high curb. 3617
3618
Rationale 3619
As for the “descends low curb” skill. The appropriate technique for a high curb differs in 3620
some respects from that used for a lower curb height. The high-curb skill is not applicable 3621
for most powered wheelchairs and scooters because of the difficulty and danger involved. 3622
3623
Prerequisites 3624
“Descends low curb” skill. 3625
3626
Spotter considerations 3627
Spotter starting position: 3628
As for the “descends high curb” skill. 3629
Risks requiring spotter intervention: 3630
As for the “descends high curb” skill. 3631
3632
Equipment 3633
As for “ascends high curb” skill. 3634
3635
Starting positions 3636
Wheelchair: The leading wheels at least 0.5 m from the curb edge. 3637
3638
Instructions to subject 3639
Optional screening questions: “Can you…?”, “How?” If a method is described that the 3640
tester has concerns about, from the perspective of being able to spot the skill in a manner 3641
that is safe for both the subject and test personnel, the tester may allow the subject to 3642
choose another method without penalty. 3643
“Get the wheelchair down the curb.” 3644
3645
Capacity scoring criteria 3646
“Advanced pass”: As for the general scoring criteria. 3647
As for the “descends low curb” skill. 3648
“Pass”: As for the general scoring criteria. 3649
As for the “descends low curb” skill. 3650
“Partial pass”: As for the general scoring criteria. 3651
As for the “descends low curb” skill. 3652
The subject successfully performs the skill using a 10 cm curb (if one is 3653
available). 3654
106
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Fail”: As for the general scoring criteria. 3655
A “fail” score should be automatically awarded if the subject fails the 3656
“descends low curb” skill. 3657
“Not possible”: This score is not an option for this skill. 3658
“Testing error”: As for the general scoring criteria. 3659
Comments recorded: As for general scoring criteria. 3660
3661
Special considerations for caregivers 3662
Serious jarring can occur if a caregiver attempts to bring the wheelchair off the curb 3663
backward in the wheelie position. The tester or trainer should intervene and award a fail 3664
score. 3665
3666
107
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.28 PERFORMS WHEELCHAIR-GROUND TRANSFERS 3667
3668
Versions applicable 3669
Manual wheelchair: (skill #26) 3670
Powered wheelchair: (skill #25) 3671
3672
Description 3673
The wheelchair user gets from the wheelchair to the ground and back. 3674
3675
Rationale 3676
Getting to and from the ground is useful for an activity (e.g. gardening or playing with a 3677
child). Getting from the ground back into the wheelchair can also be helpful when 3678
recovering from a tip or fall. 3679
3680
Prerequisites 3681
“Performs level transfers” skill. 3682
3683
Spotter considerations 3684
Spotter starting position: 3685
If there is a single spotter, he/she should be near the wheelchair, in a position to 3686
prevent the wheelchair from tipping over and to prevent the subject from falling to the 3687
ground. 3688
If two spotters are used, one spotter should focus on the wheelchair user and the other 3689
spotter on preventing the wheelchair from sliding or rolling away. However, the 3690
second spotter should not touch the wheelchair unless it is necessary to intervene. 3691
Risks requiring spotter intervention: 3692
Rear, forward or sideways tip or fall. 3693
3694
Equipment 3695
Smooth level surface. It is permissible to use a thin cushioned mat on the floor to protect 3696
the skin and to avoid soiling the clothes. 3697
3698
Starting positions 3699
Wheelchair user: 3700
Seated in the wheelchair, facing the mat (if any). 3701
Once on the ground, the subject may be seated in whatever position he/she chooses 3702
on completion of the initial transfer to the ground. 3703
3704
Instructions to subject 3705
Optional screening questions: “Can you…?” 3706
If the tester has doubts about the ability of the subject to perform this skill, he may wish 3707
to ensure that enough assistance or equipment is available to assist the subject back into 3708
the wheelchair. 3709
“Get yourself onto the ground.” 3710
“Now, get back into the wheelchair.” 3711
108
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
3712
Capacity scoring criteria 3713
“Advanced pass”: As for the general scoring criteria. 3714
“Pass”: As for the general scoring criteria. 3715
The transfer to the floor is complete when the subject is seated on the floor, on 3716
a mat (if provided) or on his/her own cushion if it has been removed. 3717
The transfer back into the wheelchair is complete when the subject is on the 3718
wheelchair seat, ready to roll away. If the subject removes the seat cushion as 3719
part of his/her technique, it is required that the cushion be picked up but it is 3720
not necessary to get the cushion back under the buttocks. This is in 3721
recognition that the wheelchair user is usually able to go to another sitting 3722
surface and transfer out of the wheelchair to replace the cushion. 3723
No external aids (e.g. the transfer bench, stairs or a lift) may be used. 3724
“Partial pass”: As for the general scoring criteria. 3725
The subject can get to the ground, but not back into the wheelchair, or vice 3726
versa. 3727
“Fail”: As for the general scoring criteria. 3728
An automatic fail score is awarded if the subject failed the “performs level 3729
transfers” skill. 3730
The subject does not describe a safe and effective method. 3731
“Not possible”: This is not an option for this skill. 3732
“Testing error”: As for the general scoring criteria. 3733
Comments recorded: As for general scoring criteria. 3734
3735
Special considerations for caregivers 3736
The caregiver may receive assistance from the wheelchair user in performing the skill. It 3737
is not a reasonable expectation that a single caregiver could carry out this skill alone. 3738
3739
Special considerations for powered wheelchairs 3740
If the powered wheelchair has positioning options (e.g. seat-height variation), they may 3741
be used. 3742
3743
109
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.29 PERFORMS STATIONARY WHEELIE 3744
3745
Versions applicable 3746
Manual wheelchair: (skill #27) 3747
Powered wheelchair: X 3748
3749
Description 3750
The subject achieves the wheelie position (balancing on the rear wheels), maintains it for 3751
a period of time and brings the casters back to the floor. 3752
3753
Rationale 3754
The stationary wheelie is a foundation skill for a number of functional skills that can be 3755
best performed in the wheelie position, skills such as descent of a steep incline or descent 3756
of a high curb. The stationary wheelie position can also be used to avoid postural 3757
problems that can cause neck strain from looking up. This skill is not applicable for most 3758
powered wheelchairs and scooters. 3759
3760
Prerequisites 3761
None. 3762
3763
Spotter considerations 3764
Spotter starting position: 3765
Usually the spotter stands behind the wheelchair holding onto a spotter strap. 3766
The skill can also be spotted from a sitting or crouching position in front of and to 3767
one side of the wheelchair, with a hand ready to apply a downward and backward 3768
force to the wheelchair user’s knee or a fixed part of the wheelchair. 3769
Risks requiring spotter intervention: 3770
Rear tip if the subject overshoots on take-off or loses balance. 3771
3772
Equipment 3773
As for the “turns in place” skill. 3774
Means (e.g. a tape measure) of measuring distance. 3775
3776
Starting positions 3777
Wheelchair: As for the “turns in place” skill. 3778
3779
Instructions to subject 3780
Optional screening questions: “Can you…?” 3781
“Get the wheelchair into the wheelie position and hold it until I tell you to stop. Keep the 3782
wheelchair as close to the starting position as possible (indicate the lines)." 3783
After 30s, "Come down now.” 3784
3785
Capacity scoring criteria 3786
“Advanced pass”: As for the general scoring criteria. 3787
“Pass”: As for the general scoring criteria. 3788
110
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
The subject achieves the wheelie position and holds this position in a 3789
controlled manner for ≥ 30 seconds. 3790
After 30 s, a controlled return to the upright position is made. The subject 3791
must wait for the instruction to bring the casters back to the floor before doing 3792
so. 3793
It is permissible to use the feet to achieve the wheelie position but not to 3794
maintain it. 3795
“Partial pass”: As for the general scoring criteria. 3796
The subject achieves the wheelie position and holds this position in a 3797
controlled manner for ≥ 15 seconds. 3798
The subject performs an aided-wheelie (casters off the floor, balanced on rear 3799
anti-tip devices). 3800
“Fail”: As for the general scoring criteria. 3801
The subject does not achieve the wheelie position. 3802
The subject achieves the wheelie position but holds it for < 15 sec. 3803
“Not possible”: This score is not an option for this skill. 3804
“Testing error”: As for the general scoring criteria. 3805
Comments recorded: The direction and extent (if > 0.5 m) of any horizontal displacement 3806
between the starting point and the rear-wheel axles after landing from the wheelie 3807
position. 3808
3809
Special considerations for caregivers 3810
There is no need for a caregiver to maintain the wheelie for 30 s as long as the tester is 3811
satisfied that the caregiver has achieved the balance position correctly and is capable of 3812
maintaining it. 3813
3814
111
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.30 TURNS IN PLACE IN WHEELIE POSITION 3815
3816
Versions applicable 3817
Manual wheelchair: (skill #28) 3818
Powered wheelchair: X 3819
3820
Description 3821
In the wheelie position, the subject turns the wheelchair around to the left and right to 3822
face in the opposite direction, in as tight a space as possible. 3823
3824
Rationale 3825
As for the “turns in place” skill. 3826
Wheelchair users often encounter situations in which they need to perform a wheelie to 3827
make a tight turn. The area needed on the support surface (the “footprint”) is less in the 3828
wheelie position than when all wheels are on the surface. 3829
3830
Prerequisites 3831
“Performs stationary wheelie” skill. 3832
3833
Spotter considerations 3834
As for the “performs stationary wheelie” skill. 3835
3836
Equipment 3837
As for the “turns in place” skill. 3838
3839
Starting positions 3840
As for the “turns in place” skill. 3841
3842
Instructions to subject 3843
Optional screening questions: “Can you…?” 3844
“Get the wheelchair into the wheelie position.” 3845
“Keeping the wheelchair in as tight a space as possible, turn the wheelchair around until 3846
you are facing in the opposite direction.” 3847
If necessary, the wheelchair is repositioned over the starting position. 3848
“Now turn the chair in the other direction (indicate it) until it is back where you started.” 3849
3850
Capacity scoring criteria 3851
“Advanced pass”: As for the general scoring criteria. 3852
As for the “turns in place” skill. 3853
“Pass”: As for the general scoring criteria. 3854
As for the “turns in place” skill. 3855
The wheelchair must be kept in the wheelie position throughout the turn. 3856
The casters may be returned to the floor between the turns to the left and right. 3857
“Partial pass”: As for the general scoring criteria. 3858
As for the “turns in place” skill. 3859
112
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Fail”: As for the general scoring criteria. 3860
As for the “turns in place” skill. 3861
An automatic “fail” score is awarded if the subject fails the “performs 3862
stationary wheelie” skill. 3863
“Not possible”: This score is not an option for this skill. 3864
“Testing error”: As for the general scoring criteria. 3865
Comments recorded: As for the “turns in place” skill. 3866
3867
Special considerations 3868
The caregiver’s feet should be considered equivalent to a wheel touching the ground for 3869
the purpose of measuring any dimensions. 3870
3871
113
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.31 ROLLS FORWARD AND BACKWARD IN WHEELIE POSITION 3872
3873
Versions applicable 3874
Manual wheelchair: (skill #29) 3875
Powered wheelchair: X 3876
3877
Description 3878
The wheelchair user achieves the wheelie position, and then moves the wheelchair forward 3879
(and later backward) a short distance in this position. 3880
3881
Rationale 3882
Moving forward in the wheelie position is useful when approaching obstacles for which it 3883
is advantageous to have the casters off the surface (e.g. for the descent of high curbs or 3884
the descent of steep inclines). Moving backward in the wheelie position is useful in tight 3885
spaces, where it is not possible to turn around, for instance to raise the casters over an 3886
obstacle (e.g. a stick on the ground or a towel on a bathroom floor). Also, the backward 3887
skill allows the wheelchair user to ease up to a wall or object against which he/she can 3888
lean (i.e. for the tilt-rest variation of the “relieves pressure from buttocks” skill). 3889
3890
Prerequisites 3891
The “performs stationary wheelie” skill. 3892
3893
Spotter considerations 3894
As for the “performs stationary wheelie” skill. 3895
3896
Equipment 3897
A smooth level surface, 2 m long and at least 1.5 m wide. 3898
Starting and finish lines at 0 and 2 m. The finish line for the forward component of the 3899
skill can function as the starting line for the backward component. 3900
Space at least 1.5 m before the starting line and beyond the finish line. 3901
Note: The floor markings for the “turns in place” skill can be used. 3902
3903
Starting positions 3904
Wheelchair: The wheelchair user is seated in the wheelchair with the leading wheels 3905
behind the starting line. The casters are the leading wheels for the forward component of 3906
the skill and the rear wheels are the leading wheels for the backward component. 3907
3908
Instructions to subject 3909
Optional screening questions: “Can you…?” 3910
“Get into the wheelie position and push the wheelchair straight forward until I ask you to 3911
stop.” After crossing the finish line, “Stop.” 3912
After the subject completes the skill attempt in the forward direction, the tester repeats 3913
the test in the backward direction. 3914
3915
Capacity scoring criteria 3916
“Advanced pass”: As for the general scoring criteria. 3917
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
“Pass”: As for the general scoring criteria. 3918
The subject is required to achieve the wheelie position and travel 2 m in both 3919
directions. 3920
The subject should come to a stop at or beyond the finish line, at the tester’s 3921
command, before allowing the casters to touch the floor. 3922
The subject may bring the casters back to the floor between the forward and 3923
backward skills, but need not do so. 3924
“Partial pass”: As for the general scoring criteria. 3925
The subject performs the skill successfully in one direction, but not the other. 3926
The subject can perform the skill in both directions for ≥ 1.0 m. 3927
“Fail”: As for the general scoring criteria. 3928
An automatic fail score should be awarded if the subject has failed the 3929
“stationary wheelie” skill. 3930
“Not possible”: This score is not an option for this skill. 3931
“Testing error”: As for the general scoring criteria. 3932
Comments recorded: As for general scoring criteria. 3933
3934
Special considerations 3935
None. 3936
3937
115
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.32 DESCENDS HIGH CURB IN WHEELIE POSITION 3938
3939
Versions applicable 3940
Manual wheelchair: (skill #30) 3941
Powered wheelchair: X 3942
3943
Description 3944
In the wheelie position, the subject descends a high curb in the forward direction. 3945
3946
Rationale 3947
Large level changes (e.g., curbs) are common obstacles for wheelchair users. Using a 3948
wheelie to descend a level change in the forward direction allows the wheelchair user to 3949
maintain forward movement and to see any dangers that lie ahead. Also, the wheelie 3950
position prevents the footrests from making contact with the lower level, which can 3951
decelerate the wheelchair and cause a forward tip or fall from the wheelchair. 3952
3953
Prerequisites 3954
“Performs stationary wheelie” skill. 3955
3956
Spotter considerations 3957
Spotter starting position: 3958
For a single spotter behind the wheelchair, both of the spotter’s hands should be placed 3959
near the push-handles of the wheelchair. 3960
If using two spotters, as is recommended, the spotter behind the wheelchair should 3961
have his/her hands near the push-handles and the second spotter should stand beside 3962
and below the curb. 3963
Risks requiring spotter intervention: 3964
Rear tip. 3965
Forward tip or fall. 3966
Sideways tip if one wheel drops off the upper level before the other. 3967
3968
Equipment 3969
As for the “descends high curb” skill. 3970
3971
Starting positions 3972
As for the “descends high curb” skill. 3973
3974
Instructions to subject 3975
Optional screening questions: “Can you…?” 3976
“Get your wheelchair into the wheelie position.” 3977
“Now, staying in the wheelie position, move forward down the curb under control.” 3978
3979
Capacity scoring criteria 3980
“Advanced pass”: As for the general scoring criteria. 3981
“Pass”: As for the general scoring criteria. 3982
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
The subject achieves a controlled wheelie on the upper level, approaches the 3983
curb by moving forward in this position and then lowers the rear wheels to the 3984
lower level under control with the rear wheels striking the floor before the 3985
casters. 3986
“Partial pass”: As for the general scoring criteria. 3987
The subject performs the skill on a 10 cm curb, if one is available. 3988
“Fail”: As for the general scoring criteria. 3989
An automatic fail score should be awarded if the subject has failed the 3990
“performs stationary wheelie” skill. 3991
“Not possible”: This score is not an option for this skill. 3992
“Testing error”: As for the general scoring criteria. 3993
Comments recorded: As for general scoring criteria. 3994
3995
Special considerations 3996
None. 3997
3998
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.33 DESCENDS STEEP INCLINE IN WHEELIE POSITION 3999
4000
Versions applicable 4001
Manual wheelchair: (skill #31) 4002
Powered wheelchair: X 4003
4004
Description 4005
In the wheelie position, the subject moves the wheelchair from a level surface down a 4006
steep incline to another level surface, stopping part way. 4007
4008
Rationale 4009
Descending a steep incline in the forward direction in the wheelie position lessens the 4010
problem of loss of traction (affecting braking and control) when the uphill wheels 4011
become unloaded. This technique also reduces the likelihood of forward tips or digging 4012
the footrests into the floor at the transition between the bottom of the incline and the level 4013
surface. For very steep inclines, this technique may be the only way to get down the 4014
incline without tipping over. Stopping part-way down the incline demonstrates control. 4015
4016
Prerequisites 4017
“Performs stationary wheelie” skill. 4018
4019
Spotter considerations 4020
As for “descends steep incline”. 4021
4022
Equipment 4023
As for “descends steep incline”. 4024
4025
Starting positions 4026
As for “descends steep incline”. 4027
4028
Instructions to subject 4029
Optional screening questions: “Can you…?” 4030
“Get your wheelchair into the wheelie position.” 4031
“Now, staying in the wheelie position, move the wheelchair down the ramp under control, 4032
stopping about half-way down.” 4033
After the stop: “Carry on to the bottom and and stop when you are off the ramp.” 4034
4035
Capacity scoring criteria 4036
“Advanced pass”: As for the general scoring criteria. 4037
As for “descends steep incline” skill. 4038
“Pass”: As for the general scoring criteria. 4039
The subject achieves the wheelie position on the platform above the incline, 4040
proceeds down the incline with the wheelchair under control. 4041
The subject brings the wheelchair to a stop about half-way down the incline and 4042
at the bottom of the ramp. The casters may be brought to the surface as soon as 4043
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the rear wheels have reached the level surface at the bottom. 4044
“Partial pass”: As for the general scoring criteria. 4045
The subject proceeds at least 2 m down the incline. 4046
The subject successfully performs the skill on a slight incline (5º). 4047
“Fail”: As for the general scoring criteria. 4048
An automatic “fail” score should be awarded if the subject fails the “performs 4049
stationary wheelie” skill. 4050
“Not possible”: This score is not an option for this skill. 4051
“Testing error”: As for the general scoring criteria. 4052
Comments recorded: As for general scoring criteria. 4053
4054
Special considerations 4055
None. 4056
4057
119
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
5.34 ASCENDS STAIRS 4058
4059
Versions applicable 4060
Manual wheelchair: (skill #32) 4061
Powered wheelchair: X 4062
4063
Description 4064
The wheelchair user and the wheelchair get from the bottom of a set of stairs to the top. 4065
4066
Rationale 4067
Although alternative means of getting from a lower to a higher level are often present 4068
(e.g. using a ramp or elevator), stairs may sometimes be the only option. Although 4069
exceptional manual wheelchair users can accomplish this skill alone while sitting in the 4070
wheelchair, this method is not recommended due to the ergonomic stresses on the arms 4071
involved. Getting out of the wheelchair or using caregivers to assist with stair ascent is a 4072
more reasonable approach. Stair ascent is not generally applicable to powered 4073
wheelchairs and scooters. 4074
4075
Prerequisites 4076
None. 4077
4078
Spotter considerations 4079
Spotter: 4080
The spotter considerations vary depending upon the method used and the 4081
number of spotters available. 4082
Regardless of the method used, at least one spotter should be below the 4083
wheelchair user on the stairs. 4084
If the wheelchair user is in the wheelchair, the spotter below the wheelchair 4085
should use one or both hands near or holding a fixed part of the wheelchair. If 4086
holding a wheelchair part, it is important to avoid assisting or interfering with 4087
the performance of the task unless deliberately intervening. 4088
If the wheelchair user is in the wheelchair and two spotters are available, one 4089
should be above (with the hands near the push-handles) and one below the 4090
wheelchair. 4091
Risks requiring spotter intervention: 4092
Forward or rear tip or fall. 4093
Runaway down the stairs. 4094
4095
Equipment 4096
In describing a set of stairs, one refers to the horizontal and vertical dimensions as the 4097
“run” and “rise” respectively. 4098
There should be at least 3 stairs, each with the following approximate dimensions – 18 4099
cm rise, 28 cm run and width of at least 1.2 m. Although 3 stairs are not many, they are 4100
representative of the skills needed for a full flight of steps (10-11). 4101
Rails should be available on both sides, at a height above the steps of about 90 cm. The 4102
120
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
rails should extend horizontally beyond the upper and lower stair boundaries by 30 cm or 4103
more. 4104
The set of stairs should end at the upper end on a level surface or platform that is at least 4105
2 m2. A lip around the open edges of the platform is recommended. 4106
No external aids (e.g. stair lift) may be used. 4107
4108
Starting positions 4109
Wheelchair: Facing the stairs at least 0.5 m from the bottom stair. 4110
4111
Instructions to subject 4112
Optional screening questions: “Can you…?” 4113
“Get yourself and the wheelchair up the stairs.” 4114
4115
Capacity scoring criteria 4116
“Advanced pass”: As for the general scoring criteria. 4117
“Pass”: As for the general scoring criteria. 4118
Any effective and safe technique is performed, as long as at least 3 stairs are 4119
completed with the wheelchair user and wheelchair coming to rest on the level 4120
surface above the stairs. If the subject uses the “out-of-wheelchair” method, 4121
he/she does not need to get back into the wheelchair because this is tested 4122
elsewhere (in the “performs wheelchair-ground transfers” skill). 4123
“Partial pass”: As for the general scoring criteria. 4124
The subject successfully ascends ≥ 2 stairs. 4125
The subject successfully ascends a set of stairs with longer runs and/or lower 4126
rises. 4127
“Fail”: As for the general scoring criteria. 4128
“Not possible”: This score is not an option for this skill. 4129
“Testing error”: As for the general scoring criteria. 4130
Comments recorded: As for general scoring criteria. 4131
4132
Special considerations for caregivers 4133
The caregiver may receive assistance from the wheelchair user in performing the skill. 4134
4135
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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5.35 DESCENDS STAIRS 4136
4137
Versions applicable 4138
Manual wheelchair: (skill #33) 4139
Powered wheelchair: X 4140
4141
Description 4142
The wheelchair user and the wheelchair get from the top of a set of stairs to the bottom. 4143
4144
Rationale 4145
As for the “ascends stairs” skill. Although there is still a potential for injury due to a fall, 4146
descent is much less strenuous than ascent. Many wheelchair users who cannot ascend stairs 4147
independently can descend them. The stair descent skill is not generally applicable to 4148
powered wheelchairs and scooters. 4149
4150
Prerequisites 4151
None. 4152
4153
Spotter considerations 4154
Spotter starting position: 4155
As for the “ascends stairs” skill. 4156
If the wheelchair user is proceeding independently down the stairs in the backward 4157
direction, the spotter should be behind the wheelchair with the hands near the push-4158
handles. 4159
If the wheelchair user is proceeding independently down the stairs in the forward 4160
direction in the wheelie position, at least two spotters should be involved. One or two 4161
spotters should be below the wheelchair with the hands near a fixed front part of the 4162
wheelchair to resist tipping or runaway. The uphill spotter should be above the 4163
wheelchair with the hands near the push-handles to react to forward, backward or 4164
sideways tips, or runaway. 4165
Risks requiring spotter intervention: 4166
Forward, rear or sideways tip or fall. 4167
Runaway down the stairs. 4168
4169
Equipment 4170
As for the “ascends stairs” skill. 4171
Because it is often possible to descend stairs that cannot be ascended, an alternative means 4172
(e.g. a ramp or lift) should be available to get the wheelchair and user to the top of the stairs. 4173
4174
Starting positions 4175
Wheelchair: Facing the top of the stairs, with the leading wheels at least 0.5 m from the edge 4176
of the top stair. 4177
4178
Instructions to subject 4179
Optional screening questions: “Can you…?”, “How?” The tester needs to know what method 4180
122
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the subject plans to use in order to approve the attempt and to position the spotter(s). 4181
“Get yourself and the wheelchair down the stairs.” 4182
4183
Capacity scoring criteria 4184
“Advanced pass”: As for the general scoring criteria. 4185
As for the “ascends stairs” skill. 4186
“Pass”: As for the general scoring criteria. 4187
As for the “ascends stairs” skill. 4188
“Partial pass”: As for the general scoring criteria. 4189
As for the “ascends stairs” skill. 4190
The subject successfully descends ≥ 2 stairs. 4191
The subject successfully descends a set of stairs with longer runs and/or lower 4192
rises. 4193
“Fail”: As for the general scoring criteria. 4194
“Not possible”: This score is not an option for this skill. 4195
“Testing error”: As for the general scoring criteria. 4196
If it is not possible to get the wheelchair to the top of the stairs. 4197
Comments recorded: As for general scoring criteria. 4198
4199
Special considerations for caregivers 4200
The caregiver may receive assistance from the wheelchair user in performing the skill. 4201
4202
123
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
CHAPTER 6. THE WHEELCHAIR SKILLS TEST QUESTIONNAIRE (WST-Q) 4203
4204
The relationship between the WST and the WST-Q has been reported in the literature (see 4205
http://www.wheelchairskillsprogram.ca/eng/publications.php). The correlation between the 4206
total WST and WST-Q capacity scores has been found to be high, although the WST-Q 4207
scores tend to be slightly higher. The WST and WST-Q each have advantages and 4208
limitations, summarized in Table 6.1. 4209
4210
Table 6.1 Comparison of WST and WST-Q 4211
Consideration WST WST-Q
Time to administer ~30 minutes ~10 minutes
Obstacles needed Yes No
Space needed ~1000 square feet None
Induces a training effect Probable (~5%) None known
Can assess capacity (can do) Yes Yes
Can assess confidence No Yes
Can assess performance (does do) No Yes
Simulated vs. real setting Simulated usually Real
Affected by missing test equipment Yes No
Likelihood of lowered score due to a testing
technicality
Occasional None
Degree of specificity of settings High Low
Possibility of a testing error Occasional Rare
Can be administered by phone No Yes
Can be administered by mailed
questionnaire
No Yes
Can be administered on-line No Yes
Can be completed by a proxy No Yes
Requires ability to follow instructions Yes No
Requires ability to communicate No Yes (unless proxy)
Potential to misrepresent functional level Low Slightly greater
Provides detail about how the skills are
performed
Yes No
Risk of injury Minimal None
Total scores Slightly lower Slightly higher
4212
The advantages of the WST-Q include that it requires less time, equipment and space to 4213
perform, it does not appear to induce much of a training effect (like the WST may do), it 4214
avoids a training-to-the-test effect, it allows one to assess confidence and performance as 4215
well as capacity (in the terms of the International Classification of Functioning, Disability, and 4216
Health [ICF]), it is more realistic (relating as it does to the subject’s own setting), it is not 4217
subject to limitations due to missing test equipment (e.g. a 15 cm curb) at the time of testing, 4218
subjects are not likely to receive a lower score due to a testing technicality (e.g. a wheel 4219
slightly over a line), the settings are less specifically defined and the WST-Q may be the only 4220
option for situations in which objective testing is impractical or impossible (e.g. during 4221
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
telephone interviews). The WST-Q can be administered by phone, postal questionnaire or on-4222
line. It can be completed by a proxy. There is no risk of injury. 4223
4224
The limitations of the WST-Q are that the tester must rely on the subject’s ability to 4225
understand the questions and to communicate valid answers. This limitation can be offset by 4226
having a proxy (e.g. a caregiver) who knows the subject well or a translator assist in 4227
providing the answers. There is potential for the subject to overestimate or underestimate 4228
his/her capacity and performance. The WST-Q does not provide any detail about how the 4229
skills are performed, limiting its usefulness as a guide to intervention (e.g. by altering the 4230
wheelchair set-up or by training). 4231
4232
The complementary benefits of the WST and WST-Q can be captured by using them in 4233
combination. When doing so, the relevant WST-Q questions for each skill are asked first, 4234
then the subject demonstrates the skill (WST) before moving on to the next skill. 4235
4236
6.1 Indications 4237
4238
As for the WST, for clinical purposes, the WST-Q can be used early in the course of a 4239
rehabilitation program as a diagnostic measure, especially to determine which (if any) skills 4240
might be addressed during the rehabilitation process. By repeating the test on completion of the 4241
rehabilitation phase (or later during follow-up), the WST-Q can be used as an outcome 4242
measure. The WST-Q may also be used for program evaluation, to answer research questions 4243
and to assist in wheelchair design. 4244
4245
6.2 Contraindications 4246
4247
The WST-Q is only valid if the subject (or proxy) is able to communicate. As a screening 4248
procedure, the tester should ask the potential subject about information (e.g. date of birth, 4249
diagnosis, length of time using a wheelchair and time up in the wheelchair each day) that can 4250
be confirmed by chart review, the nursing staff or family members. 4251
4252
6.3 Time Limits 4253
4254
There is no upper time limit for the WST-Q. Rests are permitted but are usually unnecessary 4255
because the average time to complete the WST is only about 10 minutes. If the testing is 4256
conducted on more than one day, the tester should document the dates. 4257
4258
6.4 General Scoring Template for WST-Q Individual Skill Questions 4259
4260
For individual skills, the initial question is about capacity. The capacity question, answer 4261
options and definitions are summarized in Table 6.2. A score for this question is mandatory 4262
for each skill. 4263
4264
4265
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Table 6.2. Capacity Question, Answer Options and Definitions for Each Skill 4266
Capacity question: “Can you do it?”
Answer Score What this means
Very well 3 Can do the skill safely and very well.
Yes 2 Can do the skill safely at a basic level.
Partially 1 Can do the skill in part.
No 0 Have never done the skill or could not do it right now.
Not possible
with this
wheelchair
NP The wheelchair does not have the parts to allow this skill.
(This option is only presented for skills where such a score is
a possibility.)
Testing error TE When answers have not been recorded (e.g. inadvertently or
because the test subject did not understand the question).
4267
The next question about each individual skill is about confidence. Confidence in one’s ability 4268
is an important determinant of the extent to which wheelchair skills are actually used in 4269
everyday life. A lack of confidence may be due to a fear of falling or other injury. The 4270
answer options and definitions are summarized in Table 6.3. The confidence questions are 4271
optional and may be skipped if an assessment of confidence is not one of the purposes of the 4272
questionnaire. 4273
4274
Table 6.3. Confidence Question, Answer Options and Definitions for Each Skill 4275
Confidence question: “How confident are you?”
Answer Score What this means
Very 3 As of now, I am very confident that I can do this skill safely and
consistently.
Moderately 2 As of now, I am moderately confident that I can do this skill safely
and consistently.
Partly 1 As of now, I am only partly confident that I can do this skill safely
and consistently.
Not at all 0 As of now, I am not at all confident that I can do this skill safely
and consistently.
Not
possible
with this
wheelchair
NP As for capacity.
Testing
error
TE As for capacity.
4276
If the answer to the capacity question for a skill is “no”, the score on the confidence question 4277
is automatically 0. If the score for capacity is NP, then NP is automatically the score for 4278
confidence. 4279
4280
The next question about each individual skill is about performance. The answer options and 4281
definitions are summarized in Table 6.4. The performance questions are optional and may be 4282
skipped if an assessment of performance is not one of the purposes of the questionnaire. 4283
4284
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Current edition: August 17, 2018
Table 6.4. Performance Question, Answer Options and Definitions for Each Skill 4285
Performance question: “How often do you do it?”
Answer Score What this means
Always 3 Always when I need or want to do so.
Usually 2 Usually when I need or want to, but sometimes not.
Occasionally 1 Occasionally when I need or want to, but often not.
Never 0 Never or less often than once a year.
Not possible
with this
wheelchair
NP As for capacity.
Testing error TE As for capacity.
4286
WST-Q performance is related to WST-Q capacity, but is also related to personal factors 4287
(e.g. age, confidence) and the environment (e.g. weather, architectural barriers, opportunity). 4288
Additionally, some skills (e.g. folding/unfolding the wheelchair or transferring to and from 4289
the ground) may not need to be performed frequently. Total capacity percentage scores tend 4290
to exceed total performance percentage scores. The converse could occur – for instance, if a 4291
subject had a number of skills for which the capacity scores were 2 but these skills were 4292
always performed when necessary. Also, if a wheelchair user had an acute injury (e.g. a 4293
fractured wrist), he/she might be unable to perform a skill currently that he/she had always 4294
performed in the past. However, there is no guarantee in such a circumstance that the 4295
wheelchair user will ever get back to the earlier level of performance. Therefore, for the 4296
purposes of the WST-Q, if the capacity score for an individual skill is 0, the performance 4297
score for that skill is also automatically 0. If the score for capacity is NP, then NP is 4298
automatically the score for performance. 4299
4300
As for the WST, at the beginning of the WST-Q, if it is decided by the tester or subject that 4301
one purpose of the WST-Q is to identify potential training goals then, before the assessment 4302
of individual skills, the subject is asked if there are any specific wheelchair skills on which 4303
he/she would be interested in receiving training. After the capacity, confidence and 4304
performance questions have been answered (regardless of the scores recorded) and if an 4305
assessment of training goals is one of the purposes of the assessment, the final question for 4306
each skill is about training goals. The goal question, answer options and definitions are 4307
summarized in Table 6.5. 4308
4309
Table 6.5. Training Goal Question, Answer Options and Definitions for Each Skill 4310
Question: “Is this a training goal?”
Possible Answers What This Means
Yes I am interested in receiving training for this skill.
No I am not interested in receiving training for this skill.
4311
On completion of the assessment of individual skills, the subject is asked if there are any 4312
other skills on which he/she would be interested in receiving training. 4313
4314
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6.5 Scoring Algorithm for Individual Skill Questions 4315
4316
The algorithm for the individual skill questions is shown in Figure 6.1. 4317
4318
4319
4320
4321
4322
4323
4324
4325
4326
4327
4328
4329
4330
4331
4332
4333
4334
4335
4336
4337
4338
4339
4340
4341
4342
4343
4344
4345
4346
4347
4348
Figure 6.1. Scoring algorithm for individual skill questions. 4349
4350
6.6 Calculated Scores 4351
4352
The total score for capacity that can be calculated from the WST-Q data is identical to that for 4353
the WST described earlier. Additionally, for the WST-Q, total confidence and performance 4354
scores can also be calculated as follows: 4355
4356
Total Confidence Score = sum of individual skill scores/([number of possible skills – 4357
number of NP scores – number of TE scores] x 3) X 100% 4358
4359
Possible percentage scores range from 0-100%. 4360
4361
How confident are you?
Scores of 0-3
How often do you do it?
Can you do it?
Is this a training goal?
