Manual wheelchairs are commonly used for everyday mobility among people with lower limb impairments, including persons with spinal cord injury (SCI). Manual wheelchair users often experience pain and chronic overuse injuries in their upper extremities, limiting their mobility and their ability to complete daily activities. The repetitive trauma of propelling a wheelchair may be a contributing factor to upper extremity pain and injury. The anatomy of the upper extremities is not designed for the number of repetitions and the amount of force involved in everyday wheelchair propulsion. Research has been conducted to identify recommendations for decreasing the number of repetitions and the amount of force involved with manual wheelchair propulsion; however, training on how to use a wheelchair, specifically propulsion training, is often not implemented during rehabilitation. Important steps in identifying strategies for teaching wheelchair propulsion and skills include exploring devices for training, understanding health care professional and wheelchair user perspectives of wheelchair training, and training based on motor learning approaches. Therefore, the overall goal of this project was to further explore methodology for training of new manual wheelchair users. To this end, we conducted three studies (Chapters 2-4). In study 1 (Chapter 2), we tested a wheelchair dynamometer roller system, the WheelMill System (WMS), on its use in simulating different surfaces (i.e., overground and ramps) and assessing propulsion variables that can be used for training new wheelchair users. We identified that the WMS has the ability to accurately simulate flat overground movement; however, the accuracy of the WMS was poor in simulation of ramps. Modifications to the software model and the addition of visual feedback may improve the accuracy of the simulation of ramps. The WMS was accurate in the quantification of biomechanical propulsion variables. In study 2 (Chapter 3), we identified perspectives of health care professionals and manual wheelchair users to assist in prioritizing the focus of wheelchair skills training of new manual wheelchair users. During focus groups, health care professionals and manual wheelchair users discussed if and how wheelchair propulsion biomechanics were taught and important skills that should be included in training. Results indicate that propulsion biomechanics were introduced but not addressed in detail. Important training components discussed include propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair, and navigating barriers such as curbs, ramps, and rough terrain. Health care professionals and manual wheelchair users identified many of the same skills as important but ranked them in a different order. In study 3 (Chapter 4), we piloted a wheelchair training program implementing aspects of motor learning for new manual wheelchair users and measured the impact of this program on wheelchair propulsion biomechanics and overall wheelchair skills. Post-training wheelchair biomechanics changed, as well as propulsion performance overground. Wheelchair skills did not change significantly post-training. Wheelchair training has the potential for change; however, there are many challenges associated with implementing training programs for new manual wheelchair users. Together, these results contribute knowledge to evidence-based approaches to teaching new manual wheelchair users with SCI how to efficiently and effectively use their wheelchairs. Specifically, we obtained information about technology for simulating and assessing manual wheelchair propulsion, perspectives of stakeholders with regard to the manual wheelchair training process, and methodology for training new manual wheelchair users.

This book provides a wide spectrum of readers with comprehensive but easily understandable protocols for the assessment and training of wheelchair skills. The Wheelchair Research Team at Dalhousie University and the Capital District Health Authority in Halifax (lead by the author) have focused on wheelchair safety and performance for three decades, as exemplified through the Wheelchair Skills Program. This is considered the top such program in the world. This new book is largely based on this program which has been accessed and utilized by over 75,000 people in 177 countries since 2007.

The guidelines focus on manual wheelchairs and the needs of long-term wheelchair users. The recommendations are targeted at those involved in wheelchair services, ranging from design and planning, to providing or supplying wheelchairs and their maintenance.

As anyone who has ever used a wheelchair knows, the world was not built with wheelchair access in mind. This guide can teach wheelchair users and their helpers to access the world with a full range of powered wheelchair skills. It is full of clear instructions, detailed illustrations, hints and techniques.

Seating and Wheeled Mobility: A Clinical Resource Guide presents clinical assessment considerations when working with a person with a disability who may need wheelchair seating for postural support, skin integrity, or a wheelchair base to best meet dependent or independent mobility needs. Michelle L. Lange and Jean Minkel have designed this text to support occupational and physical therapists, complex rehabilitation technology suppliers, and even third-party payers who are interested in wheelchair seating and mobility assessment and applications. Seating and Wheeled Mobility provides a wide spectrum of information from foundational information for those practitioners who are new to the field to in-depth, population-specific information for practitioners who perhaps have not worked with a particular population in the past. Information sharing, opportunities for demonstration and trial, and patience on the part of the clinician working with the person with a disability are all critical precursors to the actual process of making equipment recommendations. Seating and Wheeled Mobility is divided into sections, each addressing a different area of clinical practice. The first section is an in-depth presentation of the assessment process and the critical understanding of pressure management needed by the clinical team when working with a client population who rely on wheeled mobility. The second section focuses on postural support. Also included is a completely updated method to measure and describe the seated person and related support surfaces needed when recommending a device. The third section lays the foundation for clinical decision making around the assessment for and application of the most appropriate wheeled mobility device. The fourth section provides in-depth clinical applications for each category of mobility devices. Also addressed is proper documentation to assist in the funding of these devices. The fifth section provides population-specific information regarding the clinical application of position, pressure management, and functional mobility as it applies to the pediatric, geriatric, and bariatric populations, as well as persons with both degenerative and complex neuromuscular impairments. The last section presents additional considerations when working with persons who are aging with a disability, environmental assessments, transportation, and the application of standards. Seating and Wheeled Mobility: A Clinical Resource Guide provides the depth and breadth of the clinical practice of wheelchair seating and mobility to both those who are new to the field, as well as seasoned professionals.