Living with a spinal cord injury (SCI) presents numerous challenges, particularly when it comes to mobility. For many individuals, wheelchairs are not just a necessity but an extension of their body, enabling them to navigate the world. However, the efficacy and quality of life for wheelchair users are highly contingent upon several factors, including:
- wheelchair skills,
- proper seating,
- and fitting.
In this blog, we explore the importance of these three factors in optimizing mobility and independence, drawing from research on the Wheelchair Skills Test (WST). We also discuss how they can influence physical activity levels and participation in recreational sports among individuals with SCI and other wheelchair users.
Table of Contents:
- The role of wheelchair skills in enhancing mobility
- Proper seating and fitting for effective wheelchair use
- Physical activity and sport participation for wheelchair users
- Enhancing physical activity participation using Wheelchair Skills Test
- The role of physiotherapists in supporting wheelchair users
- Conclusion
The Role of Wheelchair Skills in Enhancing Mobility
Studies have shown that individuals with higher wheelchair skills experience greater mobility and independence in their daily lives. Research also indicates that proficiency in wheelchair skills is directly correlated with increased participation in community activities and physical exercise.
The Wheelchair Skills Test (WST) is a standardized assessment tool that evaluates a wheelchair user’s ability to perform essential tasks such as propulsion, turning, and negotiating obstacles.[i] A study found that individuals with higher WST scores were more likely to engage in physical activities, including recreational sports, which are vital for maintaining overall health and well-being in people with SCI.[ii]
This is particularly important as regular physical activity can mitigate secondary complications associated with SCI, such as cardiovascular disease, obesity, and depression.
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Proper Seating and Fitting for Effective Wheelchair Use
While developing wheelchair skills is essential, the foundation of effective wheelchair use lies in proper seating and fitting. Let’s examine what these terms mean and how they apply to wheelchair use.
The seating system of a wheelchair must be tailored to the user’s specific needs, considering factors such as body size, shape, posture, and the level of injury. Proper seating and fitting are not just about comfort; they play a critical role in preventing pressure sores, reducing pain, and enhancing overall functionality.
For individuals with SCI, proper seating can reduce or eliminate a host of complications, including skin breakdown, musculoskeletal deformities, and respiratory issues. A well-fitted wheelchair provides optimal support and alignment, allowing the user to perform daily activities with minimal effort and strain. Moreover, it enhances the user’s ability to propel the wheelchair, which is crucial for maintaining an active lifestyle.
In the case of powered wheelchairs, proper fitting is equally important. These devices are often equipped with various features such as adjustable seating, tilt-in-space functions, and specialized controls, which must be customized to the user’s needs. One study highlighted the importance of proper fitting in powered wheelchair users, demonstrating that those with well-fitted wheelchairs had significantly better mobility outcomes and higher satisfaction levels.[iii]
From a clinical perspective, clients I’ve seen who have an appropriately fitted wheelchair will be more confident and likely to use their wheelchair in a variety of situations. In addition, with some advances in wheelchair accessories, I’ve been able to see our clients living with SCI take part in activities that were once considered unlikely (e.g., wheeling on trails or uneven terrain, going for more strolls with family members).
You may also enjoy reading: A Customized Wheelchair Improved My Mobility and Independence
Physical Activity and Sport Participation for Wheelchair Users
Physical activity and recreational sports are vital components of a healthy lifestyle, particularly for individuals with SCI. However, participation in these activities is often influenced by the individual’s wheelchair skills and the quality of their seating and fitting. Research has shown that individuals with higher levels of wheelchair skills are more likely to engage in regular physical activity, which in turn can lead to improved health outcomes.
Research suggests that individuals with higher Wheelchair Skills Test scores were more likely to participate in sports such as wheelchair basketball, rugby, and tennis.[iv] These activities not only provide physical benefits but also contribute to social integration and psychological well-being. Moreover, participation in sports can foster a sense of accomplishment and empowerment, which is particularly important for individuals adjusting to life after SCI.
Wheelchair sports require a high level of skill, including the ability to maneuver the chair quickly and accurately, maintain balance during rapid movements, and perform complex maneuvers such as wheelies. Developing these skills requires practice and training, but the benefits are substantial. Engaging in sports can improve cardiovascular fitness, muscle strength, and endurance, all of which are critical for maintaining health and preventing secondary complications in individuals with SCI.
Mastering and teaching wheelchair skills is essential in physiotherapy to enhance our clients’ quality of life and independence. At Propel Physiotherapy, we recognize that developing these skills is crucial.
Some of the most technical and challenging movements in my physiotherapy career involve wheelchair skills. In particular, the ability to transfer from the floor to one’s seat (see video below ) and balancing a wheelie to clear the front casters from a barrier are incredibly demanding. These movements require extensive practice, not just for our clients but for therapists as well. It is our responsibility to demonstrate, teach, and ensure our clients are safe with their wheelchairs and the skills needed to use them effectively.
You may also enjoy reading: Sport in Spinal Cord Injury Rehabilitation
Enhancing Physical Activity Participation Using Wheelchair Skills Test
The Wheelchair Skills Test (WST) is not just a tool for assessing current abilities; it can also be used to predict future participation in physical activities and sports. Research has shown that higher WST scores are associated with greater likelihood of engaging in recreational activities.[v] This is important for clinicians and physiotherapists, as it provides a means of identifying individuals who may benefit from additional training or support to enhance their participation levels.