Proceed to next skill
Not possible
with this
wheelchair
(NP)
Score 0 Scores of 1-3
Scores of 0-3
Yes or
no
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Current edition: August 17, 2018
Total Performance Score = sum of individual skill scores/([number of possible skills – 4362
number of NP scores – number of TE scores] x 3) X 100% 4363
4364
Possible percentage scores range from 0-100%. 4365
4366
As noted earlier, the calculated scores should not be used to predict the overall safety of 4367
using a wheelchair. Someone with a low total score may be very safe within his/her limits 4368
whereas someone with a high total score may be a risk-taker and more likely to get injured. 4369
However, the calculated scores can be helpful in comparing different time points (e.g. pre- 4370
vs. post-training), different wheelchairs or different populations (e.g. people with SCI vs. 4371
people with stroke). 4372
4373
6.7 Options for How the WST-Q May be Administered 4374
4375
There are a variety of acceptable ways in which the WST-Q can be administered and 4376
recorded. The WST-Q may be tester administered in-person or by telephone with the tester 4377
reading the questions and recording the answers. If a tester is involved, he/she may explain a 4378
question if it is not understood by the subject. The tester may also use follow-up questions to 4379
reassure him/herself about the validity of the answers provided (i.e. a semi-structured 4380
interview). 4381
4382
Alternatively the WST-Q may be self-administered (e.g. in a postal or on-line questionnaire) 4383
with the test subject or proxy reading the questions and recording the answers. For the paper 4384
version of the WST-Q, the person administering the questionnaire may record the answers 4385
either on the WST-Q script or on the WST-Q Report Form. 4386
4387
A computer-assisted version of the WST-Q for desk-top computers and tablets may become 4388
available (in development), links to which will be provided on the website. The tester or test 4389
subject records the answers on the computer or tablet. The advantages of this approach are 4390
that instances of missing data and transcription errors are minimized. Also, it requires less 4391
time to complete the WST-Q in this way because the computer uses the scoring algorithm 4392
automatically. 4393
4394
The WST-Q and WST can be administered together. As noted earlier, for each individual 4395
skill, the questions about capacity, confidence, performance and goals can be followed by a 4396
demonstration of that skill – “Can you do it? How confidently? How often? Show me how”. 4397
Alternatively, the full WST can be administered after the full WST-Q is completed. 4398
4399
6.8 WST-Q Report Form 4400
4401
There is one WST-Q Report Form for each of the two versions of the WST-Q. The WST-Q 4402
Report Form may be completed by hand or be generated by software. The completed WST-Q 4403
Report Form includes identifying data, the scores for individual skills, the calculated score(s), 4404
comments and the skills (if any) for which the subject would be interested in receiving training. 4405
4406
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CHAPTER 7. WHEELCHAIR SKILLS TRAINING 4407
4408
The WSTP represents our attempt to combine the best available evidence on motor skills 4409
learning (“process”) with the best available evidence on how to perform specific skills 4410
(“content”). 4411
4412
The optimum way to perform and teach each wheelchair skill may vary depending upon the 4413
characteristics of the learner, the wheelchair being used and the setting. However, the WSTP 4414
training protocol uses training methodology based on the literature. Research evidence 4415
regarding the safety and efficacy of WSTP training can be found at 4416
http://www.wheelchairskillsprogram.ca/eng/publications.php. Although much further study is 4417
needed, to date WSTP training has been found to be safe, practical and to result in 4418
significantly greater improvements in wheelchair skills than standard care. There is also 4419
research evidence in the literature for some of the specific skills (e.g. basic propulsion 4420
technique, transfers, inclines, curbs and wheelies), but not for all skills. 4421
4422
7.1 General Background on Motor Skills Learning 4423
4424
Education can address one or more of three domains – knowledge, skills and attitudes. All 4425
three are relevant to wheelchair skills training. However, in this chapter of the WSP Manual, 4426
the focus will be primarily on motor skills learning. 4427
4428
The issues presented in this chapter of the WSP Manual are based on the extensive motor-4429
skills-learning literature (over 500 English-language papers published each year) and on the 4430
experience of the WSP team. This chapter is not intended to be a treatise for researchers. It is 4431
an attempt to synthesize the aspects of this literature that are most relevant to the learning of 4432
wheelchair skills. We have attempted to express these principles in language that the average 4433
educated, but not necessarily professional, trainer and learner might understand. Although 4434
there is a great deal of scientific evidence underlying these principles, the principles 4435
themselves are fairly simple. Trainers and/or learners who understand and apply the 4436
principles will be more effective than those who do not. In addition to the general principles 4437
summarized in this chapter, more specific “training tips” for individual skills or groups of 4438
skills later in Chapter 8. 4439
4440
7.2 What is a “Motor Skill”? 4441
4442
A motor skill is one that is voluntary, observable, has been learned and has a goal. Motor 4443
skills have been classified on the basis of the size of the muscle groups involved (gross vs. 4444
fine), on the basis of whether they are discrete tasks or more continuous ones, and on the 4445
basis of how stable the environment is (open vs. closed). 4446
4447
7.3 The Learning Process 4448
4449
In the course of learning a new motor skill, the learner progresses through stages. This is 4450
sometimes referred to as the “learning continuum”. Early in the process, success may be 4451
partial, inconsistent or only possible in a familiar setting. As learning progresses, preliminary 4452
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success is eventually achieved (skill acquisition), consistency within training sessions 4453
improves, success carries over into subsequent sessions (skill retention) and the learner is 4454
able to use the skill in more diverse settings (skill transfer). Ultimately, the skill may become 4455
autonomous, requiring little or no conscious effort. The time course of motor learning 4456
includes an initial period of rapid improvement, sometimes followed by a plateau that may be 4457
followed by additional gains. The shape of the motor-learning curve is not a straight line and 4458
may be punctuated by abrupt transitions from novice to skilled coordination patterns. 4459
4460
There is a distinction between aspects of the learning process that are in the form of facts and 4461
ideas (sometimes called the “declarative”, “cognitive” or “explicit” system) versus those that 4462
relate to the actual performance of the skill (sometimes called the “procedural”, “motor skill” 4463
or “implicit” system). Each can be acquired without the other. If both are acquired, this need 4464
not be in a fixed order. The two can assist or interfere with each other. Attempting to 4465
consciously control motor actions can disrupt optimal performance. Skills learned implicitly 4466
through a discovery approach appear to be more robust under pressure. Healthy learners can 4467
sometimes engage explicit (conscious) and implicit (automatic) motor control simultaneously 4468
without deterioration of control compared to either alone. 4469
4470
People who have acquired a high level of expertise in performing a motor skill have some 4471
characteristics in common. For instance, they have greater awareness of their situations and 4472
better ability to anticipate changes in the environment. They are better able to exclude 4473
intrusions on their attention and to remain focused on the task. Their motor performances are 4474
less affected by stress and fatigue. 4475
4476
7.4 Assessment of Wheelchair Skills 4477
4478
Periods of formal evaluation (e.g. using the WST and/or WST-Q before and after training, 4479
and at follow-up) can be useful. In addition to the assessment measures mentioned earlier in 4480
the General Assessment chapter, there are a variety of parameters that provide evidence of 4481
learning due to practice. Examples of such parameters are increased speed, improved 4482
consistency, improved adaptability to other settings, improved economy of movement and 4483
improved ability to detect and self-correct errors. Ongoing assessment by the trainer is 4484
important. What the trainer can do to facilitate the learning process varies continuously. A 4485
training log may be used by the trainer and/or learner to track the training process. 4486
4487
7.5 Goal Setting 4488
4489
From the baseline WST or WST-Q assessment, skills may be identified that are not 4490
performed as safely, effectively or efficiently as they might be. Generally, only 5-10 goals 4491
should be identified at the beginning of a series of training sessions. The goal may be from 4492
the WSP skill set – a full skill, a part of a skill, a variation of a skill – or any other skill that is 4493
important to the learner. Goal pursuit is related to the learner’s beliefs about him/herself and 4494
the task (confidence or self-efficacy). The learner may need help in coming to a decision 4495
about the goals of training because he/she may not initially recognize the functional benefits 4496
of acquiring a new skill. Additionally, a decision needs to be made as to whether it is feasible 4497
for the person to learn this skill. This is a judgment call and requires a good understanding of 4498
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the learner’s health and circumstances. If in doubt, it is recommended that the learner be 4499
given an opportunity to learn the skill. If progress is not being made, a learner can decide to 4500
abandon that skill. The trainer can assist the learner in coming to this decision. 4501
4502
Goals should be brief, specific, significant, achievable in the training time available and 4503
observable (i.e. a measureable action item). A broad participation-level goal (e.g. to go 4504
shopping) can be broken down into the constituent skills that make it up. 4505
4506
The following are examples of good WSTP goals: 4507
Roll 100 m in 2 minutes, using no more than 100 pushes. 4508
Get the wheelchair up a 2 cm curb. 4509
In the wheelie position, roll forward 10 m. 4510
Get from the wheelchair to the floor and back within 60 seconds. 4511
Come down a flight of 10 stairs backward, using one hand-rail. 4512
4513
The following are examples of poor goals from the perspective of WSTP training (and why): 4514
Go shopping at the mall (too broad, needs to be more specific). 4515
Reduce by 10% the number of pushes needed to roll 10 m (not significant). 4516
Complete a full marathon (may not be achievable in the training time available). 4517
Spend more time with my friends (not a wheelchair skill and not easily observable). 4518
Understand the importance of preventing pressure sores (not an action item). 4519
4520
Involving the learner in the goal-setting process can have a positive effect on motivation. 4521
However, the trainer has the right to refuse to provide training on any skill that he/she does 4522
not believe to be safe and feasible. The goals should be monitored and may be revised as 4523
training progresses. The goals may be formalized to allow a Goal Attainment Score (see 4524
earlier) to be calculated that can be used to track progress and quantify outcomes. A poster 4525
on Setting Goals is available at http://www.wheelchairskillsprogram.ca/eng/posters.php. It 4526
can be printed and posted in the training area. 4527
4528
7.6 Individualize the Training Process 4529
4530
Motor-learning principles generally apply almost equally well to elite athletes and to those 4531
who have severe disabilities. However, there is benefit to tailoring the training process to the 4532
learner. Learning-style preferences exist and should be respected whenever possible. 4533
Training can sometimes take the form of a problem-solving exercise, attempting to answer 4534
the question “For this learner, with this wheelchair, in this context, what would be the safest 4535
and most effective way to perform this task?” For another wheelchair user or another 4536
wheelchair, a different solution may be appropriate. 4537
4538
Inability to perform a skill may be due to a variety of limiting factors, alone or in 4539
combination. Limiting factors may be intrinsic (e.g. impairments such as cognitive 4540
limitations, weakness, deconditioning, pain, shortness of breath, limited range of motion, 4541
spasticity, poor coordination or movement disorders) or extrinsic (e.g. a faulty wheelchair 4542
part, poor seating support or poor lighting). The trainer should attempt to identify remediable 4543
limiting factors and seek to have them addressed. 4544
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4545
Motor-skills learning can be affected by personal characteristics. A trainer who understands 4546
these differences will be able to reassure learners who might be progressing more slowly than 4547
others. For instance, males learn some skills faster than females. Although learning capacity 4548
is greater early in life and the young learn motor skills more rapidly and with less practice, 4549
elderly people can acquire new motor skills well. Very young children learn better by 4550
practicing parts of skills but whole-skill practice works better by about the age of 10 years. 4551
Children using scaled equipment (appropriate to their size and strength) acquire skills more 4552
quickly, perform them better and are more engaged. Motor learning may be affected by 4553
emotion or fatigue. 4554
4555
Neurological conditions may affect motor-skills learning. The learner’s impairments (e.g. 4556
motor weakness, spasticity, sensory loss, coordination, balance, perceptual problems) may 4557
affect how a skill should be optimally performed and the ease with which learning can occur. 4558
4559
Specific neurological disorders may also need to be taken into consideration, for instance: 4560
For people with stroke, the post-stroke brain has heightened sensitivity to rehabilitation 4561
early but this phenomenon declines somewhat with time. The extent of improvement is 4562
related to the intensity of training, but high doses of training may not be well tolerated 4563
early after the stroke. Explicit information disrupts skill acquisition even more than usual 4564
in people who have had strokes affecting the basal ganglia. For people with language 4565
impairments, it may be helpful to use nonverbal cues and feedback rather than verbal 4566
ones. 4567
People with multiple sclerosis may have greater susceptibility to high environmental 4568
temperatures and may fatigue more easily. 4569
People with Alzheimer’s disease can learn and retain new motor skills. Implicit-learning 4570
strategies and demonstration appear to be particularly useful for such people. Consistent 4571
practice conditions may work better than variable ones. 4572
For people with any form of dementia, there is some evidence of superior learning of 4573
problem-solving tasks with the aid of cues (errorless learning) versus trial-and-error 4574
learning. 4575
People with Parkinson’s disease can learn new motor skills although retention may be 4576
impaired and more practice may be needed. Rhythmic auditory cues can be helpful for 4577
them. Although less helpful for healthy people, paying conscious attention to motor tasks 4578
can be useful for people with Parkinson’s disease. Consistent practice conditions may 4579
work better than variable ones. 4580
Medicated patients with schizophrenia may have difficulties with the consolidation of 4581
skills. 4582
For children with cerebral palsy, a 100% feedback schedule is more effective than an 4583
intermittent one. 4584
4585
7.7 Structure of Training 4586
4587
There are a variety of ways in which the safety, effectiveness or efficiency of training can be 4588
enhanced. The motor learning principles in this chapter can be thought of as the trainer’s 4589
“instructional tool kit” with specific tools to be used as needed. Training can take place 4590
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anywhere (e.g. in the hospital, community or the learner’s environment). Training can take 4591
place in an ad-hoc format, seizing teaching opportunities as they present themselves (e.g. 4592
during community outings). Although this approach has much to commend it after the 4593
individual skills have be learned, it is unlikely that such challenges will present themselves in 4594
the order that would be most helpful to optimize learning. In the clinical setting, it can be 4595
helpful to provide more structure (e.g. scheduled sessions with lesson plans). At the 4596
beginning of a training session, a warm-up can have a number of benefits. The same is true 4597
of a cool-down at the end of a session. Sample lesson-plan templates for initial and 4598
subsequent sessions can be found in Appendix 2. 4599
4600
7.8 Training in Pairs or Groups 4601
4602
To permit an individualized approach, a ratio of trainers to learners of 1:1 or 1:2 is ideal, 4603
although much lower ratios (e.g. 1:20) can be successful. Training in pairs or groups is 4604
practical, cost-effective and has educational merit. The optimum group size depends on the 4605
goals but more than eight people in a group can lead to fewer interactions and lower 4606
satisfaction. Group training can permit group discussions and problem-solving. Learners can 4607
serve as models for each other, both for how and how not to perform a skill. Whenever 4608
possible, it is desirable to select groups on the basis of roughly similar skill level. Learners in 4609
groups should be reminded that skill capability is affected by a number of factors (e.g. age, 4610
sex, impairments and wheelchair type), so they should not compare their progress with that 4611
of others. For individuals with low self-efficacy, collaborative training with a more 4612
experienced partner aids skill acquisition. To function well, groups may need to reach 4613
agreement on the group process (e.g. arriving on time, avoiding the use of cell phones during 4614
the session) and consequences (e.g. singing a song) for breaking the group rules. Additional 4615
hints for organizing group training can be found in Appendix 3. 4616
4617
7.9 Motivation 4618
4619
Motor-skills learning is enhanced if the learner is motivated to learn. The trainer can help to 4620
motivate the learner by making the learning meaningful and rewarding. Game-based 4621
exercises can help to create and maintain interest. Children especially may learn best through 4622
play, rather than through formal training on a skill-by-skill basis. Working in either 4623
cooperation or competition with other learners can enhance motivation. 4624
4625
Whenever possible, the trainer should explain how the learner will benefit by learning a new 4626
skill. Training should be relevant to the learner and his/her context. In addition to the long-4627
term benefits of training, there may be short-term benefits, such as the social interaction 4628
during the training sessions, the pleasure that some people get from challenging themselves 4629
or improving on a test. Without creating anxiety, the trainer should let the learner know that 4630
he/she will be assessed at the end of the training period, because this is known to have a 4631
positive effect on skill acquisition. Similarly, the expectation of having to teach another 4632
learner enhances motor learning. Encouragement and positive feedback from the trainer or 4633
fellow learners can be powerful incentives as well. Rewards significantly enhance the long-4634
term retention of motor learning. The trainer should not be reluctant to challenge the learner 4635
to try ever more difficult but potentially achievable skills. 4636
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4637
Learning, self-efficacy and affect are better when the learner perceives him/herself as having 4638
a choice (e.g. “do you want to start at that end of the line of pylons or at this end?”, “would 4639
you prefer to wheel across the yellow or the green mat?”). Autonomy is also important in 4640
deciding when and for how long to practice. 4641
4642
7.10 Demonstration 4643
4644
Demonstration (also called “observational learning”) is one of the most powerful tools for 4645
motor skills learning. The demonstrator may be the trainer, a model or a peer. Demonstration 4646
may be in-person or on a video. The Pictures and Videos section of the WSP website 4647
contains numerous video clips that can be used. The demonstrator should ideally be skilled, 4648
but this is not a necessity. One approach is to use an expert model to provide an accurate 4649
template of the movement, followed by less successful models. If the model is at a similar 4650
level to the learner (e.g. in a group setting), the learner can learn from the feedback provided 4651
to the model. 4652
4653
If the learner is unfamiliar with the skill to be practiced, the demonstration should occur 4654
before practice begins. The initial demonstration should be silent; then the demonstration is 4655
repeated while describing key elements of the skill. Otherwise, the demonstration can be 4656
used as part of the feedback provided to the learner. The demonstration may be repeated as 4657
often as needed. The trainer should briefly describe important elements of the skill or provide 4658
attention-directing cues, as part of the demonstration. The trainer should focus on what to do 4659
rather than what not to do, at least until the learner has had an opportunity to try the skill 4660
several times. 4661
4662
Observation alone can result in learning but has limits if not followed by physical practice. 4663
Demonstration is most effective for a novel task and less effective when refining a skill. 4664
When demonstrating a skill, the trainer should put equal emphasis on the movement and the 4665
outcome. 4666
4667
7.11 Verbal Instructions 4668
4669
Using the terminology of the motor learning literature, “instructions” are generally provided 4670
before practice, as distinct from “feedback” that is provided afterwards. Providing explicit 4671
instructions before task practice can be detrimental so instructions should be used with 4672
caution. Learners have a limited capacity to attend – the trainer should not overwhelm the 4673
learner with the quantity of information. Instructions are more likely to be of help for 4674
advanced learners (e.g. instructions regarding anticipation and decision making). The length 4675
of time between the instructions and actual practice should be minimized. Preferably, 4676
instructions should be given in combination with a demonstration. Learning is enhanced by 4677
instructions that portray the task as a learnable skill versus one that is based on inherent 4678
ability. 4679
4680
As for the content of instructions, some general examples follow: 4681
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Speed and accuracy are inversely related. If both are desirable, the learner will do better 4682
to start with accuracy and build speed later. An instruction may be to “take your time, it’s 4683
not a race”. 4684
The trainer may provide instructions about what to look for in the environment that might 4685
affect performance. For instance “Pay attention to the lip at the bottom of the ramp”. 4686
The trainer may provide a framework, an organization or a way of thinking about a skill. 4687
An instruction may be “Think of the right rear wheel of your wheelchair as the face of a 4688
clock and start with your hands at 11:00 o’clock”. 4689
Analogy learning has been found to be helpful perhaps, at least in part, by reducing the 4690
informational volume. For instance, during the rolling forward skill, an instruction may 4691
be “Coast between pushes just as you would between strokes when paddling a canoe”. 4692
The trainer may provide verbal cues – short, precise words or phrases that direct attention 4693
or prompt movements. For instance, when attempting to get a manual wheelchair over a 4694
obstacle from a stationary start, the trainer may ask the learner to “pop” (popping the 4695
casters over the obstacle) then “lean” (leaning forward to help get the rear wheels over). 4696
The trainer should limit the number of cues to those that are most critical. It can be 4697
helpful to have the learner verbalize the cues prior to attempting the skill and during the 4698
attempt. As noted earlier, for people with dementia, there is some evidence of superior 4699
learning of problem-solving tasks with the help of cues versus trial-and-error learning. 4700
4701
7.12 Focus of Attention 4702
4703
Early in training, the trainer may need to have the learner focus on specific actions or 4704
processes (e.g. “lean forward”), if a crucial error has been identified. However, the research 4705
literature suggests that, when most individuals engaged in motor learning tasks concentrate 4706
on movements themselves, the conscious intervention in the control processes results in poor 4707
performance and learning. People with Parkinsonism may be an exception to this general 4708
rule. 4709
4710
As the skill becomes more automatic, more advanced learners tend to do better if they focus 4711
on the overall goal or outcome of the skill performance (e.g. “get up the incline onto the 4712
platform”). This phenomenon is better documented in adults than for children. Although 4713
automatic performance is ideal, even experts may find it necessary from time to time to focus 4714
attention on an aspect of a skill that requires it. 4715
4716
7.13 Imagery 4717
4718
There is evidence that imagery or mental practice can be helpful in the acquisition of motor 4719
skills. Imagery can be assigned as homework. Imagery can focus on what the learner would 4720
see during the performance of a skill, with internal or external perspectives (i.e. seeing 4721
through one’s own eyes vs. seeing oneself as though watching another person). Alternatively, 4722
imagery can focus on what the person might feel (e.g. limb position, external forces) during a 4723
skill performance. Most studies have used verbal live or recorded imagery instructions, have 4724
had the imagery performed with the eyes closed and have used an internal perspective with a 4725
kinesthetic focus. On average, participants in such studies practiced for about 15 minutes at a 4726
time, three times a week for a total of about three hours. Even a short nap after motor 4727
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imagery aids consolidation. 4728
4729
Imagery can also be used for motivational purposes (e.g. visualizing performing with 4730
confidence and ease). Imagery can be used in advance, to prepare to perform a skill, or after 4731
the attempt, to reinforce a well-performed trial. Imagery is not as effective as physical 4732
practice but it is better than no practice. Used in combination with physical practice, imagery 4733
is almost as effective as physical practice alone, so it may be a useful strategy when there are 4734
factors that prevent physical practice (e.g. bad weather, lack of spotter availability, a sore 4735
shoulder). Imagery has a greater effect on closed skills (ones that are always the same) than 4736
open ones. Imagery is less useful for a novel task than a familiar one. 4737
4738
7.14 Feedback 4739
4740
Types of feedback. Implicit learning through intrinsic feedback (e.g. from what the learner 4741
can see, hear or feel) is useful and may be all that is needed. Feedback can be augmented in a 4742
variety of ways (e.g. by watching oneself in a mirror, by watching a video of one’s 4743
performance, by receiving biofeedback or by receiving feedback from a trainer). Augmented 4744
feedback is generally an effective tool for enhancing learning (e.g. by better participation, 4745
more rapid skill acquisition). However, augmented feedback is not always needed and it can 4746
hinder learning if the learner becomes dependent on it. The ultimate goal of skills learning is 4747
for the performer to be able to perform the skill without augmented feedback. 4748
4749
Feedback content. The trainer should be supportive and encouraging, even to the extent of 4750
slightly exaggerating how well the learner is doing in comparison with others at a similar 4751
stage of training. Such “bogus” positive feedback can have positive effects on skill 4752
acquisition, self-efficacy and affect. However, the trainer should be accurate with respect to 4753
feedback content. It is counterproductive to tell a learner that his/her performance was 4754
successful if it was not. Most people learn at least as well from their errors as from their 4755
successes. 4756
4757
When learning wheelchair skills, feedback from the trainer about the success or failure of an 4758
attempt at a skill (“knowledge of results”) is usually unnecessary, for two reasons. First, the 4759
result is usually self-evident. Second, if the learner is repeatedly unsuccessful, he/she may get 4760
discouraged by repeated statements about failure. 4761
4762
Another form of feedback is the provision of information about how the skill was performed 4763
(“knowledge of performance”). Ideally, such feedback should be directed at what the trainer 4764
suggests the learner should try differently (“prescriptive knowledge of performance”), in 4765
order to achieve a safer or more effective result. Before providing prescriptive knowledge of 4766
performance, it can be useful to ask the learner about his/her perceptions about the problem 4767
and intended solutions. The objective is to develop a learner who is an independent problem-4768
solver. If the learner does not self-diagnose the problem correctly, the trainer should identify 4769
the most critical error and suggest what might be done to correct this problem. 4770
4771
Pointing out errors is more effective than noting what the learner is doing correctly (although 4772
the latter is important for motivation). It can be useful to have learners attempt skills in 4773
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inappropriate ways (e.g. rolling across a soft surface while leaning forward, causing the 4774
casters to sink into the surface), to help them better understand why a suggestion is being 4775
made. Qualitative feedback is fine early in training (e.g. “you need to pop your casters 4776
higher”). Later, quantitative feedback (e.g. “you need to pop your casters about 2 cm 4777
higher”) may be better. Feedback can be more effective if it directs the performer’s attention 4778
away from his or her own movements and to the effects of those movements. The perceived 4779
expertise of the trainer (e.g. as evidenced by a demonstration of the skill being learned) 4780
affects the perceived usefulness of the feedback provided. 4781
4782
Timing of feedback. The optimum frequency for knowledge of results feedback (if any is 4783
needed) is affected by the difficulties of the task – the more difficult the task, the higher the 4784
frequency of feedback can be without interfering with skill acquisition. 4785
4786
When providing knowledge of performance feedback, the trainer needs to exercise judgment 4787
and to be attuned to the chemistry of the training session. The trainer should offer feedback 4788
statements no more often than after every second attempt. This may be a difficult rule to 4789
follow in a group setting. Autonomy can be provided (“let me know when you would like 4790
some feedback”). An exception to this is if a learner performs in an unsafe manner and does 4791
not appear to be aware of it; the trainer should point this out as soon as possible. The trainer 4792
should let the learner know that the absence of feedback means that the performance was 4793
adequate for the current stage of learning. This gives the learner an opportunity to problem-4794
solve on his/her own (i.e. intrinsic learning). It also decreases repetitive feedback statements, 4795
especially in the case of more advanced skills when it can take time for the learner to 4796
overcome a problem. A common error is for the trainer to spend too much time talking and 4797
not enough time allowing the learner to practice. 4798
4799
The feedback schedule is especially important for wheelchair users who have cognitive or 4800
behavioral impairments. A self-controlled feedback schedule (i.e. letting the learner ask for 4801
feedback) is generally preferable. More feedback is typically needed for a novel skill. The 4802
trainer should gradually reduce the frequency of feedback statements as time goes on. The 4803
feedback weaning schedule may need to be more gradual for children. As the fading process 4804
leads to less and less frequent feedback, the trainer should summarize a series of attempts 4805
rather than focusing only on the most recent attempt. This technique can also be used when 4806
working with a group, providing feedback that deals with a problem several of the group 4807
members are encountering. 4808
4809
Trainers should be aware of the principles of behavior modification, which have similarities 4810
to the principles of motor learning. Positive reinforcement (e.g. an encouraging remark) 4811
increases the likelihood of a behavior (or skill) being performed, whereas negative 4812
reinforcement (or no reinforcement) has the opposite effect. Initially, the trainer’s tolerance 4813
for the learner’s errors should be broad, but the “bandwidth” of acceptable performance is 4814
gradually narrowed as learning proceeds. Behaviorists refer to this as “shaping” a behavior. 4815
Intermittent positive reinforcement, at irregular intervals, is the ideal reinforcement schedule 4816
for sustaining behaviors. 4817
4818
Feedback can be provided during the skill attempt. This is more practical for continuous 4819
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skills (e.g. rolling a long distance), but there is a danger that this may interfere with the 4820
learner’s attention to intrinsic feedback. Providing the feedback after the skill is usually 4821
preferable. The trainer should wait a few seconds before providing feedback to allow 4822
intrinsic processes to work first. Before beginning the next trial, the trainer should allow the 4823
learner some time to plan the next attempt. Any augmented feedback should be followed by 4824
an opportunity to practice. 4825
4826
Improvements in communication technology has made it possible for the learner and trainer 4827
to interact when separated in space (“remotely”) and time (“asynchronously”). For instance, a 4828
learner in one part of the world who is having difficulty with a skill can send a video-4829
recording of his/her technique to a trainer in another part of the world and receive feedback at 4830
a later time that is convenient for the trainer. That feedback can be considered later, at a time 4831
convenient to the learner. The learner is not limited to an interaction with a single trainer but 4832
can seek input from anyone willing to provide it. 4833
4834
7.15 Specificity of Practice 4835
4836
If a learner wants to improve his/her ability to perform a task, the task itself should be 4837
practiced. Cross-training may help to develop fitness, but is of limited use for the 4838
development of motor skills. However, there is mounting evidence, for a broad range of 4839
motor skills, that training in simulated situations can enhance skill performance in real-life 4840
situations. Practice should be as specific as possible with respect to the task itself and the 4841
context in which it is to be performed. If the skill consists of steps that need to be carried out 4842
in a specific sequence, then that sequence should be used during practice. If the goal is for 4843
the learner to be able to conduct the task in diverse settings, then that is what should be 4844
practiced. If a wheelchair user has more than one wheelchair (e.g. powered and manual) 4845
because different wheelchairs are used in different settings, he/she should be trained in the 4846
use of both. 4847
4848
7.16 Amount of Practice 4849
4850
For motor skills to be learned well, they need to be practiced. If a learner is switching from 4851
an old to a new coordination pattern, it may take 200 or more practice trials to achieve the 4852
change. During the transition, there may be numerous errors, that the learner may find 4853
frustrating and discouraging. The amount of practice needed may be much greater (up to 50-4854
fold) for people with injury or disease of the brain. 4855
4856
The “over-learning” strategy (a term that should not be confused with “too much learning”) 4857
has a positive effect on skill retention. Over-learning means continuing to practice (by 50-4858
200%) beyond the amount needed for initial success. This can be done right away or during 4859
additional practice sessions later. However, more practice is not always better – as the saying 4860
goes “practice does not make perfect, perfect practice does”. Also, there may be a point of 4861
diminishing returns. More than 4-6 hours of practice a day is unlikely to be productive. If 4862
errors begin to occur due to fatigue or frustration, it is probably wise to take a break because 4863
technique can break down with fatigue. Multiple short practice opportunities (one hour of 4864
less) are preferable for retention. 4865
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4866
For simple tasks, continued practice may actually cause performance to deteriorate. There is 4867
little point in practicing what has become easy and comfortable, it being preferable for the 4868
learner to continue to challenge him/herself. The literature on wheelchair-skills training 4869
suggests that substantial improvements can be made on a group of skills with as little as 2-3 4870
hours of formal training spread over several sessions, but that the target for the clinical 4871
setting should probably be higher (e.g. 10-12 hours) if the situation allows. There is no strong 4872
evidence as yet regarding the optimum “dose” of wheelchair skills training. 4873
4874
Although it is not necessary to be an expert to perform a skill in a safe and useful manner, to 4875
achieve true expertise at a skill (as a professional athlete, musician or an assembly-line 4876
worker may exhibit) may require several hours of practice per day for periods of 10 years or 4877
more. There is some evidence to support that millions of repetitions and 10,000 hours of 4878
practice may be required for true expertise. Intervals of weeks or months between training 4879
are not barriers to learning. As little practice as 6 minutes a month has been shown to be 4880
effective. Self-control of the amount of practice and of the practice schedule has been shown 4881
to be superior to control by others. 4882
4883
7.17 Facilitate Retention 4884
4885
Although a learner may be able to “acquire” a skill during a practice session, it is not 4886
uncommon for the learner to fail to perform the skill adequately at the next session. This is a 4887
failure of skill “retention”. The objective of wheelchair-skills training is long-term retention 4888
(i.e. for months and years). For practical purposes, successful performance after such brief 4889
intervals as 3 days may need to be accepted as evidence of at least short-term retention, but 4890
long-term retention is the goal. The literature on the retention of wheelchair skills is limited 4891
but there is evidence to date that skills are retained for periods of a year or more. 4892
4893
There are conditions within and following a practice session that affect whether training on a 4894
new skill will be retained. To improve the likelihood of “consolidation”, the trainer (and 4895
other members of the rehabilitation team) should avoid the introduction of other new skills 4896
during the 4-6 hour period following practice. Newly acquired skills may be abolished by 4897
subsequent practice of a different novel skill within four hours (retrograde interference), 4898
especially if the competing task involves the same muscles and movement direction. 4899
Similarly, learning one skill can interfere with the subsequent learning of the second skill 4900
(antegrade interference). The extent of this interference is related to the duration of the earlier 4901
task learning. Performance saturation during training helps consolidation. 4902
4903
Ideally, the learner should sleep before the next training session. Although not always 4904
practical, a nap of as little as 40 minutes immediately post-training reduces susceptibility to 4905
interference and results in earlier consolidation, especially so for older learners. At the 4906
subsequent session, the learner may even perform better than at the previous session, without 4907
any intervening physical practice. This is sometimes referred to as “off-line learning”. Sleep 4908
affects some types of skills more than others (sequence-specific skills less so). Sleep is of 4909
most benefit to skills that were the most difficult before sleep. Learning by observation and 4910
mental imagery is also enhanced by sleep. Anticipated rewards can enhance off-line learning 4911
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during sleep. Post-training deep alternative-nostril breathing has been shown to enhance 4912
retention. 4913
4914
Although it may seem to be inconsistent with the notion of a nap after a motor learning 4915
session, aerobic exercise (preferably high intensity, but also moderate intensity) has been 4916
shown to enhance retention. The gap between the motor-learning session and the bout of 4917
aerobic exercise may be as little as 20 minutes and as long as two hours. 4918
4919
Consolidation begins as a fragile state (one that is susceptible to interference) and progresses 4920
over time to a stabilized state. Off-line, a skill becomes less vulnerable to interference 4921
(stabilization) and improves in performance (enhancement). During subsequent practice, the 4922
consolidated memory can become unstable and susceptible to improvement 4923
(“reconsolidation”) or deterioration. Elderly adults have greater susceptibility to interference 4924
and less off-line gains in motor skills. 4925
4926
7.18 Variability of Practice 4927
4928
Variation in motor performance may be a feature of how the nervous system learns, with the 4929
variation serving as an exploration of boundaries and preferred approaches. Additionally, 4930
most wheelchair skills are of little use if they can only be performed in highly controlled 4931
settings. The purpose of wheelchair skills training is for the learner to use the skill in a 4932
variety of settings in his/her life (skill “transfer”). Once a skill is initially acquired and 4933
retained, the learner should practice it in different contexts to promote such skill transfer. 4934
Diversification may include alterations of the environment (e.g. surface, lighting conditions, 4935
time of day, ambient temperature), variations in how the skill is performed (e.g. faster, 4936
slower, while multi-tasking) or variations in the learner’s state (e.g. with fatigue, anxiety, 4937
altered focus of attention). Expanding the scope of training to include a few or many skills in 4938
combination (e.g. moving turns on soft surfaces) or in sequence (as might occur while 4939
playing a game or going on a community outing) can be very helpful. 4940
4941
To enhance skill retention and transfer, random practice of a group of skills that have already 4942
been acquired is generally better than consistent (“blocked” or “massed”) practice, especially 4943
for open versus closed skills. However, there will be more errors during random practice and 4944
learning may be slower. The two approaches are not mutually exclusive. For instance, it may 4945
be reasonable to begin with consistent practice and to progress to random practice of those 4946
skills. The approach may vary depending upon the personal characteristics of the learner (e.g. 4947
children and the elderly do better with less variability and fewer distractions). 4948
4949
The WSTP approach is to make sure that the learner can do each of the basic skills in at least 4950
one of the safe and effective methods available (e.g. performing moving turns by pushing 4951
harder on the outside hand-rim). To help with skill retention and transfer, trying suitable 4952
variations (e.g. performing moving turns while carrying a cup of water in one hand) is 4953
encouraged, as well as using the skill in combinations (e.g. performing moving turns while 4954
ascending an incline). Games can be used to help the learner use the skills in a more 4955
automatic fashion, as he/she focuses on the outcome of the game rather than on performing 4956
the individual skill. 4957
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4958
After maximizing the ability of wheelchair users and caregivers to perform the representative 4959
set of individual skills that make up the WSP, these skills can be combined in the various 4960
combinations and permutations that make up real life. The WSP skills can be considered the 4961
building blocks whereas the real-life activities are the structures that can be built with these 4962
units. As part of any such community outings, the learner should be encouraged to plan the 4963
route that will be taken. 4964
4965
Real-life activities provide opportunities to identify challenges requiring intervention and 4966
opportunities to learn wheelchair skills as the challenges are encountered (“teachable 4967
moments”). However, the order in which such real-life challenges occur is random and 4968
inconsistent with a more structured approach in which the sequence of skills learned can be 4969
helpful. 4970
4971
7.19 Distribution of Practice 4972
4973
Practice may be condensed (“massed”) or spread over several sessions (“distributed”). In a 4974
rehabilitation center, practice may be organized as brief individual and/or group sessions at 4975
regular intervals (e.g. 30 minutes, 1-5 times a week for 2-4 weeks). Sessions might include a 4976
warm-up, some time on skills already acquired but requiring further practice, a period during 4977
which instruction is received on the principal new skill that is the focus of the session, and a 4978
cool-down activity. 4979
4980
When the learner has demonstrated the ability to do so safely, the trainer should encourage 4981
the learner to practice between formal sessions. Whenever feasible, it is recommended that 4982
wheelchair-skills training be spread over a series of brief sessions instead of one long one. 4983
Brief practice periods are less likely to conflict with other therapy sessions or to fatigue the 4984
learner. For wheelchair users who are elderly, who are unfit or who have a number of co-4985
morbidities, even a brief session can be fatiguing or cause overuse injury. 4986
4987
One alternative is to conduct training in and around the learner’s home. Another option for 4988
learners living in the community is to hold periodic group training courses (e.g. for 1-2 hours, 4989
weekly, for several weeks). Another alternative is a skill “camp” (e.g. all day for 1-5 days) in 4990
a central location or on a circuit basis. The single-training-session format is commonly used 4991
for workshops when training trainers. However, the use of such an approach can cause even 4992
highly motivated learners to lose focus and to become fatigued. In addition to such problems, 4993
this approach may lead to poor retention and consolidation. 4994
4995
The research literature suggests that, for the types of skills that wheelchair users and 4996
caregivers need, it is generally less effective to carry out a large amount of training in a 4997
condensed manner than it is to spread the training out over a longer period that permits rest 4998
and consolidation of what has been learned. However, too much time between practice 4999
sessions can allow the learning to decay if the skill has not yet been acquired and 5000
consolidated. Beyond this, there is little research evidence to suggest that one of the models 5001
noted above is vastly superior to another, so the choice of model(s) can be based on local 5002
considerations. 5003
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5004
7.20 Whole versus Part Practice 5005
5006
For skills that consist of a sequence of sub-skills, initially it can be helpful to break the skill 5007
down into its components (segmented “motor chunks”). For instance, the stationary wheelie 5008
skill can be broken down into three phases – take-off (getting onto two wheels), maintaining 5009
balance on two wheels and landing (returning to the condition of having all four wheels on 5010
the ground). The goal, of course, is to build up to the point that the whole skill can be 5011
practiced as a unit. 5012
5013
There are some variations on this strategy. For instance, the learner can combine whole- and 5014
part-skill practice by focusing attention on different aspects of the skill even though 5015
performing the entire skill. If the skill is to be segmented, a progressive approach, from start 5016
to finish, is generally preferred because it eventually becomes whole-skill practice. However, 5017
the order in which the segments are practiced is not critical. “Chunking” is less often useful 5018
for the elderly. Chunking may impair motor skill acquisition, if learners could have taken 5019
advantage of cues related to an earlier chunk. 5020
5021
7.21 Simplification and Progression 5022
5023
For many wheelchair skills, it is possible to begin with a simpler and less difficult version of 5024
the skill. Reducing errors during initial practice attempts may encourage a more implicit 5025
method of learning. The learner can master the simpler task before progressing to the 5026
ultimate skill level that is the goal of training. For many wheelchair skills, the simpler 5027
version may be useful itself, even if the more difficult levels cannot be learned. For instance, 5028
getting the wheelchair up a low curb is a useful skill and also a step toward getting up a high 5029
curb. Another example is to learn the wheelie skill in a high-rolling-resistance setting before 5030
progressing to a low-rolling-resistance one. This strategy for learning the stationary wheelie 5031
has the advantage of reducing the amount of forward-backward movement of the rear wheels 5032
needed to maintain balance. This reduces demands on the learner’s attention. It also 5033
eliminates a degree of freedom (forward-backward movement of the rear wheels). Reducing 5034
the degrees of freedom is a strategy that has been observed to be used by beginners learning 5035
non-wheelchair skills. 5036
5037
Children do better with scaled equipment; they are more engaged, they are more confident, 5038
they perform better and they acquire skills more quickly. Other examples of progression are 5039
adding speed to a task, doing the task in a more challenging environment, adding a second 5040
task, reducing the amount of assistance provided by an assistant and reducing the proximity 5041
of the spotter. Specific examples of simplification and progression can be found later in the 5042
training-tips sections of Chapter 8. Some of these strategies are similar to those used to 5043
increase the variability of practice, with the goal of skill transfer. 5044
5045
In many cases, more difficult skills will build on methods learned in performing simpler but 5046
similar skills. For instance, the ability to get over an obstacle requires most of the techniques 5047
needed when later learning to get up a curb. The order of individual skills listed in Tables 1.1 5048
and 1.2 reflects this. As noted earlier, this systematic approach may seem to be conceptually 5049
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incompatible with the community-outings approach whereby the learner and trainer make 5050
forays into the community (e.g. to the corner store) and learn about barriers as they are 5051
