Wheelchair Skills Assessment and Training

Introduction

The 2008 World Health Organization (WHO) guidelines on the provision of wheelchairs in low-resource settings [1] have been discussed in the previous sections of this course. WHO guidelines recommend an 8-step service delivery process that includes assessment by professionals, development of wheelchair prescription and home assistance (if needed) with wheelchair user involvement funding for proper wheelchair fitting and adjustment wheelchair maintenance and wheelchair operating skills training and training for wheelchair users and carers Long-term follow-up to improve routine maintenance and regular replacement. The Wheelchair Skills Program is a set of protocols that addresses two of these steps, wheelchair skills assessment and training. [2]

Two important elements in this care pathway are wheelchair skills assessment and training for wheelchair users and their carers. The Wheelchair Skills Program is a package of assessment and training programs related to wheelchair skills. [2] More and more peer-reviewed papers [3] on the measurement properties of the evaluation methods and the effectiveness of the training protocol (including two systematic reviews and a meta-analysis). [4][5]

Scope

Due to time and space constraints for this course and the scope of practice for most physiotherapists, this page will focus on the training of manual wheelchair users using two-handed propulsion (for example, those using a wheelchair due to a spinal cord injury). Therapists interested in material beyond scope can use the Wheelchair Skills Program Booklet [6] to supplement the material provided here. The material presented on this page of this course is taken from version 5.0 of the manual.

Warning

Some of the wheelchair skills described in this section can be dangerous and result in serious injury or death if not aided by one or more experienced observers. See Chapter 2 of the Wheelchair Skills Program Manual for details on observation. [6]

Assessment of Wheelchair Skills

As recommended by WHO guidelines, new wheelchair users should go through 8 steps in the wheelchair service delivery process. [7] One of these steps is evaluation. As part of this assessment, the wheelchair user’s wheelchair skills should be assessed. This should be done when ingesting As part of prescribing and fitting steps (e.g. comparing a wheelchair user’s skill performance with a rigid versus a folding wheelchair or with the rear axle in a more stable and less stable position) and during follow-up to determine which modifications require a wheelchair.

Details of the Wheelchair Skills Test (WST) can be found in Chapters 4 and 5 of the Wheelchair Skills Program Manual [6] and is a method of assessing a wheelchair user’s ability to safely perform required skills in everyday life. [8] More and more A peer-reviewed paper on the measurement properties of evaluation methods [3]. The following video shows a complete WST being performed on a patient with a spinal cord injury. You can also read the related WST reporting form. [9]

[10]

Information on the WST Questionnaire version (WST-Q) can be found in Chapter 6 of the Wheelchair Skills Program Manual. [6] In addition to assessing ability like the WST, the WST-Q also assesses confidence and performance (what wheelchair users do and how they do it). for better To understand what is reasonable to expect from a person with a spinal cord injury, you may wish to read the paper by Kirby et al. (2016). [11]

Training of Wheelchair Skills

Another step for WHO is training, including wheelchair skills training for wheelchair users and/or caregivers. A growing number of peer-reviewed papers [3] address the measurement properties of evaluation methods and the effectiveness of training protocols (including reviews and meta-analyses). [4][5]

The Wheelchair Skills Training Program (WSTP) combines the best available evidence on principles of motor skills learning with the best available evidence on wheelchair skills techniques. WSTP can be used during the initial provision of the wheelchair and later as necessary.

Chapter 7 of the Wheelchair Skills Program Manual [6] provides a practical overview of the motor skills learning literature, covering topics such as goal-setting demonstrations, structure of practice sessions, focus of attention, use of imagery, nature and timing of feedback skills Segmented progression of skills and steps from simpler to more complex versions, which can be used to facilitate skill retention and transfer. However, for the purposes of this course we will focus on how best to train manual wheelchair users to perform specific skills or groups Skills include;

Basic Skills

1. Pressure Relief
2. Rolling
   • Forwards
   • Backwards
   • Roll on Soft Surface
3. Stopping
4. Turning
   • Turn in Place
   • Turn While Moving
   • Maneuvers Sideways
5. Transfers
   • Level Transfer

Intermediate Skills

1. Fold & Unfold Wheelchairs
2. Going Through Doorways
3. Obstacles
4. Hills and Ramps
   • Ascends Inclines
   • Descends Inclines
   • Rolls Across Side-Slope
5. Curbs
   • Ascends Curbs
   • Descends Curbs

Advanced Skills

Transfer Wheelchair to FloorPick Up Object Stairs Up and Down StairsWheelieWheelie Related Skills ResourcesTraining ManualWheelchair Skills Program Manual – Version 4.3 FormWheelchair Skills Test (WST) Form; User Operated Manual Wheelchairs Operated by Paramedic Wheelchair Skills Test Questionnaire (WST-Q) Manual wheelchair forms and scripts operated by wheelchair users Manual wheelchair forms and scripts operated by paramedics