Wheelchaired Mobility, continued

Walking and riding in a wheelie are both forms of controlled instability. To be highly maneuverable, the body needs to respond dynamically to changes in balance. We lean forward and then place the next foot forward, to prevent us from falling; that is how we walk – in a series of interrupted falls. While in a wheelie, the rider is controlling the stability of the chair through the rear wheels. While riding on two wheels, the rider can more easily turn, move across soft surfaces like thick carpeting and lift the casters (front wheels) over an obstacle.

Learning to do and maintain a wheelie is greatly enhanced when the manual chair has been properly adjusted. An adjustable rear axle allows the rear wheels to be moved forward or backward relative the rider’s position in the chair. The further the wheel is moved forward, the tippier the chair will become. A tippier chair is much easier to “pop” into a wheelie. However, a very tippy chair will also tip backwards involuntarily when traveling up an incline, such as a ramp or a curb cut – or when accelerating from a standing start.

To maximize maneuverability and reduce stress of the upper extremities, the wheel should be placed as far forward as the rider can safely manage. If too far forward, there will be an increased chance of tipping over while performing every day activities. Riders also need to be taught how to adjust their trunk angle when traveling up and down inclined or bumpy surfaces to adjust on the fly for greater maneuverability or stability.

Many wheelchair riders are unable or unwilling to learn to do a wheelie, but are still self-propellers. Set-up of the chair is still critical for these riders as well. For those who use either both feet or one foot and one arm for propulsion, the seat-to-floor height is critical to maximize ease of propulsion.

For all self-propelling manual wheelchair users there is a known risk of overuse injuries of the upper extremities. The Paralyzed Veterans of America (PVA) has published a Clinical Guidelines Document to support needed changes in clinical care to preserve upper extremity function. (Publication Name: Preservation of Upper Limb Function Following Spinal Cord Injury - http://www.pva.org/cgi-in/pvastore/products.cgi?id=1).