encountered. However, the two approaches can be used in a complementary fashion, using an 5052
initial community outing to help identify skills that require further training and to provide 5053
motivation, followed by a systematic process to improve upon those skills, followed by 5054
additional community outings to provide variety to the training experiences that encourage 5055
skill transfer. 5056
5057
Although a learner can perform a wheelchair skill with any safe and effective method, 5058
different methods may be more suitable for some individuals or some situations. For 5059
instance, for the “turns while moving forward” skill as performed by a user of a manual 5060
wheelchair who propels the wheelchair with two hands, the basic method is to push harder on 5061
the hand-rim of the rear wheel on the outside of the turn. However, for the wheelchair user 5062
with good arm function and a wall leading to an opening into which the person wishes to 5063
turn, the turn can be accomplished more readily, with less reduction in speed and with less 5064
demand on the shoulders if the wheelchair user performs a “drag turn”. To do so, the 5065
wheelchair user drags the arm along the wall to slow the wheelchair on one side and carry 5066
out the turn. 5067
5068
7.22 When the Caregiver is the Learner 5069
5070
A skill that may not be feasible or advisable for a wheelchair user to perform alone may be 5071
possible with the assistance of a caregiver (as previously defined). The training can be 5072
directed at the wheelchair user, the caregiver or the two functioning together. The 5073
relationship between a wheelchair user and a caregiver is important. The wheelchair user’s 5074
needs and preferences should take precedence whenever possible. The wheelchair user may 5075
need some help in learning how to ask for help, how to direct the nature of any assistance and 5076
how politely to decline offers of unwanted help. 5077
5078
There are some general considerations when caregivers are the learners. There are ways for 5079
caregivers to relate well to wheelchair users. For instance, the caregiver should be instructed 5080
to seek permission before taking any actions, to speak clearly, to address the wheelchair user 5081
from the front and at eye level whenever possible, and to consider the wheelchair itself as an 5082
item of the wheelchair user’s personal property.The caregiver should be cautioned to avoid 5083
applying excessive force to the wheelchair user and to avoid sudden movements. The 5084
caregiver should always provide the wheelchair user with cues concerning what he/she 5085
intends to do before attempting a skill. When the caregiver is successfully trained, the 5086
caregiver can serve as a spotter, so the caregiver should be instructed in how to perform in 5087
this capacity. The caregiver may also serve as a motivator and trainer (e.g. during practice by 5088
the wheelchair user between formal training sessions with the primary trainer). A caregiver 5089
can assist with powered wheelchairs in ways similar to manual wheelchairs, even though the 5090
powered wheelchair is heavier and bulkier. For instance, with a rear-wheel-drive wheelchair, 5091
a caregiver can push down on the back of the wheelchair to unload the casters or to add 5092
traction to spinning drive wheels. The caregiver can push a powered wheelchair forward, to 5093
assist with overcoming resistance. In addition to these general points, caregiver issues related 5094
to specific skills are dealt with later, when those skills are discussed. 5095
5096
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CHAPTER 8. TRAINING OF INDIVIDUAL SKILLS OR GROUPS OF SKILLS 5097
5098
This chapter is organized by individual skills or groups of skills, in the order listed in Table 5099
8.1. Note that, for training purposes, it has been possible to combine some of the skills from 5100
the WST. For instance, the WST skills “ascends slight incline” and “ascends steep incline” 5101
have been combined into a single skill group “ascends inclines”. 5102
5103
Table 8.1: List of Individual Skills or Skill Groups for WSTP 5104
# WSTP Skill Names Manual Powered
1. Positions and operates controller X 2. Operates body positioning options X 3. Rolls forward 4. Rolls backward 5. Stops 6. Turns in place 7. Turns while moving 8. Maneuvers sideways 9. Picks objects from floor 10. Relieves weight from buttocks 11. Performs level transfers 12. Folds and unfolds wheelchair X
13. Gets through hinged door 14. Ascends inclines 15. Descends inclines 16. Rolls across side-slope 17. Rolls on soft surface 18. Gets over obstacle or gaps 19. Ascends curbs 20. Descends curbs 21. Performs wheelchair-ground transfers 22. Ascends stairs X
23. Descends stairs X
24. Performs wheelie X
25. Performs wheelie-dependent skills X
5105
For each section in this chapter, the following headings are used (some of which are repeats 5106
on headings shown earlier in Chapter 5): 5107
5108
Versions applicable: For which of the WSP versions (i.e. manual vs. powered 5109
wheelchairs) this skill is applicable. 5110
5111
WST/WST-Q skills: The specific skills of the WST/WST-Q that are relevant for this 5112
section. 5113
5114
Description and rationale: A brief general description of the skills and the reason why 5115
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these skills have been included in the WSP skill set. 5116
5117
Prerequisites: If the ability to perform an earlier skill is useful for these skills to be 5118
trained. 5119
5120
Spotter considerations: If there are other than the general instructions regarding safety 5121
discussed earlier, these are mentioned here, in particular the starting position for the 5122
spotter and common risks requiring spotter intervention. These considerations are 5123
primarily for manual wheelchairs operated by their users but may be adapted for the 5124
powered-wheelchair version of the WSP. 5125
5126
Adjustment tips: If there are adjustments to the wheelchair that would facilitate the 5127
training, these are mentioned here. 5128
5129
General training tips: Tips that apply to most or all of the situations relevant for this 5130
skill. 5131
5132
Special considerations: If the training tips up to this point for this skill require any 5133
special considerations, these are noted here. These might be related to the type of 5134
wheelchair being used or whether a caregiver’s assistance is being assessed. 5135
5136
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8.1 POSITIONS AND OPERATES CONTROLLER 5137
5138
Versions applicable 5139
Manual wheelchair: X 5140
Powered wheelchair: 5141
5142
WST/WST-Q skills 5143
“Positions and operates controller”. 5144
5145
Description and rationale 5146
The learner moves the controller (e.g. joystick) of a powered wheelchair or scooter away 5147
from its usual operating position and then returns it to its original position. Moving the 5148
controller away and back is useful when the controller is in the way for some activities 5149
(e.g. approaching a table, feeding, transferring). 5150
The learner turns the power of a powered wheelchair or scooter on and off. The functions 5151
of the powered wheelchair require power. However, when the wheelchair is not being 5152
used for position changes or mobility, the power should be turned off when sitting in the 5153
wheelchair doing other activities. Otherwise, an article of clothing (e.g. the cuff of a 5154
sleeve) can catch on the joystick and unintentionally drive the wheelchair into a person or 5155
object. Turning the power off also better maintains the battery charge. 5156
The learner operates the controller of a powered wheelchair or scooter to switch between 5157
drive modes, speeds and other functions (excluding those controlling body position that 5158
are dealt with in the next skill), then returns to the original setting. Most powered 5159
wheelchairs and some scooters provide an opportunity for the user to operate the 5160
wheelchair in different modes and speeds. The controller settings that are most 5161
appropriate for driving slowly in tight quarters are different from the settings that would 5162
work best when driving longer distances outdoors or when ascending low curbs. Some 5163
powered wheelchairs use the controller to activate and use other functions (e.g. 5164
communication aids). 5165
5166
Prerequisites 5167
None. 5168
5169
Spotter considerations 5170
Spotter starting position: Beside the wheelchair, on the side of the controller in a position 5171
where it is possible to intervene. 5172
Risks requiring spotter intervention: 5173
When moving the controller away and back, the mechanisms can pinch fingers or 5174
clothing. 5175
Runaway if the learner activates the joystick unintentionally 5176
5177
Adjustment tips 5178
Moving the controller away/back: 5179
Mounts can vary (e.g. midline flip up, swing away, permanent mounting). 5180
When attempting to initiate the move-away portion of the skill, it is usually 5181
necessary to overcome some initial resistance. The amount of force needed can 5182
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sometimes be adjusted. 5183
Adding a loop to the controller may allow users with limited hand function to 5184
independently move the controller. 5185
5186
Turning the power on/off: 5187
A longer lever for the on/off switch will reduce the force required but increase 5188
the arc through which the lever must be moved. 5189
The location of the on/off switch can vary greatly and may have an impact on 5190
independence. 5191
Alternative switches can be used for on/off functions (e.g. toggle, depression 5192
switch, auxiliary switch). 5193
Alternative locations (e.g. near the head or foot) can be used for the on/off 5194
switch to improve access. 5195
5196
Changing speeds and modes: 5197
The type of mode switch used will have an impact on success for some users. 5198
In some wheelchairs, the mode and speed controls are separate. 5199
A controller with the easiest access will be most appropriate for people with 5200
cognitive or physical limitations (e.g. three vs. five drive modes, toggle vs. dial 5201
for speed control). 5202
Although the manufacturer may provide a representative set of mode settings, the 5203
dealer and/or therapist may adjust the settings with a programmer to make them 5204
as ideal as possible for the user. These settings can be altered later, as skill 5205
improves. For many powered wheelchairs, it is possible to independently select 5206
the maximum speed, acceleration and deceleration in different directions as well 5207
as the sensitivity to joystick deflections. 5208
The order of drive modes (e.g. 1, 2, 3 and 4) may be varied. For instance, some 5209
users may prefer to have the order reflect progressively increasing speed whereas 5210
other users may wish to order the modes from the most often to the least often 5211
used. Through programming, the dealer and/or therapist can reduce the number 5212
of steps to get to the most commonly used drive modes or speeds. 5213
The wheelchair user should be able to see or hear an indication of the mode and 5214
speed status. 5215
5216
General training tips 5217
5218
Moving the controller away/back: 5219
The controller should be moved sufficiently out of the way that it would not 5220
interfere with approach to a table or to another surface during a transfer. 5221
The force applied to the controller may need to be applied in a specific 5222
location and direction. This location can be identified in a way that it can be 5223
better seen (e.g. with a piece of colored tape) or felt (e.g. with a piece of 5224
velcro). 5225
When moving the controller out of the way, it should not be placed in a 5226
position that would make it impossible for the wheelchair user to restore it to 5227
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its original position. 5228
If the controller changes its orientation (e.g. by 90°) when it is moved out of 5229
the way, the wheelchair user needs to take this into consideration if activating 5230
the joystick in this position, to avoid driving in an unintended direction. 5231
5232
Progression: 5233
To avoid runaway, the power should be turned off while this skill is initially 5234
being practiced. 5235
Training should begin with moving the controller away then moving the 5236
controller back. 5237
The skill should eventually be used functionally, such as when approaching a 5238
table. 5239
5240
Variations: 5241
If the wheelchair user has poor hand control, he/she can use a gross motor 5242
movement to move the controller. Using the side of the arm or hand along with 5243
shoulder movement may allow the controller to be moved independently. 5244
The powered wheelchair can be slowly driven at an angle against a fixed external 5245
object (e.g. a desk top) to help indirectly push the controller out of the way. 5246
5247
Turning the power on/off: 5248
The joystick should be in a neutral position before the controller is turned on. 5249
Turning the controller off while the wheelchair is being operated will bring it to a sudden 5250
stop. This can be useful when a sudden stop is needed or if the wheelchair begins to 5251
behave erratically. 5252
5253
Variations: 5254
Rolling the hand onto and off the on/off switch may reduce the need for fine finger 5255
dexterity. 5256
Using larger movements and body parts may allow users to switch toggle levers on 5257
and off independently, if fine motor control is not available. 5258
On/off switches may be located on an attendant control unit that can be attached to 5259
the wheelchair or operated remotely. Depending on the control method used by the 5260
wheelchair user, it may be necessary to turn the controller on before the attendant 5261
control can be operated. 5262
The attendant control overrides that of the wheelchair user. 5263
5264
Changing speeds and modes: 5265
The user should be trained to select different mode and speed settings for different 5266
skills. 5267
The process of changing modes may be quite specific. For instance, a switch may 5268
need to be activated to make mode selection available, followed by movement of 5269
the joystick to the right to move from one mode to the next, followed by 5270
movement of the joystick forward to select or use that mode. 5271
5272
149
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Other features: 5273
If the powered wheelchair has other operating features (e.g. horn, turn indicators, 5274
lights), the trainer should make sure that the user can operate them. 5275
5276
Special considerations for scooters 5277
5278
Moving the controller away/back: 5279
The controller for a scooter is usually in the midline, on top of the tiller, between the two 5280
handles. 5281
For many scooters, the tiller can be unlatched and tilted toward or away from the user, to 5282
ease transferring onto and off of the scooter. 5283
5284
Turning the power on/off: 5285
Turning the power on and off is usually done using a key that can be removed. 5286
Many scooter users leave the key in its receptacle when the power is off. However, to 5287
lessen the likelihood of theft when the scooter is left alone, the scooter user may wish to 5288
remove the key. If so, removing the key and reinserting it should be practiced. 5289
5290
Changing speeds and modes: 5291
Commonly, faster speeds are possible by turning the speed dial clockwise and slower 5292
speeds by turning the dial counter-clockwise. These may be graphically illustrated (e.g. 5293
with a turtle on the left and a rabbit on the right). 5294
If the scooter has other operating features (e.g. horn, turn indicators, lights) that are 5295
controlled on the “dashboard” of the tiller, the trainer should make sure that the user can 5296
operate them. 5297
5298
150
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.2 OPERATES BODY POSITIONING OPTIONS 5299
5300
Versions applicable 5301
Manual wheelchair: X 5302
Powered wheelchair: 5303
5304
WST/WST-Q skills 5305
“Operates body positioning options”. 5306
5307
Description and rationale 5308
The learner changes body position (i.e. tilts, reclines, elevates the seat, elevates the leg-5309
rests and/or uses the sit-to-stand feature) using the available options of a wheelchair and 5310
then restores the wheelchair to the original position. Powered wheelchairs capable of 5311
variable body positions or postures are used for a variety of reasons, including pressure 5312
redistribution, comfort, breathing, postural control, stability, transfers, obstacle 5313
negotiation, bladder management, tone and venous return from the legs. Not all powered 5314
wheelchairs have body-positioning options. Although some manual wheelchairs also 5315
have options for modifying body position, these will only be trained with the skills that 5316
require changes in body position (e.g. caregiver-assisted tilt as a means of relieving 5317
weight from the buttocks). 5318
5319
Prerequisites 5320
None. 5321
5322
Spotter considerations 5323
Spotter starting position: Beside the wheelchair, in a position where it is possible to 5324
intervene. 5325
Risks requiring spotter intervention: 5326
Runaway. 5327
Tips. 5328
Damage to body parts from the wheelchair mechanism or the external environment. 5329
5330
General training tips 5331
Before changing position or restoring the wheelchair to the original position, the learner 5332
should check that there is room behind the wheelchair and above the knees to change the 5333
position without damaging the environment, the wheelchair, the contents of a knapsack, the 5334
user or a bystander. 5335
For wheelchair users with limited trunk balance, to reduce the likelihood of falling forward, 5336
5-10º of tilt or recline is usually adequate at rest or when driving. 5337
Depending upon the positioning mechanism, the extent of forward and rear stability may 5338
differ in the new position. This should be taken into consideration when in a situation where 5339
reduced stability could be unsafe (e.g. proceeding forward up an incline in the tilted position) 5340
or when it might be helpful to alter the weight distribution between the front and rear wheels 5341
(e.g. tilting toward the drive wheels to increase traction or reduce the tendency for smaller-5342
diameter wheels to sink into a soft surface). 5343
If the wheelchair allows both tilt and recline, it is advisable to tilt first and then recline. When 5344
151
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
returning to the upright position, it is advisable to reverse the order (i.e. return from the 5345
recline position before recovering from the tilt position). This reduces the tendency for the 5346
wheelchair user to slide forward on the cushion. 5347
For wheelchairs that have stand-up and recline features, reclining the wheelchair user before 5348
standing him/her up may be preferable to standing up from the sitting position. In the other 5349
direction, the order should be reversed (i.e. recover from standing before recovering from 5350
reclining). 5351
For wheelchairs that have all three features, the order is tilt, then recline, then stand; the 5352
converse is the recommended order when returning to upright sitting. 5353
5354
Progression: 5355
For the wheelchair user to adjust to a position change may involve starting with a 5356
small position change and progressing to the full desired change. 5357
5358
Adjustment tips 5359
Programming by the dealer and/or therapist should be considered to allow the wheelchair 5360
user to get into the desired position with as few steps as possible (e.g. using a preset position 5361
of 45º of tilt). 5362
The wheelchair user needs to have access to the controller when in the altered position. 5363
5364
General training tips 5365
For safety, some powered wheelchairs will prevent the wheelchair from being driven while in 5366
extreme positions. Powered wheelchairs may slow down or stop if the user attempts to 5367
operate them in unsafe circumstances (e.g. driving up a steep incline forward with the seat 5368
tilted fully back). 5369
Some seats can be turned to the side, allowing the powered wheelchair to be driven 5370
“sideways”, such as along a table. The learner should be aware that joystick movement 5371
directions may relate to the original seat orientation, not the sideways one. 5372
Some seats can be turned completely backward, essentially converting a rear-wheel-drive 5373
wheelchair into a front-wheel-drive one and vice versa. The learner should be aware that 5374
joystick movement directions may relate to the original seat orientation, not the reversed one. 5375
When reversing the direction of the positioning option (e.g. from tilt back to tilt forward), it 5376
may be necessary to pause briefly with some controllers. 5377
5378
Progression: 5379
If the rate of position change can be programmed, it is advisable to begin with a slow rate 5380
and progress to a faster one. This will provide more time in which to ensure that the 5381
wheelchair user is adjusting to the new position and that there are no body parts that are at 5382
risk of being injured. 5383
5384
Special considerations for scooters 5385
Some scooters allow the seat back to be reclined, slid forward and backward and/or rotated to 5386
the side or back. If such options exist, they are usually carried out manually. 5387
5388
152
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.3 ROLLS FORWARD 5389
5390
Versions applicable 5391
Manual wheelchair: 5392
Powered wheelchair: 5393
5394
WST/WST-Q skills 5395
“Rolls forward short distance”. 5396
“Rolls forward longer distance”. 5397
5398
Description and rationale 5399
The learner moves the wheelchair forward on a smooth level surface. Forward rolling is a 5400
skill used during many wheelchair activities. The short distance is intended to simulate 5401
moving about indoors or the distance involved when crossing a two-lane street. Most 5402
bouts of wheelchair use are relatively short but occur many times a day. The ability to 5403
manage longer distances allows wheelchair users to get around in the community (e.g. 5404
getting from a parking lot to an office or getting around inside a store). Learners who are 5405
able to move their wheelchairs short distances may not be able to roll longer distances 5406
due to the additional endurance or attention required. 5407
5408
Prerequisites 5409
None. 5410
5411
Spotter considerations 5412
Spotter starting position: 5413
If a manual wheelchair, the spotter should be behind the wheelchair, holding onto 5414
the spotter strap with one hand. 5415
If a powered wheelchair, the spotter should be beside the wheelchair on the side 5416
of the controller. 5417
Risks requiring spotter intervention: 5418
If a manual wheelchair, rear tip when accelerating (especially during the first 5419
push). 5420
If a powered wheelchair, runaway or collision. 5421
Because speeds are usually faster if the skill is being performed in a smooth open 5422
space, the higher momentum can cause greater injury or damage if there is a 5423
collision with a fixed or moving obstacle. 5424
5425
Adjustment tips 5426
The distribution of weight on the front and back wheels can be adjusted in some 5427
wheelchairs. This has effects on the stability of the wheelchair, traction and rolling 5428
resistance. 5429
If the wheelchair user experiences difficulties maintaining a straight direction, the 5430
problem may be due to a wheelchair part (e.g. a flat tire) or something rubbing on a wheel 5431
(e.g. a seat belt). 5432
Underinflated tires increase the rolling resistance. 5433
153
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Solid tires roll better on smooth surfaces but are less comfortable than pneumatic tires on 5434
rough ground. 5435
5436
General training tips 5437
There are three segments of this skill: starting, rolling straight and stopping. Stopping 5438
will be dealt with separately, in section 9.5. 5439
When first attempting to move forward, the direction in which any swivel casters are 5440
trailing can lead to some initial resistance to movement or lateral deviation as movement 5441
begins. The learner should reposition the casters in the appropriate direction before 5442
setting out. Learning how to reposition the casters is a technique that is useful for a 5443
number of skills. To reposition the casters, the wheelchair should be moved short 5444
distances in a manner that causes the casters to swivel (e.g. forward, then left, than 5445
backward, then right). 5446
The learner should maintain attention in the direction of travel, avoiding distractions to 5447
either side but remaining alert to potential hazards. 5448
The wheelchair user should keep the wheelchair away from dangers like walls or drop-5449
offs. 5450
The learner should also be alert to the moving environment. If a hallway is clear enough 5451
to permit it, it may be advisable to drive in the middle of the hallway, to avoid collisions 5452
with people unexpectedly coming around corners or out of doors. 5453
The learner should obey driving conventions (the “rules of the road”), with respect to 5454
altering course to one side (e.g. to the right in North America) when approaching others, 5455
use of horn or verbal warnings, overtaking and slowing down when approaching others or 5456
blind intersections. 5457
5458
Progression: 5459
Speed and accuracy are inversely related. It is advisable to begin movement skills 5460
with accuracy before increasing the speed. 5461
Start in a smooth level indoor space and progress to the outdoor setting. 5462
5463
Variations: 5464
The learner can experiment with different speeds. 5465
A strip of bubble wrap can be used for the wheelchair to straddle, providing 5466
audible feedback if a straight path is not followed. 5467
To work on directional control, the learner can follow a wall or sidewalk edge while 5468
trying to stay within an arm’s reach. 5469
5470
Special considerations for manual wheelchairs 5471
Each propulsion cycle includes propulsion and recovery phases. 5472
Endurance may be a limiting factor for longer distances if the wheelchair user is poorly 5473
conditioned. 5474
5475
Two-hand-propulsion pattern: 5476
Adjustment tip: 5477
The wheelchair parts and their set-up can affect propulsion. For instance, the 5478
154
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
rear-wheel axle should be directly under or slightly ahead of the acromion 5479
process of the shoulder when the wheelchair user is sitting upright at rest. The 5480
fingers should be able to touch the axle of the rear wheel. When the hands are 5481
on the hand-rims of the rear wheels at top dead center (12:00, using the clock 5482
analogy), the elbow should be flexed 60-70º from full extension. These 5483
adjustments will allow the wheelchair user to have the hands in contact with 5484
the hand-rims in a manner that permits optimal propulsion as described below. 5485
For instance, having the elbows slightly flexed at 12:00 means there is range to 5486
allow the elbows to extend at the beginning and end of the propulsion phase. 5487
The friction between the hands and the hand-rims can be increased by the use 5488
of gloves, high-friction covering on the hand-rims or surgical tubing wrapped 5489
in a spiral fashion around the hand-rims. However, too much friction can cause 5490
discomfort or blisters when slowing the wheelchair (e.g. while descending an 5491
incline). 5492
5493
Starting: 5494
When starting to roll forward, the wheelchair user should lean forward slightly 5495
and avoid overly vigorous accelerations that could cause the wheelchair to tip 5496
over backward. This is the first example of a skill that can benefit by leaning. 5497
Because the weight of most wheelchair users is large relative to the weight of 5498
the wheelchair, leaning can have a major effect on the relative weight on the 5499
different wheels. Leaning affects the stability of the wheelchair, traction and 5500
rolling resistance. Leaning is a strategy used often in the later skills. 5501
5502
Propulsion phase: 5503
Once up to speed, propulsion mechanics vary with the task and the 5504
characteristics of the wheelchair user. However, on smooth, level surfaces 5505
there are some general guidelines that should be considered the starting point. 5506
During the propulsion phase, the hands should initially match the speed of the 5507
moving wheels. 5508
The wheelchair user should avoid overly vigorous accelerations that could 5509
cause the wheelchair to tip over backward. 5510
To propel the wheelchair straight forward, the wheelchair user should grasp 5511
the hand-rims and push evenly with both hands. He/she should not wrap the 5512
thumbs around the hand-rims, but point them forward. 5513
The wrists should be in a roughly neutral orientation, avoiding the extremes of 5514
range. 5515
To improve friction, if necessary, the wheelchair user may rest the palms of 5516
the hands on the tires in addition to using the hand-rims. The disadvantage of 5517
this technique is that the palms pick up dirt from the tires. 5518
To minimize shoulder injury due to repetitive strain, it is generally accepted 5519
that the wheelchair user should try to push with long, slow strokes, allowing 5520
the wheelchair to coast between strokes where possible. However, this 5521
technique may actually increase the loads on the shoulders during each cycle 5522
(although it is generally assumed that the reduction in the number of cycles 5523
offsets this). As for walking, optimization of energy efficiency may be more 5524
155
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
important than minimizing shoulder loads. 5525
As noted earlier, hand positions can be illustrated by having the wheelchair 5526
user imagine the right rear wheel as the face of a clock; the initial and final 5527
contact positions for the wheel might then be referred to as 11:00 and 2:00 5528
o’clock. This “three-hour time period” corresponds to a contact angle of 90°. 5529
The wheelchair user should lean forward as the elbows are extended during 5530
the latter part of the propulsion phase, to get more contact time between the 5531
hands and the hand-rims and to reduce the chance of a rear tip. 5532
To maintain a straight direction during the coast between pushes, the 5533
wheelchair user may need to push harder on the side toward which the 5534
wheelchair is deviating or use the fingers on the hand-rim to apply friction on 5535
the other side. Although it is possible to coast for several meters from a single 5536
push, a cadence of about 1 push per second is commonly used, at least in part 5537
to maintain directional control. If the learner is having difficulties in achieving 5538
the desired cadence, the trainer can provide audible cues (e.g. by clapping). 5539
5540
Recovery phase: 5541
A recovery path for the hands below the hand-rims is usually recommended 5542
for wheelchair users propelling for any distance on smooth level surfaces. 5543
After releasing the hand-rims at the end of the propulsive phase, the arms can 5544
be allowed to swing in a relaxed pendular fashion below the hand-rims (the 5545
“semi-circular” recovery pattern) back toward where the propulsive phase will 5546
begin for the next cycle. (The hands need to move slightly outward as well as 5547
backward, to avoid contact with the rear wheels.) To reinforce the desired 5548
path of the hands, the trainer can ask the wheelchair user to touch the rear-5549
wheel axles during each recovery phase (“like the drive shaft of a choo-choo 5550
train”). This allows the hands to make initial contact with the hand-rims while 5551
moving upward. 5552
An additional reason to reach back during the recovery phase and to use long 5553
strokes is to exercise the shoulder retractor muscles and maintain shoulder 5554
retraction range. This may help to offset the tendency for manual wheelchair 5555
users to become round-shouldered due to muscle imbalance and loss of 5556
flexibility. 5557
Wheelchair users with weak or insensitive hands may prefer to slide their 5558
hands back along the hand-rims (the “arc” recovery pattern), rather than 5559
letting go at the end of the propulsive phase, but any friction should be 5560
minimized to avoid braking. Short strokes with arc recoveries may be 5561
appropriate for propelling short distances in confined spaces when fine control 5562
is the priority. 5563
5564
Variations: 5565
The wheelchair user can see how far he/she can roll on a single push. 5566
The wheelchair user can see how quickly he/she can cover a distance. 5567
The wheelchair user can try propelling with one hand at a time (e.g. as when 5568
carrying a cup of coffee). 5569
The wheelchair user can push an empty wheelchair with one hand, steering 5570
156
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
with the empty wheelchair. 5571
The wheelchair user can try to straddle a strip of bubble wrap while coasting, 5572
without bursting any bubbles. 5573
The wheelchair user can try to straddle objects of various heights and widths 5574
(e.g. using a few bricks) to better understand the clearance between the wheels 5575
and under the wheelchair. 5576
The wheelchair user can pull another occupied wheelchair behind him/her 5577
(with the second wheelchair user holding onto the wheelchair in front) 5578
(another “choo-choo train” analogy). 5579
After weaving around objects, it is important to remember to return to the 5580
proper propulsion/recovery pattern. An easy, multi-task activity is to weave 5581
through cones (e.g. during the “turns while moving” skill) and then transition 5582
into a few pushes in a straight line before returning to the cones. 5583
5584
Hemiplegic-propulsion pattern: 5585
Note: Hemiplegia due to stroke is used as a representative example of a condition 5586
for which foot propulsion can be useful. Wheelchair users with other impairments 5587
may find foot propulsion useful as well. 5588
5589
Adjustment tip: 5590
While the wheelchair user is properly positioned on the seat, the height of the 5591
seat should be low enough to allow the full foot to be on the ground when it is 5592
directly below the knee but high enough to fully support the thigh. 5593
The wheelchair user should wear shoes that do not fall off, that provide 5594
protection for the foot and that provide good traction. 5595
5596
Propulsion phase: 5597
If only the sound-side arm is used, the wheelchair will deviate to the weaker 5598
side. 5599
The wheelchair user propels the wheelchair with the sound-side leg to both 5600
propel and steer the wheelchair, with or without the assistance of the sound-5601
side arm. 5602
There is no need to synchronize the cadence of the hand and foot. Indeed, 5603
once moving, some wheelchair users use only the foot to maintain forward 5604
movement. 5605
The propulsion phase for the leg begins with the knee relatively extended, 5606
pushing down on the floor with the heel of the shoe, and then flexing the knee 5607
under the seat to pull the wheelchair forward. 5608
The propulsion phase for the arm is the same as that described above for two-5609
hand propulsion. 5610
If wheelchair users are experiencing difficulties (e.g. due to low friction 5611
between the shoe and the ground), they may find it helpful to rock the trunk 5612
forward at the hips in time with each flexion of the knee. 5613
5614
Recovery phase: 5615
157
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
At the end of the propulsion phase for the leg, the foot is lifted off the ground, 5616
and the knee is extended. 5617
The recovery phase for the arm is the same as that described above for two-5618
hand propulsion. 5619
5620
Special considerations for caregivers 5621
5622
For caregivers of people with hemiplegia, if there is only one footrest, because the 5623
wheelchair user uses one arm and one leg to self-propel the wheelchair, the unsupported 5624
foot can be crossed over the supported one. 5625
5626
Special considerations for powered wheelchairs 5627
Adjustment tips: 5628
For this skill and later moving skills, when it is possible to program the 5629
wheelchair modes (e.g. with respect to speed, torque and deceleration), the trainer 5630
should use a mode that is safe without being ineffective when training begins. 5631
When set in the slowest speed, there may be a time lag between when a joystick is 5632
moved and when the action occurs. This can lead to overcorrection while steering 5633
the wheelchair. 5634
The learner should alter the controller mode and speed settings to the ones most 5635
appropriate for the task. For the mode used for longer distances, the controller 5636
setting can be adjusted by the therapist or dealer to one that permits more speed 5637
and less sensitivity. 5638
Non-proportional drives (on/off) are just as dependent on proper programming as 5639
proportional drives, if not more so. The set-up of non-proportional drives can be 5640
graded to include less cognitive demand and physical load depending on the 5641
user’s needs and abilities. 5642
If the wheelchair user’s hand slips off the joystick or control is poor, a different 5643
shape for the joystick may be appropriate (e.g. U-shape vs. ball-shape). 5644
Powered wheelchairs may be rear-wheel, front-wheel or mid-wheel drive. The 5645
drive configuration will affect the path of the wheelchair and the ease with which 5646
the wheelchair can be kept moving in a straight line. For instance, a front-wheel-5647
drive wheelchair tends to be more difficult to keep moving forward in a straight 5648
line; some wheelchairs have built-in compensation for this problem. 5649
5650
This is the first powered wheelchair skill involving movement of the powered wheelchair 5651
in a drive mode. With powered wheelchairs, although there are a number of input devices 5652
that can be used to control the wheelchair, the term “joystick” has been used in the WSP 5653
Manual because it is the most common device used. Unless programmed otherwise for a 5654
wheelchair user with special needs, displacement of the joystick in a direction will cause 5655
the wheelchair to move in that direction. If the controller is of the proportional-control 5656
type, the farther the joystick is moved from its rest position, the faster the wheelchair will 5657
move in that direction. The user should move such a joystick forward gradually to 5658
achieve a smooth start. It may take some practice for the wheelchair user to use the 5659
joystick in a proportional way – an exercise may be for the wheelchair user to see how 5660
slowly he/she can move. 5661
158
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
If the wheelchair user is over-correcting for minor deviations from the intended path 5662
when driving, changing the contact point with the joystick (e.g. from finger tips to the 5663
web-space between the thumb and index fingers) and resting the forearm on the armrest 5664
may improve driving smoothness. 5665
5666
Progression: 5667
The learner can practice moving the joystick in an open space and progress to 5668
more enclosed ones. 5669
The learner can begin at responsive but low torque settings and progress to 5670
different modes. 5671
5672
Special considerations for caregivers 5673
When a caregiver is first learning to handle a powered wheelchair, it is preferable to do 5674
so with the wheelchair unoccupied, to avoid injury to the wheelchair user. 5675
Some wheelchairs permit the wheelchair to be operated by a caregiver behind the 5676
wheelchair, which is the preferred position if the equipment allows. 5677
For this and other moving skills, the caregiver may operate the wheelchair by using the 5678
same joystick that the wheelchair user does. Where space permits, this should be done 5679
with the caregiver standing beside the wheelchair and facing forward. In some situations 5680
(e.g. going through a narrow opening), the caregiver may need to stand in front of the 5681
wheelchair. The caregiver in this situation should be careful not to drive the wheelchair 5682
over his/her own feet. 5683
Standing behind the wheelchair and leaning forward to reach the joystick is not generally 5684
recommended but may occasionally be necessary. 5685
Sitting on the wheelchair user’s lap to operate the joystick is not recommended for a 5686
number of self-evident reasons. 5687
Disengaging the motors allows the powered wheelchair to be pushed manually without 5688
power (e.g. if the battery is dead). To do so, the power should be turned off before the 5689
motors are disengaged. The wheelchair may be harder to push if the power is on, even if 5690
the motors are disengaged. The caregiver can confirm that the motors have been 5691
disengaged, by pushing on it to see that the wheelchair can be rolled a short distance. 5692
Depending on the type of wheelchair, rolling the wheelchair slightly when disengaging 5693
the motors may ease the lever into the disengaged position. Various makes and models of 5694
powered wheelchairs and scooters have different methods of disengaging the motors. For 5695
most powered wheelchairs, there are two motors that need to be separately disengaged 5696
and engaged. For caregivers, good ergonomic principles should be used when engaging 5697
and disengaging the motors. The caregiver’s knees should be bent and the back kept 5698
straight. In many cases, a foot can be used to perform the task but this should be gently 5699
done to avoid damaging the mechanism. 5700
5701
Special considerations for scooters 5702
The handles on the tiller control the orientation of the front wheel for steering purposes. 5703
Lever mechanisms on the handles usually control forward versus backward direction and 5704
moment-to-moment speed. 5705
A dial on the tiller controls the general speed setting (high vs. low) depending upon the 5706
circumstances. 5707
159
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
The scooter user can set the speed control so that he/she can proceed at the desired speed 5708
with the lever fully pushed or pushed part-way depending upon the user’s preference. 5709
The stiff suspension of most scooters can lead to some bouncing over rough surfaces such 5710
as sidewalk cracks. 5711
5712
160
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.4 ROLLS BACKWARD 5713
5714
Versions applicable 5715
Manual wheelchair: 5716
Powered wheelchair: 5717
5718
WST/WST-Q skills 5719
“Rolls backward short distance”. 5720
“Rolls longer distance”. 5721
5722
Description and rationale 5723
The learner moves the wheelchair backward on a smooth level surface. Backward rolling 5724
is a skill used during many wheelchair activities. However, a short distance is usually all 5725
that is necessary, unless overcoming high rolling resistance (e.g. on a soft surface or 5726
ascending an incline using foot propulsion). 5727
5728
Prerequisites 5729
None. 5730
5731
Spotter considerations 5732
Spotter starting position: 5733
For a manual wheelchair the spotter should be behind the wheelchair, holding a 5734
spotter strap (if a manual wheelchair) or beside the wheelchair near the front in 5735
position to push downward on a knee or wheelchair part. 5736
Risks requiring spotter intervention: 5737
Rear tip when stopping. 5738
Collision with fixed or moving objects. 5739
5740
General training tips 5741
If backing up immediately follows rolling forward, then the casters will be trailing 5742
backward rather than forward as they will while moving backward. As the backing up 5743
begins, there may be some initial resistance and directional instability as the casters move 5744
into the forward-trailing position. The casters can easily be repositioned by moving them 5745
in a circular path. 5746
The learner should proceed slowly and look over both shoulders regularly to avoid 5747
obstacles and collisions. Using the analogy of backing up a motor vehicle may be helpful. 5748
Directional stability is more difficult to maintain when backing up a rear-wheel-drive 5749
wheelchair. This may lead to a sinuous path, with a series of deviations and over-5750
corrections (“fish-tailing”). This may not be apparent when wheeling backward for a 5751
short distance like that used for the WST, so a longer distance should be used for training 5752
purposes. Slowing down will make it easier for the learner to steer. 5753
5754
5755
Variations: 5756
Bubble wrap can be placed behind a moving rear wheel without the learner’s 5757
161
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
knowledge to provide audible feedback that shoulder checks are needed. 5758
5759
Special considerations for manual wheelchairs 5760
In many ways, the technique is the opposite of what is used for rolling forward (as dealt 5761
with in the previous skill). 5762
5763
Two-Hand-Propulsion Pattern: 5764
To propel the wheelchair straight backward, the wheelchair user should reach 5765
forward, grasp the hand-rims and pull backward evenly. 5766
Some wheelchair users with very weak arms (e.g. people with tetraplegia) may find it 5767
more effective to make contact under the hand-rims with the palms up. Others may 5768
prefer to place both hands on the backs of the wheels (about 11:00 o’clock, using the 5769
clock analogy) with the arms straight and the shoulders shrugged. Then, the 5770
wheelchair user can lean back and use the body weight to push down on the wheels. 5771
Unlike forward rolling, it is not easy to coast backward without deviating to one side 5772
or the other. Therefore, the length of the strokes is usually shorter when rolling 5773
backward. 5774
Because the distances are usually short, there is no need to use long propulsion 5775
strokes or to recover the hands below the hand-rims. 5776
5777
Variations: 5778
As for the “rolls forward” training section. 5779
5780
Hemiplegic-propulsion pattern: 5781
As for “rolls forward” training, except the sequence for the leg is to first flex the leg, 5782
push down on the floor with the foot enough to ensure good traction, then push the 5783
wheelchair backward by straightening the leg. 5784
5785
Special considerations for caregivers 5786
The caregiver needs to do regular shoulder checks to avoid collisions or obstacles and 5787
will need to move to one side of the wheelchair if backing up to a fixed object (e.g. a 5788
wall). 5789
5790
Special considerations for powered wheelchairs 5791
Adjustment tip: 5792
The programming of a powered wheelchair is separate for the forward and 5793
backward directions. It is possible that a wheelchair that has not been programmed 5794
correctly could have difficulty backing up unless the speed control is adjusted 5795
upward. 5796
If the wheelchair is fitted with a rear-view mirror, this lessens the need to turn 5797
around to see where the wheelchair is going for wheelchair users with limitations 5798
of neck range. 5799
5800
To move backward, the wheelchair user ordinarily pulls the joystick backward. 5801
5802
Special considerations for scooters 5803
162
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
As for “rolls forward” training, the handles on the tiller control the orientation of the front 5804
wheel for steering purposes, lever mechanisms on the handles control forward versus 5805
backward direction and moment-to-moment speed, and a dial on the tiller controls the 5806
general speed setting (high vs low). 5807
5808
163
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.5 STOPS 5809
5810
Versions applicable 5811
Manual wheelchair: 5812
Powered wheelchair: 5813
5814
WST/WST-Q skills 5815
“Rolls forward short distance”. 5816
“Rolls forward longer distance”. 5817
“Rolls backward short distance”. 5818
“Stops on command”. 5819
“Turns while moving forward”. 5820
“Turns while moving backward”. 5821
5822
Description and rationale 5823
While the learner is moving the wheelchair forward or backward, he/she may 5824
intentionally come to a stop at a pre-determined location (e.g. next to a table or wall) or 5825
need to come to a sudden stop in reaction to an unexpected event (e.g. other wheelchairs 5826
or pedestrians moving into the path) to avoid injury to themselves or others. 5827
5828
Prerequisites 5829
“Rolls forward short distance” for the forward direction. 5830
“Rolls backward short distance” skill for the backward direction. 5831
5832
Spotter considerations 5833
Spotter: As for the appropriate shorter-distance skill (forward or backward). 5834
Risks requiring spotter intervention: 5835
As for the appropriate shorter-distance skill (forward or backward). 5836
Forward or sideways tip or fall due to a sudden stop or turn. 5837
Because speeds are usually faster if the skill is being performed in a smooth open 5838
space, the higher momentum can cause greater injury or damage if there is a 5839
collision with a fixed or moving obstacle. 5840
5841
General training tips 5842
The learner should be alert to the fixed and moving environment while the wheelchair is 5843
moving. 5844
Sudden stops or changes of direction can lead to the wheelchair user falling forward or to 5845
the side in the wheelchair. 5846
When attempting to stop as close as possible to a target without contacting it, the learner 5847
may need help to understand what are the foremost and rearmost points of the occupied 5848
wheelchair (e.g. the toes, the footrests, a knapsack or rear anti-tip devices) because it may 5849
not be visible to the wheelchair user. 5850
5851
Progression: 5852
Start at a slow speed before stopping and increase as tolerated. 5853
164
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Start in a smooth level indoor space and progress to the outdoor setting. 5854
Start on the level and progress to inclined surfaces. 5855
To practice the avoidance of moving obstacles, the learner should start with a 5856
single moving obstacle moving slowly at a consistent speed, seen well in advance, 5857
to obstacles moving more rapidly and unpredictably, with less warning (e.g. 5858
actual pedestrian traffic in a crowded setting). 5859
5860
Variations: 5861
The learner can practice stopping progressively closer to an obstacle, but without 5862
touching it. This can include progress from a tall obstacle that can be seen no 5863
matter how close the person is to it (e.g. a door), to one that is lost to sight as the 5864
user gets closer (e.g. a line on the floor). This requires good awareness of the most 5865
forward and rear-most aspects of the wheelchair. A mirror positioned to the side 5866
of the wheelchair can provide useful feedback. 5867
The wheelchair user can see how quickly he/she can stop on command. 5868
Different moving obstacles can be used (e.g. a rolled ball, a swinging pendulum). 5869
5870
Special considerations for caregivers 5871
For caregivers of manual wheelchair users, secure push handles (ones that will not pull 5872
off when a backward force is applied to them) are important for this skill. 5873
Sudden changes in speed or direction can cause the wheelchair user to fall forward or to 5874
the side. The caregiver should use good spotting techniques, reaching forward or to the 5875
side with a hand to stabilize the wheelchair user. 5876
5877
Special considerations for manual wheelchairs 5878
When there is ample space in which to stop, on a level surface the wheelchair will coast 5879
to a gradual stop due to frictional forces and rolling resistance when the wheelchair user 5880
stops pushing. 5881
If the wheelchair user wishes to stop more quickly, the rate of slowing can be controlled 5882
by how hard the hand-rims are gripped. The hand-rims should be allowed to run through 5883
the wheelchair user’s hands. While stopping, the hands should be ahead of top dead 5884
center (about 1:00 o’clock using the clock analogy). 5885
If the wheelchair user stops too quickly while moving forward, the wheelchair user may 5886
fall forward out of the wheelchair or tip over forward. To prevent this, the wheelchair 5887
user should lean back whenever he/she is required to stop quickly. 5888
Sudden stops while moving forward can transfer weight forward onto the casters, 5889
allowing the unloaded rear wheels to skid. 5890
When stopping while moving backward, to avoid tipping backward when stopping, the 5891
wheelchair user should avoid grabbing the wheels suddenly and should lean forward 5892
slightly. 5893
On a slope, the wheelchair will continue to roll (or even accelerate) unless stopping 5894
forces are applied. If the wheelchair starts to roll too quickly down an incline that is wide 5895
enough, instead of grasping both hand-rims to stop, the wheelchair user can grab one, 5896
turning across the slope. 5897
On a slope that is being descended in the wheelie position, when stopping part-way down 5898
165
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the incline, the learner may remain facing downhill or turn the wheelchair across the 5899
