Powered Wheelchair Training Guide
References and Resources
If you are interested in obtaining additional information about wheelchairs and mobility skills, there are a number of resources you can tap with a visit, a phone call, a letter or a modem.
Centers for Independent Living (CIL)
Most communities have a Center for Independent Living (also called Independent Living Centers or ILCs). These centers are run by and for people with disabilities. Their mission is to help people with disabilities live more independently and become productive, fully participating members of society.
The rehabilitation center in your area may have facilities you can use to try out equipment and see which devices might benefit you. They may recommend an evaluation by an occupational or physical therapist, or a RESNA certified assistive technology practitioner. These professionals can often provide you with insight into your abilities and potential needs, and may be able to direct you toward other helpful accessories.Your rehabilitation center may also refer you to other centers that can better meet your specific needs.
Medical Equipment Suppliers
Medical Equipment Suppliers represent equipment manufacturers and should be able to help you make equipment choices compatible with your lifestyle. Remember that these companies are in the business of selling equipment, so you need to be an educated consumer and look further than the salesperson. The National Registry of Rehabilitation Technology Suppliers has a registry of equipment suppliers.
When buying equipment, consider the resources and reliability of the supplier. Ask them about their repair policies. For instance, will they loan you equipment when yours is being repaired? Are they helpful on the telephone? Do they seem willing to spend time telling you about the pros and cons of the variety of equipment? Will they help you adjust and re-adjust your equipment? The supplier should be willing to give you the names of a few of their customers. Contact these people to determine how they feel about the supplier’s services.
Most wheelchair and related equipment manufacturers have toll-free numbers and are available for assistance. They will often refer you to a local supplier or others in your area who are familiar with their products. Some manufacturers have technical assistance departments that may be able to help you with specific questions about modifications, adjustments or repairs. Some manufacturers publish documents in addition to their wheelchair owner’s manuals.You can talk with your local supplier about getting documents from any of the manufacturers.
Find people in your community who have similar interests and needs. Other people often have recommendations for equipment and you can combine their information with the recommendations you get from rehab professionals and equipment suppliers. By learning as much as you can, you will be able to make informed decisions about your equipment.
Some professional organizations may be able to provide you with information directly or refer you to members in your area who may be familiar with similar circumstances to yours.
- American Physical Therapy Association
- 1111 N. Fairfax St.
- Alexandria, VA 22314
- Voice 800-999-2782
- Internet address http://www.apta.org
- American Occupational Therapy Association
- 4720 Montgomery Lane
- PO Box 31220
- Bethesda, MD 20824-1220
- Voice 800-729-2682
- Internet address http://www.aota.org
- National Registry of Rehabilitation Technology Suppliers
- P.O. Box 4033
- Lago Vista, TX 78645-4033
- Voice 512-267-6832
- Internet address http://www.nrrts.org
- Paralyzed Veterans of America
- Spinal Cord Injury Education and Training Foundation
- 801 18th Street NW
- Washington, DC 20006
- Voice 800-424-8200
- Internet address http://www.pva.org
- Rehabilitation Engineering and Assistive Technology Society of North America
- 700 N. Moore St., Suite 1540
- Arlington, VA 22209-1903
- Voice 1 (703) 524-6686
- Internet address http://www.resna.org
A Guide to Wheelchair Selection: How to Use the ANSI/RESNA Wheelchair Standards to Buy a Wheelchair
Written by Peter Axelson, Jean Minkel and Denise Chesney Paralyzed Veterans of America, Washington, DC PVA Publications Distribution Center
- Voice 888-860-7244
- Active Living Magazine
- P.O. Box 2659
- Niagara Falls, NY 14302-9945
- Internet address http://www.cripworld.com/themall/activeliving/shtml
- New Mobility
- No Limits, Inc.
