Best Practice Guidelines for Use of
Mobility Equipment within the
Educational Environment –
Practical Training
Department for Education Project
2011 – 2013
Outline of Presentation
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Introduction
Advantages of Independent Mobility
Importance of Seating and Postural Management
Measuring for the Correct Wheelchair
Tips for Wheelchair Skills Training
Any Further Information?
Introduction to Whizz-Kidz
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Medium sized national charity
Independence to enjoy an active childhood
Life Journey approach
Highly qualified mobility therapists
Partnership working within the NHS
What we do
We give disabled children and young people across the UK customised
mobility equipment, training, advice and life skills.
But more than this, we give them the independence to be themselves. We
make an immediate and life changing difference to them, their families and
their communities.
Introduction
Number of disabled children using
assistive technology has increased
by 60%
(Long et al 2003)
“…the window that enables a child to
have greater independence and more
active involvement in play.”
(Judge 2002)
Advantages of Independent Mobility
• A child is expected to learn
more about their world
through movement
• Benefits increase interactions
with people, objects and
surrounding environments
• Aids the development of
cognitive, emotional and
psychological skills
• Interactions create sense of
achievement and autonomy
leading onto further
exploration
Lack of independence may mean:
• decreased motivation
• reduced confidence
• feelings of frustration
• passive
• incurious
• learned helplessness
Nisbet 2002
Advantages of Independent Mobility
Research shows that children should be
provided with equipment to enable them to
become independent as close as possible to
the age when mobility would be occurring
naturally within normal childhood
development
Butler 1986
Posture and Seating
What is postural management?
“… the control of an individual’s body posture, recognising that postural
stability is a fundamental necessity for effective functional performance”
Three aims of seating intervention:
1. Seating for postural control and deformity management
2. Seating for pressure management
3. Seating for comfort and postural accommodation
Hobson and Molenbroek 1990
Importance of Postural Management
It is vital that children and young people who are seated in their
wheelchairs for long periods at a time recognise:
1. how important posture is
2. the influence it has on their everyday functioning
3. the problems it can cause
4. their reduced ability to change their own position, as well as the affects
of tone and gravity, can lead to serious secondary complications.
5. good seated posture relates to balance and stability
6. it is the method by which we support the body so that maximum
performance is achieved with minimal energy.
Importance of Good Posture
Did you know that poor seated posture can contribute to the
following problems?
• skeletal contractures
• tissue breakdown leading to pressure ulcers
• reduced functional performance
• respiratory difficulty and infections
• urinary tract infections
• digestive difficulties
• general discomfort and pain
Importance of Good Posture
Pelvis
Common pelvic deformities:
• Posterior pelvic tilt
• Anterior pelvic tilt
• Obliquity
• Rotation
Checklist
• Is the child’s pelvis level? Place
your hands on their hips and if
one looks higher than the other,
then they won’t be sitting level.
• Likewise, if one hand appears to
be further forward that the other,
then they are twisting their body.
• Are the child’s knees facing
forward or off to an angle? This
is also a good indication as to the
position of their pelvis.
Importance of Good Posture
Spine and Trunk
Common spine / trunk deformities:
• Scoliosis
• Lordosis
• Kyphosis
• Rotation
• Protraction
• Retraction
Checklist
• Are the child’s shoulders level and
front facing?
• Where is their head? Is it difficult
for them to look upwards?
• Do they lean on one of the
armrests more than the other?
• All these questions could indicate
that this individual requires
additional support in sitting, and if
not provided, could lead to longer
term problems with their spine.
Importance of Correct Size
Wheelchair
Children and young people who have issues with immobility, poor
postural control or decreased sensation frequently cannot maintain
proper positioning or are unaware that they are not maintaining an
upright, symmetrical posture.
As discussed previously, asymmetrical posture can lead to many
secondary complications with function, skin integrity, breathing,
swallowing and digestion. Therefore , it is imperative that the wheelchair
size be measured appropriately for them.
Wheelchair dimensions - width
Seat width is usually close to the hip width or the
widest part of the body.
Seat width too wide:
1) Pelvic obliquity and scoliosis
2) Effect positioning of secondary supports
3) Impede access to wheels or joystick
4) Impact upon accessibility
Seat width too narrow:
1) Create rotational deformities
2) Cause discomfort
3) Increase pressure on the thighs or lower legs.
Wheelchair dimensions - depth
The seat depth should be slightly shorter than the upper leg length.
Seat depth too long:
1) Create slumping in the seat, sliding out of seat, pressure problems
2) Increases overall frame length
3)Impede transfers
Seat depth too short:
1) Cause postural problems at pelvis
2) Increase pressure on buttocks
3) Impede transfers
Wheelchair Skills Training
• Providing disabled children with
wheelchairs means making sure
they know how to use them to
their full potential
• Improving confidence and
independence in the process
• