Individual Skill
Training
Goal? (Y/N)
#
Capacity
Score* (0-2)
Wheelchair Skills Test (WST) Version 4.2 Form
Manual Wheelchairs Operated by Their Users
Name of wheelchair user: _______________________
Tester: _________________ Date: ________________
Comments
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2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Rolls forwards (10 m)
Rolls backwards (2 m)
Turns while moving forwards (90°)
Turns while moving backwards (90°)
Turns in place (180°)
Maneuvers sideways (0.5 m)
Gets through hinged door
Reaches high object (1.5 m)
Picks object up from floor
Relieves weight from buttocks (3 sec)
Transfers to and from bench
Folds and unfolds wheelchair
Rolls 100 m
Avoids moving obstacles
Ascends 5° incline
Descends 5° incline
Ascends 10° incline
Descends 10° incline
Rolls across side-slope (5°)
Rolls on soft surface (2 m)
Gets over gap (15 cm)
Gets over threshold (2 cm)
Ascends low curb (5 cm)
Descends low curb (5 cm)
Ascends curb (15 cm)
Descends curb (15 cm)
Performs stationary wheelie (30 sec)
Turns in place in wheelie position (180°)
Descends 10° incline in wheelie position
Descends curb in wheelie position (15 cm)
Gets from ground into wheelchair
Descends stairs
Total score:*
%
* See score options and formula for calculating total score on page 2
1
WST 4.2 Form for MWCs operated by Users
Originally approved for distribution and use: April 3, 2013; Current version: April 3, 2013
Comments:
Training goals:
Person (if any) and address to whom the test subject would like a copy of the report to be sent:
Score
Pass
Pass with difficulty
Fail
Not possible
Testing error
Score
2
1
0
NP
TE
Scoring Options for Individual Skills
What this means
Task independently and safely accomplished without any difficulty.
The evaluation criteria are met, but the subject experienced some difficulty worthy of note.
Task incomplete or unsafe.
My wheelchair does not allow this skill. (Only for skills where a NP score is noted as a
possibility in the script.)
Testing of the skill was not sufficiently well observed to provide a score
Formula for Calculating Total Scores
Total Capacity Score = sum of individual capacity scores/([32 – # of NP and TE scores] x 2) X 100%
Copies can be downloaded from www.wheelchairskillsprogram.ca
2
WST 4.2 Form for MWCs operated by Users
Originally approved for distribution and use: April 3, 2013; Current version: April 3, 2013