- P.O. Box 220
- Horsham, PA 19044
- Voice 888-850-0344
- Internet address http://www.newmobility.com
- Paraplegia News
- PVA Publications
- 2111 East Highland Avenue, Suite 180
- Phoenix, AZ 85016-4702
- Voice 606-224-0500
- Internet address http://www.pn-magazine.com
- Sports ’n Spokes
- PVA Publications
- 2111 East Highland Avenue, Suite 180
- Phoenix, AZ 85016-4702
- Voice 602-224-0500
- Internet address http://www.sns-magazine.com
Sports ‘n Spokes publishes articles comparing available wheelchair models.
There are numerous websites with information about wheelchairs and for wheelchair users. Here are a few of them.
- Internet address http://www.abledata.com
- A searchable database of rehabilitation products.
- Beneficial Designs, Inc.
- Internet address http://www.beneficialdesigns.com
- A rehabilitation engineering design firm specializing in recreational technologies, innovative wheeled mobility and seating, and access to outdoor recreation environments.
- Internet address http://www.SpinLife.com
- A site featuring wheelchairs, scooters and accessories.
- Internet address http://www.WheelchairJunkie.com
- A site for wheelchair users by wheelchair users.
- Internet address http://www.WheelchairNet.org
- A virtual community that provides information, support and a forum for wheelchair users.
Setting Limits and Offering Help
It can be hard to admit you have reached your limits. However, you should safeguard your own health and well-being.You need to know your limits and how to say “no” when you have reached them.
How to Say “No”
It is important to understand that you should not assist a wheelchair rider if it presents a physical hazard to your own health or you are not confident in the outcome. This could result in injury to the wheelchair rider and/or yourself. For example, pushing a wheelchair up a curb with an injured back could be painful and may cause further injury to your back. Do not be afraid to say “No.” The following are several ways to decline to help:
- Politely decline by saying, “I don’t feel comfortable or safe assisting you in that way.” Explaining why you declined is often appreciated. However, if your reasons are personal, you have no obligation to explain yourself.
- Offer to find someone who can help. “I’m not able to assist you up this curb because I have a shoulder injury. Can I help you find someone else to assist?”
- Offer an alternative skill. “I’m not comfortable pulling your wheelchair backward up the curb because I don’t think I can lift the weight of the wheelchair. Can we try lifting your casters up onto the curb and then I can push you up the curb?”
- Offer an alternative route. “I’m concerned about trying to assist you down this steep hill. The hill isn’t so steep if we go to the next corner.”
Sometimes watching a wheelchair rider do something is difficult because you can see that whatever the rider is doing is not easy. Remember that the person may not want assistance; it may be important for the person to accomplish the activity independently. It might be easier for the wheelchair rider to do the activity alone than to explain to others how they can help. The wheelchair rider might have had bad experiences or even injuries in the past when people tried to help. It may be difficult to watch, but you do not necessarily need to help the person.
Only assist a wheelchair rider when you are asked and/or have been given permission. If you think a wheelchair rider might need assistance, offer. The wheelchair rider may be in a position that looks precarious, but have the situation under control. Unexpected assistance might throw him or her off balance.
- Ask if the wheelchair user wants help. Avoid assertive statements such as, “Let me do this for you,” which make it difficult for the wheelchair rider to decline your help.
- Try wording your offer more casually. “Could you use a hand?” or “Can I help you out?”
If your offer to assist has been accepted, let the wheelchair rider be in charge. Ask the wheelchair rider how you can help and follow the rider’s instructions. Ask the wheelchair rider to talk you
through the sequence before trying it, then work together to do it correctly.
- Do not push, lift or pull unless the wheelchair rider asks. Often you will be working together (e.g. to climb a curb, you may be pushing on the push handles as the wheelchair user drives forward).
- Speak up if you feel in danger of injuring yourself by following the rider’s instructions.
Learning Your Limits
Riding at different speeds, going up and down hills, over different surfaces and past obstacles affects your stability. Depending on the terrain and your speed, you might have difficulty keeping your balance or your hand on the joystick. It is important to know your limits. To learn what you can do, you have to experience a variety of situations. Each time you try something new, it is best to have another person stand by to help you regain your balance and prevent you from falling. That person is referred to as a spotter throughout this book.