slope. 5900
For people using the hemiplegic-propulsion pattern, the wheelchair user may use the 5901
hand (as for two-hand propulsion) and friction between the foot and the floor to stop. 5902
5903
Variations: 5904
When moving forward, the wheelchair user can practice both quick stops (leaning 5905
back and grabbing both hand-rims firmly) and swerves (leaning toward the 5906
direction of turn and grabbing one hand-rim firmly). 5907
See wheelie variation later. 5908
5909
Special considerations for powered wheelchairs 5910
Adjustment tips: 5911
The setting for the deceleration distance may be increased so that a sudden stop 5912
does not cause the wheelchair user to fall or tip forward. However, the greater the 5913
deceleration distance, the more planning is required to avoid the obstacle. 5914
5915
When stopping a powered wheelchair, the user should allow the joystick to return to the 5916
neutral position gradually for a smooth stop. Simply letting go of the joystick will bring 5917
the wheelchair to a stop at a rate that has been programmed. Some wheelchairs can be 5918
brought to a stop more rapidly if the power is turned off or the joystick is put into reverse. 5919
5920
Special considerations for scooters 5921
The high speed that is possible with some scooters, combined with the high center of 5922
gravity and narrow wheelbase can make the scooter vulnerable to sideways tips during 5923
sudden turns. 5924
5925
166
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.6 TURNS IN PLACE 5926
5927
Versions applicable 5928
Manual wheelchair: 5929
Powered wheelchair: 5930
5931
WST/WST-Q skills 5932
“Turns in place”. 5933
5934
Description and rationale 5935
The learner turns the wheelchair around to the left and right to face in the opposite 5936
direction, in as tight a space as possible. Turning around in tight spaces is a common 5937
challenge for wheelchair users. The type of wheelchair and its dimensions affect the ease 5938
with which this skill can be performed. The environment may be such that the preferred 5939
direction of turn is not possible, so the learner must be capable of turning in both 5940
directions. 5941
5942
Prerequisites 5943
None. 5944
5945
Spotter considerations 5946
Spotter starting position: Near the wheelchair or behind the wheelchair, holding onto the 5947
spotter strap if done in the wheelie position. 5948
Risks requiring spotter intervention: See WST risks. 5949
5950
Adjustment tips 5951
The ease of making a turn in a tight space depends on the overall length and width of the 5952
occupied wheelchair, the distance between the wheels and how free the casters or steering 5953
wheels are to swivel. 5954
The rear anti-tip devices for some wheelchairs increase the overall length of the 5955
wheelchairs. Adjusting or removing them may make it easier to turn around in confined 5956
spaces. 5957
The footrests of some wheelchairs also increase the overall length of the wheelchairs, so 5958
more turning space is required. Removing the footrests may make it easier to turn around 5959
in close quarters. If the footrests are removed, it is important to avoid injuring the feet by 5960
bumping them or running over them with a wheel. If elevated footrests are lowered, the 5961
space needed for turning will be reduced. 5962
If a wheelchair is in the tilted or reclined position, the turning space needed may be 5963
larger. 5964
5965
General training tips 5966
For most wheelchairs (but not scooters), the ability to turn is made easier by casters. 5967
Casters are wheels that are free to swivel around a vertical axis. The location of the 5968
casters (front vs. back) will affect the nature of the turn. 5969
It may be helpful for the learner to shuttle forward and backward (e.g. forward turn to the 5970
left, backward turn to the right, repeating as necessary) to minimize the space required, 5971
167
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
turning part of the way with each cycle. The longer the chair, the more likely it is that this 5972
will be necessary. 5973
The trainer should help the learner clearly understand the difference between the size of 5974
the turning circle (that is affected by parts, such as footrests, that stick out above the 5975
ground) and the size of the turning footprint (that only includes the chair or body parts 5976
that touch the ground). 5977
The footrests can be moved out of the way in tight spaces to reduce the radius of the 5978
turning circle. 5979
5980
Progression: 5981
The wheelchair user should begin with small angular displacements and progress 5982
to larger ones. 5983
The learner should start with a larger space in which to turn and progress to 5984
smaller ones. 5985
The learner should start at a slow speed, focussing on accuracy and increase the 5986
speed as skill develops. 5987
The wheelchair user can practice on progressive smaller areas of support. 5988
The wheelchair user can practice on a soft surface. 5989
5990
Variations: 5991
Game: Ask the learner to pretend that his/her feet are the hour hand of a clock 5992
facing up from the floor and see how quickly and accurately he/she can respond 5993
to times that the trainer calls out (e.g. from a starting position of 12:00 o’clock, 5994
“turn to 3:00 o’clock”). 5995
5996
Special considerations for manual wheelchairs 5997
Two-hand-propulsion pattern: 5998
To make the turn most tightly, the wheelchair user should pull back on one hand-rim, 5999
while pushing forward to an equivalent extent on the other. In such a case, the 6000
vertical axis of rotation for the turn is midway between the drive wheels. It may take 6001
a few cycles to complete the turn. If the arc moved through by one hand is less than 6002
that for the other hand, on completion of the turn, the wheelchair will come to rest 6003
closer to the hand that moves less. This can be an issue for the trainer to correct to 6004
achieve a tighter turning circle. Alternatively, this asymmetry of forces can be used as 6005
a strategy if the wheelchair user wishes to move in a direction as well as turning 6006
around. 6007
6008
Progression: 6009
Small displacements do not require that the hands be repositioned on the hand-6010
rims. 6011
The wheelchair user should then progress to larger displacements that require the 6012
hands to be repositioned, using several steps to get all the way around to 180. 6013
Some wheelchair users may be able to get all of the way around to 180 (or 6014
beyond) in a single movement (the so-called “snap turn”) by allowing the hand-6015
rims to slide through the fingers. To prepare for a snap turn, the wheelchair user 6016
168
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
places one hand as far forward as possible on one hand-rim and the other hand as 6017
far back as possible on the other hand-rim. Then, in a single uninterrupted motion, 6018
the wheelchair user “snaps” the wheelchair around, letting the hand-rims slide 6019
through the fingers until the wheelchair reaches the desired angle. Depending 6020
upon the rolling resistance of the surface, the wheelchair may continue to spin in a 6021
circle until wheel or hand-rim friction brings the wheelchair to a stop. 6022
6023
Variations: 6024
When turning around in confined spaces, it can be helpful for the wheelchair user 6025
to push or pull on external objects rather than using the hand-rims. 6026
See wheelie variation later. 6027
6028
Hemiplegic-propulsion pattern: 6029
To turn to the side away from the stronger hand, the wheelchair user should push 6030
forward on the hand-rim and push sideways toward the stronger side with the foot. 6031
To turn toward the stronger hand the wheelchair user should pull back on the hand-6032
rim and push sideways toward the weaker side with the foot. 6033
The wheelchair user may reach across to the opposite wheel with the stronger hand. 6034
6035
Special considerations for caregivers 6036
To turn a manual wheelchair around in a tight space, the caregiver should pull back on 6037
one push-handle, while pushing forward on the other. 6038
The caregiver should stand close to the back of the wheelchair if space is limited. If a 6039
knapsack prevents this, it can be temporarily removed and placed in the wheelchair user’s 6040
lap. 6041
This skill can be performed in the caregiver-assisted wheelie position. 6042
6043
Special considerations for powered wheelchairs 6044
Adjustment tips: 6045
Adjusting the speed, acceleration and deceleration for turning will affect turning. 6046
The location of the drive wheels and seating configurations have impacts on the 6047
turning characteristics of the system. 6048
The closer the drive wheels are to the loaded wheelchair’s center of gravity, the 6049
easier it is to turn in place by simply moving the joystick straight to the left or 6050
right. The vertical axis of rotation for such a turn is midway between the drive 6051
wheels. 6052
6053
If the drive wheels are well forward or back, the casters will swing more widely so that a 6054
series of to-and-fro motions may be needed to minimize the turning radius. 6055
6056
Special considerations for scooters 6057
Because the drive wheels are not independent and because of the limited angle through 6058
which the tiller can turn for most scooters, a scooter cannot turn in place in the same way 6059
that manual and powered wheelchairs can. 6060
The tightness of the turn is also affected by the length of the wheelbase. 6061
169
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
When maneuvering in tight spaces, the speed setting should be reduced. 6062
6063
170
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.7 TURNS WHILE MOVING 6064
6065
Versions applicable 6066
Manual wheelchair: 6067
Powered wheelchair: 6068
6069
WST/WST-Q skills 6070
“Turns while moving forward”. 6071
“Turns while moving backward”. 6072
6073
Description and rationale 6074
The learner turns the wheelchair to the left and right while moving forward or backward. 6075
Such moving turns are often necessary to avoid obstacles or to change direction. The 6076
amount of space needed for turning is affected by such factors as the type of wheelchair, 6077
the wheelbase (distance between the ground contact points for the front and back wheels), 6078
the overall length of the wheelchair and the freedom of the steering wheels to turn. For 6079
most wheelchair users, turns while moving backward are required less often in everyday 6080
life than moving turns in the forward direction. 6081
6082
Prerequisites 6083
None. 6084
6085
Spotter considerations 6086
As for the “rolls forward short distance” and “rolls backward short distance” skills, unless 6087
the learner has safely performed the appropriate skill, in which case the spotter needs 6088
only to be nearby. 6089
6090
General training tips 6091
The path of the wheelchair parts (e.g. footrests) will differ depending upon the 6092
characteristics of the wheelchair (i.e. whether the chair has rear-wheel, mid-wheel or 6093
front-wheel drive). As a general rule when turning, the vertical axis for the turn is 6094
midway between the drive wheels, so the farther away from this axis that a wheelchair 6095
part or body part is, the greater the circumference through which it will swing. 6096
When turning around an object (e.g. a pylon or a corner) that the wheelchair is close to, 6097
the wheelchair user should focus on ensuring that rear wheel, specifically the contact 6098
point between the wheel and the ground, clears the obstacle. 6099
When driving a rear-wheel-drive wheelchair toward a 90 turn into a narrow opening, 6100
when space is available the wheelchair user should stay as far as possible away from the 6101
wall on which the opening is found. This is analogous to parking a car between two other 6102
cars in a crowded parking lot. 6103
If the approach path is narrow but the opening is wide, approaching the corner close to the 6104
wall is preferable, watching closely that the axle of the near-side rear wheel is slightly 6105
beyond the corner before turning sharply. 6106
With a front-wheel-drive wheelchair, there is less of a problem steering a path close to the 6107
wall. 6108
171
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
If maneuvering around a series of fixed obstacles (such as the pylons used in the WST) 6109
that are widely spaced, a useful strategy is to use a path that takes the drive wheels close 6110
to the obstacles. If the obstacles are closer together, the wheelchair may need to be driven 6111
farther away from each obstacle to have sufficient room in which to complete the turn. 6112
The user should be especially careful not to catch the feet on an immovable external 6113
object – if the foot stops and the chair continues to turn, a serious injury can result. 6114
6115
Progression: 6116
The learner should start with small changes of direction (e.g. around widely spaced 6117
pylons) and progress to more closely spaced ones. 6118
When beginning training around full 90° corners, learners may find it easier to 6119
break a turn down into its segments – driving straight, turning, then driving 6120
straight again, rather than following a smooth curved path. 6121
6122
Variations: 6123
Three-point turns (e.g. using an opening like a doorway to turn around and go back 6124
in the opposite direction) can be carried out by making the first turn into the 6125
opening while moving forward, followed by a backward turn in the opposite 6126
direction. 6127
Alternatively, the initial turn into the opening can be backward (after rolling past 6128
the opening), followed by a forward turn in the opposite direction. 6129
When using the moving-turns skill in real-life settings, the learner should obey the 6130
rules of the road at corners – he/she should slow down if the path around the 6131
corner cannot be seen, he/she should stay to the right or left (whichever is the 6132
convention in the country in which the training is taking place) and he/she should 6133
not cut the corner. 6134
6135
Special considerations for manual wheelchairs 6136
Two-hand-propulsion pattern: 6137
When ready to turn, the wheelchair user should slow down the inside wheel and/or 6138
push harder on the outside wheel. Slowing down the inside wheel results in a tighter 6139
turn, but causes the wheelchair to slow down. Pushing harder on the outside wheel 6140
causes the wheelchair to speed up. The decision on the relative speeds of the two 6141
wheels depends on how tight a turn is needed and safety considerations. 6142
6143
Variations: 6144
While coasting forward in a straight line, the wheelchair user can experiment 6145
with the effect on direction caused by rotating the outstretched arms from side 6146
to side – for instance, swinging the arms counterclockwise (as viewed from 6147
overhead) causes the wheelchair to turn clockwise. 6148
The fixed environment can be used to assist with turning. Timing, intensity, 6149
direction and location of the forces applied to a fixed object such as a wall are 6150
important features of success. Using the environment minimizes the need to 6151
slow down. 6152
In the “drag” turn, the wheelchair user drags a hand, in a rear 6153
position, along the wall to turn toward the wall and around the 6154
172
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
corner. If the learner is having difficulties, the skill can be 6155
simplified by segmenting the skill, for instance having the trainer 6156
push the wheelchair forward toward the corner while the 6157
wheelchair user has the wall-side hand in the ready position and 6158
the opposite hand on the lap. 6159
In the “push-off” turn, the wheelchair user uses a hand, in a 6160
forward position, to push away from the wall. 6161
See wheelie variation later. 6162
6163
Hemiplegic-propulsion pattern: 6164
The wheelchair user should use the foot to help steer. 6165
It is easier to turn away from the sound (unaffected) side than toward it. 6166
6167
Special considerations for caregivers 6168
When turning while moving forward, the caregiver should push harder with the push-6169
handle on the outside of the turn and pull back slightly on the inside handle. The opposite 6170
is the case when turning while moving backward. 6171
The caregiver should be careful to avoid having the wheelchair user’s hands or feet hit 6172
any barriers. 6173
The wheelie position can be used to turn in tight spaces. 6174
6175
Special considerations for powered wheelchairs 6176
The path of the wheelchair is affected by whether the wheelchair is rear-wheel, mid-wheel 6177
or front-wheel drive. The general rule of paying attention to the axle of the near-side drive 6178
wheel applies. 6179
If the leading wheels are the drive wheels (i.e. a front-wheel-drive wheelchair when 6180
moving forward), the trailing casters may swing wide of the path and may strike the wall 6181
on the far side, depending upon the radius of the turn. 6182
If the wheelchair is about to collide with the corner, the wheelchair user should not reach 6183
out to fend off with the hands or feet – this is ineffective and may cause injury. The body 6184
parts should be kept within the protective envelope of the wheelchair. 6185
Although operation of the joystick is fairly intuitive when performing turns while moving 6186
forward (e.g. if one wishes to turn to the right, the joystick is moved to the right), it can 6187
be difficult to get used to performing moving turns in the backward direction. It can be 6188
helpful to remember that the left-right direction in which the joystick should be displaced 6189
should be the direction in which the wheelchair user wishes his/her knees to move. For 6190
instance, when making a backward turn to the left, the knees will move to the right, so 6191
that is the direction toward which the joystick should be displaced. 6192
6193
Special considerations for scooters 6194
Some scooters have three wheels and some have four. All other things being equal, a 6195
three-wheeled scooter will corner better but will be more vulnerable to sideways tips. 6196
Unlike powered wheelchairs, the drive wheels do not operate independently. Steering the 6197
scooter is related to the orientation of the front wheel(s), controlled by the handles of the 6198
tiller. 6199
Because most scooters are rear-wheel-drive, turning is similar to driving a car, an analogy 6200
173
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
that may be useful to the learner. 6201
Because most scooters have long wheelbases in comparison with other wheelchairs and 6202
because there are usually limits to how far the handles can be turned, scooters cannot turn 6203
as tightly as other wheelchairs. 6204
Having a mirror attached to a handle can be useful when driving straight backward but is 6205
of less use when turning – as one backs up and turns to the right, the mirror looks to the 6206
left. 6207
6208
174
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.8 MANEUVERS SIDEWAYS 6209
6210
Versions applicable 6211
Manual wheelchair: 6212
Powered wheelchair: 6213
6214
WST/WST-Q skills 6215
“Manuevers sideways”. 6216
6217
Description and rationale 6218
The learner maneuvers the wheelchair sideways to the left and right parallel to an object 6219
(e.g. a window, bed or table). Repositioning the wheelchair sideways in a tight space is 6220
commonly necessary to get closer to or farther away from objects. 6221
6222
Prerequisites 6223
None. 6224
6225
Spotter considerations 6226
Spotter starting position: Near the wheelchair. 6227
Risks requiring spotter intervention: No common risks. 6228
6229
Adjustment tip 6230
The length of the wheelchair can sometimes be minimized through set up (e.g. by moving 6231
the axles forward) or positioning (e.g. tilt, recline, footrest elevation). 6232
6233
General training tips 6234
The learner needs to be aware of the widest and longest points of the wheelchair as well 6235
as the footprint created by the wheels on the floor. 6236
If the space available in a real-life situation is limited, the learner may need to shuttle the 6237
wheelchair forward and backward a number of times to get into the desired position, 6238
moving more to the side with each attempt. 6239
6240
Progression: 6241
The learner should start with ample forward-backward room in which to maneuver 6242
and gradually decrease the space. 6243
The learner should start with small sideways steps and progress to larger ones. 6244
The learner should start at a slow speed, focussing on accuracy (staying within any 6245
designated boundaries), increasing the speed within the limits of accuracy. 6246
6247
Variations: 6248
The learner may mimic parallel parking a car, pulling forward ahead of the target 6249
opening, then backing into the opening. 6250
6251
Special considerations for manual wheelchairs 6252
Two-hand-propulsion pattern: 6253
175
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Variations: 6254
An alternative for the wheelchair user with good upper-body strength and co-6255
ordination is to use the “bunny-hop” method. To do so, the wheelchair user 6256
hops the rear wheels to the side by shifting the body weight in the desired 6257
direction and pulling up on the rear wheels to have them move in the same 6258
direction. Although there remains some controversy regarding this, it seems 6259
that the head should move initially in the direction intended, then in the 6260
opposite direction while moving the hips over (analogous to the head-vs.-hips 6261
method used in the sideways transfer discussed later in section 9.11). The 6262
wheels do not need to get fully off the ground to be successful. The bunny hop 6263
is most useful when space is very limited (e.g. when very close to a wall). 6264
Initially, the wheelchair user can get used to just hopping up and down, with 6265
no sideways movement. If the hands holding onto the hand-rims are not at the 6266
top dead center, the rear wheels will rotate when they become unloaded. This 6267
can be prevented by applying the wheel locks. 6268
A similar effect can be created by rocking the wheelchair from side to side, 6269
although the wheelchair may move forward as well as to the side. The 6270
wheelchair user should lean hard in the direction that he/she wishes to move 6271
and return more gently to the upright position. 6272
The learner may use the sideways-maneuvering technique to negotiate to the 6273
other side of two barriers with a space between them (e.g. two concrete 6274
bolsters in a parking lot) that is too narrow to drive straight through but is low 6275
enough from the ground to allow clearance between the wheels. It may be 6276
possible to move one pair of wheels through the gap at a time, transiently 6277
straddling the obstacles with one pair of wheels on either side of the obstacles 6278
and the wheelchair parallel with the obstacles before getting all wheels 6279
beyond the obstacle. 6280
See wheelie variation later. 6281
6282
Hemiplegic-propulsion pattern: 6283
No special considerations. 6284
6285
Special considerations for caregivers 6286
The caregiver should generally not attempt to lift the occupied wheelchair sideways. 6287
However, it may be possible to use the “wheelbarrow” approach. To do so, the 6288
wheelchair user leans forward to unload the rear wheels, being careful not to tip over or 6289
fall from the wheelchair. Then the caregiver may be able to slightly lift the rear wheels 6290
and move them sideways in small increments. 6291
The caregiver should be careful that the wheelchair user’s arm or hand is not caught 6292
between the lateral barrier and the rear wheel. 6293
6294
Special considerations for powered wheelchairs 6295
Adjustment tip: 6296
A mirror attached to the wheelchair can be used to provide visual feedback on the 6297
position of the chair with respect to the rear barrier. 6298
6299
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The strategies for front-wheel-drive and rear-wheel-drive wheelchairs are somewhat 6300
different. For instance, when maneuvering away from a wall that is very close, it is 6301
helpful to move the casters away from the wall first. 6302
6303
Special considerations for scooters 6304
Adjustment tip: 6305
A mirror attached to a tiller handle can be used to provide visual feedback on the 6306
position of the chair with respect to the rear barrier. 6307
6308
Because of the long wheelbase of most scooters, it is often not possible to move sideways 6309
when the amount of space is very limited, but the skill should still be practiced in larger 6310
spaces. 6311
6312
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.9 PICKS OBJECTS FROM FLOOR 6313
6314
Versions applicable 6315
Manual wheelchair: 6316
Powered wheelchair: 6317
6318
WST/WST-Q skills 6319
“Picks objects from floor”. 6320
6321
Description and rationale 6322
The learner picks objects up from the floor and passes them to the tester. Objects that 6323
need to be picked up from the floor or ground vary from those as small and light as a coin 6324
or a piece of paper to those as bulky and heavy as a young child. This is also an 6325
opportunity for the trainer to work on other reaching tasks (e.g. horizontally across a table 6326
or overhead as when removing an object from a shelf). 6327
6328
Prerequisites 6329
None. 6330
6331
Spotter considerations 6332
Spotter starting position: Near the wheelchair, on the side toward which the learner leans 6333
(if any). 6334
Risks requiring spotter intervention: 6335
Forward or sideways tip or fall when reaching, leaning or standing up. 6336
Forward fall or tip due to standing on a footrest. 6337
6338
Adjustment tip 6339
Chair height and the overall length of the wheelchair can have impacts on the wheelchair 6340
user’s ability to reach objects, depending upon the method used. 6341
6342
General training tips 6343
Reaching and leaning reduce stability, putting the wheelchair user at risk of falling out of 6344
the wheelchair or, if in a manual wheelchair, tipping the wheelchair over. 6345
If the armrest on the side to which the wheelchair user wishes to reach is moved out of 6346
the way, it allows the wheelchair user to bend further sideways. 6347
To be safer if leaning or bending forward, the wheelchair user should move the footrests 6348
out of the way and place the feet on the floor. 6349
If the wheelchair user chooses to lean forward to accomplish the task, he/she should 6350
make sure the casters are trailing forward to decrease the likelihood of tipping forward. 6351
As noted earlier, when the casters are trailing forward, they lie ahead of the portion of the 6352
wheelchair frame to which they are attached, as is the case when the wheelchair is rolled 6353
backward. This is a good opportunity to review with the wheelchair user how to swivel 6354
the casters into different directions. Caster swivel control is a skill that will be useful for 6355
later skills. To swivel the casters 180° in a tight space requires that a combination of 6356
forward-backward and left-right forces be applied to the casters. As an exercise, the 6357
trainer can ask the learner to point the casters at targets or to pretend the caster is the hour 6358
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
hand on a clock (“Set your caster to 3:00 o’clock”). Alternatively the trainer can ask the 6359
learner to swivel the casters around an object (e.g. a coin) on the floor without touching 6360
it. 6361
The wheelchair user should use one hand on the wheelchair or thigh to help with balance 6362
and the other hand to pick up the object. 6363
For a wheelchair user with weak trunk muscles, to reach the ground he/she should move 6364
the arms to the thighs one at a time, and then to the feet, placing the chest on the thighs. 6365
Turning an object on its side may help to get a better grip. 6366
To make it easier to pick up an object, the wheelchair user may pull the object up against 6367
one of the wheels so that it does not move. 6368
If a wheelchair user has weak pinch strength, increasing the friction between the fingers 6369
and the object (e.g. by wearing gloves or wetting the fingers with saliva) can help to 6370
prevent dropping the object. 6371
When passing the object to someone or placing it on a table or shelf, the wheelchair 6372
should be positioned to take advantage of the learner’s reach, strength and balance. 6373
For a person with weak trunk muscles, to avoid falling in the direction that he/she is 6374
leaning, he/she may hook the non-reaching arm behind the push handle or hold onto the 6375
armrest or wheel. 6376
To help right him/herself in the chair after reaching for the object, the wheelchair user 6377
can pull on the opposite armrest or wheel. 6378
6379
Variations: 6380
If standing up and crouching, the wheelchair user should first apply the wheel 6381
locks and clear the footrests out of the way. If the wheelchair user stands up on 6382
the footrests, a forward tip is likely unless the footrests are behind the front 6383
wheels. If standing up and crouching, the wheelchair user should keep one hand 6384
on the wheelchair to keep from falling. 6385
The wheelchair user needs to exercise caution when reaching across the body, 6386
especially when reaching for or picking up something (e.g. a heavy object on a 6387
high shelf, hot coffee, a knife) that could injure the user if it was spilled or 6388
dropped onto the lap. Also, bending and twisting at the same time can cause 6389
back injury. 6390
If the wheelchair user is reaching for a light and unbreakable object from a high 6391
shelf, he/she can use an improvised reaching aid (e.g. a rolled up magazine or a 6392
cane) to help move the object off the shelf and catch it. In a store, when an 6393
object is out of reach, an object (e.g. a cereal box) on a lower shelf can be used 6394
to ease the desired object off the higher shelf so that it can be caught. 6395
The learner may use a reaching aid, but should carry it with him/her. 6396
6397
Progression: 6398
The object can be picked up using different approaches (e.g. front vs. side). 6399
Objects of different sizes and weights can be used. 6400
6401
Special considerations for caregivers 6402
For a caregiver, to pick a dropped object off the ground, the caregiver may maneuver the 6403
179
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
wheelchair so that he/she can keep one hand on the wheelchair, for balance and control. 6404
Then, the caregiver can crouch and pick up the object with the other hand. 6405
6406
Special considerations for manual wheelchairs 6407
Adjustment tip: 6408
Caster locks can be helpful to keep the casters oriented in the correct direction 6409
(trailing in the direction of lean). 6410
6411
Variations: 6412
A moving pick-up can be accomplished if the wheelchair user holds the object 6413
against the bottom of the rear wheel with one hand as the wheelchair rolls 6414
forward, then both hands can be used to grasp the object when it rotates to the top 6415
of the wheel. 6416
6417
Special considerations for powered wheelchairs 6418
If the wheelchair can be repositioned (e.g. with respect to tilt, recline or seat height), this 6419
may be helpful. For instance, if the wheelchair user’s balance is good and his/her feet can 6420
be placed on the floor, the wheelchair user can move to the front of the seat and obtain 6421
help in rising to reach upward by using the tilt mechanism. 6422
There is a danger of unintentionally rolling a wheel over the fingers or pinching the 6423
fingers between the drive wheel and fender. The safest approach is to first position the 6424
wheelchair, shut off the power, then pick up the object. 6425
6426
Special considerations for scooters 6427
Scooter users most often stand and get out of the scooter to pick up objects. This is safer 6428
than leaning from the seat, due to the high center of gravity and the possibility of a 6429
sideways tip. 6430
When getting out of the scooter, the scooter user should keep at least one hand on the 6431
scooter for balance. 6432
6433
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8.10 RELIEVES WEIGHT FROM BUTTOCKS 6434
6435
Versions applicable 6436
Manual wheelchair: 6437
Powered wheelchair: 6438
6439
WST/WST-Q skills 6440
“Relieves weight from buttocks”. 6441
6442
Description and rationale 6443
The learner relieves weight from both buttocks, although not necessarily at the same 6444
time. Weight relief is important for comfort and the prevention of pressure sores. 6445
6446
Prerequisites 6447
None. 6448
6449
Spotter considerations 6450
Spotter starting position: Near the wheelchair, on the side toward which the learner leans 6451
(if any). 6452
Risks requiring spotter intervention: Forward or sideways tip or fall when leaning. 6453
6454
General training tips 6455
Partial unloading (30-90%) of each buttock for 15 seconds every 25 minutes and 6456
complete off-loading (90% or more) of both buttocks for at least 15 second every 2 hours 6457
is recommended. Frequent bouts of short-duration movement (”squirming”) are also 6458
recommended. 6459
Trainers should recognize that susceptibility to pressure ulceration varies among 6460
wheelchair users (e.g. due to such factors as variations in co-morbidities, sensation, local 6461
anatomy, blood supply, nutrition, moisture, nature of clothing worn), many of which are 6462
not affected by skills training. However, if the trainer notices any such correctable 6463
factors, these should be pointed out to the learner and/or an appropriate health-care 6464
provider. 6465
If using either of the recommended leaning methods (forward or sideways) (introduced 6466
earlier for the “picks objects from ground” skill) to relieve weight from the buttocks, the 6467
extent of weight relief is proportional to the extent of the lean. 6468
With the forward leaning method, the casters should be in the forward-trailing position to 6469
increase forward stability. The elbows can be rested on the thighs or a table. Further 6470
unloading can be achieved by resting the trunk on the thighs, grabbing the footrests and 6471
pulling on them. It may be socially inconvenient to use the full forward-leaning technique 6472
in some circumstances. A more moderate forward lean may be adequate. Getting back 6473
upright from the forward-bent position can be a challenge for some wheelchair users. The 6474
hands can be walked up the thighs until an armrest or the backrest can be reached to 6475
allow the person to pull him/herself the rest of the way. 6476
Side leaning or shifting the weight onto one buttock can also be effective, for those who 6477
cannot lean forward and recover, or in situations when the wheelchair user might find it 6478
inconvenient to lean forward. The armrests or rear wheels can be used to push or pull on. 6479
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As was the case for leaning forward, the wheelchair user can lean sideways on a table. 6480
6481
Variations: 6482
Transferring out of the wheelchair (e.g. onto a bed), where the wheelchair user can lie 6483
on his/her side or front is also effective. 6484
Standing up is effective, but if it is done using a stand-up wheelchair feature, there 6485
may be new pressure areas to consider related to how the wheelchair user is supported 6486
in the upright position. Standing on the footrests is generally not recommended, 6487
although it can be safe if the footrests are not too far forward and/or the casters are 6488
oriented in the forward-trailing position. After a weight-relief maneuver, the 6489
wheelchair user’s buttocks should be gently repositioned on the seat rather than 6490
dropped back into place. 6491
Bridging (lifting the weight off the buttocks by pushing down firmly on the feet) is 6492
effective but difficult to maintain for prolonged periods. 6493
Tilt and recline are alternative methods that may be adequate for some wheelchair 6494
users, although neither can be expected to achieve the > 90% relief target. If tilt or 6495
recline are used, the greater the extent of tilt or recline the better, preferably at least 6496
45°. 6497
Reclining a wheelchair can cause shear forces between the backrest and trunk that can 6498
be compensated for by lifting the trunk away from the backrest after the reclining has 6499
taken place. Some wheelchairs provide built-in compensation for such shear forces, 6500
but the extent of such compensation may not exactly match the amount needed. 6501
Push-ups are not recommended because of the high loads on the upper limbs (that 6502
may contribute to overuse symptoms) and because they cannot easily be sustained for 6503
long. 6504
6505
Special considerations for manual wheelchairs 6506
The leaning techniques can cause tips in the direction toward which the wheelchair user 6507
is leaning. 6508
6509
Variations: 6510
The tilt-rest position (with the wheel locks applied [or hands holding the hand-6511
rims] and the wheelchair or wheelchair user leaning against a wall or curb) may 6512
permit sufficient rear tilt for partial unloading that can be sustained for many 6513
minutes. This position can be achieved in a variety of ways, for instance: 6514
Pull-back technique: The wheelchair user positions the wheelchair close to 6515
the object (e.g. a sofa or wall) that he/she intends to lean against. Some 6516
trial and error may be needed to select the correct distance from the object; 6517
it is better to start too close to the object than too far from it. The wheel 6518
locks are applied and are checked to ensure that they are functioning. The 6519
wheelchair user then reaches back and pulls on the external object to tilt 6520
the wheelchair back just beyond the balance position, so that the 6521
wheelchair or wheelchair user rests against the object. 6522
Push-back technique: As for the pull-back technique except that the 6523
wheelchair user pushes against an external object to create the tilt. This 6524
can include using the foot to push on the ground. 6525
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See wheelie variation later. 6526
When returning from the tilt-rest to the upright position, the wheelchair 6527
user should leave the wheel locks on and tilt forward by leaning or by 6528
pushing against the object being leaned against. 6529
See wheelie variation later. 6530
Resting on the rear anti-tip devices may permit sufficient rear tilt but can result in 6531
a rear tip. With a spotter in place behind the wheelchair resting on the rear anti-tip 6532
devices, the wheelchair user can lean and rock backward to see if the wheelchair 6533
tips over; if so, this technique should not be used. 6534
6535
Special considerations for caregivers 6536
A caregiver can assist in a variety of ways, such as reminding the wheelchair user of the 6537
need to unload the buttocks or by assisting the wheelchair user in getting into or 6538
recovering from the unloaded position. 6539
A caregiver can sit behind the wheelchair and tilt the wheelchair backward to rest against 6540
the caregiver and provide pressure relief. To prevent the rear wheels from rolling forward, 6541
the wheel locks should be applied. This is a variation of the tilt-rest skill. 6542
6543
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Current edition: August 17, 2018
8.11 PERFORMS LEVEL TRANSFERS 6544
6545
Versions applicable 6546
Manual wheelchair: 6547
Powered wheelchair: 6548
6549
WST/WST-Q skills 6550
“Performs level transfers”. 6551
6552
Description and rationale 6553
The wheelchair user transfers from the wheelchair to another surface that is about the 6554
same height as the wheelchair seat and back again. A level transfer is a commonly used 6555
skill to move between the wheelchair and a chair, bed, tub, toilet, car or other surface. 6556
The average wheelchair user spends about 10 hours per day in the wheelchair and 6557
performs about 8 transfers a day but the range is high. A higher number of transfers per 6558
day increases the likelihood of overuse injury to the upper limbs. Proper technique is 6559
advisable as a means of reducing overuse and minimizing pain during transfers. The level 6560
wheelchair transfer should only be considered a representative transfer. More difficulty 6561
may be experienced when transferring to and from other surfaces or heights. 6562
6563
Prerequisites 6564
None. 6565
6566
Spotter considerations 6567
Spotter starting position: 6568
Usually in front of the wheelchair and slightly to one side, close enough to 6569
catch the learner if he/she falls and to prevent the wheelchair from rolling or 6570
sliding away or tipping. 6571
The spotter may ask the learner where it would be best to stand, given the 6572
learner’s previous experiences. 6573
Risks requiring spotter intervention: 6574
Forward or sideways tip or fall when reaching or standing. 6575
Rear tip when sitting back down in the wheelchair after a standing-pivot or 6576
crouching transfer. 6577
Fall between the wheelchair and bench if the wheelchair rolls or slides away. 6578
In the course of a standing pivot or crouching transfer, tripping over the 6579
footrests and falling. 6580
6581
General training tips 6582
There are a number of transfer techniques and surfaces to which a wheelchair user may 6583
wish to transfer. The methods described here are representative, but by no means 6584
comprehensive. Which type of transfer will be most suitable for a wheelchair user, with 6585
or without the assistance of a caregiver, will depend on a number of factors. An 6586
experienced clinician should make this determination. A thorough discussion of these 6587
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Current edition: August 17, 2018
options is beyond the scope of the WSP Manual. 6588
Care should be taken to avoid catching the wheelchair user’s intravenous line, urinary 6589
catheter or other collection devices when transferring. 6590
The height of the starting and target surfaces should be adjusted, to the extent possible, 6591
such that the target surface is slightly lower. 6592
The path between the starting and finish surfaces should be cleared of any obstacles. 6593
The wheelchair should be positioned as close as possible to the target surface, with the 6594
casters trailing in a way that enhances stability in the direction of transfer. 6595
The footrests should be cleared away (if possible). 6596
The wheel locks (if any) should be applied. 6597
The wheel locks of any wheeled target surface (e.g. bed) should be applied. 6598
The comments below generally apply to the transfer out of or into the wheelchair, but 6599
will be described as though the transfer is out of the wheelchair. Transfer into the 6600
wheelchair is generally the same except that, once the wheelchair user is back in the 6601
wheelchair, he/she should restore the footrests fully and put the feet back on them. The 6602
wheelchair user should also make sure that any removed or repositioned wheelchair parts 6603
(e.g. armrests, footrests, cushion, seat belt) are in the same position that they were before 6604
he/she left the wheelchair. 6605
6606
Sideways transfer: 6607
This is sometimes called a “sliding” transfer but actual sliding is not recommended 6608
(to avoid shear forces or injury to the buttocks). 6609
The wheelchair user should move the armrest (if any) out of the way on the bench 6610
side. 6611
The wheelchair user should remove the wheel-lock extension (if any) on the side 6612
toward which the transfer will take place. 6613
People using sideways transfers tend to lead with the weaker or more painful arm. 6614
However, if the arms are fairly symmetrical, alternating the leading and trailing arms 6615
allows them to share the stresses. 6616
The feet should be stably supported on the floor if the footrests can be easily moved 6617
out of the way. If the footrests cannot be moved, it is acceptable to leave one or both 6618
feet on the footrests as long as forward tipping does not occur during the transfer. In 6619
addition to an actual tip, when the rear wheels become unloaded the wheel locks 6620
become ineffective and the rear wheels may move sideways due to caster swivel. A 6621
forward tip is less likely to cause a problem in wheelchairs that have the footrests 6622
behind the casters and will not happen if caster swivel locks (if any) are applied with 6623
the caster trailing in the appropriate direction. In considering where to place the feet, 6624
the wheelchair user should try to avoid situations in which the feet are not free to 6625
swivel when the buttocks are moved to the new surface – this could lead to a torsion 6626
injury of the lower leg. 6627
The wheelchair user should move forward on the seat, to avoid such obstacles to 6628
sideways movement as the rear wheels. 6629
To get the transfer board (if using one) under the buttock, the wheelchair user should 6630
lean away from it. 6631
The wheelchair user should push down on the transfer board and wheelchair to 6632
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
unload the buttocks. 6633
The wheelchair user should avoid fully extending the fingers and wrists, allowing the 6634
fingers to wrap around the edge of the target sitting surface. This avoids 6635
overstretching the joints and tendons, which may be of importance for people with 6636
tetraplegia who use a tenodesis grip (whereby active wrist extension causes passive 6637
finger flexion if the tendons are of appropriate length). Keeping the wrists in a neutral 6638
position also functionally lengthens the arms, making it easier to get the buttocks off 6639
the sitting surface. 6640
The wheelchair user should keep the leading hand just far enough away from the 6641
body to allow room for the buttocks to land on the target surface, but no farther. The 6642
trailing hand should be close to the body. 6643
The wheelchair user may shift sideways toward the target surface in a single large 6644
movement or several smaller ones. 6645
If possible, the wheelchair user should lean well forward (“nose over toes”). During 6646
the actual transfer from this position, the hips and the head move in opposite 6647
directions. For instance, if the wheelchair user wishes to move the buttocks up and to 6648
the left, the head should move down and to the right. This technique reduces the 6649
forces needed from the arms. 6650
Once the buttocks are fully supported by the target surface, the wheelchair user 6651
should sit up and remove the transfer board. The wheelchair user should lean away 6652
from it to do so. 6653
Note: It is not recommended that the wheelchair user place his/her feet on the bed or 6654
bench before independently attempting to move the buttocks sideways. 6655
Hamstring tightness will prevent the wheelchair user from being able to flex the 6656
hips adequately. 6657
6658
Standing pivot transfer: 6659
This is one of the most common types of transfer. The person stands fully upright 6660
from the wheelchair seat, pivots in place until his/her buttocks face the target surface, 6661
then sits down. 6662
Wheelchair users with hemiplegia using standing-pivot transfers tend to transfer to 6663
their stronger sides. 6664
The wheelchair user should leave the armrests in place. 6665
The wheelchair user should move forward on the seat before beginning the transfer. 6666
The wheelchair user should try to flex the knees to get the feet under the body, in 6667
preparation for the sit-to-stand phase of the transfer. During the transfer, the hips 6668
should be flexed. 6669
To avoid the need for turning through a greater arc than necessary when pivoting, the 6670
wheelchair user should turn the back toward the bench rather than away from it (i.e. a 6671
90º turn, not a 270º one). 6672
The wheelchair user may use the armrest on the unaffected side to help maintain 6673
balance while transferring but this can lead to unequal weight-bearing during 6674
standing-pivot transfers. If the wheelchair user can manage it, the sound-side hand 6675
may be placed on the thigh during the sit-to-stand segment of the skill. 6676
If a wheelchair user with hemiplegia can only transfer back into the wheelchair with 6677
the strong side leading, he/she or a caregiver will need to move the wheelchair to the 6678
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Current edition: August 17, 2018
other side. 6679
6680
Variation: 6681
o The crouch pivot transfer is similar to the standing-pivot transfer, except that the 6682
knees and hips are not fully extended. The wheelchair user may need to move the 6683
armrest and the wheel lock extension (if any) out of the way on the bench side. 6684
The wheelchair user should stay low, and not try to stand up fully. However, the 6685
buttocks need to be high enough to clear any obstacles (e.g. the armrest or rear 6686
wheel). The hips and the head move in opposite directions as for the sideways 6687
transfer. 6688
6689
Forward transfer: 6690
When transferring straight-on (e.g. for a person with amputations of both legs 6691
above the knees), the wheelchair user should pull the wheelchair as close as 6692
possible to the transfer bench and at right angles to it. 6693
A transfer board may be used. 6694
The armrests should be left in place. If the armrests are desk-length, in some 6695
wheelchair designs they may be reversed to provide better support as the 6696
wheelchair user moves from the wheelchair to the new surface. 6697
Wheelchair users who have used the forward transfer method to transfer out of the 6698
wheelchair may be able to enter the wheelchair in the forward direction and then 6699
turn around, if the amputation residual limbs are short enough. Alternatively, the 6700
wheelchair user can back onto the wheelchair seat. 6701
6702
Progression: 6703
Once the basic transfer is mastered, it should be practiced with different target 6704
surfaces, at different relative heights. The “performs wheelchair-ground transfers” 6705
skill discussed later is an example of an advanced transfer. 6706
6707
Special considerations for caregivers 6708
General 6709
This section only deals with transfers for wheelchair users who require no more 6710
than moderate assistance to perform the final movement between the wheelchair 6711
and the bench. If the caregiver must perform the majority of the effort, or if a 6712
mechanical lift is needed, additional training by experienced rehabilitation 6713
professionals is needed. This is outside the scope of the WSP Manual. 6714
The caregiver should be attentive to the position of the wheelchair user’s arms to 6715
avoid injuring them during the transfer. 6716
The caregiver, if unfamiliar with the wheelchair, should inquire as to whether the 6717
wheelchair user has ever experienced falls during transfers and, if so, in which 6718
direction. This may help the caregiver to know how best to provide assistance. 6719
Care should be paid to good back ergonomics by the caregiver: 6720
The feet should be shoulder-width apart for balance. 6721
The caregiver should avoid bending the back and twisting at the same 6722
time. 6723
The caregiver should bend his/her knees and keep the rest of his/her 6724
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body straight to avoid injury to the back. 6725
The caregiver should keep the wheelchair user close to the caregiver 6726
(vs. arms straight). 6727
The caregiver should use aids (e.g. transfer belt, transfer board, 6728
mechanical lift) as needed. 6729
The caregiver should use the help of other people, if needed. One option is for one 6730
caregiver to be behind the wheelchair user, reaching under the upper arms to 6731
grasp the wheelchair user’s forearms that have been crossed in front of the body. 6732
The second caregiver is positioned in front of or to the side of the wheelchair and 6733
lifts the legs from behind the knees. 6734
The wheelchair user should not hold the caregiver around the neck. 6735
If the wheelchair user is falling, it may be necessary for the caregiver to lower 6736
him/her to the floor rather than risk injury to the caregiver. 6737
If it is necessary for the caregiver to move the unoccupied wheelchair to the other 6738
side, the caregiver may leave the wheel locks on. Using the push handles at the 6739
rear of the wheelchair, the caregiver should lift the rear wheels slightly off the 6740
floor and push or pull the wheelchair on the casters (the “wheelbarrow” method). 6741
This will save time, avoid strain on the back and ensure that the wheel locks are 6742
applied when the wheelchair user transfers back into the wheelchair. Because the 6743
only wheels on the floor are the casters, the wheelchair can be moved straight 6744
sideways. 6745
If a mechanical lift is being used by the caregiver, it can be helpful to put the seat 6746
in the tilted position to assist in ensuring that the wheelchair user is properly 6747
positioned in the sling. 6748
If a mechanical lift is being used by the caregiver, after the wheelchair user has 6749
been lifted sufficiently, it may be easier to drive the wheelchair backward out 6750
from under the wheelchair user rather than moving the lift. 6751
6752
Sideways transfers: 6753
It may be necessary to perform the transfer in steps. 6754
6755
Standing pivot transfers: 6756
To assist the wheelchair user in getting from sitting to standing, the caregiver 6757
should stand or sit in front of the wheelchair or stand to one side. 6758
The caregiver should apply an assisting force to the wheelchair user’s body, near 6759
the hips. The caregiver should not pull on the wheelchair user’s arms. 6760
The caregiver may use a transfer belt around the wheelchair user’s waist. 6761
The caregiver may need to use his/her knees to keep the standing wheelchair 6762
user’s knees from buckling, by blocking them. 6763
Once standing, the caregiver should ask the wheelchair user to pivot, turning the 6764
back, in the shortest possible route, toward the bench. 6765
6766
Special considerations for manual wheelchairs 6767
Wheel locks: 6768
Prior to the actual transfer, the learner should apply the wheel locks (if any). If the rear 6769
wheel is able to turn with the wheel lock applied, the wheel lock may need to be adjusted 6770
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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or the tire may need to be pumped up, if it is pneumatic. If strength is a limiting factor to 6771
applying the wheel locks, the wheelchair user may use wheel-lock extensions. 6772
A wheelchair user with weak trunk muscles can avoid falling forward during wheel-lock 6773
handling, by hooking an arm around a push handle or holding onto an armrest or wheel. 6774
To apply a push-to-lock wheel lock, the wheelchair user grasps the handle of the wheel 6775
lock and pushes it toward the front of the wheelchair until it is firmly in place. 6776
To apply a pull-to-lock wheel lock, the wheelchair user pulls the handle backward until it 6777
is firmly in place. 6778
Retractable wheel locks are ones that can be positioned completely out of the way when 6779
they are not in use, so the wheelchair user does not scrape his/her hands on them during 6780
wheelchair propulsion. They are most often found on rigid-frame wheelchairs. To apply a 6781
retractable scissor wheel lock, the wheelchair user pulls or pushes the handle in the 6782
appropriate direction until it is firmly in place. 6783
To release wheel locks, the learner should reverse the action used to apply them. For a 6784
retractable scissor wheel lock, the learner should fold the wheel lock fully out of the way. 6785
6786
Armrests: 6787
Generally, it is easier to reposition the armrests than it is to remove them completely. 6788
To move the armrests away, any of the following options can be used, depending upon 6789
the armrest design: 6790
For a flip-up armrest, the learner should unlock the front of the armrest from 6791
the receptacle and lift the front of the armrest so that it flips back out of the 6792
way. 6793
For a swing-away armrest, the learner should lift the armrest up slightly to 6794
disengage it and then swing it horizontally out of the way. 6795
To completely remove an armrest, the learner should unlock whatever locks 6796
are necessary. There may be ones at both the front and back of the armrest. 6797
The learner should lift the armrest straight up so that the armrest is detached 6798
from the chair. If the armrest is height-adjustable, the wheelchair user should 6799
be careful not to just remove the elevating arm pad. 6800
For a wheelchair with a tray (e.g. for a person with hemiplegia), the learner 6801
should first flip the tray away or slide it forward to detach it. 6802
To restore the armrests, with some armrest designs, it is easy to unintentionally reverse 6803
left and right. To avoid this, the learner should be encouraged to follow a routine with 6804
respect to where the armrests are placed when removed. The learner should reverse the 6805
process used when moving the armrests away. The learner should make sure the armrest 6806
posts are lined up with the receptacles before locking them. The learner should check to 6807
make sure the armrests are locked in place by pulling up on them. 6808
6809
Footrests: 6810
The learner should clear the footrests out of the way prior to a transfer, whenever 6811
possible. It may be easier to do so before moving the wheelchair into its final position. 6812
Before moving the footrests out of the way, the learner should first remove the feet from 6813
the footrests. A person with weak hands may need to use two hands or an extended wrist 6814
of one hand under the knee to lift the leg. If one leg is stronger, it may be used to assist in 6815
lifting the weaker leg. Later, after restoring the footrests, the learner should put the feet 6816
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
back on the footrests. 6817
To move a swing-away footrest out of the way, the learner should unlock the footrest. 6818
Locking mechanisms vary from wheelchair to wheelchair. The learner should swing the 6819
footrest completely out of the way. Some footrests swing away to the side and others to 6820
the middle. To replace the footrest, the learner should push the footrest back toward the 6821
front of the wheelchair until it clicks into place. The learner should check that it is locked 6822
in place by pulling on it. 6823
To completely remove the footrests, the learner may need to first swing the footrest away. 6824
The learner should then pull up on the footrest. The learner should pay attention to how 6825
the footrest was attached to the chair to simplify restoring it later. To replace the footrest, 6826
the learner may need to start in the swung-out position, line up the post or pins with the 6827
hole(s) and put the footrest back in place. The learner should then swing the footrest back 6828
to the front. 6829
Some wheelchairs do not allow the footrests to be swung away or removed, but it may be 6830
possible to flip the foot-plates up. The learner should pull the foot-plates up until they are 6831
fully vertical. To do so on some wheelchairs, it may be necessary to push the heel loops 6832
(if any) forward. To replace the footrests, the learner should push the foot-plates down. 6833
The learner should push the heel loops back into place, if they were displaced earlier. 6834
To raise an elevating footrest on a manual wheelchair, the learner should grasp it near the 6835
end and lift it to the desired position. This requires less force if the leg is not on the leg-6836
rest. To lower the footrest, the learner should support its weight, and hold the position 6837
lock open while lowering the footrest. The position lock is often located at the top of the 6838
leg-rest (near the knee). 6839
For a wheelchair user with weak trunk muscles, to reach the footrests, the arms can be 6840
moved to the thighs one at a time, and then to the feet, until the chest is resting on the 6841
thighs. To get back into the upright position, the stronger arm can be hooked over the 6842
push handle or armrest and the body pulled up through elbow flexion and wrist extension. 6843
6844
Casters: 6845
If possible, the learner should position the wheelchair so that the casters are trailing in the 6846
direction of the transfer to reduce the likelihood of the wheelchair tipping in that 6847
direction. To achieve this position, the learner should finish the wheelchair positioning 6848
with a slight movement away from the direction of the transfer. 6849
For wheelchairs that are equipped with them, caster swivel locks can be used to help 6850
maintain caster orientation. 6851
6852
Special considerations for powered wheelchairs 6853
Positioning (e.g. tilt, recline, seat height, seat swivel) may be useful while preparing the 6854
wheelchair for a transfer. 6855
The power should generally be turned off while the transfer is being performed. 6856
Although not the only consideration, if all other factors are equal, it will be easier to 6857
make a sideways transfer toward the non-controller side. 6858
The controller may need to be moved out of the way for a sideways transfer in that 6859
direction. 6860
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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If the wheelchair user is using a standing-pivot transfer, with the feet on the ground the 6861
tilt mechanism of the wheelchair can be used to assist in lifting the buttocks if the 6862
wheelchair user has moved well forward on the seat. 6863
6864
Special considerations for scooters 6865
The tiller handles can be an asset while transferring if the scooter user needs assistance 6866
for balance. However, the amount of force applied to them should be minimal because 6867
they may swivel into a different position. 6868
The handles can get in the way if the tiller is turned to the side toward which the scooter 6869
user is transferring. Conversely, turning the tiller in the opposite direction provides 6870
additional space for the transfer. 6871
6872
191
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.12 FOLDS AND UNFOLDS WHEELCHAIR 6873
6874
Versions applicable 6875
Manual wheelchair: 6876
Powered wheelchair: X 6877
6878
WST/WST-Q skills 6879
“Folds and unfolds wheelchair”. 6880
6881
Description and rationale 6882
The learner folds or takes apart the unoccupied wheelchair to make it as small as 6883
possible, and then restores it to its original condition. 6884
For transport or storage, the size or weight of the wheelchair may need to be reduced. 6885
This can be done by folding the wheelchair. Removal of the rear wheels or other parts is a 6886
useful way to further diminish the size and weight of the wheelchair. In everyday life, 6887
wheelchair users may not need to break their wheelchairs down completely and this 6888
should be taken into consideration when setting goals for training. For the purposes of the 6889
WSTP, this skill is considered “not applicable” for powered wheelchairs and scooters, 6890
even though some parts of some models may be readily foldable or removable. 6891
6892
Prerequisites 6893
None. 6894
6895
Spotter considerations 6896
Spotter starting position: 6897
Near the learner, on the side toward which the learner leans (if any). 6898
Risks requiring spotter intervention: 6899
Forward fall while reaching. 6900
Pinching fingers between folding or rotating parts. 6901
Injury to lower leg or foot due to dropping or rotating wheelchair parts. 6902
6903
General training tips 6904
There is no rigid sequence of step to be used, but the trainer may identify changes that 6905
would be of benefit to the learner. 6906
6907
Fold wheelchair: 6908
The learner should pay attention to each item as he/she removes or alters it, to ensure 6909
that he/she will be able to reassemble the chair later. 6910
The learner should remove anything that may prevent folding (such as the cushion, 6911
rigid seat, backrest or knapsack). 6912
To remove a rigid seat or backrest, the learner may need to release restraining 6913
devices. 6914
For rear wheels that can be removed without tools, there is usually a release 6915
mechanism at the center of the axle, a button or lever that needs to be depressed. If 6916
the wheel does not come off easily, the learner should check to be sure the wheel 6917
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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lock is not on and that the rear wheel is off the ground. 6918
To fold a cross-braced wheelchair (one that becomes narrower from side to side when 6919
folded), the learner should first clear the footrests (e.g. by flipping them up, 6920
swinging them away or removing them). 6921
To fold a cross-braced wheelchair more easily, the learner should position the 6922
wheelchair so that he/she is on one side of it. The learner should then tip the chair 6923
slightly toward him/herself so that the wheels on the side away from him/her are off 6924
the ground. This eliminates the friction between the far-side rear wheel and the 6925
ground and allows gravity to assist in folding the wheelchair. The learner should 6926
then pull the seat or seat rails upwards, with one or both hands, to fold the chair. 6927
For a rigid-frame wheelchair with a fold-down back, although the frame cannot be 6928
folded, the learner can often make the chair easier to transport by folding down the 6929
back. The learner may need to release any restraining devices before he/she can do 6930
so. After folding the wheelchair, if the wheelchair does not have a latch mechanism 6931
to prevent the wheelchair from opening while it is being lifted, it may be helpful to 6932
use a strap. 6933
When lifting a folded wheelchair for which the rear wheels cannot be removed, 6934
injury can occur if the unlocked rear wheels are grasped, because the frame will be 6935
free to rotate. 6936
It may be possible to reduce the weight and size of the wheelchair by removing the 6937
armrests and footrests. 6938
The push-handles of some wheelchairs can be folded to further reduce the 6939
wheelchair dimensions. 6940
6941
Unfold Wheelchair: 6942
Generally, the learner should reverse the steps used to fold the wheelchair and in 6943
roughly reverse order (e.g. starting by putting the rear wheels back on and 6944
finishing with putting the cushion back in place). 6945
To replace the rear wheels it may be necessary to push the quick-release plunger to 6946
allow the axle to get into the housing. To check that the axle is fully seated, the 6947
plunger should be out and it should not be possible to pull the rear wheel off. 6948
Some tires have a directional tread pattern (more rolling resistance in one direction 6949
than the other). If so, the left and right wheels should not be considered 6950
interchangeable. 6951
The learner should be careful not to tangle the seatbelt (if any) under the seat. 6952
To get the process of opening a cross-braced wheelchair started, the learner should 6953
use the push-handles to lift the rear wheels off the ground (thereby avoiding 6954
friction with the ground) and separate the push-handles. 6955
The learner usually then needs to push the seat rails back down into the starting 6956
position. The learner should keep the fingers on top of the rails to prevent them 6957
from being pinched. 6958
For wheelchairs with backrests that fold forward, the backrest may lock in the 6959
folded position, necessitating a release of the locking mechanism to unfold the 6960
backrest. 6961
The learner should put the cushion back on the seat properly before transferring 6962
back into the chair. 6963
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
6964
Progression: 6965
Once the learner is able to fold and unfold the wheelchair, he/she can progress 6966
toward full use of this skill by putting the folded wheelchair up on the transfer 6967
bench and into his/her vehicle. Variations in the designs of the wheelchair and 6968
vehicle preclude a thorough discussion of this in the WSP Manual. 6969
6970
Variations: 6971
The advanced wheelchair user may be able to remove and replace rear wheels 6972
while seated in the wheelchair by leaning sideways (e.g. in a doorway). This can 6973
be useful if the wheelchair user wishes to change the wheels for ones more 6974
suitable for a new activity. Also, removing the rear wheels can be helpful in 6975
getting through narrow spaces if there are transport wheels or rear anti-tip devices 6976
that can be used for the purpose. 6977
6978
Special considerations for powered wheelchairs and scooters 6979
Although generally not applicable, some powered wheelchairs and scooters can be folded 6980
or reconfigured without tools for storage or transportation. If that is the case and doing so 6981
is a goal of the learner, training should be provided. 6982
6983
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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8.13 GETS THROUGH HINGED DOOR 6984
6985
Versions applicable 6986
Manual wheelchair: 6987
Powered wheelchair: 6988
6989
WST/WST-Q skills 6990
“Gets through hinged door”. 6991
6992
Description and rationale 6993
The learner opens, passes through and closes a hinged door that opens away from the 6994
learner, then repeats the task in the opposite direction (with the door opening toward the 6995
learner). Wheelchair users frequently encounter such hinged doors or gates. Although 6996
there are a variety of door types, this is considered a representative skill. 6997
6998
Prerequisites 6999
None. 7000
7001
Spotter considerations 7002
Spotter starting position: Near the wheelchair, on the side toward which the learner leans 7003
(if any). 7004
Risks requiring spotter intervention: 7005
Rear, forward or sideways tip or fall due to reaching and pulling on the door 7006
handle. 7007
Pinching the fingers between the door and the frame. 7008
Scraping the hands between the door frame and the wheelchair. 7009
7010
Adjustment tips 7011
For doors in the wheelchair user’s own environment, attaching something (e.g. a handle 7012
or piece of rope) in the middle of the door can make closing easier. 7013
Having a roller on the outer corner of the wheelchair’s footrest can be useful when using 7014
the footrests to apply force to a door. 7015
7016
General training tips 7017
Although the footrests can be useful to help push doors open or closed, this method 7018
should not be used on glass doors that might break. 7019
The feet often extend beyond the footplates, so care needs to be taken to avoid injury. 7020
If using the footrests to apply a force to a door, it is best to approach the door at a slight 7021
angle toward the side that will open. This ensures that it is the outer corner of the footrest 7022
that contacts the door and not the feet. 7023
If there is a threshold in the doorway, the principles for dealing with such an obstacle can 7024
be found in the later section on the “gets over obstacles or gaps” skill. 7025
For a door that opens away from the wheelchair, the wheelchair user can begin the skill 7026
by positioning the wheelchair directly in front of the door. 7027
For a door that opens toward the wheelchair, if there is enough space, the wheelchair user 7028
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should position the wheelchair to the side of the door to allow room for it to be swung 7029
open without striking the wheelchair or a body part. 7030
Once a self-closing door has been opened enough to allow the wheelchair to proceed 7031
through it, the widest part of the wheelchair can be used to prevent the door from closing. 7032
To avoid scraping the door, the wheelchair user can use his/her hand or elbow to push the 7033
door open briefly to allow progress. 7034
While moving past the door, the wheelchair user should be careful to avoid catching any 7035
clothing or body parts on the door handle or the surface of the door if it is rough. 7036
The wheelchair user may wish to move his/her hands from the hand-rims to the tires to 7037
avoid them being pinched between the hand-rims and the door or door frame. 7038
To close a door that opens toward the wheelchair, after passing through it, there are 7039
several options (if the door does not close by itself): 7040
The wheelchair user may gently swing the door closed behind him/her, moving the 7041
wheelchair quickly through the door and out of the way. 7042
The wheelchair user may turn around once through the doorway, reach forward 7043
and pull the door toward him/her while backing away. 7044
The wheelchair user may go through the door backward, pulling the door with 7045
him/her. 7046
The wheelchair user should not put his/her fingers between the door and door-7047
frame for any longer than necessary (preferably not at all) because they may get 7048
pinched when the door closes. 7049
Reaching over the back of the wheelchair to close the door is effective, but there is 7050
risk of a rear tip in a manual wheelchair. 7051
To close a door that opens away from the wheelchair after passing through it, there are 7052
several options (if the door does not close by itself): 7053
The wheelchair user can swing the door closed. 7054
The wheelchair user can turn the wheelchair around and push the door closed with 7055
the footrests. 7056
The wheelchair user can back up to close the door using the rear wheel or other 7057
wheelchair part to push on the door. 7058
7059
Progression: 7060
Judging the width of doorways relative to wheelchair dimensions can require 7061
practice. To avoid damage to the hands, wheelchair or door frame, it can be useful 7062
to attempt getting through progressively more narrow openings using objects that 7063
are not firmly fixed (e.g. pylons). Bubble wrap can be used to provide audible 7064
feedback. 7065
The learner should start with a door that does not close on its own and progress to 7066
one that does. The trainer can reduce or add resistance to door opening by 7067
applying forces with his/her hand. 7068
The space available to the side of the door can be varied. 7069
7070
Variations: 7071
The learner can experiment with negotiating the door in the forward or backward 7072
directions. 7073
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Game: There are many variations in the ways doors open and close, alone or in 7074
sequence with other doors. Also, a variety of door handles exist. A game that 7075
provides opportunities to practice these variations is to have a “door scavenger 7076
hunt”, seeing how many different combinations and permutations can be found 7077
and successfully managed in a period of time. 7078
Game: To get used to the relative widths of the wheelchair and doorways, the user 7079
can attempt to get between two obstacles that are lightweight and movable enough 7080
that injury is not a concern. The distance between the obstacles can be gradually 7081
narrowed (“lateral limbo”) and they can be approached at progressively greater 7082
speeds. 7083
7084
Special considerations for caregivers 7085
Before moving a wheelchair through any type of door or narrow space, the caregiver 7086
should make sure that the wheelchair user’s hands or elbows are not extending beyond 7087
the sides of the wheelchair where they could be injured. 7088
The caregiver should keep part of his/her body between the door and the wheelchair user. 7089
The skill can be accomplished by moving the wheelchair through the door forward or 7090
backward. 7091
For a narrow doorway, one option is for the caregiver of a manual wheelchair user to 7092
remove one rear wheel. With the wheelchair user leaning the other way and the caregiver 7093
supporting the push-handle, it may be possible to get through the door on three wheels. 7094
For a door that opens away from the wheelchair, the caregiver should open the door, 7095
grasp the push handles at the rear of the wheelchair and push or pull the wheelchair 7096
through the doorway. When the wheelchair and caregiver are completely out of the way, 7097
the caregiver should close the door. 7098
For a door that opens toward the wheelchair, if there is room the caregiver should angle 7099
the wheelchair away from the door on the side that will open. 7100
7101
Special considerations for manual wheelchairs 7102
7103
Two-hand-propulsion pattern: 7104
The door-frame can be used to help propel the wheelchair user through the door 7105
(the “slingshot” method). To do so, the wheelchair user reaches forward and 7106
places one hand on the door frame and the other on the door or the door frame on 7107
the other side. Then, by pulling with both hands, the wheelchair is moved through 7108
the opening. This has the advantage of keeping the hands from being injured by 7109
bumping or scraping them between the door frame and the wheelchair. 7110
To open a door that opens away from the wheelchair more easily, the wheelchair 7111
user can turn sideways in front of it. This allows the wheelchair user to get closer 7112
to the door and to resist the tendency of the wheelchair to roll backward when the 7113
door is pushed. Alternatively, the wheelchair user can hold onto the door-frame 7114
with one hand, as the door is pushed with the other. This is more likely to be 7115
necessary if the door resists opening. 7116
To open a door that opens toward the wheelchair, the wheelchair user should push 7117
on the door-frame with the hand farthest from the hinge to open the door more 7118
easily with the other hand. Turning the wheelchair sideways will also prevent the 7119
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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wheelchair being pulled forward as the wheelchair user pulls on the door. 7120
7121
Variations: 7122
If there is a threshold or level change in the door opening, after popping the 7123
casters over the threshold or up onto the higher level, it may be helpful to use the 7124
door frame to help provide the forces needed to proceed. 7125
For a door that opens away from the wheelchair and that is latched with a bar 7126
mechanism that will open when a force is applied to it, the wheelchair user can 7127
approach the door without slowing down. At the last moment, the wheelchair user 7128
can lean and reach forward with one or both hands and use momentum to open 7129
the door. The feet should not strike the door. This should initially be practiced at 7130
slow speeds. 7131
For a doorway that is too narrow for the wheelchair to pass through, an option is 7132
to remove both rear wheels and rest on the rear anti-tip devices or transport 7133
wheels to get through the door. For wheelchairs that fold from side to side, some 7134
wheelchair users can partially fold the wheelchair and sit on an armrest. 7135
7136
Hemiplegic-propulsion pattern: 7137
Using one hand to cross over from one wheel to the other can be helpful to keep the 7138
wheelchair straight while getting through a door. 7139
7140
Special considerations for powered wheelchairs 7141
When applying a force to open a door toward a powered wheelchair, it may be easier to 7142
simply grasp the door handle with the hand on the side away from the joystick and then 7143
back the wheelchair up, rather than doing all of the work with the arm. 7144
Unlike with a manual wheelchair, the force of a self-closing door does not require the 7145
user to brace himself/herself with the other hand on the door frame or to turn sideways to 7146
prevent the wheelchair from being moved unintentionally. 7147
For a person with hemiplegia, it is impossible for the sound arm to simultaneously hold the 7148
door lever and control the joystick. It may be necessary to complete the task in several 7149
small steps. 7150
Because of the risk of injury and because overcoming the force of a self-closing door 7151
mechanism is not a problem, it is not recommended that momentum be used to open doors 7152
with latch mechanisms. 7153
If the powered wheelchair is about to collide with the door or door frame, the wheelchair 7154
user should not reach out to fend off with the hands or feet – this is usually ineffective and 7155
may cause injury. The body parts should generally be kept within the protective envelope 7156
of the wheelchair. 7157
7158
Special considerations for scooters 7159
The width of some scooters may make it difficult to get them through narrow openings. 7160
The length of some scooters can make it difficult to reach door handles, making it 7161
necessary for the scooter user to get off the scooter. When getting off the scooter, the user 7162
should keep at least one hand on the scooter for balance. The scooter user should not 7163
operate the scooter while standing because the movement may cause a fall. 7164
7165
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8.14 ASCENDS INCLINES 7166
7167
Versions applicable 7168
Manual wheelchair: 7169
Powered wheelchair: 7170
7171
WST/WST-Q skills 7172
“Ascends slight incline”. 7173
“Ascends steep incline”. 7174
7175
Description and rationale 7176
The learner moves the wheelchair up inclines of different slopes. Inclines with different 7177
slopes are encountered frequently in the natural and built environments. For instance, a 5 7178
(~1:12) grade meets the current building codes for ramps in North America. Inclines with 7179
slopes greater than the standard recommended value are encountered frequently in the 7180
natural and built environments. 7181
7182
Prerequisites 7183
None. 7184
7185
Spotter considerations 7186
Spotter starting position: Behind the wheelchair, holding onto the spotter strap (if a 7187
manual wheelchair). 7188
Risks requiring spotter intervention if moving forward up the incline: 7189
Rear tip when initially accelerating. 7190
Forward tip or fall due to deceleration when striking the lower floor-incline 7191
transition. 7192
Hyper-flexion injury of the lower limb at the lower floor-incline transition if the 7193
foot catches on the ground. 7194
Rear tip while ascending the incline. 7195
7196
General training tips 7197
The steeper the incline, the greater is the likelihood of problems due to scraping the 7198
footrests or anti-tip devices at the transition between the floor and the lower end of the 7199
incline. 7200
If the drive wheels are uphill, they become relatively unloaded. This can cause loss of 7201
traction so that propulsion, braking and directional control become difficult. If traction is 7202
lost to the extent that the wheels spin or the wheelchair begins to slide, the wheelchair 7203
user should lean toward the affected wheels. If this is insufficient, then the wheelchair 7204
should be turned around so that the drive wheels are downhill. It is best to turn around on 7205
the level but, if that is not possible, the wheelchair user should lean uphill during the turn. 7206
Edges and drop-offs at the sides of the incline or at the sides of the platform at the top of 7207
the incline should be avoided to prevent injury. 7208
Momentum can be used to ascend short inclines by approaching at speed. However, if the 7209
wheelchair user strikes the floor-ramp transition too quickly, he/she may tip the 7210
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
wheelchair forward or fall forward out of the wheelchair. 7211
7212
Progression: 7213
The learner should start with the wheelchair stationary at the lower end of the 7214
incline and progress to a moving approach. 7215
The learner should start with a minimal incline and proceed to more extreme ones. 7216
Although only 5 and 10 inclines are mentioned specifically in the WSP Manual, 7217
for learners and wheelchairs capable of handling steeper inclines, it is reasonable to 7218
attempt these under the supervision of a trainer, even if only to help the learner 7219
recognize the limits of what is possible for him/her with that wheelchair. 7220
7221
Variations: 7222
Inclines with different surfaces, such as grass, cobblestone or loose rock may be 7223
used. 7224
Stopping and turning around on the incline should be practiced. 7225
7226
Special considerations for caregivers 7227
For a caregiver of a manual wheelchair user with hemiplegia, the caregiver can put the 7228
unsupported foot on the other footrest to avoid it getting caught on the transition. 7229
To push a manual wheelchair forward up an incline, the caregiver should bend his/her 7230
knees and lean toward the wheelchair. The caregiver should not use a knee to apply 7231
pressure to the backrest. 7232
If the wheelchair does not have a headrest and if the wheelchair user is having difficulty 7233
maintaining an upright head position while ascending an incline, the caregiver can 7234
support the head with a hand. 7235
For a caregiver of a powered wheelchair user, if the space is narrow and the caregiver 7236
must operate the wheelchair from in front, the caregiver should be careful not to run over 7237
his/her own toes. 7238
7239
Special considerations for manual wheelchairs 7240
Adjustment tips: 7241
A heavy knapsack will reduce rear stability. It can be moved to the lap (although this 7242
may limit forward lean) or footrests. 7243
At the lower transition, either ascending or descending, the clearance of footrests can 7244
create problems. 7245
If the rear anti-tip devices are too low, this can cause rear-wheel “float” whereby the 7246
rear wheels are not in contact with the surface (because the wheelchair is suspended 7247
between the casters and anti-tip devices) and are thereby unable to be used for 7248
propulsion or braking. 7249
“Grade aids” (or “hill holders”) may be used for the ascent of inclines. These are 7250
ratchet-like attachments that, when activated, allow the rear wheels to roll forward but 7251
not backward. These devices allow the wheelchair user to rest on the incline without 7252
rolling back. The wheelchair user should apply them before he/she starts up the 7253
incline. 7254
Some wheelchairs have gears that permit inclines to be handled more easily. 7255
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
7256
Two-hand-propulsion pattern: 7257
When negotiating the incline-floor transition at the lower end, during either ascent 7258
or descent, the wheelchair user should be careful not to catch an unsupported foot, 7259
as this could lead to a hyper-flexion injury of the knee. 7260
When getting the casters onto the bottom of an incline, it may be necessary to 7261
transiently tip the wheelchair (“popping” the casters, as will be described later in 7262
section 9.18) if the footrests are low and to reduce the sudden braking that occurs 7263
at the transition. 7264
Some wheelchair users use a rocking action to get the casters over the initial lip. 7265
The wheelchair user should lean forward as he/she goes up the ramp to apply 7266
more force to the hand-rims and to avoid tipping backward. The need for forward 7267
lean increases as the slope increases. In addition to a consistent forward lean, it 7268
can be helpful to lean forward a little more with each push to apply greater forces 7269
to the hand-rims. 7270
If the wheel locks are not of the retractable type, forward leaning can result in 7271
injury to the backs of the thumbs. 7272
It may be necessary to use shorter propulsive strokes than on the level, to avoid 7273
rolling backward between strokes. 7274
The recovery path of the hands at the end of the propulsive stroke may be more 7275
like an arc (following the hand-rim) than a loop (below the hand-rim) for this skill. 7276
If the wheelchair user gets tired part of the way up the incline, he/she should turn 7277
the wheelchair to the side and rest. This can be done without applying the wheel 7278
locks. Although it may seem counter-intuitive, the static rear stability of an 7279
occupied wheelchair is significantly lower with the wheel locks applied than not. 7280
If the wheelchair starts to roll backward, instead of grasping both hand-rims (that 7281
might cause a rear tip), the wheelchair user can grab one. As the other wheel rolls 7282
backward, this will turn the wheelchair across the slope. 7283
As the steepness of the incline increases, the wheelchair user should lean farther 7284
forward and move the initial contact with the hand-rims forward. The propulsion 7285
contact angle diminishes (although the duration of the push phase remains 7286
similar) and the force increases. The recovery phase becomes faster and an arc 7287
recovery pattern (back along the hand-rims) may be used. 7288
7289
Variations: 7290
Alternating hands during propulsion may help to prevent roll-back. 7291
If the incline is wide enough, the learner can steer back and forth across the 7292
incline (“slalom” or “zig-zag”), to decrease the apparent slope. The more turns 7293
used, the lower is the effective slope (but the greater the distance travelled). 7294
Although a slalom path up an incline will reduce the effective slope, it will 7295
introduce an element of side-slope (dealt with more specifically in section 9.16). 7296
If using a slalom path up the incline, the wheelchair user will generally turn uphill 7297
(e.g. 90°) at the end of each traverse to go back the other way. However, if this is 7298
not possible due to limitations of strength or stability, the turn may be downhill 7299
(e.g. 270°). Although a little height up the incline is lost, the additional speed 7300
during the turn provides momentum to assist in regaining the loss. For sailors, the 7301
201
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
analogy of “jibing” rather than “tacking” to progress upwind may be useful. 7302
As a learning exercise, it may be helpful to have the wheelchair user try to ascend 7303
the incline (with a spotter) without leaning forward. 7304
The wheelchair user may use the ramp handrails if available. 7305
See wheelie variation later. 7306
7307
Hemiplegic-propulsion pattern: 7308
It is usually easier for a wheelchair user with hemiplegia (who propels the wheelchair 7309
with one arm and one leg) to go up inclines backward. Whenever rolling resistance is 7310
encountered (including when ascending inclines), foot propellers find it easier to push 7311
backward than to pull forward with the feet. 7312
7313
Special considerations for powered wheelchairs 7314
A small lip on the side of an incline may be sufficient to prevent a manual wheelchair 7315
from accidentally going over the edge, but a powered wheelchair can go over such a lip 7316
more easily. 7317
Most powered wheelchairs can handle 5° with ease, at least from the perspective of 7318
having enough power to manage the slope. 7319
Altering the position of the wheelchair seat (i.e. with respect to tilt, recline, seat height) 7320
may be helpful to improve stability or to alter the weight distribution on the wheels (e.g. 7321
for more traction). 7322
The tilt or leg-elevation functions can be used to avoid scraping the footrests at the lower 7323
incline transition. 7324
7325
Progression: 7326
The learner may begin training with the controller in a low setting but 7327
programming that provides more power and torque may be needed for success. 7328
The user may need to change to a different drive mode to get up the incline. 7329
7330
Special considerations for scooters 7331
Most scooters have adequate power to get up steep inclines. 7332
Scooters may have difficulty at the upper incline-level transition due to inadequate 7333
clearance (“break-under angle”) between the front and back wheels. 7334
Scooters may have difficulties at the lower incline-level transition if any rigid rear anti-7335
tip devices cause the rear wheels to “float” off the surface. Approaching with a little extra 7336
speed may help, but the stiff suspension of many scooters may cause the scooter user to 7337
bounce off the seat causing a loss of control. 7338
7339
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8.15 DESCENDS INCLINES 7340
7341
Versions applicable 7342
Manual wheelchair: 7343
Powered wheelchair: 7344
7345
WST/WST-Q skills 7346
“Descends slight incline”. 7347
“Descends steep incline”. 7348
7349
Description and rationale 7350
The learner moves the wheelchair down inclines of different slopes. The general rationale 7351
is as for “ascends inclines”. 7352
7353
Prerequisites 7354
None. 7355
7356
Spotter considerations 7357
Spotter starting position: 7358
If the wheelchair is to move forward down the incline, the spotter should be behind 7359
the wheelchair, holding onto the spotter strap (if a manual wheelchair) with one 7360
hand and with the other hand in front of the wheelchair user’s shoulder. 7361
If using two spotters, one spotter should be behind the wheelchair, holding onto the 7362
spotter strap and the second spotter should be in front of and beside the wheelchair 7363
to resist a forward tip or fall. 7364
A removable seat belt may be used if there is concern about the learner falling 7365
forward from the wheelchair. 7366
Risks requiring spotter intervention: 7367
Forward tip or fall due to deceleration when striking the lower incline-floor 7368
transition. 7369
Hyper-flexion injury of the lower limb at the lower incline-floor transition due to 7370
catching the foot on the ground. 7371
Runaway leading to collision or tip-over. 7372
Hand injuries to the wheelchair user due to friction burns or lacerations due to 7373
hand-rim irregularities if the wheelchair is allowed to descend too rapidly. 7374
Thumb injury on the wheel locks if the wheelchair user grabs the hand-rims when 7375
they are rolling too quickly because the hands can get pulled forward into the 7376
wheel locks by the wheels. 7377
7378
General training tips 7379
A smooth controlled descent in the forward direction is the basic method for descending 7380
inclines. 7381
The learner should proceed slowly to maintain control and should be prepared to stop at 7382
any time. It is easier to maintain speed control than to regain it after it has been lost. 7383
7384
203
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Special considerations for caregivers 7385
For caregivers of manual wheelchair users, the push-handles should be checked to ensure 7386
that they will not pull off. 7387
The basic method for caregivers of manual wheelchair users is in the forward direction 7388
with all four wheels on the incline. 7389
The caregiver of a manual wheelchair user holds the push-handles firmly and allows the 7390
wheelchair to roll down the ramp while controlling the speed and direction. 7391
The caregiver should avoid sudden stops and slow down as he/she reaches the bottom 7392
transition to level ground. 7393
The caregiver can put one hand on the wheelchair user’s shoulder to prevent a forward 7394
fall and also to steer the wheelchair as the wheelchair will tend to twist if only one push-7395
handle is held. 7396
For caregivers of manual wheelchair users, forward descent can be performed in the 7397
wheelie position. This is useful on steep inclines, to prevent the wheelchair user from 7398
falling forward. Descending an incline forward in the wheelie position is comfortable for 7399
the wheelchair user with no risk of falling out of the wheelchair. Also, the caregiver has 7400
the advantage of being able to see where he/she is going. However, this method may 7401
require the caregiver to bend too far forward, which may strain his/her back. 7402
For caregivers of manual wheelchair users, another method is to descend backward. This 7403
ensures that the wheelchair does not run away from the caregiver and that the wheelchair 7404
user does not fall forward. The caregiver should look over his/her shoulder for obstacles. 7405
For caregivers of powered wheelchair users, if the space is narrow and the caregiver must 7406
operate the wheelchair from in front, the caregiver should be careful not to run over 7407
his/her own toes. 7408
7409
Special considerations for manual wheelchairs 7410
Two-hand-propulsion pattern: 7411
Adjustment tip: 7412
Appropriate friction between the hands and hand-rims is important to carrying out 7413
this skill safely and effectively. Gloves are helpful. The type of coating (if any) on 7414
the hand-rims affects friction, as do hand-rim size and shape. A quick and 7415
inexpensive way to increase the friction of a hand-rim is to spiral-wrap it with 7416
rubber tubing. 7417
7418
The wheelchair user should keep his/her weight back, to maintain good traction on the 7419
rear wheels and to avoid forward tips or falls. 7420
To slow down or steer, the wheelchair user should hold the hands still in a position 7421
ahead of top dead center (at about the 1:00 o’clock position, using the clock analogy) 7422
and let the hand-rims slide through his/her fingers. It is generally better to provide 7423
continuous friction than to use a jerky grasp-and-release (“like milking a cow”) 7424
method. However, the grasp-and-release method may be useful to minimize the heat 7425
that builds up through friction, grasping either with both hands at the same time or 7426
alternating from one to the other. 7427
The wheelchair user can slalom down the incline by letting the hand-rim of one wheel 7428
at a time slide through the fingers. By descending using the slalom method, the 7429
apparent slope of the incline is lessened. Also, this technique may prevent the hands 7430
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
from overheating due to sustained friction. Downhill-turning tendency (see section 7431
9.16) can be used to advantage when the wheelchair user wishes to turn downhill. 7432
Leaning forward will accentuate the tendency and ease the turn. 7433
As for ascending inclines, the wheelchair may be turned sideways on the incline to 7434
rest without applying the wheel locks. 7435
7436
Variations: 7437
Caution should be used when using the wheel locks as a means of controlling 7438
speed. This is not a commonly used method. 7439
If the wheelchair user has weak trunk muscles and a tendency to fall forward 7440
when facing downhill on inclines, he/she may feel more comfortable descending 7441
the incline backward. The backward approach may also be used if, when 7442
descending forward on a steeper incline, the wheelchair user experiences loss of 7443
traction due to the unloading of the uphill wheels. When going downhill 7444
backward, the wheelchair user should lean uphill to reduce the likelihood of 7445
tipping over backward. As with any time the wheelchair is moving backward, it is 7446
important to proceed slowly with frequent shoulder checks and to avoid sudden 7447
stops that can cause rear tips. 7448
The wheelchair user may use the handrails of the incline, if available. 7449
See wheelie variation later. 7450
7451
Hemiplegic-propulsion pattern: 7452
The wheelchair user can proceed forward down the incline, using the foot to control 7453
the speed. 7454
The wheelchair user needs to be cautious that the foot does not get caught under the 7455
chair at the lower incline-floor transition. 7456
7457
Special considerations for powered wheelchairs 7458
Altering the position of the wheelchair seat (i.e. with respect to tilt, recline, seat height) 7459
may be helpful to improve stability, alter the weight distribution on the wheels (e.g. for 7460
more traction) or ensure footrest clearance at the lower transition. However, some 7461
wheelchairs do not permit the wheelchair to be driven when the positioning options 7462
exceed a threshold. 7463
Training should begin with the controller in a low setting. 7464
In a powered wheelchair, unlike a two-hand-propelled manual one, only one hand is 7465
needed to control speed and direction. The other arm can be hooked around the backrest 7466
to prevent falling forward onto the lap. 7467
7468
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8.16 ROLLS ACROSS SIDE-SLOPE 7469
7470
Versions applicable 7471
Manual wheelchair: 7472
Powered wheelchair: 7473
7474
WST/WST-Q skills 7475
“Rolls across side-slope”. 7476
7477
Description and rationale 7478
The learner moves the wheelchair across a slight side-slope without turning downhill or 7479
uphill significantly, then repeats the task in the opposite direction. Side-slopes (or cross-7480
slopes) are frequently encountered in built and natural environments. Sidewalks, for 7481
instance, are usually sloped 2% (1:50) toward the street to allow water to run off. Steeper 7482
grades are also often found (e.g. where sidewalks cross driveways). The yaw axis of a 7483
wheelchair (i.e. the vertical axis around which the wheelchair turns toward the left or 7484
right) is between the drive wheels. If the combined center of gravity of the wheelchair 7485
and user is ahead of the drive wheels and more on the casters that are free to turn (as is 7486
usually the case with rear-wheel-drive wheelchairs), the wheelchair will tend to turn 7487
downhill on a side-slope (“downhill turning tendency”). If the combined center of gravity 7488
of the wheelchair and user is behind the drive wheels (as is usually the case with front-7489
wheel-drive wheelchairs), the wheelchair will tend to turn uphill on a side-slope (“uphill 7490
turning tendency”). 7491
7492
Prerequisites 7493
None. 7494
7495
Spotter considerations 7496
Spotter starting position: Slightly behind and downhill from the wheelchair. 7497
Risks requiring spotter intervention: Sideways tip or fall downhill. 7498
7499
General training tips 7500
The extent of downhill- or uphill-turning tendency is directly proportional to how far the 7501
combined center of gravity of the wheelchair and occupant is in front of or behind the 7502
drive wheels. The person operating the wheelchair can take steps to minimize this 7503
distance by repositioning the center of gravity (e.g. by leaning, tilting or reclining). 7504
If there is room to do so on a path, the person operating the wheelchair should stay away 7505
from the downhill edge of a side-slope to avoid veering off the path. 7506
7507
Variation: 7508
Slowly turning the wheelchair 360° in place on a side-slope will provide a good 7509
sense of how downhill-turning tendency affects the wheelchair at different angles. 7510
7511
Progression: 7512
Although only a 5 side-slope is mentioned specifically in the WSP Manual, for 7513
learners and wheelchairs capable of handling steeper inclines, it is reasonable to 7514
206
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
attempt these under the supervision of a trainer, even if only to help the learner 7515
recognize the limits of what is possible for him/her with that wheelchair. 7516
7517
Special considerations for caregivers 7518
If the wheelchair user is in a tilt-in-space or reclining wheelchair, tilting or reclining the 7519
wheelchair can be used to get the center of gravity farther back. 7520
For caregivers of manual wheelchair users, to resist the downhill-turning tendency while 7521
pushing the wheelchair across a side slope, the caregiver needs to push harder on the 7522
downhill push-handle and pull back on the uphill push-handle. 7523
For a steeper slope, the caregiver of a manual wheelchair user may choose to use the 7524
wheelie position. 7525
7526
Special considerations for manual wheelchairs 7527
Adjustment tip: 7528
Moving the rear axles of a rear-wheel-drive wheelchair forward reduces the 7529
downhill-turning tendency. 7530
7531
Side-slopes require significantly more energy to push across. 7532
The wheelchair user should lean backward to keep the weight away from the casters. 7533
7534
Two-hand-propulsion pattern: 7535
To avoid turning downhill, the wheelchair user should push harder on the 7536
downhill wheel. 7537
Different push frequencies may be used for the two hands. For instance, when 7538
moving across a side-slope with the right side downhill, the right hand may push 7539
2-3 times for every 1 push on the left. 7540
When pushing longer distances, route planning can be used to avoid overuse on 7541
one side. For instance, part of the journey can be carried out on the right-hand 7542
sidewalk (where the left side is downhill) and part of the journey on the left-hand 7543
sidewalk. 7544
In some cases, the uphill hand may be used exclusively for braking (to minimize 7545
downhill-turning tendency) rather than for assisting with propulsion. 7546
Shorter stokes may need to be used to keep the wheelchair moving straight. 7547
On steep cross-slopes, problems (e.g. loss of uphill-wheel traction, lateral tip-7548
over, folding of the wheelchair) may arise due to the lack of weight on the uphill 7549
wheel. These problems can be minimized by leaning uphill. 7550
As noted earlier, downhill-turning tendency can be used to advantage when the 7551
wheelchair user wishes to turn downhill. Leaning forward will accentuate the 7552
tendency and ease the turn. 7553
7554
Variations: 7555
A useful learning experience to demonstrate the downhill-turning 7556
tendency is to have the wheelchair user lean forward as he/she rolls 7557
forward, to illustrate how the downhill-turning tendency increases. 7558
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Current edition: August 17, 2018
If there is an uphill wall that can be used, the wheelchair user can drag the 7559
uphill hand on the wall behind the rear axle to counteract the downhill-7560
turning tendency. This is analogous to the drag turn discussed earlier. 7561
See wheelie variation later. 7562
7563
Hemiplegic-propulsion pattern: 7564
When learning the skill in the forward direction, it may be less frustrating to cross 7565
the side-slope with the sound side downhill first; this will tend to counteract rather 7566
than aggravate the downhill-turning tendency. 7567
Some users may choose to go backward with the sound side downhill rather than 7568
forward with the sound side uphill, to help manage the downhill-turning tendency. 7569
7570
Special considerations for powered wheelchairs 7571
Although a rear-wheel-drive wheelchair will tend to turn downhill (analogous to a 7572
manual wheelchair), a front-wheel-drive wheelchair will tend to turn uphill. 7573
Many powered wheelchairs are equipped with automatic correction of downhill/uphill-7574
turning tendency on side-slopes. 7575
If there is no automatic correction, the wheelchair user should aim slightly away from the 7576
expected deviation (i.e. aim uphill for a rear-wheel-drive wheelchair and downhill for a 7577
front-wheel-drive wheelchair). 7578
If the wheelchair user is in a tilt-in-space or reclining wheelchair, tilting or reclining the 7579
wheelchair can be used to get the center of gravity over the drive wheels. 7580
7581
Special considerations for scooters 7582
On steeper side-slopes, sideways tips are possible due to the relatively narrow base width 7583
and high center of gravity of some scooters. 7584
7585
208
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Current edition: August 17, 2018
8.17 ROLLS ON SOFT SURFACE 7586
7587
Versions applicable 7588
Manual wheelchair: 7589
Powered wheelchair: 7590
7591
WST/WST-Q skills 7592
“Rolls on soft surface”. 7593
7594
Description and rationale 7595
The learner moves the wheelchair a short distance on a soft surface. There are many types 7596
of soft surfaces (e.g. carpet, dirt, grass, gravel, sand or snow) that a wheelchair user may 7597
encounter. Propulsion is more difficult on such surfaces (increased rolling resistance) 7598
because the wheels tend to sink into the surface, especially wheels that are narrow or of 7599
small diameter. 7600
7601
Prerequisites 7602
None. 7603
7604
Spotter considerations 7605
Spotter starting position: Behind the wheelchair, holding onto the spotter strap with one 7606
hand (if a manual wheelchair). 7607
Risks requiring spotter intervention: 7608
Rear tip when accelerating. 7609
Overuse injury due to the additional forces needed. 7610
7611
Adjustment tip 7612
The diameter, width and shape of the wheels and tires will affect the extent to which they 7613
sink into the soft surface. 7614
7615
General training tips 7616
When approaching a section of soft or irregular terrain, the wheelchair user should look 7617
ahead and plan a route that will minimize difficulties. When proceeding across a soft or 7618
rough surface, it is easiest to move forward in a straight line because, if the casters sink 7619
into the soft surface, they will be less free to swivel should the user wish to change 7620
direction. 7621
When moving from a smooth level surface onto a soft surface, the wheelchair will 7622
decelerate, so it may be necessary to slow down (or pop the casters, if in a manual 7623
wheelchair) when approaching such a transition. 7624
To minimize rolling resistance, reducing the weight on the small wheels (casters) and 7625
increasing the weight on the drive wheels is a helpful strategy. 7626
If one drive wheel is spinning, the wheelchair user should shift his/her weight in the 7627
direction of the slipping wheel to increase the traction. 7628
For rear-wheel-drive wheelchairs, it may be easier to lead with the larger wheels (i.e. in 7629
the backward direction). The larger-diameter wheels make it easier to get started. The 7630
casters will trail backward and the resulting longer wheelbase may help as well because 7631
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the casters will be farther from the center of gravity. 7632
7633
Variations: 7634
A variety of surfaces (e.g. sand, thick carpet, foam, a gym mat, gravel) provide 7635
similar, but not identical, experiences. 7636
If the surface is too soft to proceed over, a mat or other materials can be laid down 7637
over it. If an assistant is available, long distances can be covered by using two 7638
mats, picking up the mat behind the wheelchair and moving it to the front, 7639
proceeding forward in a step-wise fashion. 7640
7641
Special considerations for caregivers 7642
For caregivers of manual wheelchair users, to proceed in the forward direction (which has the 7643
advantage of allowing the caregiver to see where he/she is going more easily), it may be 7644
necessary for the caregiver to lean forward to apply the extra force needed. 7645
The caregiver of a manual wheelchair user should not use his/her knee against the backrest of 7646
the wheelchair to apply more force because this may be uncomfortable for the wheelchair 7647
user (if the backrest is flexible) or dislodge a rigid removable backrest. 7648
For caregivers of powered wheelchairs with rear-wheel-drive, a caregiver can push down (or 7649
stand) on the back of the wheelchair to unload the casters and add traction to spinning 7650
wheels. The caregiver can also push forward, to assist with overcoming resistance. 7651
7652
Variations: 7653
The caregiver of a manual wheelchair user may find it easier to push or pull the 7654
wheelchair in the wheelie position, so that almost all of the weight is on the rear 7655
wheels. If there is very high rolling resistance, pulling may be more effective. This is 7656
the first of many skills for which it may be useful for the caregiver to be able to get 7657
the wheelchair into the wheelie position. The caregiver should always let the 7658
wheelchair user know before he/she tips the wheelchair backward. To tip the 7659
wheelchair backward, the caregiver should use one foot on a tipping lever (an 7660
extension of the wheelchair frame, to which the rear anti-tip device [if any] may be 7661
attached) while pulling backward with the hands on the push handles (if any). The 7662
caregiver should tip the wheelchair back far enough so that it is just beyond the 7663
balance position, with the weight of the wheelchair pushing down slightly on the 7664
caregiver’s hands. How far back the wheelchair needs to be tipped will vary 7665
depending on the wheelchair user and the wheelchair. To land after such an assisted 7666
wheelie, the caregiver should slowly allow the casters to return to the floor using a 7667
foot on the tipping lever to help slow the landing. 7668
7669
Special considerations for manual wheelchairs 7670
Adjustment tips: 7671
This is the first of several skills for which it is of benefit to pop the casters off the 7672
surface either transiently or to perform a full wheelie. Any adjustment that lowers the 7673
rear stability of the wheelchair (e.g. moving the axles of the rear wheels forward) will 7674
make it easier to pop the casters. 7675
It may be necessary to reposition the rear anti-tip devices to allow the wheelchair to be 7676
tipped backward sufficiently to pop the casters. To reposition most rear anti-tip devices, 7677
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WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the person doing so needs to press a button or release mechanism on the wheelchair 7678
frame that locks the anti-tip device in place. The position of the anti-tip devices should 7679
be noted, to simplify restoring them later. The anti-tip devices can either be 7680
repositioned or removed. To restore the anti-tip devices, the learner should simply 7681
reverse the steps. Note that whenever the rear anti-tip devices have been inactivated, the 7682
wheelchair user is at increased risk of a rear tip. The spotter should be vigilant to spot 7683
the wheelchair user closely until the wheelchair user becomes used to this new 7684
condition. Even if the rear anti-tip devices are left in place, the wheelchair user should 7685
not rely on them to prevent rear tipping because they might sink into a soft surface. 7686
If the wheelchair has elevating footrests, it will be easier to pop the casters if the 7687
footrests are lowered. 7688
7689
Two-hand-propulsion pattern: 7690
The forward approach to negotiating soft surfaces is preferred because the wheelchair 7691
user can see where he/she is going. 7692
The wheelchair user should use long slow strokes to keep the wheels from slipping in 7693
loose surfaces. 7694
Because there is more rolling resistance on soft surfaces, more force is required by 7695
the wheelchair user. 7696
Leaning forward slightly may help the wheelchair user to apply more force to the 7697
hand-rims and to prevent the additional force from causing a rear tip. However, 7698
keeping as much weight as possible on the rear wheels (e.g. by leaning backward 7699
slightly) will improve traction and keep the front wheels from digging into the soft 7700
surface. The wheelchair user should experiment with the extent of trunk lean to find 7701
the optimum (the “sweet spot” between too much and too little). As a learning 7702
exercise, the wheelchair user should try the skill while leaning forward and 7703
backward to different extents, to find the optimum position for him/her. 7704
Transient caster pops are a good option, lifting the casters off the surface during 7705
each push, but letting them touch the surface as the hands recover for the next push. 7706
During a caster pop, the longer the hands remain on the hand-rims, the farther 7707
forward the wheelchair will move with the casters off the surface. This can be 7708
thought of as analogous to taking a series of walking “steps” across the surface; a 7709
few long steps are preferable to many short steps. 7710
7711
Progression: 7712
For wheelchair users who are unfamiliar with caster pops, it can be a useful 7713
exercise to practice such pops on a smooth firm surface. The emphasis is on 7714
pushing the hand-rims forward but more forcefully than to simply roll forward 7715
but less forcefully than is needed to achieve a full wheelie position. For a learner 7716
who is having difficulty applying enough force, the trainer can hold out his/her 7717
palm and ask the learner to use his/her own hand first to simply push against the 7718
trainer’s palm (to illustrate the amount and timing of the force needed to roll 7719
forward) and then to slap the trainer’s palm (to illustrate the amount and timing 7720
of the force needed to pop the casters off the surface). 7721
7722
Variations: 7723
211
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
See wheelie variation later. 7724
7725
Hemiplegic-propulsion pattern: 7726
Rolling on soft surfaces with the hemiplegic-propulsion pattern (one arm and one 7727
leg) is easier in the backward direction, because there is less rolling resistance with 7728
the large rear wheels than the smaller casters. Also, when pushing backward with 7729
the foot, the casters become slightly unloaded which makes it easier to move them. 7730
7731
Special considerations for powered wheelchairs 7732
If possible and necessary, the wheelchair user should adjust the controller setting to one 7733
that provides more torque. 7734
Positional control (e.g. tilt, recline) can alter the weight distribution between the front and 7735
rear wheels. It is easier to proceed on a soft surface if more of the weight is on wheels 7736
with larger diameters. Clearance for the feet can also be affected by this change. 7737
On soft or irregular terrain, there is an optimal speed that is fast enough to maintain 7738
forward movement but not so fast that the motion is uncomfortable or leads to a loss of 7739
control. 7740
Maintaining a steady speed is preferable to a series of stops and starts. 7741
On a “bottomless” soft surface (e.g. sand, gravel or mud), if the drive wheels are allowed 7742
to spin, the wheelchair may dig itself into a hole that it can be difficult to get out of 7743
without assistance. 7744
7745
212
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.18 GETTING OVER OBSTACLES OR GAPS 7746
7747
Versions applicable 7748
Manual wheelchair: 7749
Powered wheelchair: 7750
7751
WST/WST-Q skills 7752
“Gets over obstacle”. 7753
“Gets over gap”. 7754
7755
Description and rationale 7756
The learner moves the wheelchair over an obstacle or a gap across the line of progression. 7757
Wheelchair users often encounter obstacles (e.g. door thresholds) of various sizes and 7758
shapes that they may not be able to simply roll over. Alternative strategies may be 7759
needed. For example, a manual wheelchair user might need to pop the casters over the 7760
obstacle whereas a powered wheelchair user might need to change the mode setting to 7761
one with more power. A gap in surface support is a commonly encountered barrier (e.g. 7762
due to a rut in the road, a water channel or a space between a subway platform and a 7763
subway train). Gaps that only affect one wheel at a time are not usually major obstacles. 7764
In this section, only gaps that are as wide as the wheelchair will be considered. Small-7765
diameter wheels (such as casters) can drop into such gaps, causing a sudden deceleration 7766
that can tip the wheelchair over forward or lead to the wheelchair user falling out of the 7767
wheelchair. Even if no tip or fall occurs, it can be difficult to get the wheelchair out of the 7768
gap. 7769
7770
Prerequisites 7771
None. 7772
7773
Spotter considerations 7774
Spotter starting position: 7775
If using a single spotter, he/she should be behind the wheelchair, holding onto a 7776
spotter strap with one hand (if a manual wheelchair) and the other hand in front of the 7777
wheelchair user’s shoulder. 7778
If using two spotters (as is recommended), the second spotter should stand to one side 7779
of the obstacle or gap. 7780
A removable seat belt can prevent the wheelchair user from falling from the 7781
wheelchair. 7782
Risks requiring spotter intervention: 7783
Rear tip when accelerating to pop casters from the surface (if a manual 7784
wheelchair). 7785
Forward tip or fall if the casters strike the obstacle or drop into the gap. 7786
7787
Adjustment tips 7788
Rear anti-tip devices may need to be repositioned or removed to permit caster pops (for 7789
manual wheelchairs). 7790
Rear anti-tip devices that are too low may cause the drive wheels to “float” when 7791
213
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
overcoming obstacles (i.e. with the weight being distributed on the casters and the anti-tip 7792
devices, unloading the drive wheels). 7793
Footrests or anti-tip devices may contact the obstacle before the wheels do, making it 7794
impossible to negotiate the obstacle in that direction without repositioning the wheelchair 7795
parts concerned. 7796
A seat belt may be useful for higher obstacles to prevent falling out of the wheelchair 7797
while the rear wheels are on top of the obstacle and the seat is tilted forward. 7798
Wheelchairs with longer wheelbases are less likely to tip forward as the rear wheels 7799
surmount higher obstacles. 7800
Wheelchairs with large-diameter leading wheels are able to roll over higher obstacles than 7801
those with small-diameter wheels. 7802
The diameter of the wheels affects the size and depth of gaps that can be overcome. A 7803
large-diameter wheel will be able to roll over a small gap rather than dropping fully into 7804
it. 7805
7806
General training tips 7807
The best approach is to avoid obstacles or gaps, steering around them or straddling them. 7808
If the wheelchair gets hung up on an obstacle due to insufficient distance between the 7809
front and rear wheels (short wheelbase), the learner may be able to escape by backing up 7810
slightly; this will swings the casters from the rear-trailing position to the side- or forward-7811
trailing one, where there is more space between the front and rear wheels. 7812
If the casters drop into the gap and they turn sideways (a common problem if the 7813
wheelchair is moved forward and backward repeatedly in an attempt to get the casters out 7814
of the gap), it can be very difficult or impossible to proceed without assistance. 7815
7816
Progression: 7817
Although the techniques used for getting over gaps and obstacles are very similar and 7818
the gap technique is easier, the gap can be more intimidating for learners so we 7819
usually teach the learner how to get over an obstacle before progressing to the gap. 7820
The learner should start with a slow speed and progress to faster ones. 7821
The learner should start with low obstacles and progress to higher ones. Obstacles 7822
with a height of 10 cm or greater are negotiable in the right wheelchair. Before 7823
attempting to negotiate a high obstacle, the learner should be aware of how much 7824
clearance exists between the wheels and under the frame or chassis of the wheelchair, 7825
to avoid getting hung up on the obstacle. 7826
The learner should start with small shallow gaps and progress to more challenging 7827
ones. 7828
7829
Variations: 7830
Leading with the larger-diameter wheels may be helpful. 7831
The oblique approach to a gap is often safer and more effective than the square-on 7832
approach. As long as three wheels are supported at any time, the wheelchair will 7833
usually remain upright. That being the case, an oblique approach to a gap (e.g. 30-45° 7834
from the line of progression so that only one wheel is unsupported at a time) is a 7835
useful strategy. The wheelchair user should keep his/her weight away from the 7836
214
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
unsupported wheel. 7837
7838
Special considerations for caregivers 7839
A caregiver may request assistance from the wheelchair user during these skills, in the 7840
form of having the wheelchair user lean backward or forward at the caregiver’s direction, 7841
to facilitate the different stages of the skill. 7842
A caregiver of a manual wheelchair user may proceed in the forward direction over a gap, 7843
using the transient caster pop or full wheelie method. After the rear wheels are in the gap, 7844
the casters can be lowered to the surface beyond the gap. Then the wheelchair user is 7845
asked to lean forward and the wheelchair is rolled out of the gap. 7846
The backward direction for overcoming gaps may be easier for the caregiver of a manual 7847
wheelchair user. If this technique is used, the rear wheels of the wheelchair can be 7848
lowered into the pothole, then the wheelchair tipped into the wheelie position to be pulled 7849
out of the gap on the rear wheels. 7850
For caregivers of powered wheelchair users attempting to negotiate a gap, if the casters 7851
get stuck sideways in the gap, the caregiver may need to stand on the back of the 7852
wheelchair to tilt the chair enough to get the casters out of the gap. If the wheelchair user 7853
cannot operate the joystick enough to help, a second caregiver may be needed. The 7854
motors may need to be disengaged to allow the wheelchair to be pushed out of the gap. 7855
7856
Special considerations for manual wheelchairs 7857
This is the first of a series of skills for which the ability to pop the casters in a specific 7858
location and to move forward are very helpful. 7859
7860
Forward Approach, Stationary Method: 7861
The square-on forward approach is useful to include in training because the 7862
method used is part of a step-wise sequence leading toward the ascent of 7863
curbs. 7864
The wheelchair user should approach the obstacle and stop with the casters 5-7865
10 cm before reaching the obstacle, to avoid striking the casters on the vertical 7866
section of the obstacle while popping them. 7867
The stationary method is comprised of two steps: “pop” and “lean”. These 7868
cues can be verbalized as the steps are performed. 7869
The wheelchair user first briefly pops the 7870
castershttps://wheelchairskillsprogram.ca/en/7-80/ from the floor, just high 7871
enough to clear the obstacle. To do so using the two-hand propulsion method, 7872
the wheelchair user applies forward forces of moderate intensity to the hand-7873
rims (a “slap” vs. a “push”, as noted earlier). After the casters land beyond the 7874
obstacle and the rear wheels encounter resistance, the wheelchair user leans 7875
forward to help power the rear wheels over the obstacle and prevent rear 7876
tipping. Some rocking may be needed. 7877
Once the rear wheels are on top of a high obstacle, the wheelchair user should 7878
lean back to decrease the likelihood of a forward tip or fall out of the 7879
wheelchair. 7880
For a gap, the casters can be stopped at the edge of the gap. There is less need 7881
to pop the casters “high” than to pop them “long” to get across the gap. As for 7882
215
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
the “rolls on soft surface” skill (section 9.17), a long “step” can be achieved 7883
by ensuring that the hands remain on the hand-rims for as long as possible (i.e. 7884
11:00-2:00 o’clock, using the clock analogy). 7885
7886
Forward Approach, Momentum Method: 7887
This method is comprised of three phases: “approach”, “pop” and “lean”. As 7888
for the stationary method, the cues can be verbalized as they are performed. 7889
In preparing to pop the casters while the wheelchair user moves forward 7890
during the approach, the wheelchair user may briefly coast to allow correct 7891
placement of the hands when he/she is at the proper distance from the 7892
obstacle. The trainer can demonstrate the reason for the coast by using the 7893
analogy of walking toward the obstacle, adjusting the step length rather than 7894
stopping before the obstacle and stepping over it. 7895
The wheelchair user should initially approach at a slow speed, square to the 7896
obstacle or gap. It is simpler to pop the casters when moving slowly. Also, if 7897
the wheelchair user fails to pop the casters for long enough to clear the front 7898
edge of the obstacle or the back edge of the gap, the sudden stop will be less 7899
jarring at a slow speed. 7900
The wheelchair user should not lean forward to look at the feet when he/she 7901
approaches the obstacle or gap, because that increases the weight on the 7902
casters. In timing the caster pop, the wheelchair user needs to understand 7903
where the casters are (often below the knees rather than under the feet). A 7904
mirror placed to the side of the obstacle or gap can be used to provide 7905
feedback. 7906
The correct position of the hands at the beginning of the popping phase is 7907
when they are ready to grasp the hand-rims, behind top dead center (11:00 7908
o’clock on the right wheel, using the clock analogy). Then, the wheelchair 7909
user should accelerate the chair even faster than it is coasting, by using a 7910
stroke of moderate force that is powerful enough to pop the casters from the 7911
surface high enough and long enough. 7912
Once the casters have landed beyond the obstacle or gap and the rear wheels 7913
strike the obstacle or gap, the wheelchair user should lean forward and propel 7914
the rear wheels to bring the rear wheels over the obstacle or up out of the gap. 7915
If the obstacle is a high one, the wheelchair user should lean back once the 7916
rear wheels are on top of the obstacle. 7917
When moving forward over an obstacle or gap, some advanced wheelchair 7918
users prefer to allow the rear wheels to reach the surface beyond the obstacle 7919
before having the casters land on the surface. However, when initially 7920
learning the skill, it is preferable that the casters land beyond the obstacle or 7921
gap before the rear wheels strike the obstacle. This will be especially useful 7922
when learning to ascend curbs, to avoid “caster slap”. 7923
7924
Progression: 7925
To practice getting the timing correct without the fear of having the 7926
casters strike the obstacle or gap, the wheelchair user may practice 7927
propelling the wheelchair forward and transiently popping the casters at 7928
216
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
a predetermined point on the floor. This can be a line on the floor or a 7929
strip of bubble wrap. The horizontal distance over which the casters 7930
need to be off the floor can be gradually increased. 7931
The learner should start with the stationary approach then progress to the 7932
momentum method. 7933
For learners experiencing difficulties in coordinating the sequence of the 7934
three phases of the skill (approach, pop and lean), it may be useful to 7935
practice them in segments before putting the segments together. 7936
7937
Variations: 7938
The wheelchair user may use the external environment if available (e.g. door frame) 7939
to pull the rear wheels over the obstacle or gap. 7940
The hands-free version of the skill is useful because the wheels may be spinning too 7941
quickly for the hands to catch up with them (e.g. coming down a hill). However, this 7942
is an advanced skill that can be difficult to spot. 7943
As noted earlier for the “maneuvers sideways” skill, to get beyond a pair of obstacles 7944
(e.g. concrete parking bolsters) or gaps that are too close to wheel between, it may be 7945
possible to move one wheel (or pair of wheels) through the space at a time, transiently 7946
straddling the obstacles with one wheel (or pair of wheels) on either side of the 7947
obstacles or gaps and the wheelchair parallel with the obstacles or gaps. 7948
The wheelchair user may find it easier to back over a low obstacle or gap. The 7949
wheelchair user should approach the obstacle or gap slowly, because a sudden stop 7950
can cause a rear tip. As the wheelchair user approaches the obstacle or gap in the 7951
backward direction, he/she should lean forward to unload the rear wheels and further 7952
reduce the likelihood of a rear tip. The wheelchair user pulls the wheelchair straight 7953
backward by applying equal force to both wheels. Otherwise, the casters may turn 7954
and catch sideways on the obstacle or in the gap. Once the rear wheels are over the 7955
obstacle or gap, the wheelchair user should lean back enough to unload the casters as 7956
they reach the obstacle or gap), but not so much as to cause a rear tip. 7957
When popping the casters over a long obstacle or gap (in the line of progression), the 7958
wheelchair user can use the full wheelie position or perform a transient pop with two 7959
pushes, the second push while the casters are still in the air. 7960
See wheelie variations later. 7961
7962
Hemiplegic-propulsion pattern: 7963
The backward approach (as described above) is useful whenever high rolling 7964
resistance (as the obstacle and gap represent) is encountered. 7965
7966
Variations: 7967
The obstacle or gap can be approached in the forward direction, using the 7968
foot/feet to pop the casters. While popping the casters, at the same time the 7969
wheelchair user should roll the wheelchair forward so that the casters land on the 7970
floor beyond the obstacle or gap. 7971
7972
Special considerations for powered wheelchairs 7973
Adjustment tip: 7974
217
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
If the casters are rounded on their sides (i.e. ball-shaped), they will better resist the 7975
tendency to get caught sideways. 7976
7977
Leaning the body away from the casters will unload them and make it easier to get them 7978
over the obstacle or gap. 7979
Positional control (e.g. tilt, recline) can be used to alter the weight distribution of the 7980
wheelchair and to provide footrest clearance. 7981
Smooth continuous forward movement is often the most successful method of traversing an 7982
obstacle or gap. 7983
Depending upon the size of the obstacle or gap, it may be necessary to switch drive 7984
modes to have the necessary wheel torque. 7985
If the powered wheelchair has come to a stop with the casters against the obstacle or in 7986
the gap, as extra force is applied to the obstacle, the casters may suddenly pop up. The 7987
wheelchair user should not apply any more force than is needed and should reduce the 7988
force applied to the joystick as soon as possible. 7989
Getting the larger drive wheels over an obstacle or gap is usually easier than getting the 7990
smaller caster wheels over. 7991
If a gap cannot be managed in the oblique direction or avoided, but appears to be 7992
negotiable in the straight-forward direction, it is best to proceed at a slow speed but a 7993
steady pace because the momentum may help bounce the wheels over the gap. 7994
7995
Special considerations for scooters 7996
If there is insufficient ground clearance between the front and rear wheels, the scooter 7997
may get hung up on a high obstacle. 7998
Approaching the obstacle with a little extra speed may help. However, if the scooter user 7999
approaches the obstacle too quickly, the stiffness of the suspension may cause the scooter 8000
user to bounce off the seat and lose control of the scooter. 8001
8002
218
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.19 ASCENDS CURBS 8003
8004
Versions applicable 8005
Manual wheelchair: 8006
Powered wheelchair: 8007
8008
WST/WST-Q skills 8009
“Ascends low curb”. 8010
“Ascends high curb”. 8011
8012
Description and rationale 8013
The learner gets the wheelchair up curbs of various heights. Level changes (e.g. curbs, 8014
home entries, uneven sidewalk sections) are common obstacles in the natural and built 8015
environment. The ability to manage low curbs (~5 cm) is useful but practice on low curbs 8016
also provides an opportunity to hone techniques that will be needed for higher curbs (~15 8017
cm). Although curb cuts (“pedestrian ramps”) are now commonplace in many parts of the 8018
world, curbs or large level changes are still commonly encountered. 8019
8020
Prerequisites 8021
None. 8022
8023
Spotter considerations 8024
Spotter starting position: 8025
For this and later curb-handling and stairs skills, the spotter strap is of little use if 8026
a sideways tip or fall occurs. 8027
If using a single spotter, he/she should be behind the wheelchair, with both hands 8028
close to the push-handles (if any) or to the backrest components. 8029
If using two spotters (as is recommended), the second spotter should stand to one 8030
side of the level change. 8031
A removable seat belt can prevent the wheelchair user from falling from the 8032
wheelchair. 8033
Risks requiring spotter intervention: 8034
Rear tip when accelerating to pop casters from surface (if a manual wheelchair). 8035
Forward tip or fall if the casters strike the curb. 8036
Sideways tip if one wheel gets up onto the upper level before the other. 8037
8038
General training tips 8039
It may be necessary to reposition or remove the footrests or rear anti-tip devices. 8040
This skill is similar to and builds upon the previous ones, specifically the “rolls on soft 8041
surface” and “gets over obstacles or gaps” sections. 8042
8043
Progression: 8044
The learner should start with a minimal level change and progress to higher ones. 8045
It is useful to have a variety of curb heights (e.g. 2.5, 5, 10 and 15 cm). If space is 8046
an issue, these can be stacked or nested. 8047
219
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
For learners and wheelchairs capable of handling curbs higher than 15 cm, it is 8048
reasonable to attempt these under the supervision of a trainer, if it can be done 8049
safely. 8050
8051
Special considerations for caregivers 8052
For caregivers of manual wheelchair users, to ascend a level change in the forward 8053
direction, the caregiver should put the wheelchair into the full or partial wheelie position 8054
to get the casters onto the upper level. Then, the caregiver should roll the chair forward 8055
until the rear wheels press firmly against the vertical face of the level change. The 8056
caregiver should then ask the wheelchair user to lean forward to reduce the weight on the 8057
rear wheels. The caregiver then applies a forward and upward force on the push handles 8058
or some other rigid part of the wheelchair to help the rear wheels roll up onto the upper 8059
level. If the rear wheels do not turn, the caregiver is lifting rather than rolling them. Once 8060
the rear wheels are on the upper level, the wheelchair user sits upright again. 8061
Alternatively, for a small level change, the caregiver can bring a manual wheelchair up 8062
the curb in the backward direction. If the level change is large enough, the caregiver may 8063
need to tip the wheelchair into the full wheelie position (to avoid tipping the wheelchair 8064
user forward out of the wheelchair) and pull the wheelchair up onto the upper level. Once 8065
on the upper level, the caregiver should roll the wheelchair well away from the edge of 8066
the level change before lowering the casters. The caregiver should not use this technique 8067
for a large level change, because he/she would need to bend forward too far and might 8068
injure his/her back. 8069
8070
Special considerations for manual wheelchairs 8071
Two-hand-propulsion pattern: 8072
This skill is similar to the “gets over obstacles or gaps” section in that the low 8073
curb can be approached with stationary and momentum methods, but the 8074
momentum method is usually necessary for high curbs. 8075
It is slightly more challenging to deal with the rear wheels than for the preceding 8076
skills because the tilted position, due to having the casters on top of the curb, 8077
moves more weight to the back of the wheelchair. This shift of weight is present 8078
until the rear wheels are all the way up on the upper level. 8079
In the stationary approach, if the wheelchair user has difficulty getting the rear 8080
wheels up onto the upper level, the wheelchair user should roll the wheelchair 8081
backward until the front wheels are almost off the edge of the curb. This has two 8082
effects. First, it reverses the caster trail, thereby reducing the extent of rear tip 8083
(because the caster stems are no longer vertical). This provides a greater safety 8084
margin between the resting position and the rear tip-over threshold, so the 8085
wheelchair user can push harder without tipping over. Second, because the rear 8086
wheels have been backed slightly away from the edge, a small amount of 8087
momentum can be used. Before backing the rear wheels away from the curb edge, 8088
the wheelchair user should lean forward and place his/her hands on the hand-rims 8089
in the position where the most force can be applied. The hands should remain on 8090
the hand-rims as the wheelchair user sits up and the rear wheels are backed away 8091
from the curb, ensuring that the hands and trunk will be optimally placed when 8092
moving forward again. When the rear wheels strike the curb, the wheelchair user 8093
220
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
should lean forward and push the rear wheels up onto the upper level. The forward 8094
lean should be timed to coincide with when the rear wheels contact the curb. 8095
As noted earlier, with the momentum method, the wheelchair user should ensure 8096
the casters are on the upper surface (rather than in the air) when the rear wheels 8097
strike the curb. If the casters are still in the air, the energy from the forward pitch 8098
caused by the collision of the rear wheels with the curb will be expended in noisily 8099
bringing the casters down onto the upper level (“caster slap”) rather than bringing 8100
the rear wheels up onto the upper level. 8101
8102
Variations: 8103
The wheelchair user might find it easier to ascend low curbs in the backward 8104
direction. 8105
The wheelchair user may use the external environment if available (e.g. door frame) 8106
to pull the rear wheels up onto the upper level. 8107
8108
Hemiplegic-propulsion pattern: 8109
The wheelchair is backed up until the rear wheels contact the obstacle. Then, leaning 8110
forward to unload the rear wheels, the foot is used to push the rear wheels up the level 8111
change. Then the wheelchair user sits upright and uses the foot to push down on the 8112
floor or top of the curb to bring the casters up to the upper level. 8113
8114
Special considerations for powered wheelchairs 8115
Ascending high curbs is not applicable for most powered wheelchairs, because of the 8116
difficulty and danger involved. However, low and medium curbs may be feasible. 8117
Positional control (i.e. tilt, recline) can be used to alter the weight distribution on the 8118
wheels and to provide footrest clearance. 8119
Getting the larger drive wheels up the curb is usually easier than getting the smaller 8120
caster wheels up. Leaning away from the casters will unload them and make it easier to 8121
get them up onto the upper level. 8122
Depending upon the height of the curb, it may be necessary to switch drive modes to 8123
have the necessary wheel torque. 8124
Smooth continuous forward movement is often the most successful method of ascending a 8125
curb. 8126
If the powered wheelchair has come to a stop against the curb, the casters may suddenly 8127
pop up as extra force is applied to the curb. The wheelchair user should not apply any 8128
more force than is needed and should reduce the force applied to the joystick as soon as 8129
possible. 8130
8131
Variation: 8132
In some instances, especially with a rear-wheel-drive wheelchair, it may be easier 8133
to ascend the level change in the backward direction. 8134
8135
Special considerations for scooters 8136
Ascending high curbs is not applicable for most powered wheelchairs, because of the 8137
difficulty and danger involved. However, low and medium curbs may be feasible. 8138
221
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
If there is insufficient ground clearance between the front and rear wheels, the scooter 8139
may get hung up on the edge of the curb. 8140
Approaching the curb with a little extra speed may help to mount the curb. However, if 8141
the scooter user approaches the curb too quickly, the stiffness of the suspension may 8142
cause the scooter user to bounce off the seat and lose control of the scooter. 8143
8144
222
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.20 DESCENDS CURBS 8145
8146
Versions applicable 8147
Manual wheelchair: 8148
Powered wheelchair: 8149
8150
WST/WST-Q skills 8151
“Descends low curb”. 8152
“Descends high curb”. 8153
8154
Description and rationale 8155
The learner gets the wheelchair down curbs of various heights. The rationale is the same 8156
as that for the “ascends curbs” section (9.19). The appropriate technique for a high curb 8157
differs in some respects from that used for a lower curb height. 8158
8159
Prerequisites 8160
None. 8161
8162
Spotter considerations 8163
Spotter starting position: 8164
If the wheelchair user uses the backward technique, the spotter should be standing 8165
on the lower level with the hands positioned near the push-handles (if a manual 8166
wheelchair). 8167
For the task performed forward, this is discussed later, in the 9.20 section. 8168
Risks requiring spotter intervention: 8169
Forward tip or fall from the wheelchair if the task is performed by rolling forward off 8170
the curb. 8171
Rear tip if performed in the backward direction. 8172
Sideways tip if one wheel drops off the upper level before the other. 8173
8174
General training tips 8175
The wheelchair may be able to simply roll forward off the upper level of a low curb. This 8176
is less of a problem for wheelchairs with long wheelbases. The forward roll-off approach 8177
for low curbs is convenient and allows the learner to watch for traffic. It may be as safe 8178
and effective to go off the lip at a moderate or full speed as it is to go slowly. 8179
8180
Special considerations for caregivers 8181
For caregivers of manual wheelchair users descending low curbs, the caregiver may 8182
slowly push the wheelchair off the upper level in the forward direction, allowing the 8183
casters to gently land on the lower level, followed by the rear wheels. However, it is often 8184
dangerous for the caregiver to use this technique for medium or large level changes – the 8185
wheelchair user may tip forward out of the wheelchair or the footrests may dig in and 8186
prevent a smooth descent. 8187
Another option, and the one that should be used for higher curbs, is to descend a level 8188
change in the backward direction. The caregiver should turn the wheelchair around so 8189
223
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
that the rear wheels go off the edge first. The caregiver should stand on the lower level 8190
behind and close to the wheelchair. The caregiver should align the rear wheels so that 8191
they are both on the edge of the upper level. The caregiver then asks the wheelchair user 8192
to lean forward to reduce the weight on the rear wheels. Controlling the movement of the 8193
chair, the caregiver slowly and evenly rolls the rear wheels down onto the lower level, 8194
avoiding any jarring. Leaning the caregiver’s torso against the backrest is acceptable. 8195
Once the rear wheels are on the lower level, the wheelchair user sits upright. Then the 8196
caregiver may need to tip the wheelchair back into the wheelie position to avoid the 8197
footrests scraping on the upper level as the wheelchair is moved backward away from the 8198
curb. Alternatively, the caregiver can turn the wheelchair sideways to prevent the 8199
footrests from getting caught because the footrests will have cleared the curb edge by the 8200
time that the second caster rolls off the curb. 8201
Alternatively, the caregiver can tip the wheelchair back into the full wheelie position and 8202
lower the rear wheels to the lower level in the forward direction. The caregiver should be 8203
careful about the extent to which his/her back is flexed. However, this technique has the 8204
advantage of allowing continuous progression along a street, with the eyes facing any 8205
dangers in traffic. 8206
Note: The caregiver should not attempt to descend the level change backward with the 8207
wheelchair in the wheelie position because, at greater heights, this causes severe 8208
jarring of the wheelchair and its occupant. 8209
8210
Special considerations for manual wheelchairs 8211
Two-hand-propulsion pattern: 8212
The forward roll-off approach for low curbs is convenient and allows the learner 8213
to watch for traffic. 8214
For a high curb, the backward approach is simple and generally safe if the 8215
wheelchair has adequate rear stability and sufficient visibility is available to avoid 8216
oncoming traffic. However, even more so than for descending low curbs, it is 8217
important to keep the rear wheels moving backward to avoid a rear tip. Learning 8218
the backward approach on low curbs is helpful when advancing to higher curbs. 8219
To perform the backward approach, the wheelchair user should line the rear 8220
wheels up with the edge of the curb. The wheelchair user should lean as far 8221
forward as possible (chest on lap, if necessary) and reach forward on the hand-8222
rims. The wheelchair user should move backward very slowly and let the rear 8223
wheels roll evenly down off the upper level under control. Once the rear wheels 8224
are on the lower level, the wheelchair user can sit more upright if this is possible 8225
without tipping over backward. The wheelchair user should avoid braking 8226
suddenly when the rear wheels land on the lower level because this can induce a 8227
rear tip; keeping the wheelchair moving backward reduces the likelihood of this 8228
problem. If the wheelchair can be brought to a stop with the rear wheels on the 8229
lower level and the casters on the upper level, the wheelchair user can turn to the 8230
left or the right to get the casters off the upper level without scraping the footrests. 8231
8232
Variations: 8233
Approaching the curb edge in the forward direction, the wheelchair user 8234
can transiently pop the casters as they reach the curb edge. The wheelchair 8235
224
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
user approaches the curb edge squarely with all four wheels on the surface 8236
and pops the casters as they reach the edge. This is similar to the technique 8237
used to pop the casters transiently for the “gets over obstacles or gaps” 8238
skill. The extent of the caster pop should be sufficient to allow the rear 8239
wheels to land on the lower level at about the same time or slightly before 8240
the casters land. This method requires good timing and skill, but is a 8241
natural way to maintain forward progression and to watch for traffic. It 8242
can be difficult to spot, so two spotters are recommended. 8243
See the wheelie variation later. 8244
8245
Hemiplegic-propulsion pattern: 8246
The wheelchair is moved forward to the edge of the curb. Then, leaning backward to 8247
avoid a forward tip or falling out of the wheelchair, the foot is placed on the surface 8248
below the curb. The wheelchair is moved slowly forward until the rear wheels are on 8249
the surface below the curb. This technique can also be safely used at higher curb 8250
heights. 8251
8252
Special considerations for powered wheelchairs 8253
Ascending high curbs is not applicable for most powered wheelchairs, because of the 8254
difficulty and danger involved. However, low and medium curbs may be feasible. 8255
8256
Special considerations for scooters 8257
Ascending high curbs is not applicable for most scooters, because of the difficulty and 8258
danger involved. However, low and medium curbs may be feasible. 8259
If there is insufficient ground clearance between the front and rear wheels, the scooter 8260
may get hung up on the edge of the curb. 8261
8262
225
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
8.21 PERFORMS WHEELCHAIR-GROUND TRANSFERS 8263
8264
Versions applicable 8265
Manual wheelchair: 8266
Powered wheelchair: 8267
8268
WST/WST-Q skills 8269
“Performs wheelchair-ground transfers”. 8270
8271
Description and rationale 8272
The wheelchair user gets from the wheelchair to the ground and back. Getting onto the 8273
ground is useful for an activity (e.g. gardening or playing with a child). Getting from the 8274
ground back into the wheelchair can also be helpful when recovering from a fall. 8275
8276
Prerequisites 8277
“Performs level transfers” skill. 8278
8279
Spotter considerations 8280
Spotter starting position: 8281
If there is a single spotter, he/she should be near the wheelchair, in a position to 8282
prevent the wheelchair from tipping over or prevent the learner falling to the ground. 8283
If two spotters are used, one spotter should focus on the wheelchair user and the other 8284
spotter on preventing the wheelchair from sliding or rolling away. However, the 8285
second spotter should not touch the wheelchair unless it is necessary to intervene. 8286
Risks requiring spotter intervention: 8287
Rear, forward or sideways tip or fall. 8288
8289
General training tips 8290
There are a number of techniques that wheelchair users can use to get safely from their 8291
wheelchairs to the ground and back, the variations reflecting differences in the nature of 8292
the wheelchair user’s impairments and wheelchair characteristics. Only a few of the more 8293
commonly used techniques will be described. There is no available literature as yet 8294
supporting the superiority of one technique over the others. The trainer and wheelchair 8295
user may wish to try the variations before selecting the one that will be used in most 8296
circumstances. 8297
After a fall, if one has occurred, unless there is some immediate danger, the wheelchair 8298
user and/or caregiver should take time to assess whether there has been any injury or 8299
damage to the wheelchair user or wheelchair before getting back into the wheelchair. 8300
The technique for getting to the ground is similar to that for a level sideways transfer, the 8301
major exception being that the hand of the reaching arm should be positioned on the 8302
ground before any significant weight is transferred to it. The learner should not use a 8303
controlled fall due to the potential for injury to the hand or wrist. The non-reaching hand 8304
holds the seat rail or another non-removable wheelchair part. 8305
The technique for getting from the ground to the wheelchair is more variable and is 8306
described in more detail below under “Special considerations for manual wheelchairs”. 8307
8308
226
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
Special considerations for caregivers 8309
The caregiver can assist the wheelchair user by helping to position and stabilize the 8310
wheelchair. 8311
The caregiver should try to avoid bending and twisting his/her back at the same time and 8312
should lift with bent knees. 8313
A single caregiver may have difficulty in getting a wheelchair user back into his/her 8314
wheelchair from the ground without the significant help of the wheelchair user and/or a 8315
second caregiver. A mechanical lift or a team of people are recommended when lifting 8316
from the floor. 8317
If the caregiver is large and strong and the wheelchair user is light, the caregiver may be 8318
able to safely lift the wheelchair user from the side, with one arm around the back and 8319
under the arms and the other arm under the bent knees. 8320
If there are two caregivers, they may pick up the wheelchair user together. This can be 8321
done in two ways. 8322
One option is to have one caregiver behind the wheelchair user, holding the 8323
wheelchair user’s arms by reaching under the upper arms and grasping the folded 8324
forearms. The other caregiver lifts with his/her hands behind the wheelchair user’s 8325
knees. 8326
The other option is for the two caregivers to be on opposite sides of the 8327
wheelchair user, each with one arm under one of the wheelchair user’s arms and 8328
around the back and the other arm under the wheelchair user’s bent knees. 8329
If a third caregiver is available, he/she can help with the legs or manage the wheelchair. 8330
In some circumstances, it may be practical to move the wheelchair under the lifted 8331
wheelchair user rather than moving the wheelchair user to the wheelchair. 8332
If a caregiver is restoring the occupied wheelchair to the upright position from the fully 8333
rear-tipped position (if a rear tip has accidentally occurred), applying the wheel locks or 8334
otherwise preventing the wheels from rolling forward will keep the wheelchair from 8335
rolling forward (submarining). 8336
8337
Special considerations for manual wheelchairs 8338
Fall practice: 8339
Learning about “performs wheelchair-ground transfers” is an opportunity to practice 8340
and/or discuss how to fall as safely as possible. 8341
Generally, regardless of the fall direction, the wheelchair user should not reach out 8342
toward the ground with an arm. Even an otherwise minor arm injury can have major 8343
functional consequences for a person who uses that arm for mobility and transfers. 8344
However, some wheelchair users with low backrests, long arms and good flexibility 8345
can prevent full rear or sideways tips with a gentle push on the ground. 8346
Rear falls can be safely practiced. The trainer should first lower the wheelchair user 8347
backward from the assisted-wheelie position onto a gym mat that has been elevated to 8348
about the height of the rear-wheel axles. The rearmost part of the rear wheel should 8349
be far enough away from the mat (about 10 cm) to avoid having the mat block the 8350
rear tip. While being lowered onto the mat, the wheelchair user should flex his/her 8351
neck and pull firmly on the hand-rims. Failure to hold onto the hand-rims will result 8352
in the rear wheels of the wheelchair rolling rapidly forward (“submarining”). The 8353
wheelchair user can then progress to real falls onto the elevated mat, the height of 8354
227
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
which can be progressively lowered. As described earlier, if a rear fall seems 8355
imminent the wheelchair user should flex his/her neck and pull backward as 8356
forcefully as possible on the hand-rims. In addition to preventing submarining, the 8357
rate of rear tip will be decreased and the arms will act as shock absorbers when the 8358
wheelchair strikes the floor. Immediately after hitting the ground, the wheelchair user 8359
can use the hands or forearms to prevent the knees from striking the face. 8360
There is no safe and practical way to practice forward or sideways falls. However, 8361
they should at least be discussed. During a forward fall, the wheelchair user should 8362
twist to one side and try to roll sideways after striking the ground, protecting the head 8363
with the hands. During a sideways fall, the wheelchair user should lean away from the 8364
direction of tip, pulling vigorously on the uphill armrest or hand-rim. 8365
If falling backward in a powered wheelchair, the wheelchair user should tuck the chin 8366
