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.

Mobility is fundamental to health, social integration and individual well-being of the human being. Henceforth, mobility must be viewed as being essential to the outcome of the rehabilitation process of wheelchair dependent persons and to the successful (re-)integration into society and to a productive and active life. Many lower limb disabled subjects depend upon a wheelchair for their mobility. Estimated numbers for the Netherlands, Europe and USA are respectively 80.000, 2,5 million and 1,25 million wheelchair dependent individuals. Groups large enough to allow a special research focus and conference activity. Both the quality of the wheelchair, the individual work capacity, the functionality of the wheelchair/user combination, and the effectiveness of the rehabilitation programme do indeed determine the freedom of mobility. Their optimization is highly dependent upon a continuous and high quality research effort, in combination with regular discussion and dissemination with practitioners. The book intends to give a state of the art view on the current fundamental, clinical and applied research findings and their consequences upon wheelchair propulsion, arm work, wheelchair training and possible consequences of a wheelchair confined life style. Also its implications for rehabilitation, as well as alternative modes of ambulation and activity in the wheelchair confined population, such as functional electrical stimulation and its possible future developments, are dealt with.