Techniques for Keeping Your Weight Back
Hitting an obstacle, coming to an abrupt stop or driving down a ramp, curb ramp or hill can all cause you to fall forward. Shifting your weight back in your wheelchair might help you keep your balance. In order to counteract falling forward, it is important to stay as far back in your wheelchair as possible. Although the wheelchair’s back support will prevent you from leaning back very far, leaning even your head and shoulders back will help keep you in your wheelchair. If you tend to lose your balance or fall forward, the following suggestions might be useful to you.
Hook your arm behind you
Hooking will help keep your body “locked against the back of your wheelchair.” You will need sufficient arm movement and strength to position your arm and hold the push handle in the crook of your elbow.You may find that hooking your non-driving arm around the push handle will provide added stability while driving over obstacles or down ramps.
Hooking your arm can help you keep your balance when you ride downhill or over rough ground in your powered wheelchair.
Since hooking requires you to twist and lean, using this technique over many years can lead to back pain, pressure ulcers on your buttocks, and skeletal deformation. Hooking also occupies an arm that might be better used for other activities. If you find you need to hook often to feel safe while driving, you may want to obtain additional postural supports to minimize usage of this technique. Extended lateral supports or a chest support might be of great benefit.
Use of additional straps
A lap belt will help hold your buttocks back and keep you from sliding forward in your seat. Sliding forward in your seat could allow you to get dumped out on the ground. A lap belt can be positioned at different angles; however, a strap that crosses your thighs at an angle between 60 and 90 degrees will work the best. A chest strap can help hold your upper body in place, preventing you from falling forward. Different styles are available depending on your needs and preferences. An alternative to the traditional chest strap is an across-the-shoulder automotive style belt or backpack style straps that come down across each shoulder. Chest straps should be used with great care, because if you slide down (or forward) in your wheelchair, a chest strap can get caught around your throat and choke you. Chest straps of any type should only be used with a properly functioning lap belt.
WARNING: Lap belts mounted at angles less than 60 degrees have the potential of pivoting up, and can allow the hips to slide underneath and forward on the wheelchair seat. For people using a chest support of some type, sliding down in the wheelchair can create a strangulation hazard. People have also slid down in their wheelchairs such that the lap belt created a strangulation hazard.
A chest strap in combination with a lap belt can help you maintain your sitting balance. Try several chest support styles to see what works best for you.
Power recline back support
If your wheelchair is equipped with power recline, you can adjust the back support rearward to prevent you from losing forward stability. The next section discusses this type of seating system in more detail.
Reclining the back support a little might help you keep your balance when going downhill.
CAUTION: Never recline your back support when traveling uphill.This could lead to rearward instability when driving uphill, through a curb ramp or other uphill sloped situation.
Power tilt-in-space seating system
In a power tilt-in-space seating system the entire seating system tilts back, not just the back support. This type of seating system is discussed in more detail in the next section.
A power tilt-in-space feature can also help you keep your balance when going downhill.
CAUTION: Never use the power tilt feature when traveling uphill. This could lead to rearward instability when driving uphill, through a curb ramp or other uphill sloped situation.
Techniques for Keeping Your Weight Forward
When traveling uphill, you may need to keep your weight forward to prevent your wheelchair from tipping backward.
- Lean forward with your head and shoulders when driving over obstacles and when driving up hills and ramps.
- If you use a chest strap, it may be easier to lean forward against the strap with it slightly loosened.
When traveling up a steep hill, you may need to keep your weight forward to prevent your wheelchair from tipping backward.
When You are Learning Your Limits
- First learn your balance point when sitting in your powered wheelchair. With a spotter’s assistance, find out how steep a ramp (forward, rearward and sideways) you can handle before you start to lose your balance.
- Try different postural supports to see which will help you maintain your upper body balance.
- Learn to recognize environments that are beyond your ability to maintain your postural stability. Learn how to recognize ramps that are too steep for you to manage.
- Have a spotter stand by to help you regain your balance and prevent you from falling.
According to the Americans with Disabilities Act (ADA) Accessibility Guidelines, a standard ramp in the built environment should have a grade no steeper than 1:12. This means that for every inch of rise (change in height), there should be 12 inches of run (change in length). This is sometimes referred to as an 8 percent grade or slope. Using this formula, a ramp going to a door with two 8-inch steps should be at least 16 feet long.
A standard ramp is gradual enough for powered wheelchairs to climb safely, but the limit beyond that is different for each powered wheelchair.With experimentation, you will learn how steep a ramp you can negotiate without assistance. Always use a spotter when practicing on ramps and when driving up a steeper ramp for the first time. Practice descending steep ramps with a spotter until you find one that is at the limit of your trunk stability. Experience the loss of stability, and remember the steepness of the slope that caused this to happen. When climbing steeper ramps you may reach a point where you will begin to tip to the rear or the wheelchair may just run out of power. Obtain assistance before going up or down slopes this steep, or steeper, in the future. Loading docks are good places to find steeper than normal ramps for practice on steep ramps.
Going Up a Ramp
- There will be a tendency for the wheelchair to tip backward when driving up a steep ramp. A backpack or other gear on the back of your wheelchair will cause you to tip backward more easily. If you use a recliningback wheelchair or a tilt-in-space seating system, you will find that having your back support in the fully upright position gives you the greatest stability when driving up a ramp.
- Drive slowly to maintain control.
- On steep ramps, it is best to keep a straight path. Approaching a steep ramp at an angle will increase the severity of the cross slope. Cross slopes are discussed later in this section.
Lean forward when you are going up a steep ramp facing forward.
How a spotter can help
- Walk behind the wheelchair and place your hands close to the push handles or back posts. Try not to influence the movement of the wheelchair.
- Prevent the front casters from lifting off the ground by lifting up or by pushing forward on the push handles or back support.
- If the wheelchair runs out of power, assist by pushing the wheelchair up the slope.
Going Down a Ramp
Before descending a ramp, always check for obstacles such as cracks and changes in level. Also examine the base of the ramp for obstacles you may need to cross, such as drainage grates.Always shift your weight back when going down ramps, and proceed slowly to maintain control. As you get more comfortable and confident with ramps, you will be able to increase your speed and remain safe. Be careful of foot support clearance when you get to the base of the ramp. Drive slowly in case your foot supports contact the ground. If they do, you will come to an abrupt stop.
Always practice descending ramps with a spotter. Travel down ramps of increasing steepness until you find the angle where you can no longer descend the ramp alone with confidence. Always obtain assistance when you do not feel comfortable descending a ramp independently.
Practice with a spotter on the non-joystick side of your wheelchair, ready to catch your upper body if you should fall forward.
Going down a ramp forward independently
- Examine the ramp for obstacles.
- Drive slowly to maintain control.
- The ramp may be so steep that you will lose forward balance. If this happens, compensate by shifting your weight back (see Section 2.3 for more information about shifting your weight).
- Putting the joystick in reverse can further slow the speed of some chairs. However, this technique is not recommended for wheelchairs with non-digital controllers on a continuous basis, as the braking action could permanently damage the controller or motors.
- Some ramps might be so steep that you will lose traction under the rear wheels and begin to slide.You will maintain more control by driving forward than you will sliding forward.
Hooking one arm around a push handle and leaning back into your back support may help you keep your balance when going down ramps.
How a spotter can help
- Walk on the non-joystick side of the wheelchair rider as the rider moves down the ramp.
- Be ready to catch the wheelchair rider’s upper body if the rider falls forward.
- Stand behind the wheelchair rider and reach over the shoulder to provide additional trunk support.
Going down a ramp backward independently
Traveling down a steep ramp can cause you to lose trunk stability in the forward direction. When shifting your weight back during the descent or hooking your elbow on the push handle is not enough to maintain your balance, descend the ramp backward.You should also descend a ramp backward if you believe it is so steep that the foot supports will hit the ground at the bottom.
- Check the ramp for any obstacles.
- Move slowly to maintain control.
- It may be difficult to maintain the direction you want to go when you are driving backward down a ramp. Have a spotter or an assistant ready to help guide the wheelchair from the rear.
- If you are using anti-tippers, watch for clearance of the anti-tippers at the bottom of the ramp. If your anti-tippers get caught at the bottom of the ramp, you could tip over backwards.
- Letting go of the joystick should cause the wheelchair to dynamically brake and slow or stop.
How a spotter can help.
- Walk on the non-joystick side of the wheelchair and hold on to the wheelchair frame to physically assist with guiding the wheelchair straight.
- If the ramp is steep, position yourself behind the wheelchair, hold the push handles, and walk backward down the ramp. Move with the wheelchair as it drives backward.
To slow the wheelchair, a spotter can walk behind the wheelchair with his or her hands on the push handles, leaning forward into the back support.
Very Steep Ramps
- If the ramp is too steep for your wheelchair to ascend or descend, even with an assistant, find an alternate route or have two or three assistants help you by pushing and/or pulling.
- Attach pull straps to the wheelchair near the front casters to enable helpers to pull on the left and right sides of the wheelchair. Have the strongest assistant behind the wheelchair assist by pushing.
- You can assist by driving the wheelchair slowly to apply as much power as possible.
- When going down, applying a very small amount of reverse power will keep the parking brakes from engaging.You will also be able to assist with steering. If this does not work, disengage the drive motors and have your assistant(s) manually roll the chair down.
If the ramp is too steep or narrow, have your assistant transport you and your wheelchair separately.
How a spotter can help
- Walk behind the wheelchair rider as the rider moves up the ramp with your hands near the push handles. If necessary, push the wheelchair to keep the casters from lifting off the ground, and to provide extra power to ascend the ramp or to slow the descent.
- The second spotter should walk on the joystick side of the wheelchair rider as they move up or down the ramp. Be prepared to shut the wheelchair off if there are any difficulties.
Telescoping or Portable Ramps
Telescoping or portable ramps are made so that they can be moved and used in different locations. Sometimes the ramp is wide enough for the whole wheelchair to fit on it. Other times, two narrow ramps are used under the wheels on each side. If these narrow ramps are used, make sure they are wide enough for your wheels. Some wheelchairs are made so the casters are not in line with the main wheels. If this is the case with your wheelchair, you may have more difficulty using portable ramps because individually they may not be wide enough for both the front and rear wheels. Before using telescoping or portable ramps:
- Stretch the ramps out on a flat surface and be sure your wheels can safely drive through the full length of the ramps before attempting to use them on an incline.
Turning Around on a Ramp
The safest way to turn around on a ramp is to continue traveling until you reach a level resting area or the end of the ramp. However, this is not always possible. For example, you might be driving on a road or trail that is a steep ramp. With a little practice, you will be able to turn around on a ramp safely. Lean and shift your weight in the uphill direction as you turn. This helps to move the center of
mass uphill and will help to prevent your wheelchair from tipping.
How to turn around on a ramp
- Look behind you to check for oncoming traffic.
- If the path is clear, move to the non-joystick side of the ramp and stop.
- When you have come to a halt, turn your wheelchair in the direction of the joystick until you are sideways on the ramp. This allows you to maintain your upper body position with your joystick arm.You may find it easier to turn in the other direction if you have more ability to balance with the other arm.
- Keep your weight shifted uphill.
- Continue to turn your wheelchair using the joystick until you are facing downhill. Be sure to keep your weight shifted back.
- Drive your wheelchair forward down the ramp.
Note: It will be important for you to determine the steepest ramp on which you can ascend, descend, and turn around. Always have a spotter with you when determining the maximum limits of your wheelchair.
When you make a turn on a ramp, be careful that your wheelchair does not tip sideways.
How a spotter can help
Stand downhill from the rider throughout the turn to keep the rider from falling forward out of the chair and to keep the chair from tipping.
Curb ramps are, unfortunately, often built up to or beyond the maximum slope allowance (8.3%), and at the bottom of the curb ramp the gutter slopes up in the opposite direction toward the center of the street. This creates a downslope-to-upslope transition where the foot supports can dig into the ramp or the gutter, bringing the wheelchair to an abrupt stop. This can cause you to be thrown forward in the chair or completely out of the chair if you do not use a lap belt.
Foot supports that are adjusted too low can get caught going through a curb ramp.
Anti-tip wheels can get caught where there is a lip at the base of the curb ramp and the ramp and gutter slopes create a rapidly changing grade.
Asking for Help
Access improvements for people with disabilities are being made everyday. However, you will still encounter situations where you need help.
Everyone with or without a disability needs help now and then. The need for assistance will vary from situation to situation, and person to person. The hardest part for many people is knowing and understanding when they have reached their limits.
“Assistance” has many meanings.You may need to be lifted up stairs, helped over a loose gravel pathway, up a steep ramp, across a street, up or down a curb, over a railroad track, etc.
- Independent Skills: Independent skills are those things you can do without help.
- Supervised/Assisted Skills: Supervised/assisted skills are those things you are uncomfortable doing totally by yourself, but you can do partially.You might need occasional help or someone nearby “just in case.” Being able to ask for help and being able to instruct others is very important.
- Dependent Skills: Dependent skills are those things you can only do with a lot of help.
Who Can Help?
The amount of help you need will depend on your present skills and abilities, as well as the task you need to accomplish. In some cases, you might want someone nearby because you are learning a new skill or you are just a bit unsure about the situation. At other times, you may be trying to get past an obstruction that you are unable to negotiate. This section gives you some pointers on working with different kinds of helpers, including spotters, assistants, personal care attendants or PCA’s, family or friends, coworkers, acquaintances and strangers.
A spotter is a person who stands nearby to help if you need it. Always use a spotter when learning a new skill, such as driving down a steep ramp, and when you are not confident in your ability to handle a situation alone. The spotter could help to prevent you from tipping or falling forward out of your wheelchair. It is up to you to decide when you are uncomfortable with a maneuver and would like to use a spotter.You might need more than one spotter when learning a new skill. It is also important to instruct your spotter(s) as to exactly how you need to be spotted. For example, going down a ramp you might ask a spotter to walk alongside of the wheelchair, ready to catch your upper body should you lose your balance in the forward direction.
A spotter becomes an assistant when you know you will need help or will require more assistance than someone standing by offering an occasional hand. Assisting often involves pushing or lifting the wheelchair in some capacity (e.g., up a curb or threshold that is too high to cross independently). An assistant might also be required to perform other tasks, such as picking up things you drop or getting things you cannot reach. In many cases, an assistant is hired and trained by the wheelchair rider. These assistants are often referred to as personal care assistants (PCA’s) and attendants.
Personal Care Assistant (PCA)
If you need help frequently or at regular times during the day, you may want to hire a personal care assistant. Some wheelchair users find it difficult to ask a family member or a friend to help because they feel they are burdening them. Relationships with family members or friends may become strained if they always feel responsible for helping you. A potential advantage of a hired assistant is that the assistant can help you with personal tasks, such as bowel and bladder care, and is generally not as emotionally involved with you. It is the job of a hired assistant to provide the help you need in a given situation.You can train your professional assistant to do things the way you want. If the arrangement does not work out, you also have the freedom to replace the PCA.
Family and friends
Family and friends with whom you spend most of your time will need to spot or assist you on some occasions. It can be valuable to rely on people you feel comfortable with when facing a difficult or challenging situation.
Do not assume that a family member or friend will always be comfortable helping you. Be sure to ask if they are willing to help. Make sure they know not to help you unless you request assistance. You probably have a good idea of which friends and family members you can trust as assistants based on your familiarity with their personalities.
Coworkers or acquaintances
Coworkers or friendly acquaintances can also make good assistants when you need help at work. If you are on good terms with a coworker, you may be comfortable casually asking for assistance (e.g., “Hi. Can you give me a push over this threshold?”). People you meet after your injury may be more comfortable with you as a wheelchair user than friends or family still making the adjustment to your new circumstances.
When you are alone, situations may arise where you need the assistance of a stranger. For example, you may have dropped your car keys where you cannot reach them. In these cases, you may need to ask someone you do not know for help.
Alternatively, you may be out with a friend and find yourself in a situation where the assistance of a second person is necessary. For example, you may need an additional person to help lift the front end of your wheelchair up a curb.