and pull himself/herself vigorously forward using the armrests or seat. After such a 8367
fall, the power should be turned off. Those involved should check to be sure that there 8368
is no spilled battery acid. 8369
8370
Getting from the wheelchair to the ground: 8371
The casters of the wheelchair should be oriented so that they are trailing forward, the 8372
wheel locks and caster locks (if any) should be applied and, unless they will be used 8373
as an intermediate sitting surface, the footrests should be moved out of the way if 8374
possible. 8375
If there is a removable seat cushion and the learner can remove it (either while seated 8376
in the wheelchair or after transferring to another surface), the cushion may be placed 8377
on the ground in the position that the buttocks will land. This provides a surface that 8378
will protect the buttocks from excessive pressure. Additionally, doing so lowers the 8379
effective seat height and raises the effective floor height. For instance, if the 8380
wheelchair has a seat height of 50 cm and a 5 cm-thick cushion on top of the seat, 8381
instead of transferring from 55 to 0 cm (a total change in height of 55 cm), by placing 8382
the cushion on the ground, the wheelchair user will transfer from 50 cm to 5 cm (a 8383
total change in height of 45 cm), a net reduction of 10 cm. 8384
8385
Getting from the ground to the wheelchair: 8386
As noted above, the wheelchair user can use the seat cushion to increase the starting 8387
height above the floor and to lower the height of the wheelchair seat. 8388
A commonly used technique is with the wheelchair user in the sitting position on top 8389
of the seat cushion facing sideways in front of the wheelchair as close to the seat as 8390
possible, with the hips and knees flexed as much as possible. The wheelchair user can 8391
lift the buttocks with one arm on the seat and one on the ground. This approach is 8392
similar to a sideways level transfer (discussed earlier). Moving the head in the 8393
direction opposite to the direction to the hips is useful (i.e. move the head down when 8394
moving the hips up). 8395
After getting up onto the wheelchair seat, the cushion can be placed back under the 8396
buttocks by rolling to a transfer surface that is the same height as the wheelchair seat 8397
and transferring out of the wheelchair. When replacing the cushion, the learner 8398
should ensure that the well area (if any) is at the back of seat and the cushion is 8399
oriented evenly between the seat rails. Although it is possible for some wheelchair 8400
228
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
users to replace the cushion without getting out of the wheelchair, the methods for 8401
doing so vary widely. 8402
8403
Variations: 8404
The technique described above can also be performed with the wheel locks off. 8405
As the wheelchair user lifts the buttocks off the floor, he/she can use the hand on 8406
the wheelchair to simultaneously pull the wheelchair under the buttocks. 8407
The wheelchair user with his/her back facing the front of the wheelchair can lift 8408
the buttocks with both arms on the seat or front rigging. The footrests can be used 8409
as an intermediate level between the ground and the wheelchair seat, if they are 8410
wide enough and if sitting on them does not tip the wheelchair forward. Even if 8411
the footrests are not wide enough for both buttocks, by turning slightly to one 8412
side, if may be possible to support one buttock. 8413
The wheelchair user can move progressively from the floor to a foot stool, a 8414
bench and finally to the wheelchair seat. The number of steps can be gradually 8415
reduced. 8416
Some wheelchair users may find it easier to face the wheelchair, getting up onto 8417
the knees (which may be on top of the seat cushion) before moving up to the seat 8418
level and twisting into the forward-facing position. If one leg has adequate knee-8419
extension strength, the wheelchair user can kneel on the knee of the weaker leg 8420
with the foot of the stronger leg on the ground. 8421
If the wheelchair user has the use of both of his/her legs, he/she can use the 8422
wheelchair to help get up onto his/her feet, then pivot and sit down. 8423
If there is another stable object nearby (e.g. a chair or low table), the wheelchair 8424
user can put one hand on the object and the other hand on the wheelchair seat. 8425
Some wheelchair users are able to right themselves while remaining in the 8426
wheelchair. To train someone to perform this technique, the wheelchair user can 8427
start on a surface partway between seat height and the ground, with the 8428
wheelchair on its back (as would be the case after practicing a fall backward onto 8429
an elevated mat, as described above). The wheelchair user should first pull on the 8430
rear wheels to get the buttocks firmly against the wheelchair seat. The wheelchair 8431
user may let the knees bend over the front of the seat. The wheel lock should be 8432
applied on the side of the stronger arm. The wheelchair user turns the trunk to the 8433
other side and uses the forward (stronger) hand to grab the hand-rim of the rear 8434
wheel on the unlocked side, with the hand as far forward as possible. The 8435
wheelchair user then reaches with the other hand to the surface on which the 8436
backrest of the wheelchair rests. The wheelchair user simultaneously and 8437
vigorously pushes with the floor hand and pulls with the hand-rim hand. This step 8438
is repeated as necessary, moving the floor hand progressively forward on the 8439
surface until the wheelchair is upright. 8440
8441
Special considerations for powered wheelchairs 8442
The power should be off while “performs wheelchair-ground transfers” are being 8443
practiced, unless one of the positioning options (e.g. seat-height elevation or tilt) is being 8444
used. 8445
8446
229
WSP 5.0 originally approved for distribution and use: August 17, 2018
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8.22 ASCENDS STAIRS 8447
8448
Versions applicable 8449
Manual wheelchair: 8450
Powered wheelchair: X 8451
8452
WST/WST-Q skills 8453
“Ascends stairs”. 8454
8455
Description and rationale 8456
The wheelchair user and the wheelchair get from the bottom of a set of stairs to the top. 8457
Although alternative means of getting from a lower to a higher level are often present 8458
(e.g. using a ramp or elevator), stairs may sometimes be the only option. This skill is not 8459
generally applicable to powered wheelchairs and scooters. 8460
8461
Prerequisites 8462
None. 8463
8464
Spotter considerations 8465
Spotter: 8466
The spotter considerations vary depending upon the method used and the 8467
number of spotters available. 8468
Regardless of the method used, at least one spotter should be below the 8469
wheelchair user on the stairs. 8470
If the wheelchair user is in the wheelchair, the spotter below the wheelchair 8471
should use one or both hands near or holding a fixed part of the wheelchair. If 8472
holding a wheelchair part, it is important to avoid assisting or interfering with 8473
the performance of the task unless deliberately intervening. 8474
If the wheelchair user is in the wheelchair and two spotters are available, one 8475
should be above and one below the wheelchair. 8476
A removable seat belt may be used, 8477
Risks requiring spotter intervention: 8478
Forward or rear tip or fall. 8479
Runaway down the stairs. 8480
8481
General training tips 8482
Alternative routes (e.g. ramps or elevators) to get to the upper level should be sought 8483
wherever possible. 8484
With the exception of the initial preparation for the first step of a set of stairs and 8485
concluding the task after ascending the last step, the same technique is used for each step. 8486
Safety is of particular importance, given the consequences of a loss of control. 8487
If a stair lift or elevator is available in the learner’s home or workplace, the use of this 8488
technology should be practiced. 8489
There are a variety of methods, the choice of which depends upon the characteristics of 8490
the wheelchair user (e.g. strength, flexibility, ability to use the legs) and the stairs. 8491
230
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Current edition: August 17, 2018
8492
Getting out of the wheelchair and ascending in the seated position is probably the safest 8493
technique and the one most likely to be possible for the wheelchair user without 8494
assistance: 8495
A strapped-on buttocks protector is advisable. 8496
The wheelchair should be positioned next to the stairs, in a way similar to how the 8497
wheelchair would be positioned for the “performs level transfers” skill. 8498
The wheelchair user transfers from the wheelchair to a sitting position on the 8499
second or third step. The stair handrail may be used. 8500
The wheelchair may be brought up to the top the stairs by the wheelchair user or 8501
by an assistant. If bringing the wheelchair up the stairs himself/herself, the 8502
wheelchair user should pull the wheelchair up by facing it downhill with the 8503
wheel locks off, and tipping it back fully. The wheelchair user should push 8504
straight down with one hand on the wheelchair’s push-handles that are resting on 8505
a step, to keep the wheelchair from rolling or sliding down the stairs. 8506
For the wheelchair user to move up each step, he/she should flex the neck and 8507
hips and push down with the arms and feet to bring the buttocks up and back onto 8508
the next higher step (another example of the hips-vs.-head strategy described in 8509
the “performs level transfers” skill). Then the hands, feet and wheelchair are 8510
moved up to the next step. 8511
At the top of the stairs, a stool is helpful as a half-way step to the wheelchair seat. 8512
Otherwise, this final phase is the same as for the getting from ground into 8513
wheelchair phase of the “performs wheelchair-ground transfers” skill. 8514
8515
Variations: 8516
Out of the wheelchair, on hands and knees: 8517
As for the seated approach above, but facing up the stairs and using a 8518
crawling action, advancing one limb at a time. A caregiver is usually 8519
needed to bring the wheelchair up the stairs. 8520
8521
In the wheelchair: 8522
Although this technique is not recommended for wheelchair users acting 8523
alone, because of the long-term consequences of the stresses placed on the 8524
shoulders and the safety consequences of poor technique, the following 8525
tips are provided for the exceptional wheelchair user who wishes to 8526
acquire this skill for the unusual occasion when it would be helpful. 8527
The rear anti-tip devices (if any) should be repositioned to allow the rear 8528
wheels to contact the first stair and to permit the wheelchair to tip 8529
backward sufficiently. 8530
The starting position is with the wheelchair user in the wheelchair, with 8531
the seat belt (if any) on. 8532
The wheelchair should be backed up to the lowest step, closest to the 8533
handrail on the side of the stronger arm. 8534
The wheelchair user reaches back as far as he/she can with the stronger 8535
arm and grabs the handrail with the palm facing up. 8536
231
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
By pulling on the handrail, the wheelchair user tilts the wheelchair back 8537
but not beyond the wheelie balance point to avoid having the rear wheels 8538
roll forward (submarining). 8539
The wheelchair user uses the hand on the stair handrail to pull while using 8540
the other hand on the hand-rim (starting well forward) to roll the rail-side 8541
wheel up the step. 8542
Because both hands are acting on the same side of the wheelchair, the 8543
front of the wheelchair will tend to turn toward the stair rail. The 8544
wheelchair should be squared-up (i.e. bringing both rear wheels against 8545
the vertical face of the step) before each new stair is attempted. 8546
At the top of the stairs, the casters should not be brought down until there 8547
is surface to support them. 8548
8549
Progression: 8550
It is useful to have stairs with a variety of dimensions to permit 8551
gradual progression. The wheelchair user can use a curb first, if 8552
there is a rail beside it, as an example of a single step. 8553
If the staircase is curved, there is more “run” on the outside of the 8554
curve, so it will be easier on the outside. 8555
It is reasonable to start with the caregiver-assisted versions of this 8556
skill. Caregivers can apply upward rolling forces to one or both 8557
rear wheels to assist in getting up the stair and to prevent the rear 8558
wheel on the side away from the hand-rail from moving away from 8559
the stair rise. 8560
8561
Escalators: 8562
Escalators that are wide enough and are not excessively steep can be safely 8563
managed in a manual wheelchair. Permission should be obtained before 8564
practicing on escalators in public places. To ascend an escalator, the 8565
wheelchair user slowly approaches the lower end in the forward direction, 8566
grasps both or one moving hand-rails and allows the wheelchair to be pulled 8567
onto the escalator. The wheelchair will settle itself into a stable position with 8568
the casters on a stair above the rear wheels. The wheelchair user should lean 8569
forward until on the level at the top. The major difficulty comes at the top, 8570
where there is usually a lip that will stop the wheelchair or cause it to tip 8571
forward. To prevent this, the wheelchair user should lean well back without 8572
tipping the wheelchair over, still holding onto the hand-rails. A second spotter 8573
at the top can help to pop the casters over the lip until the wheelchair user has 8574
mastered this on his/her own. 8575
8576
Special considerations for caregivers 8577
Wheelchair user in the wheelchair: 8578
If more than one caregiver is involved, as should usually be the case, the 8579
wheelchair user or one of the caregivers should by agreement take the lead in 8580
coordinating the timing (e.g. to the count of “ready, set, go” for each step). 8581
The starting position is with the wheelchair user in the wheelchair, with the seat 8582
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WSP 5.0 originally approved for distribution and use: August 17, 2018
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belt (if any) on. It can be helpful to remove the footrests. 8583
The wheelchair should be backed up to the lowest step with the rear wheels firmly 8584
against the step rise. 8585
The wheelchair user may place his/her hands on the rear wheels or the stair 8586
handrails, assisting to the extent possible but keeping his/her hands out of the way 8587
of the caregiver’s hands. 8588
For most methods, the location of the combined center of gravity of the 8589
wheelchair user and the wheelchair is a key factor. If the center of gravity is 8590
behind the rear-wheel axles, the rear wheels will tend to submarine (i.e. move 8591
away from the step rise) if not prevented by the wheelchair user’s or caregiver’s 8592
hands on the hand-rims. If the center of gravity is in front of the rear-wheel axles, 8593
the rear wheels will tend to move backward, toward the step rise (which is where 8594
they need to be to roll the rear wheels up the step). 8595
If the wheelchair user cannot physically assist much, ideally there should be three 8596
caregivers available. One caregiver positions him/herself above the wheelchair, 8597
pulling on the push-handles, but not too forcefully because the awkward 8598
positioning could lead to injury of the caregiver’s back. This uphill caregiver is 8599
turned slightly to one side, with one foot on the stair above the rear wheels and 8600
the other on the next higher stair. The primary role of the uphill caregiver is to 8601
control the degree of rear tilt, which should be ahead of the balance point as noted 8602
earlier. The uphill caregiver can tell where the center of gravity is relative to the 8603
balance point by whether the push-handles are pushing back (as they should not 8604
be) or pulling forward (as they should be). The two downhill caregivers are below 8605
the wheelchair. Each uses the inside hand (closest to the mid-line of the 8606
wheelchair) to hold the frame of the wheelchair, not a part (e.g. a footrest) that 8607
could come off. The outside hand is placed on the hand-rim of the rear wheel and 8608
is used to roll the wheel up onto the next step. The outside hand begins at about 8609
the horizontal position and moves up to the vertical position. 8610
8611
Variations: 8612
If only a single caregiver is available and the wheelchair user is able to assist, 8613
then the caregiver can provide some of the needed force from downhill (e.g. 8614
rolling the non-rail-side wheel up the step while the wheelchair user pulls on 8615
the stair handrail with one hand and the rail-side hand-rim with the other 8616
hand) as described below. 8617
With two caregivers, one of the caregivers can be positioned uphill and pull 8618
on the push-handles while the other caregiver is below and pushes on the 8619
wheelchair frame. 8620
Although not recommended because of the stresses involved, a single strong 8621
caregiver can help a light wheelchair user in a light wheelchair proceed up a 8622
set of stairs from behind (uphill), tipping the wheelchair back beyond the 8623
balance point and rolling it up one step at a time. This is similar to the 8624
“ascends high curb” skill performed in the same way. 8625
8626
Wheelchair user out of the wheelchair: 8627
The caregiver can assist by spotting and/or bringing the wheelchair up the stairs. 8628
233
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
For the latter, the caregiver proceeds backward up the stairs with the tipped empty 8629
wheelchair facing downhill. 8630
8631
Variations: 8632
The caregiver can carry the wheelchair user “piggy-back” style, with the 8633
wheelchair user on the caregiver’s back. The wheelchair user holds onto 8634
the caregiver with his/her arms over the caregiver’s shoulders. The 8635
caregiver holds onto the wheelchair user’s bent knees. 8636
A strong caregiver can carry the wheelchair user “fire-fighter” style with 8637
the wheelchair user facing the caregiver and the hips flexed over one of the 8638
caregiver’s shoulders. The caregiver secures the wheelchair user by 8639
wrapping his/her arm around the wheelchair user’s knees. 8640
Two caregivers can share the load, either front and back or by creating a 8641
“seat” of their interlocked hands as described earlier in the “gets from 8642
ground into wheelchair” skill. 8643
8644
Special considerations for powered wheelchairs 8645
The “ascends stairs” skill is not generally applicable although the out-of-wheelchair 8646
method (as for manual wheelchairs but without the wheelchair) may be useful in an 8647
emergency (e.g. a house fire). 8648
8649
234
WSP 5.0 originally approved for distribution and use: August 17, 2018
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8.23 DESCENDS STAIRS 8650
8651
Versions applicable 8652
Manual wheelchair: 8653
Powered wheelchair: X 8654
8655
WST/WST-Q skills 8656
“Descends stairs”. 8657
8658
Description and rationale 8659
The wheelchair user and the wheelchair get from the top of a set of stairs to the bottom. The 8660
rationale is as for the “ascends stairs” skill. Although there is still a potential for injury due to 8661
a fall, descent is much less strenuous than ascent. Many wheelchair users who cannot ascend 8662
stairs independently can descend them. This skill is not generally applicable to powered 8663
wheelchairs and scooters. 8664
8665
Prerequisites 8666
None. 8667
8668
Spotter considerations 8669
Spotter starting position: 8670
As for the “ascends stairs” skill. 8671
If the wheelchair user is proceeding independently down the stairs in the backward 8672
direction, the spotter should be behind the wheelchair with the hands near the push-8673
handles. 8674
Risks requiring spotter intervention: 8675
Forward or rear tip or fall. 8676
Runaway down the stairs. 8677
8678
General training tips 8679
To descend with the wheelchair user out of the wheelchair in the seated position or on the 8680
hands and knees, the technique is the reverse of the “ascends stairs” skill. 8681
8682
Variations: 8683
Descending stairs with the user in the wheelchair is much safer and more feasible than 8684
ascending stairs in the wheelchair: 8685
The wheelchair is initially positioned with the back of the wheelchair facing the 8686
stairs. 8687
The wheelchair user grabs one or both stair rails, leans forward enough to keep 8688
the casters from lifting off, lowers the rear wheels down one stair, then slides the 8689
hands down the rail. The trainer should alert the wheelchair user that this method 8690
can be noisy, because the casters and/or footplates bang down each stair; this can 8691
be minimized by not leaning too far forward. 8692
If the footrests interfere with smooth progression down the stairs and they can be 8693
removed, this may be done. The feet are unlikely to be injured as they slide gently 8694
235
WSP 5.0 originally approved for distribution and use: August 17, 2018
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from step to step, especially if shoes are worn. 8695
A variation for the use of two hands on the same rail is for the wheelchair user to 8696
turn the trunk toward the rail and reach farther downhill with the rail-side arm. 8697
This reduces the load on the casters and helps to prevent the wheelchair from 8698
turning on the stair. 8699
Another option is to face up the stairs as above, but to use one hand on the stair 8700
hand-rail and the other hand on the hand-rim of the wheelchair. This technique 8701
can prevent the tendency of the non-rail-side wheel to roll away from the stair 8702
riser. 8703
Using a transient caster pop, the wheelchair user can descend forward continuously rather 8704
than stopping on each step. This method is similar to the previous one except that the 8705
wheelchair is moving forward as it reaches the edge of the top step. The wheelchair user 8706
pops the casters just before the casters reach the drop off. This technique is difficult to 8707
spot safely. 8708
Descending an escalator is similar to ascending an escalator as described above in the 8709
“ascends stairs” skill. The wheelchair user approaches the upper end of the escalator 8710
backward, grasps the hand-rails of the escalator and allows the wheelchair to be pulled 8711
onto the escalator. While descending, the wheelchair user leans forward enough to keep 8712
the casters from lifting off the stair. At the bottom, although there is a lip, it usually 8713
presents little difficulty because it is first struck by the rear wheels, the large diameter of 8714
which allows the relatively unloaded rear wheels to easily roll over. 8715
See wheelie variation later. 8716
8717
Special considerations for caregivers 8718
As for the “ascends stairs” skill, but in the reverse direction. 8719
8720
Special considerations for powered wheelchairs 8721
Not generally applicable although the out-of-wheelchair method (but without the 8722
wheelchair) may be useful in an emergency (e.g. a house fire). 8723
8724
236
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8.24 PERFORMS WHEELIE 8725
8726
Versions applicable 8727
Manual wheelchair: 8728
Powered wheelchair: X 8729
8730
WST/WST-Q skills 8731
“Performs stationary wheelie”. 8732
8733
Description and rationale 8734
The learner achieves the wheelie position (balancing on the rear wheels), maintains it for 8735
a period of time and brings the casters back to the floor. The stationary wheelie position 8736
can also be used to avoid postural problems that can cause neck strain from looking up. 8737
The stationary wheelie is also a foundation skill for a number of functional skills that can 8738
be best performed in the full wheelie position and that will be dealt with in the next 8739
section. 8740
8741
Prerequisites 8742
None. 8743
8744
Spotter considerations 8745
Spotter starting position: 8746
Usually the spotter stands behind the wheelchair holding onto a spotter strap. 8747
The skill can also be spotted from a position in front and to one side of the 8748
wheelchair, with a hand ready to apply a downward and backward force to the 8749
wheelchair user’s knee or a fixed part of the wheelchair. 8750
Risks requiring spotter intervention: 8751
Rear tip if the learner overshoots on take-off or loses balance. 8752
8753
Adjustment tips 8754
As was noted earlier with respect to adjustments that make it easier for the wheelchair 8755
casters to be transiently popped from the surface, the wheelchair type and set-up 8756
influence the ease with which the wheelchair can be tipped backward into the full wheelie 8757
position. It is easier to achieve the wheelie position in a wheelchair that is less stable to 8758
begin with; this can be achieved by moving the rear axle position forward. 8759
If rear anti-tip devices do not allow the wheelchair to be tipped back far enough, they 8760
need to be adjusted out of the way or removed. Even for rear anti-tip devices that do 8761
permit a wheelie to be performed, they may not be sufficiently stable to prevent a full 8762
rear tip. 8763
8764
General training tips 8765
The description that follows is for people using two hands for propulsion, but people who 8766
only have the use of one arm can perform wheelies in a similar way. 8767
To avoid frustration and manage expectations, the trainer may wish to inform the learner 8768
that most people require a total of 45-60 minutes of practice, spread over 2-3 sessions, to 8769
acquire and retain this skill. 8770
237
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
The sequence of phases trained is not critical but the more natural sequence (and one that 8771
is supported by the general motor skills literature) is described below. 8772
8773
Take-off phase: 8774
The learner will already have learned how to transiently pop the casters from the 8775
surface in earlier skills. It may be useful to review transient caster popping before 8776
proceeding to the full wheelie take-off. 8777
It may be useful to use simulation, having the trainer tip the wheelchair back into the 8778
balance position, to give the wheelchair user a sense of how much tilt will be needed. 8779
If properly timed and the wheelchair is appropriately set up, the wheelchair user 8780
should require little force to achieve take-off. 8781
For the wheelie take-off, many wheelchair users roll backward slowly, then quickly 8782
forward. This method is very effective and is to be preferred when the wheelchair 8783
user wishes to perform a wheelie in the same position in which he/she started (e.g. 8784
during the WST). If using this method, the wheelchair user should start with the 8785
hands just ahead of the top center of the wheel (i.e., ~1:00 o’clock, using the clock 8786
analogy). The wheelchair user should try not to pause between rolling back and 8787
pushing quickly forward, otherwise he/she may not tip backward as easily. 8788
However, the method of only rolling the wheels forward is preferred when the 8789
available space is not an issue because the forward-only method can be used while the 8790
wheelchair is moving forward (as is occasionally necessary). The hands will need to 8791
start farther back on the wheels (i.e., ~11 o’clock, using the clock analogy) and 8792
slightly more force will be needed by the wheelchair user than for the backward-then-8793
forward method. 8794
The forward motion that is common to both methods can be thought of as an action to 8795
get the base of support (the rear wheels) under the center of gravity (located near the 8796
lap of the wheelchair user). 8797
Some wheelchair users may find it easier if they lean back into the backrest to cause 8798
or help with the initial rear tip. However, skilled wheelie performers can achieve the 8799
wheelie position while maintaining an upright body position. Leaning forward is a 8800
natural tendency to prevent rear tip-over but this makes it more difficult to achieve 8801
take-off. 8802
Whichever method is used, the wheelchair user should progressively pop the casters 8803
higher and higher until he/she can tip backward far enough to reach and slightly 8804
overshoot the wheelie balance point. Once past the balance point, the wheelchair user 8805
should then pull back on the hand-rims to prevent tipping too far and to return to the 8806
balance point. 8807
If the wheelchair user is having difficulty getting tipped far enough backward to reach 8808
the balance point, he/she should push forward more forcefully. An alternative is to 8809
start the take-off with the casters uphill or on a small level change although there 8810
needs to be room for the rear wheels to roll forward if using the forward-only method. 8811
If a learner is having difficulties due to fear of tipping over backward, the wheelchair 8812
user can pop back onto the spotter then progress to a self-save (flexing the neck and 8813
trunk while pulling back vigorously on the hand-rims, as has been dealt with earlier 8814
during rear-falling practice, to bring the casters back to the floor). Once the learner is 8815
able to tip backward far enough to be caught by the spotter, in subsequent attempts 8816
238
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
he/she should gradually reduce the amount of overshoot until it is possible to self-8817
save without the spotter’s assistance. 8818
Although take-off can usually be achieved with a single push, if the wheelchair has 8819
not been tilted back far enough with the first push, a second push before the casters 8820
return to the floor may be successful. 8821
Once the learner can consistently perform the wheelie take-off, attention should be 8822
shifted to the balance phase. 8823
8824
Balance phase: 8825
The wheelchair user does not need to use much force to maintain balance. It is 8826
preferable for the wheelchair user to keep a light grip on the wheels (“avoid the grip 8827
of death!”). It should be possible for the wheelchair user to slide his/her hands 8828
forward and backward on the hand-rims. 8829
During the early learning stage, some wheelchair users find it useful to isolate the 8830
variations of pitch from those of rear-wheel displacement (i.e. using the motor-8831
learning principle of “reducing the degrees of freedom”). This can be done by 8832
reducing the extent to which the rear wheels can move (e.g. by using obstacles such 8833
as bricks or pieces of wood in front of and behind the rear wheels). If the wheelchair 8834
is well set up and the wheelchair user has adequate strength, he/she may be able to 8835
push forward hard enough to tilt the wheelchair into the balance position with the 8836
rear wheels blocked. Otherwise, the trainer can tip the wheelchair back to the 8837
balance point while the wheelchair user rests his/her hands in the lap. For a 8838
wheelchair that is difficult for the trainer to tip backward (e.g. due to a low backrest, 8839
absence of push-handles, absence of tipping levers or excessive stability), the trainer 8840
can alternatively lift a forward section of the wheelchair frame. The trainer then 8841
turns over control to the wheelchair user by having the wheelchair user grasp the 8842
hand-rims. The trainer should then take his/her hands off the wheelchair – it can be 8843
confusing to have two people attempt to maintain balance at the same time – and let 8844
the learner know (“It’s all you now”). 8845
Once the wheelchair user is in control with the rear wheels blocked, learning 8846
exercises can include any or all of the following: 8847
Having the wheelchair user experiment with the extent of tip (more and less 8848
than the ideal balance point, where the force to maintain position is minimal). 8849
Leaning forward (which increases the amount of tip needed to be at the ideal 8850
balance point). 8851
Using only two fingers and a thumb of each hand on the hand-rims. 8852
Sliding the hands backward and forward on the hand-rims to find the ideal 8853
position. 8854
Holding on with only one hand while waving the other. 8855
Closing the eyes and focussing on the feel of the balance position. 8856
Once these variations are mastered at the high rolling-resistance level (i.e. with the 8857
wheels fully blocked), the barriers in front of the rear wheels can be moved a few 8858
cm away while the wheelchair leans against the rear barrier. This allows a small 8859
amount of forward and backward movement of the rear wheels. At either extreme of 8860
movement, the wheelchair user can lean the rear wheel against the front or rear 8861
barriers. This stage can be considered analogous to having “training wheels” like 8862
239
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Current edition: August 17, 2018
those used by children learning to ride bicycles. Once the wheelchair user is 8863
familiar with this, the barriers can be moved progressively farther away and 8864
removed. 8865
When the wheelchair user has become comfortable with not spending too much 8866
time leaning on the barriers, the wheelchair can be moved to a surface with medium 8867
rolling resistance (e.g. on a gym mat). Here the take-off and balance phases can be 8868
combined. The soft surface allows the learner to perform a “slow-motion” wheelie. 8869
Once this is mastered, the wheelchair can be moved to a low rolling-resistance 8870
surface (e.g. a tile floor). 8871
When a basic wheelie can be performed on a low rolling-resistance surface, the 8872
learner can refine his/her skill by becoming familiar with and practicing the two 8873
balance strategies that have been reported in the scientific literature: 8874
Proactive balance strategy: In this strategy, analogous to balancing a 8875
meter stick on a finger, the wheelchair user keeps the wheels moving 8876
forward and backward over a small area. The wheelchair user should try 8877
to move the hands only between the 12:00 and 1:00 o’clock positions, 8878
using the clock analogy. This will allow a safety margin, so that the 8879
wheelchair user can react to a loss of balance in either direction. If the 8880
wheelchair user wants the wheels to move farther than the intermediate 8881
hand position permits, the hand-rims can be allowed to slide through the 8882
grip. It may be helpful to time the movement of the rear wheels to the 8883
breathing pattern while using the proactive balance strategy. 8884
Reactive balance strategy: The reactive balance strategy is analogous to 8885
the step strategy used in standing balance – if a standing person is pushed 8886
forward or backward hard enough that he/she would otherwise fall, the 8887
person steps forward or backward to bring the base of support under the 8888
displaced center of gravity. If the wheelchair user begins to tip too far 8889
forward, he/she should roll the rear wheels forward to return to the 8890
balance point (“when you fall forward, push forward”). If the wheelchair 8891
user imbalances backward, he/she should roll the rear wheels backward 8892
to re-establish balance (“when you fall back, pull back”). The strategy to 8893
prevent a rear fall or to minimize its consequences was dealt with earlier 8894
in the rear-falling practice section of the “performs wheelchair-ground 8895
transfers” skill. 8896
8897
Landing Phase: 8898
To land from the balance position, the wheelchair user pulls back on the wheels, or leans 8899
forward to gently bring the front wheels to the ground. 8900
8901
Progression: 8902
Once the full wheelie can be performed with the spotter nearby, the wheelchair user 8903
can practice performing the stationary wheelie with variations (e.g. with the spotter 8904
progressively farther away, with low lighting, while multi-tasking). 8905
8906
Variations: 8907
During the balance phase, the wheelchair user can lean forward or place a knapsack 8908
240
WSP 5.0 originally approved for distribution and use: August 17, 2018
Current edition: August 17, 2018
on the lap or footrests to increase the caster height needed for the wheelie position. 8909
The wheelchair user can practice this by placing the casters on different height targets 8910
(e.g. pylons, steps). 8911
See other wheelie variations in the next section. 8912
8913
Special considerations for caregivers 8914
As noted earlier in the “rolls on soft surface” skill, to achieve a caregiver-induced 8915
wheelie, the caregiver should pull back on the push-handles, with one foot pushing down 8916
on a tipping lever, to tip the wheelchair back to the balance point. 8917
Once in the wheelie balance position, only minimal force is needed by the caregiver to 8918
maintain balance. 8919
When moving the wheelchair forward or backward in the wheelie position, the caregiver 8920
should allow the wheelchair to tip back far enough so that it is just beyond the balance 8921
position pushing down slightly on the hands. 8922
To lower the wheelchair to the horizontal position, the caregiver should put one foot on 8923
the tipping lever at the back of the wheelchair to keep the wheelchair from pitching 8924
forward too abruptly. 8925
8926
241
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8927
8.25 PERFORMS WHEELIE-DEPENDENT SKILLS 8928
8929
Versions applicable 8930
Manual wheelchair: 8931
Powered wheelchair: X 8932
8933
WST/WST-Q skills 8934
“Rolls forward and backward in wheelie position” 8935
“Relieves weight from buttocks” 8936
“Rolls on soft surface” 8937
“Turns in place in wheelie position” 8938
“Turns while moving forward” 8939
“Turns while moving backward” 8940
“Maneuvers sideways” 8941
“Descends low curb” 8942
“Descends high curb” 8943
“Descends high curb in wheelie position” 8944
“Descends slight incline” 8945
“Descends steep incline” 8946
“Descends steep incline in wheelie position” 8947
“Rolls across side-slope” 8948
“Descends stairs” 8949
8950
Description and rationale 8951
The learner performs a variety of previously discussed skills for which non-wheelie 8952
methods are available, but that can be performed (and sometimes need to be performed) 8953
in the wheelie position. Once the learner has mastered the stationary wheelie, the learner 8954
should return to these earlier skills and attempt to learn them using the wheelie technique. 8955
Caregiver-aided wheelies are dealt with in the previous sections because of their relative 8956
simplicity in comparison with wheelies performed by wheelchair users. 8957
8958
Prerequisites 8959
The “performs stationary wheelie” skill. 8960
8961
Spotter considerations 8962
Spotter starting positions: 8963
Unless otherwise noted below, as for the “performs stationary wheelie” skill and for 8964
the specific skill being learned. 8965
Risks requiring spotter intervention: 8966
Unless otherwise noted below, as for the “performs stationary wheelie” skill and for 8967
the specific skill being learned. 8968
8969
Adjustment tips 8970
As for the “performs stationary wheelie” skill. 8971
242
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Current edition: August 17, 2018
8972
General training tips 8973
The training tips for the skills in this section build upon the tips presented earlier where 8974
the non-wheelie methods were described. Only aspects specific to the wheelie method 8975
will be presented here. 8976
8977
Rolls forward and backward in the wheelie position 8978
Rolling forward in the wheelie position is useful when approaching obstacles for 8979
which it is advantageous to have the casters off the surface (e.g. for the descent of 8980
high curbs). Moving backward in the wheelie position is useful in tight spaces, where 8981
it is not possible to turn around, for instance to raise the casters over an obstacle (e.g. 8982
a stick on the ground or a towel on a bathroom floor). Also, the backward skill allows 8983
the wheelchair user to ease up to a wall or object against which he/she can lean (i.e. 8984
for the tilt-rest variation of the “relieves pressure from buttocks” skill). 8985
Moving the wheelchair forward and backward in the wheelie position utilizes the 8986
reactive balance strategy noted in the previous section. The wheelchair user should 8987
allow the wheelchair to begin to fall (dip) slightly in the direction in which he/she 8988
wishes to move and then roll the rear wheels in the same direction to catch up. To 8989
initiate the dip, the wheelchair user can move the head or lean slightly in the direction 8990
he/she wishes to move. Alternatively, the wheelchair user can initiate the dip by 8991
pushing the wheels slightly in the opposite direction. The wheelchair user should be 8992
encouraged to take his/her time to achieve control and to move slowly. The 8993
wheelchair user should grip the wheels lightly, giving a light push and letting the 8994
hand-rims slide through the fingers. In catching up to the center of gravity after the 8995
first dip, there is no need for the wheelchair user to catch up completely. By 8996
undershooting slightly, the wheelchair user can initiate the next dip. Some wheelchair 8997
users may find it easier to move forward or backward with one hand at a time. It is 8998
easier to begin with short steps then proceed to longer ones. The forward and 8999
backward “dip-and-roll” processes can be practiced against resistance (e.g. on a soft 9000
surface, up an incline, over an obstacle or up a 5 cm curb). The dip needs to be 9001
accentuated in such circumstances. 9002
9003
Stops 9004
Some highly skilled wheelchair users can induce a controlled wheelie by throwing the 9005
trunk backward while coasting quickly forward. The goal is to overshoot the balance 9006
point and then grasp the hand-rims firmly to stop the wheelchair and prevent a rear 9007
tip. With a different amount of force applied to the two hand-rims, a rapid turn can be 9008
made. 9009
9010
Relieves weight from buttocks 9011
A wheelie can be used to achieve tilt but the extent of tilt (rarely more than 25°) 9012
means that no more than partial unloading can be achieved. 9013
A wheelie can be used to achieve the tilt-rest position discussed earlier, that permits a 9014
greater degree of tilt but still not enough to achieve complete unloading. To get into 9015
the tilt-rest position using the wheelie, the wheelchair user achieves the wheelie 9016
position with the back of the wheelchair facing the object that will be leaned against. 9017
243
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The wheelchair is then rolled back in the wheelie position until the rear wheel or 9018
backrest of the wheelchair or back of the wheelchair user (for low and high objects 9019
respectively) contacts the object. Then the wheelchair is allowed to tilt back slightly 9020
further and the wheel locks are applied one at a time (or the hand-rims are held with 9021
the hands). The wheelchair user must not let go of both wheels at the same time or the 9022
rear wheels will roll rapidly forward (“submarining”) and a rear tip will occur. 9023
9024
Rolls on soft surface 9025
If using the full wheelie position to move on a soft surface, the wheelchair user 9026
needs a strong forward dip to get going as was discussed earlier. If the casters 9027
touch the surface during the dip, the wheelchair user can lean forward slightly. This 9028
allows the casters to lift off further during the wheelie and provides better clearance 9029
during the dip. 9030
9031
Turns in place 9032
Wheelchair users often encounter situations in which they need to perform a 9033
wheelie to make a tight turn. The area needed on the support surface (the “turning 9034
footprint”) is less in the wheelie position than when all wheels are on the surface. 9035
The learner should be careful not to let the elevated feet hit any external object. 9036
9037
Turns while moving forward and backward 9038
These skills are similar to moving straight forward and backward in the wheelie 9039
position except that, in correcting for the initial dip, the rear wheels are rolled 9040
forward or backward to different degrees. 9041
Alternatively, this skill can be broken into two components performed sequentially 9042
(e.g. rolling straight forward to a slight extent, then turning in place to a slight 9043
extent, repeating these steps) rather than simultaneously. 9044
9045
Maneuvers sideways 9046
In tight spaces, the wheelie allows the wheelchair to be moved sideways by a series 9047
on forward and backwards turns. 9048
9049
Descends curbs 9050
Using a wheelie to descend a curb in the forward direction allows the wheelchair 9051
user to maintain forward movement and to see any dangers that lie ahead. Also, 9052
the wheelie position prevents the footrests from making contact with the lower 9053
level, which can decelerate the wheelchair and cause a forward tip or fall from the 9054
wheelchair. 9055
If the wheelchair user descends a curb in the wheelie position, a single spotter 9056
should stand on the upper level with both hands near the push-handles to react to 9057
rear, forward or sideways tips. A removable seat belt can prevent the wheelchair 9058
user from falling forward from the wheelchair. If using two spotters, as is 9059
recommended for the wheelie forward descent, the spotter behind the wheelchair 9060
should have his/her hands near the push-handles and the second spotter should 9061
stand beside and below the curb. 9062
9063
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The forward full-wheelie method is an excellent method for the descent of a large 9064
level change. The wheelchair user should get into the wheelie position slightly 9065
away from the edge of the level change. The wheelchair user should roll forward 9066
to the edge of the curb in the wheelie position, staying square to the edge. The 9067
“Rolls forward and backward in wheelie position” skill will have prepared the 9068
learner to approach the curb edge under control. After initiating the forward dip to 9069
move the rear wheels over the edge of the curb, the wheelchair user should 9070
quickly slide the hands backward from just ahead to just behind top dead center of 9071
the hand-rims, so that he/she can firmly grip the hand-rims and resist the descent. 9072
The wheelchair user should let the rear wheels hit the lower level before the 9073
casters. As soon as the rear wheels touch the ground, the momentum should bring 9074
the casters down to the surface, but the wheelchair user should lean forward as 9075
well. The skill should be practiced first on a low curb, increasing the height of the 9076
curb as skill and confidence allow. 9077
As a variation, the wheelchair user can land on the lower level and maintain the 9078
wheelie position rather than allowing the casters to land, either maintaining balance 9079
or leaning back against the curb rise. This is useful where there is little space for the 9080
casters to land, such as on a series of widely spaced stairs. 9081
9082
Ascends inclines 9083
For the ascent of very steep inclines, some wheelchair users will go up backward. 9084
The uphill movement is initiated by allowing the wheelchair to dip backward, 9085
followed by a strong pull backward on the hand-rims to re-achieve balance a short 9086
distance up the slope. 9087
9088
Descends inclines 9089
Descending a steep incline in the forward direction in the wheelie position lessens 9090
the problem of loss of traction (affecting braking and control) when the uphill 9091
wheels become unloaded. This technique also reduces the likelihood of forward 9092
tips or digging the footrests into the floor at the transition between the bottom of 9093
the incline and the level surface. For very steep inclines, this technique may be the 9094
only way to get down the incline without tipping over. 9095
The wheelchair user usually achieves the wheelie position on the level at the top 9096
of the incline. Then he/she moves forward onto the incline. Moving forward and 9097
backward in the wheelie position will already have been practiced. When initially 9098
moving onto the incline, the wheelchair user may be startled to feel as though the 9099
wheelchair is tilting farther backward. When stopped facing downhill in the 9100
wheelie position, the sensation is similar to that felt while leaning back on a 9101
barrier, as when learning the balance phase of the “performs stationary wheelie”. 9102
Once on the incline, facing downhill, the wheelchair user should let the hand-rims 9103
run smoothly through the hands to control the wheelchair’s speed, direction and 9104
pitch angle. Letting the hand-rims run more quickly through the hands will allow 9105
the wheelchair to pitch (tilt) farther back. Slowing the rate at which the hand-rims 9106
slide through the fingers will cause the wheelchair to pitch forward. The learner 9107
should have the casters touch down shortly after the rear wheels reach the level 9108
surface at the bottom of the incline. 9109
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A variation is for the learner to achieve wheelie take-off while on the incline and 9110
facing downhill. This is useful when an unexpected obstacle is encountered. If the 9111
wheelchair user is facing downhill, more force is needed for take-off (because the 9112
wheelchair is pre-tilted in the wrong direction) and the wheelchair may accelerate 9113
rapidly downhill. 9114
On steep or slippery inclines, or if the wheelchair has too much rear stability, 9115
there may not be enough rear-wheel traction to allow wheelie take-off while 9116
facing downhill. In such situations, the wheelchair can be turned so that it is 9117
facing across the hill or even uphill. This will place more weight on the rear 9118
wheels and avoid runaway. Once in the wheelie position, a wheelie turn-in-place 9119
will allow the wheelchair user to proceed down the incline. 9120
9121
Rolls across side-slope 9122
In the wheelie position facing across a slope, there is no downhill-turning 9123
tendency, because the center of gravity is between the rear wheels. 9124
9125
Descends stairs 9126
In the full wheelie position, the wheelchair user can descend forward, one step at 9127
a time. This is possible if there is an adequate horizontal distance (“run”) on each 9128
step. 9129
At least two spotters should be involved. One or two spotters should be below the 9130
wheelchair with the hands near a fixed front part of the wheelchair to resist 9131
tipping or runaway. The uphill spotter should be above the wheelchair with the 9132
hands near the push-handles to react to backward, forward or sideways tips, or 9133
runaway. 9134
The wheelchair user drops down one step at a time as for the “descends curbs” 9135
skill. The difference is that the casters cannot land after the rear wheels do. The 9136
wheelchair user instead balances on the rear wheels or, more simply, allows the 9137
wheelchair to tilt back after the rear wheels land on the step such that the rear 9138
wheels push against the step rise (analogous to the “tilt rest” version of the 9139
“relieves weight from buttocks” skill) before proceeding to the next step. This 9140
should be practiced on a single curb first. 9141
In the full wheelie position, the wheelchair user can descend forward continuously 9142
rather than stopping on each step. However, this method is difficult to spot. It is 9143
only recommended for a short flight of stairs and when no handrails are available. 9144
If the wheelchair user is going to fall, it is better to fall backward than forward. 9145
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CHAPTER 9. GAMES 9147
9148
In Chapter 9 on the training of individual skills or skill groups, some variations and activities are 9149
described that can be used as means of encouraging varied practice and providing motivation for 9150
people learning wheelchair skills. In the chapter that follows, more detail is provided on some 9151
structured games that are suitable for individuals or small groups. Although the importance of 9152
organized sports is recognized, descriptions of structured wheelchair sports (e.g. wheelchair 9153
basketball, wheelchair rugby, track and field) have not provided because that would be beyond 9154
the scope of this Manual. Depending upon the skill of the participants and the game, spotters 9155
may be needed. Note that some of the games or their variations are based around competition 9156
and may not be of interest to all participants. 9157
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9.1 Line Game
Suggested minimum number
of players
5
Wheelchair type Manual or powered
Equipment and set-up Line grid on floor. Many gyms already have court lines
outlined on the floor for participants to follow but, if not, a
grid can be easily made using tape.
