Wheelchair use does not come naturally — skills training required

Programs evaluate training, address issue of older adults receiving little or no wheelchair instruction.

Two randomized control trials focusing on assessing and improving the efficacy of wheelchair training are tackling misconceptions about ease of wheelchair use and the need for skills training.

“There’s a stereotyping going on – ‘They’re just going to get pushed around by their caregiver, so why waste the resources?’,”says Dr. Bill Miller, co-director of the VCHRI’s Rehabilitation Research Program and professor in the Department of Occupational Science and Occupational Therapy at UBC. “Wheelchair users are also victims of our low expectations – just because they may not be able to go up and down stairs, we write them off.”

Dr. Miller’s EPICWheels (Enhancing Participation in the Community by improving Wheelchair Skills) program studies the efficacy of wheelchair training. The WheelSeeU (Wheelchair Self-efficacy enhanced for Use) program examines the impact of a training program led by older adults experienced in wheelchair use. The peer-trainer meets two learners (also 55 or older) in six, two-hour sessions, in Vancouver and Quebec City.

Both programs are designed to impart skills more cost-effectively than the ‘gold-standard’ of individualized training with professional therapists. EPICWheels is low-cost and convenient for users, since it can be done at home. WheelSeeU is more costly and involves more effort by participants, but provides individualized goal-setting and customized task-specific practice.

Either program, in theory, would be a significant improvement over the current situation for most older adults who are prescribed a wheelchair.

“People who have broken a hip, or are suffering from progressive osteoarthritis, or have not fully recovered from a stroke rarely get the gold-standard treatment,” says Dr. Miller, whose father spent most of his adult life in a wheelchair after contracting polio. “Usually, they receive little or no instruction beyond transferring from the chair to the bed, toilet or car.”

Compounding the stereotype that older adult wheelchair users will be pushed around by a caregiver, there may also be a lack of appreciation for wheelchair mobility skills, which do not come naturally.

Proper ergonomics are essential. After two years in a chair, shoulder joint pain and deconditioning is common, so users must learn how hard to push efficiently and how to relax.

“People push more often than they need to, and they just don’t realize it,” said Ed Giesbrecht, a PhD student in Rehabilitation Sciences, and one of the EPICWheels co-investigators.

Only a few of the challenges faced by wheelchair users include making turns tighter (for navigating smaller spaces) or turning without slowing down (by sliding one’s hand along a wall. Keeping a wheelchair straight on a side-sloping sidewalk can also cause frustration without proper technique. Similarly, obstacles such ramps require strength to go up while going down can be dangerous. Elevation changes are often best overcome by popping a wheelie.

Both studies are meant to test the feasibility of larger, multi-site trials, while also collecting preliminary results about the actual impact on wheelchair users. Dr. Miller hopes the studies demonstrate an impact, because too many wheelchair users are socially isolated or overly dependent on caregivers, due to a lack of skills or confidence in using the device.

 


The EPICWheels and WheelSeeU studies are both seeking research participants. To learn more, contact Kate Keetch, 604-714-4108, kate.keetch@vch.ca

 

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