How to Ask for Help
How you ask for help will vary from situation to situation. Ask for assistance in a way that allows the person to comfortably decline.You can practice asking for assistance with a companion acting as a stranger. This will help you learn how to ask strangers for assistance, as well as teach your companion to help only when asked. This type of practice also helps you learn how to instruct others to safely assist you.
Remember that there can be many valid reasons for people to decline to help you. Some people have disabilities that may not be visible, such as arthritis or heart disease, and they may be reluctant to disclose their condition to you. Other people’s beliefs or customs may present a barrier to assisting you.
Gracefully accept refusals to help. After all, you don’t want help from a person who feels uncomfortable with the task because their apprehension can increase the risk of injury for both of you. Consider the following before asking a stranger for help:
- Do not ask for assistance from anyone you feel might be a threat.
- Consider the people around you and approach only those who look prepared to provide some physical assistance.
- Body size is not that critical when performing most assisting skills. Do not assume a smaller person is not strong enough to help you.
- Ask for assistance from people involved in activities similar to your own. For example, if you are shooting baskets in the park and lose the basketball in a bush, ask another ball player for assistance.
- If you enjoy challenging environments, such as hiking trails, remember that this type of environment attracts a lot of people who, like yourself, might be looking for an adventure. They may see helping you as yet another challenge and be very eager to assist.
- If there are few people around and you know you will need assistance soon (e.g., there is a curb around the corner), ask someone if they would be willing to follow you to the place where you will need help.
- Try “Do you mind giving me a hand up this curb?” or “Could you help me down this steep curb ramp? I can talk you through what I need you to do.”
Observe the people around you and ask those who look ready and willing to assist.
Be clear and concise when giving instructions. Most of the skills in this book include instructions you can give an assistant.
- You are in charge. Instruct your assistant not to do anything unless you specifically ask.
- Read Section 6.1 for more information about protecting the back. Make sure friends and family who assist frequently read that chapter also.
- Tell your assistant where to stand.
- Indicate how to hold onto your wheelchair (e.g., “Please do not lift from the foot supports because it might break off. Hold the frame next to my knees instead”).
- Give body mechanics suggestions (e.g., “Bend at your knees and keep your back straight”).
- Always instruct your assistant to move on your count of three to coordinate the efforts of all parties.
- Remember to thank your assistant for the help.
Manually Rolling Your Wheelchair
It will be difficult or impossible to manually push your wheelchair with the motor engaged. Know how to explain the disengagement of the motors so an assistant can push you if necessary. Be sure you know where the motors are located and how to operate the motor disconnect system.
Describing Safe Body Mechanics to the Spotter or Assistant
Be sure to protect your spotter or assistant from injury by reminding her to watch her body position. Remind your spotter or assistant to:
- Bend at the knees, not at the waist.
- Use her legs for strength rather than the weaker muscles of the back or arms. This will help prevent back strain.
- Keep her knees bent, not locked straight.
- Never twist at the waist. Instead, she should keep her torso facing the same direction as her hips. This will help prevent back strain.
- Keep her back straight. Hunching over or rounding at the shoulders can cause back strain.
- Keep breathing. Sometimes people forget to breathe when they are involved in physical activity. When someone holds their breath, they are more likely to tense their muscles and when their muscles are tense, they are more prone to strain and injury.
When You Do Not Want or Need Assistance
Sometimes people will try to help even when you do not ask. This can be very frustrating.
- A simple “Thanks, but I would like to do this by myself” or “Thank you, but it is actually easier for me to do this without assistance” can be effective.
- “Please don’t grab my wheelchair” or a similar instruction is sometimes necessary for the more aggressive helper.
Experiencing New Environments
It is important to have assistance available when you try things for the first time (e.g., your first time using a crosswalk with curb ramps). Having a companion along to both spot and assist makes it safer to experiment with new or different skills.
The goal is to develop full independence. This does not necessarily mean that you will be able to perform all skills independently. Rather, it means that you are able to understand when and where you may need assistance, how to ask for it, and how to instruct others to assist safely.