Name tags.
Instructions Participants propel along the lines on the floor. When
participants meet each other on a line they must turn around
and propel in the opposite direction.
Skills reinforced Rolling forward and backward, moving turns, turns in
place, spatial awareness.
Variations As an ice-breaker, have participants introduce themselves
when they meet, give each other high fives, shake hands or
wave.
Participants are each given a bingo style sheet with
questions in each block such as ‘brown eyes’, or ‘birthday
in April’ or ‘likes to play basketball’, etc. When
participants meet they must match their new partner with
one of the ‘bingo’ blocks and cross it off. The first person
to get five blocks in a row wins.
When participants meet, instead of turning around, they
propel backward away from their partner until they can turn
off down another line, at which point they can propel
forward again.
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9162
9.2 Traffic Lights
Suggested minimum number
of players
5
Wheelchair type Manual or powered
Equipment and set-up 3 colored balloons or signs (green, yellow, red)
Instructions Participants propel wherever they wish in the space
provided. At intervals, a volunteer or trainer holds up one
of the three balloons/signs. Each balloon/sign represents a
different instruction. For example red = stop immediately,
yellow = Go slowly and green = Go quickly around the
room. When the sign is held up participants must
immediately follow the new instructions.
Skills reinforced Rolling forward, moving turns (all directions), spatial
awareness and stopping.
Variations Trainer shouts out instructions or uses a whistle.
Ask participants to propel backward.
The last person to stop is disqualified.
Use music and encourage participants to go quickly or
slowly depending on the speed of the music. When the
music stops, so must the participants.
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9165
9.3 Gears
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Line markings or pylons.
Mark off the room into three different areas or zones.
Instructions Participants are instructed to move as slowly as possible
through the first area, at a medium speed through the
second area and as quickly as possible in the final area.
Skills reinforced Rolling forward, speed control and braking.
Variations The same game, but in the backward direction.
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9168
9.4 What time is it Mr. Wolf?
Suggested minimum number
of players
5
Wheelchair type Manual
Equipment and set-up None.
Instructions The participants are lined up beside each other at the
baseline on one side of the room and Mr. Wolf is on the
other side of the room, facing away from the participants.
The participants together shout ‘What time is it Mr. Wolf?’
Mr. Wolf’s response corresponds to how many pushes they
can give in an attempt to catch the wolf while his/her back
is turned. (For instance, if Mr. Wolf says that it is 3 o’clock
each participant can move as far as they are able with 3
pushes.)
If Mr. Wolf says that “It’s dinner time!” all participants
must turn around and propel to the opposite side of the gym
without being caught by Mr. Wolf.
Skills reinforced Rolling forward, stopping, turns in place and avoiding
moving obstacles.
Variations See next game (8.5)
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9.5 Red Light, Green Light
Suggested minimum number
of players
5
Wheelchair type Manual or powered
Equipment and set-up None.
Instructions Participants line up at one end of the gym.
One participant is chosen as “it” and waits at the opposite
end of the gym.
“It” turns his/her back to the rest of the group and calls
“green light”, at which point all participants begin to propel
forward.
“It” can then call “red light” at any point and turn around
quickly. When red light is called all participants must
freeze.
If “it” catches anyone moving when he/she turns around
that person has to go back to the other end of the gym and
start again.
The goal is to tag “it” while his/her back is turned to
become the new “it”.
Skills reinforced Rolling forward, stopping and turns in place.
Variations When “it” calls red light and turns around all participants
must turn around to face the opposite direction and then
freeze.
For more advanced players, when “it” calls red light all
participants must perform a wheelie. The first person to be
unable to sustain the wheelie is “out” (disqualified). The
last person “out” becomes the new “it”.
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9.6 Follow the Leader
Suggested minimum number
of players
3
Wheelchair type Manual or powered
Equipment and set-up None.
Instructions A leader is chosen who is responsible for leading the group
around the space provided (indoor or outdoor). This leader
can perform different skills that the rest of the group tries to
copy.
Skills reinforced Potential to cover all skill groups, depending on the leader.
Variations Having more than one group going at once is a good way to
group participants by skill level.
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9.7 Trains
Suggested minimum number
of players
6
Wheelchair type Manual or powered
Equipment and set-up Flags or equivalent.
Instructions Participants form at least two ‘trains’ of three or more
people and move around the room with each wheelchair as
close as possible to the wheelchair in front of it. Different
trainers stand around the room with a flag or other sign.
When a flag is raised by a trainer, the trains must propel
toward the person holding the flag. The first train to reach
the ‘station’ wins that round and the wheelchairs change
order.
Skills reinforced Rolling forward, speed control, spatial awareness, stopping
and moving turns.
Variations For manual wheelchairs, the first wheelchair in each train
pulls the wheelchairs behind it, with the occupant of the
wheelchair behind holding onto the push-handle of the
wheelchair in front.
If there is a mixture of manual and powered wheelchairs in
the group, the powered wheelchairs can pull the manual
wheelchairs.
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9.8 Slalom
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Start and finish lines 5-10 m apart.
Lines and/or walls about 1.5 m apart on each side to limit
how widely the wheelchair can go on either side of the
slalom course.
Obstacles – at least 4 items to turn around, such as pylons,
chairs, paper cups or stones – set up in a line with 1.2-2 m
between them.
Instructions Participant(s) must propel around the obstacles beginning in
a prescribed direction (e.g. to the left of the first obstacle)
as quickly as possible without touching or displacing the
obstacles.
Skills reinforced Rolling forward, stopping, spatial awareness and moving
turns.
Variations Try different positions for the obstacles for example closer
together, closer to one wall or line, following a curved path.
Make the course more competitive by counting the number
of obstacles displaced and/or measuring the time from the
start to the finish line.
Try the course backward.
The same game, but on an incline – up, down or across.
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9183
9.9 Orienteering
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Plan a route outdoors. The route could include obstacles
such as different surfaces, cross slopes, curbs, pot holes,
inclines and level changes, depending on the skill level of
the group.
Photo clue book.
A congratulations sign is placed at each landmark, along
with instructions to look at the next photo clue in the book.
Instructions In small groups, participants use photo clues to navigate the
route. Each photo shows a landmark that the participants
can find (e.g. a tree, a bench).
Skills reinforced Depending on the route used, any combination of skills
could be reinforced.
Variations When each new clue is found, participants can collect
objects or cards that can be put together at the end.
Organize different skill level courses so that different routes
can be assigned depending on the varying abilities of the
groups.
To make this activity more competitive or to be able to
assess improvement in ability and skill, performance
through the course can be timed.
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9.10 Go Fish
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Various small objects – for instance, pens, magazines, paper
clips, coins, coffee cups, peanuts.
Container for each participant to hold the objects after they
are picked up.
Surfaces on which to place the objects – chairs, tables,
shelves, floor.
Objects are placed on the surfaces around the room.
Instructions The participant moves around the room picking up the
objects and placing them in the container on his/her lap.
When completed, the participant brings the container to the
finish point.
Skills reinforced Rolling, turning, sideways maneuvering and reaching.
Variations Have participants pick up objects in a certain order. For
example picking up the highest objects first or the lowest
objects first. Alternatively, pick up objects only of a certain
color or shape.
Hide peanuts or a similar sized object around the room, split
participants into teams. The team with the most peanuts at
the end of a time period wins.
9187
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9.11 Circle Game
Suggested minimum number
of players
7
Wheelchair type Manual or powered
Equipment and set-up Space about 5 m square.
Participants form a circle, facing the center.
Instructions When a participant’s name is called by the trainer, he or she
moves clockwise around the outside of the circle until
returning to his/her place.
Skills reinforced Rolling forward, stopping, spatial awareness, speed control
and moving turns.
Variations Cat and Mouse: One participant (the cat) propels around the
outside of the circle. As the cat does so, he/she tags another
participant (the mouse) in the circle and the two race in
opposite directions around the circle. The last person to
return to the original spot is now the cat.
9190
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9192
9.12 Relay Race
Suggested minimum number
of players
10
Wheelchair type Manual or powered
Equipment and set-up Batons (any object will do).
Cones (or equivalent obstacle to turn around).
Instructions Divide participants into groups. Each group lines up at one
end of the room. When the trainer shouts ‘go’ the first
participant in each group races to the other end of the hall,
makes a turn around a cone and returns to his/her group,
passing the baton to the next participant. The first group
that finishes wins.
Skills reinforced Rolling forward, moving turns and reaching.
Variations Instead of going around a cone, have participants perform a
skill (e.g. wheelie, 360-degree turn in place, circling the
cone twice) once they reach the opposite end of the room.
Instead of returning to the back of the group when a
participant finishes the relay, he/she passes the baton to the
next person and then follows behind him/her (as in follow
the leader). This continues until the whole group is led by
the final participant around the course.
A series of stations can be spread out at each of which a
task must be performed (e.g. picking an object off the floor
and placing it on a chair, doing a weight shift for 3 seconds,
pouring a cup of water).
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9.13 Shrinking Space
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Cones (or equivalent obstacles).
Instructions A line of cones is placed close to a wall. Each participant
attempts to pass between the cones and the wall without
touching either. Each time a participant completes this
successfully, the cones are moved closer to the wall.
Skills reinforced Rolling forward or backward, and spatial awareness (a good
way for participants to learn exactly what gap they can
manage in their wheelchair).
Variations Do it in the backward direction.
See how quickly participants can get through the space by
timing them.
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9.14 What’s Your Clearance?
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up Objects that can be used to create barriers of increasing
widths and heights, for instance by placing them side by
side or stacking them. Pieces of wood or bricks are
examples. To start the game, a low and narrow obstacle is
set up.
Instructions Each participant attempts to pass over the obstacle with the
object passing between the wheels without the wheels or
footrests touching the object. Each time a participant
completes this successfully, the width and/or the height of
the obstacle is increased.
Skills reinforced Rolling forward or backward, and spatial awareness (a good
way for participants to learn exactly what clearance they
have under their wheelchairs).
Variations Sheets of bubble wrap as obstacles are useful to provide
audible feedback that a wheel has gone over the obstacle.
Do it in the backward direction.
For manual wheelchairs, permit the wheelchair user to use a
transient or full wheelie to eliminate the front wheels or
footrests from consideration.
To add an element of competition, participants can be “out”
(disqualified) if they are unable to get over the obstacle
without touching it.
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9.15 Case Open and Shut
Suggested minimum number
of players
1
Wheelchair type Manual or powered
Equipment and set-up A building or structure with different types and styles of
doors.
A route description.
Instructions Participants are given a route to a series of different doors,
returning to the starting point when finished.
Skills reinforced Opening and closing a variety of doors.
Variations To avoid crowding and delays, teams of 2-3 participants can
be routed to the doors in different orders or at intervals
(staggered start).
This game can be turned into an orienteering exercise by
providing only directions to the next door, where the next
set of directions will be posted.
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9204
9.16 Stormy Seas
Suggested minimum number
of players
10
Wheelchair type Manual or powered
Equipment and set-up None.
Instructions Each participant is given membership to a category of fish
(e.g. starfish, shark or octopus).
Participants line up against a wall at one end of the room.
One participant (the fisherman) positions himself/herself in
the middle of the room and yells out one of the above
categories. When their category is called, the participants
must try to get across the room to the other wall without
being caught by the fisherman. If tagged, a participant must
stop where he/she was caught and he/she becomes seaweed.
The seaweed’s job is similar to the fisherman’s except
seaweed cannot move.
If the fisherman yells “stormy seas”, all participants try to
get to the other side of the room regardless of their
category.
Skills reinforced Rolling forward, moving turns, stopping and spatial
awareness.
Variations When a participant is caught, he/she becomes an ‘island’ in
the sea (rather than seaweed), creating a passive obstacle
for the remaining participants to negotiate.
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9207
9.17 Simon Says
Suggested minimum number
of players
3
Wheelchair type Manual or powered
Equipment and set-up None.
Instructions A leader is chosen who instructs the group to perform
certain skills. The participants should only perform the skill
when the leader says “Simon Says” before the instruction. If
a participant performs a skill when the leader has not said
“Simon Says”, that participant is ‘out’. The last participant
in the game wins.
Skills reinforced Potential to cover all skill groups.
Variations Simon Says Mix-Up: Participants must do the opposite of
what ‘Simon’ instructs. For example, if Simon says “turn to
the right” participants must turn to the left. If they do what
Simon says, rather than the opposite, they are ‘out’.
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9210
9.18 Reverse Limbo
Suggested minimum number
of players
3
Wheelchair type Manual or powered
Equipment and set-up Obstacles of various heights.
Instructions Participants take turns getting over the obstacle until
everyone has completed the task.
The obstacle is then replaced with a higher obstacle.
Participants are eliminated when they can no longer get
over the obstacle, and the game continues until only one
participant is left.
Skills reinforced Getting over obstacles of various heights.
Variations Regular limbo: having an obstacle like a broom handle or
rope that can be progressively lowered from an initial
position about head-high.
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9213
9.19 Garbage-Can Basketball
Suggested minimum number
of players
6
Wheelchair type Manual or powered
Equipment and set-up Ball (any size).
Basket (can be a garbage can or waste basket on a chair).
Instructions To begin create two teams, each with an equal number of
participants.
Participants are only permitted to carry the basketball for
the time it takes them to complete two pushes (if using a
manual wheelchair, or equivalent time if using a powered
wheelchair) at which point they must either pass the ball to
a team member or bounce it on the ground.
Points are scored by getting the ball in the garbage can.
Skills reinforced Rolling forward, moving turns, turns in place, spatial
awareness and speed control.
Variations Break the game down into its components. Have
participants practice bouncing and throwing the ball with a
partner. Or practice how to carry the ball for two pushes
and then quickly bounce it. Add a quick turn on the end
(i.e. push, bounce, fast turn).
Practicing throwing skills by sitting in a circle and passing
the ball around. Each time that the ball is passed around the
circle without dropping on the floor get the participants to
make the circle bigger by giving one push backward. Then
try again.
Practice shooting. Change the height of the net, increasing
the height as the participant’s skill improves.
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9216
9.20 Beach Ball Chaos
Suggested minimum number
of players
3
Wheelchair type Manual or powered
Equipment and set-up Beach balls.
Instructions A variation on dodge ball, this game can be played as a
team or individually. Place one or more balls on the floor
and have participants hit the balls with their hands toward
members on the other team. Participants must maneuver
around balls or block the ball with their hands to avoid the
wheelchair getting hit. If the wheelchair is hit by the ball,
the participant is frozen until another member of their team
high-fives them.
Skills reinforced Moving turns and reaching.
Variations Once a participant is tagged, he/she can be required to come
to the back of the court and perform a designated
wheelchair skill.
Place two pylons at each end of the room about 2 m apart to
create goals. The team that scores the greatest number of
goals wins.
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9219
9.21 Horse
Suggested minimum number
of players
2
Wheelchair type Manual or powered
Equipment and set-up None.
Instructions Players are numbered and remain in order. Player #1
performs a skill that he/she thinks is possible but that others
might find difficult. Starting with Player #2, each player
must successfully complete that same skill. If a player is
not able to complete the skill, that player is given sequential
letters from the word ‘HORSE’. Once a player has all the
letters to spell HORSE, he/she is disqualified. Once
everyone has tried Player #1’s skill, Player #2 presents a
different skill and the game continues in the same fashion
until there is only one player remaining.
Skills reinforced Any combination of skills.
Variations Words that are longer (e.g. WHEELCHAIR) or shorter (e.g.
PIG) can be used.
Player #1 describes a situation without demonstrating it
(e.g. “get your wheelchair through the door with your eyes
closed”), to avoid providing clues as to how the skill is
accomplished.
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APPENDIX 1: OPTIONAL WST SKILL ORDER 9222
9223
The order of skills shown below in Table A1.1 reflect an efficient ordering of the skill tests that 9224
requires the least movement among locations, assuming that most of the floor markings and 9225
obstacles are set up in the same room, except for the “rolls longer distance” skill that can be 9226
accessed through a hinged door. 9227
9228
Table A1.1: Order of Individual Skill Tests for the WST for Manual Wheelchairs 9229
Manual
WST
Skill #*
WST Skill Names
1 Rolls forward short distance
2 Rolls backward short distance
3 Stops on command
4 Turns in place
27 Performs stationary wheelie
28 Turns in place in wheelie position
29 Rolls forward and backward in wheelie position
5 Turns while moving forward
6 Turns while moving backward
7 Maneuvers sideways
8 Picks objects from floor
9 Relieves weight from buttocks
10 Performs level transfers
11 Folds and unfolds wheelchair
26 Performs wheelchair-ground transfers
12 Gets through hinged door
13 Rolls longer distance
14 Ascends slight incline
15 Descends slight incline
16 Ascends steep incline
17 Descends steep incline
31 Descends steep incline in wheelie position
18 Rolls across side-slope
19 Rolls on soft surface
20 Gets over obstacle
21 Gets over gap
22 Ascends low curb
23 Descends low curb
24 Ascends high curb
25 Descends high curb
30 Descends high curb in wheelie position
32 Ascends stairs
33 Descends stairs * According to Table 4.3. 9230
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APPENDIX 2: LESSON PLANS 9232
9233
Before each WSTP session, the trainer should have a plan for how each session will be 9234
conducted as well as a plan for the series of sessions. The lesson plans will be affected by 9235
whether the training will be 1-on-1 or in a group, by the group size, by the group makeup 9236
(diagnoses accounting for wheelchair use, skill level), by session specifics (e.g. the number, 9237
frequency and duration of sessions), by the training facilities and by the number of trainers and 9238
spotters available. This sample outline is intended to be used in combination with other materials 9239
found earlier in this Manual and on the WSP website. 9240
9241
The sample lesson plans below are general templates for one-on-one training in sessions 9242
scheduled for 30 minutes following an intake session of 40 minutes. 9243
9244
Advance preparation by the trainer for any session:
Confirm that the space has been booked, if necessary.
Ensure that the participant and any other training personnel know the session date, time
and location. (It is a good idea to remind the participant and training personnel of the
upcoming session if it will be more than a week since the previous session.)
Obtain, prepare or review materials needed for every session:
o Participant’s contact information.
o Attendance sheet.
o Documentation of intake data for participant.
o Clip-board and pen or pencil for participant.
o List of goals for participant.
o Name tags for training personnel.
o Whistle or other noise maker for calling attention.
o Air pump for tires.
o Tool kit for urgent repairs or adjustments.
Obtain, prepare or review any materials needed for this specific session:
o If necessary, review the appropriate chapters of the WSP Manual on-line.
o If necessary, review on-line videos of the skills to be covered.
o If the session being prepared for is the 1st session:
Signage directing participants to the arrival area.
o If the session being prepared for is the final session:
Evaluation form for the participant to complete.
Report card.
Certificate.
9245
Intake Session (40 minutes)*
A. Welcome (2 minutes)
Explain the purpose of this and subsequent sessions.
Obtain consent to proceed.
B. Perform an intake assessment (25 minutes)
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Record contact information (phone numbers, email address, next-of-kin).
Document demographic, clinical and wheelchair-experience data.
Identify any contraindications for testing or training.
Document wheelchair specifications.
Wheelchair skills assessment (WST-Q and/or WST).
C. Goal setting (5 minutes)
From the intake assessment and discussion with the learner, identify and record a set of
relevant and potentially achievable training goals.
D. Begin training (5 minutes)
Begin work on an initial goal so that the learner goes away with at least one skill to
practice before the next session.
E. Closing (3 minutes)
Describe the nature of subsequent sessions.
Schedule the next session.
Assign homework.
Answer any questions that the learner may have.
Provide strong encouragement.
Complete any final documentation of the session.
* Times are rough guidelines only 9246
9247
Subsequent Sessions (30 minutes)
A. Welcome and Warm-Up (5 minutes)
Check status: Any new health concerns since the last session? Any after-effects from the
last session? Any practice since the last session? Any wheelchair changes?
Review the goals and planned activities for the current session.
Questions and answers.
Warm-up activity.
B. Practice skills that have already been acquired but that need work (10 minutes)
Random order, but begin with less stressful ones until the learner is warmed up.
Variety of settings.
Trainer role: provide structure, safety, minimal feedback.
This portion of the session can also serve to provide conditioning, if the sessions are
scheduled often enough to serve in that capacity (i.e. at least 3 times a week).
Games can be a fun way to carry out this stage of the session.
C. Practice a skill that has not been acquired yet (10 minutes)
Trainer role: provide structure, safety, instructions, demonstration and feedback.
D. Closing (5 minutes)
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Questions and answers.
Plan next session content.
Assign homework.
Schedule next session.
o Complete any final documentation of the session.
If it is the final session in a series:
o Review any arrangements for obtaining a post-training assessment of wheelchair
skills (e.g. using the WST-Q or WST), preferably a minimum of 3 days after the
final training session
o Congratulate the participant on his/her participation and achievements
o Have the participant complete an evaluation of the training sessions; a simple list
of aspects of the sessions that he/she liked most and least is adequate.
o Distribute a report card and certificate.
o Thank the training personnel for their efforts.
o Let the participant know how he/she can access training again at a later date
should he/she need or wish to do so.
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APPENDIX 3: SAMPLE OUTLINES FOR GROUP TRAINING SESSIONS 9250
9251
A 2.1 Small groups 9252
9253
This sample outline is intended to assist trainers working with groups of 5-10 participants, all of 9254
whom are using two-hand wheelchair propulsion. The syllabus has been structured to be used 9255
over a period of 6 sessions, each lasting one hour. A general template begins on the next page. 9256
9257
The content should be adjusted depending upon the skill level of the participants and the local 9258
setting. This sample outline is intended to be used in combination with other materials found 9259
earlier in this Manual and on the WSP website. 9260
9261
Prior to any training sessions, for the purposes of this example, it is assumed that each participant 9262
has already been seen individually to perform an intake assessment. 9263
9264
It is also possible to obtain most of this intake information in a group setting. However, if the 9265
WST is to be used as an outcome measure, the WST should not be performed as a group because 9266
witnessing others may affect the participant’s technique. 9267
9268
General Session Template that Applies to All Sessions Unless Otherwise Specified
Advance Preparation by the Trainer
Confirm that the space has been booked, if necessary.
Ensure that participants and training personnel know the session date, time and location.
(It is a good idea to remind participants and training personnel of the upcoming session if
it will be more than a week since the previous session.)
Obtain, prepare or review materials needed for every session:
o List of participants and their contact information.
o Attendance sheet.
o Documentation of intake data for each participant.
o Clip-board and pen or pencil for each participant.
o List of goals for each participant.
o Name tags for participants and training personnel.
o Whistle or other noise maker for calling attention.
o Air pump for tires.
o Tool kit for urgent repairs or adjustments.
Obtain, prepare or review any materials needed for this specific session:
o Decide which “old” and “new” skills will be the focus of this session (see Table
A.2.1 as an example).
o If necessary, review the appropriate chapters of the WSP Manual on-line.
o If necessary, review on-line videos of the skills to be covered.
o If the session being prepared for is the 1st session:
Signage directing participants to the arrival area.
o If the session being prepared for is the final session:
Evaluation forms for the participants to complete.
Report cards.
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Certificates.
Humorous prizes.
The Actual Training Session
A. Arrival of participants (5 minutes)
Greet participants as they arrive
If this is the 1st session:
o Direct participants to where they should hang up their coats and knapsacks.
o Let participants know that an air pump and tools are available for urgent
maintenance.
o Each participant picks up his/her name tag, clipboard with goal list attached and pen
or pencil.
B. Session Opening (10 minutes)
Call to order: Form a circle (“huddle”).
Introductions (mostly at 1st session but at subsequent sessions if there are any new people
in attendance).
Record attendance.
At 1st session, achieve consensus on rules and post them on the wall for reference
purposes, for instance:
o Make every reasonable effort to attend all sessions.
o If unable to attend a session, notify the trainer (provide trainer contact information
to enable this).
o Be on time for sessions.
o Turn off cell phones during sessions.
o During huddles or explanations, only one person should be talking at a time.
o Do not attempt any skill that you are not sure that you can do safely without a
spotter.
o Agree on a penalty for rule violation. Pick something fun (e.g. sing a song or do a
dance) rather than punitive.
Check for any participant status changes since the last session (the intake session, in the
case of the 1st session):
o Any after-effects from the last session (for sessions #2-6)?
o Any practice carried out (encourage this)?
o Any wheelchair changes?
o Any new health concerns? (Invite participants to speak to you privately, before
beginning the warm-up activity.)
Review the general purpose of the training sessions – to improve specific wheelchair
skills in order to prevent injury and overcome environmental barriers.
Have each participant independently review his/her overall goals for the series of training
sessions, revising them if appropriate.
Explain the planned activities for the current session.
Warm-up activity:
An activity designed to warm up the muscles, heart and lungs.
The activity should include some skills that have already been learned or, if the 1st
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session, skills that the trainer knows from the intake assessments that all
participants can perform.
A game (see Games chapter of the WSP Manual) can be a fun way to carry out
this activity.
C. Practice “Old” Skills (15 minutes)
Explain or remind participants of the rationale for practicing skills that have already been
learned – need practice to refine them, build efficiency, explore alternative ways to
perform them and generalize them to different settings.
Generally, using a random order for practicing the old skills is ideal, but it is acceptable
to begin with less stressful ones before proceeding to more difficult ones.
Practice old skills in a variety of settings and using a variety of methods.
For the old-skill practice, the trainer provides structure and safety, keeping feedback to a
minimum.
Individualize the difficulty level to the extent possible.
D. Practice “New” Skills (ones that have yet to be acquired or perfected) (15 minutes)
This section of the session may carry over from one session to the next.
The trainer should focus on a single skill or series of a few related skills.
When introducing a new skill, the trainer should explain the rationale for the skill,
demonstrate how it is done, then ask each participant to attempt the skill (either all at the
same time or sequentially, depending upon the skill and the setting).
Trainer role: provide structure, safety, instructions, demonstration and feedback.
E. Warm-Down Activity (10 minutes) (Optional if pressed for time)
An activity designed to reduce any tension or frustration from working on the new skills.
As for the warm-up activity, the activity should include some skills that have already
been learned.
A game can be a fun way to carry out this activity.
Moving outside the regular training area (e.g. outdoors) can be useful.
F. Closing (5 minutes)
Form a circle (“huddle”).
Answer any questions that the learners may have.
Summarize the key points about the “new” skills covered earlier in the session.
If it is not the final session:
o Have each participant review his/her training goals, revising them if appropriate.
o Remind participants and training personnel of the date, time and location for the
next session.
o Strongly encourage participants to practice their skills (with a spotter if needed)
before the next session.
If it is the final session in a series:
o Review any arrangements for obtaining a post-training assessment of wheelchair
skills (e.g. using the WST-Q or WST), preferably a minimum of 3 days after the
final training session.
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o Congratulate the participants on their participation and achievements.
o Have the participants complete an evaluation of the training sessions.
o Distribute report cards and certificates.
o Award prizes – preferably some small trinket for each participant with a
humorous reason (e.g. “For the best spotter scare”, “For the best uphill slalom”,
“For the fastest downhill sprint”, “For the wobbliest wheelie without falling”).
o Thank training personnel for their efforts.
o Let the participants know how they can access training again at a later date should
they need or wish to do so.
Retrieve materials (name tags, clip-boards, pens or pencils) from the participants.
Complete any final documentation of the session.
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Table A.2.1. Example schedule of “old” and “new” skill coverage 9271
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9277
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Individual Skills Session #
1 2 3 4 5 6
1. Rolls forward short distance New Old
2. Rolls backward short distance New Old
3. Turns in place New Old
4. Turns while moving forward New Old
5. Turns while moving backward New Old
6. Maneuvers sideways New Old
7. Reaches high object New Old
8. Picks object from floor New Old
9. Relieves weight from buttocks New Old
10. Operates body positioning options New Old
11. Level transfer New Old
12. Folds and unfolds wheelchair New Old
13. Gets through hinged door New Old
14. Rolls longer distance New Old
15. Avoids moving obstacles New Old
16. Ascends slight incline New Old
17. Descends slight incline New Old
18. Ascends steep incline New Old
19. Descends steep incline New Old
20. Rolls across side-slope New Old
21. Rolls on soft surface New Old
22. Gets over obstacle New Old
23. Gets over gap New Old
24. Ascends low curb New Old
25. Descends low curb New Old
26. Ascends high curb New Old
27. Descends high curb New Old
28. Performs stationary wheelie New Old
29. Turns in place in wheelie position New Old
30. Descends high curb in wheelie
position
New Old
31. Descends steep incline in wheelie
position
New Old
32. Gets from ground into wheelchair New
33. Ascends stairs New
34. Descends stairs New
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A2.2 Large groups 9279
9280
Group of up to 20 learners can be managed by 1-2 trainers for workshops lasting 1-8 hours on a single 9281
day. Typically for a group of 20, if the whole group will work together on the same skills (e.g., “rolls 9282
forward short distance”), a “conga line” can be used (each learner following the other by a few meters). 9283
For other skills (e.g., “maneuvers sideways”), a “chorus line” can be used (all learners performing the 9284
same skill at the same time). 9285
9286
Groups of more than 20 learners can be divided into smaller groups and managed on different days. 9287
Alternatively, stations can be used. For instance, a group of 24 therapy students undergoing a 90-minute 9288
workshop on wheelchair skills in a 2-hour period of time can be divided in 6 group of 4 student with each 9289
group starting at a different station (“shotgun” start). At each station, one trainer deals with a different 9290
set of skills for 15 minutes, then the students move to the next station. 9291
9292
If there is more flexibility with respect to the starting and finishing time (e.g., a 4-hour time period even 9293
though each student will only receive 90 minutes of training), it is preferable to use a “staggered” start, 9294
with each group beginning at Station 1 and progressing every 15 minutes in order to Station 6. This has 9295
the advantage over the shotgun start of allowing each student to learn about the skills in the preferred 9296
sequence. 9297
9298
When working with large groups of able-bodies learner (e/g., student in the health professions), the 9299
number of available wheelchairs can be a limiting factor. For a group of 20 able-bodies learners, 10 9300
wheelchairs of different sizes are ideal with 10 students in the wheelchairs and the other 10 acting as 9301
spotters at any time. If there are more students or fewer wheelchairs, then the students can be divided 9302
into group sizes that are a multiple of the number of wheelchairs. For each skill, Group 1 students would 9303
begin in the wheelchairs, Group 2 would be spotters and Group 3 student would be observers. After each 9304
student in Group 1 has attempted the skill, the Group 2 students get into the wheelchairs and the Group 3 9305
student act as spotters. This rotation continues until every student has attempted every skill. 9306
9307