For our country’s approximately 5.5 million wheelchair users, learning to use their chairs fully, safely, and sustainably is key to an independent and abundant life. Indeed, studies show if a wheelchair user’s skill level is low, so is their participation in and quality of life.
Wheelchair skills include movements like entering and exiting doors, navigating curbs, gaps, and thresholds, going up and down stairs, and moving from a wheelchair to a car, bus, or T — all without injury.
In a perfect world, a comprehensive wheelchair skills program would be taught by therapists before a patient is discharged from rehab and continue during outpatient therapy. Unfortunately, there are barriers to this type of program.
In a recent study, only 55% of wheelchair users reported receiving basic skills training before discharge. (Basic skills include things like how to push a wheelchair and maneuver in tight spaces.) Only 10% reported learning advanced skills.
The low percentages are due, in part, to a lack of therapist training. In a survey of occupational therapists, 25% reported receiving no manual wheelchair skills training, while 38% received less than 5 hours on basic skills.
Therapist also have less time to teach wheelchair skills. In the last 35 years, the length of rehab has decreased from 98 days to 37.
DR. LYNN WOROBEY
There are also competing concerns. “Patients with recent spinal cord injuries may be determined to re-learn how to walk or focus on nerve recovery,” says University of Pittsburgh’s Dr. Lynn Worobey. “That can take time away from learning mobility skills.”
Dr. Worobey is Assistant Professor in the Department of Physical Medicine and Rehabilitation and co-director of Pitt’s Model Center on Spinal Cord Injury (SCI). She studies SCI assistive technology, functional mobility, training programs, activity monitoring, and wheelchair quality.
Her most recent research focuses, in part, on supplementing clinical training with a virtual, direct-to-user manual wheelchair skills program that’s taught using a peer mentor method. Unlike previous successful in-person programs, this one takes place via video chat sessions.
“Virtual technology costs less than in-person sessions and reaches a wider audience,” Dr. Worobey explains. “The technology breaks down transportation barriers that can prevent people from learning in-person and connects them with peers from diverse backgrounds.”
Because it costs less, Dr. Worobey is hopeful rehab centers, community-based programs, and advocacy groups can better support it. “It could also create additional income opportunities by employing more people with spinal cord injuries who don’t need clinical degrees,” she adds.
In the study, peer mentors serve as wheelchair skills ‘coaches’ who share via video chat what they’ve learned navigating and mastering real-world mobility obstacles. “They’re passing along their lived experience,” says Dr. Worobey. “They’re teaching people how to do different types of wheelies, for example, or move smoothly from one type of surface to another or get safely on a subway from a platform.”
The lived experience increases a coach’s credibility, too. “The peer coaches are people who go to work, raise families, play adaptive sports — all while using a wheelchair,” she adds.
There are other benefits to the peer mentor method. It gives wheelchair users emotional, practical, and informational support. It provides a boost in confidence and self-esteem. It offers hope for the future by helping users see it’s possible to live an active, full life. It provides encouragement, friendship, and a sense of equality with peers. It normalizes the challenges and limitations people face when they use a wheelchair.
“Watching other wheelchair users demonstrate skills is important to the learning process,” says Dr. Worobey. “It motivates and empowers people in a profound way. As it decreases activity limitations it increases independence and life satisfaction.”
Timing is critical, too, which may be better supported by virtual training versus in-person. “Peer training can be a particularly important resource early after discharge from rehab,” Dr. Worobey explains. “That’s a time when new users are vulnerable to isolation and low levels of physical and social activity.
She continues, “We tend to also see larger gains for new wheelchair users compared to those with many years of experience. However, even experienced individuals who participated in our training — some of them 30 years after they were injured — still experienced meaningful improvements.”
The value of peer mentor training even extends to health outcomes. “People with spinal cord injuries who are independently mobile have been shown to have greater subjective well-being, participation, and health,” Dr. Worobey adds.
It’s good news for people whose mobility is wheelchair based. “After a spinal cord injury or neurological disorder, a person may feel their life is less than it was,” she says. “This new virtual program may help to change that by making it easier and faster for them to learn the skills they need to live fully and joyfully on wheels.”
Dr. Worobey encourages readers to listen to and amplify wheelchair users’ voices. For example, look around your neighborhood from a mobility standpoint. How might a wheelchair user attend your church, visit a local bank, barber or beauty shop, or catch the bus or T? If there are physical barriers, identify them and make local leaders aware. Readers can also support inclusive policies when they vote and challenge ableism.
NOTE: Dr. Worobey’s study also includes remote wheelchair skills training for clinicians.