Evidence demonstrates that WST scores could predict the level of participation in wheelchair sports, with higher scores indicating a greater likelihood of involvement.[vi] This predictive capability is valuable for physiotherapists working with individuals with SCI, as it allows for the development of targeted interventions aimed at improving wheelchair skills and encouraging active lifestyles.
Moreover, the WST can be used to track progress over time, allowing clinicians to assess the effectiveness of interventions and adjust treatment plans accordingly. Regular assessment with the WST can help ensure that wheelchair users continue to improve their skills and maintain their independence, ultimately leading to better health outcomes and quality of life.
Clinically, the Wheelchair Skills Test does take a lot of time and effort to complete, which may limit its use in an outpatient or community-based setting. I’ve found it useful to use some portions of the WST to help some of my clients with SCI navigate around their practical and patient-specific goals. In addition, there is a WST- Questionnaire that helps to provide some information for the client’s self-reported abilities in order to get an understanding of their capabilities while using their wheelchair.
You may also enjoy reading: Meaningful Goals Fuel Motivation
The Role of Physiotherapists in Supporting Wheelchair Users
As physiotherapists, our role in supporting wheelchair users extends beyond traditional rehabilitation exercises. We must take a broader and holistic approach, addressing all aspects of mobility, including wheelchair skills, seating, and fitting. By doing so, we can help our clients achieve their full potential, enabling them to lead active and fulfilling lives.
One of the key aspects of our work is providing education and training in wheelchair skills. This includes teaching clients how to propel their chairs efficiently, navigate different terrains, and perform essential maneuvers. We must also work closely with clients to ensure that their wheelchairs are properly fitted and adjusted to meet their specific needs. This may involve collaborating with occupational therapists, seating specialists, and equipment providers to create a customized seating system that offers optimal support and comfort.
Furthermore, we should encourage our clients to participate in physical activities and sports, as these can have profound benefits for their physical and mental health. By promoting an active lifestyle and providing the necessary training and support, we can help our clients overcome the barriers associated with SCI and achieve greater independence and quality of life.
During my career at Propel Physiotherapy and other research positions I held, I can recount that the clients who were more skilled at using their wheelchairs were, indeed, more participatory in the community and at home. Participation would take the form of increased independence preforming activities of daily living (e.g., grooming, feeding, toileting) or instrumental activities of daily living (e.g. grocery shopping, chores, errands).
Clients with increased wheelchair skills also demonstrated improved independence in attending their clinical appointments and were often able to progress their goals quicker and were more resilient to any barriers that could get in the way.
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You may also enjoy reading: Physiotherapist’s Guide: Promoting Physical Activity to Clients with Spinal Cord Injuries
Conclusion
Wheelchair skills, proper seating, and fitting are fundamental to the well-being and independence of individuals living with spinal cord injuries. The ability to effectively use a wheelchair not only enhances mobility but also plays a critical role in predicting and promoting participation in physical activities and recreational sports.
As physiotherapists, we have a vital role in supporting our clients in developing these skills and ensuring that they have access to the best possible seating and equipment. By doing so, we can help our clients lead healthier, more active, and fulfilling lives.
At Propel Physiotherapy, we have extensive experience conducting wheelchair seating and fitting assessments, and prescribing appropriate seating devices. We strive to help our clients achieve their goals by providing thorough assessments, and using the findings to match our clients with the device that best suits their needs.
You may also enjoy reading: Maintaining Heart Health with Spinal Cord Injury
We have physiotherapists that are Assistive Devices Program (ADP) Authorizers, including Kyle Whaley, Sarah Cross and David Friesen, experienced in complex seating systems as well as straightforward prescriptions for manual and/or power wheelchairs, seating systems, and scooters.
Contact us for more information about our wheelchair seating and fitting assessment services.
References
[i] Kirby, R. L., Smith, C., Parker, K., McLean, D., & Thompson, K. (2004). The Wheelchair Skills Test: A pilot study of a new outcome measure. Archives of Physical Medicine and Rehabilitation, 85(12), 1974-1978.
[ii] Mulroy, S. J., Thompson, L., Kemp, B., Hatchett, P. P., Newsam, C. J., & Lupold, D. (2010). The impact of wheelchair propulsion technique on shoulder pain and dysfunction in long-term users. Archives of Physical Medicine and Rehabilitation, 91(7), 1080-1085. https://doi.org/10.1016/j.apmr.2010.03.014
[iii] Sonenblum, S. E., Sprigle, S., & Maurer, C. L. (2012). Use of power tilt systems in everyday life. Disability and Rehabilitation: Assistive Technology, 7(6), 481-490. https://doi.org/10.3109/17483107.2011.648237
[iv] Tolerico ML, Ding D, Cooper RA, Spaeth DM, Fitzgerald SG, Cooper R, Kelleher A, Boninger ML. Assessing mobility characteristics and activity levels of manual wheelchair users. J Rehabil Res Dev. 2007;44(4):561-71. doi: 10.1682/jrrd.2006.02.0017. PMID: 18247253.
[v] Boninger, M. L., & Cooper, R. (2007). Assessing mobility characteristics and activity levels of manual wheelchair users. Journal of Rehabilitation Research and Development, 44(4), 561-571. https://doi.org/10.1682/jrrd.2006.10.0127
[vi] Best, K. L., Routhier, F., Sweet, S. N., Borisoff, J., & Kirby, R. L. (2016). The relation between wheelchair mobility and participation in life situations among manual wheelchair users in Canada. Disability and Rehabilitation: Assistive Technology, 11(2), 119-123. https://doi.org/10.3109/17483107.2014.1002543
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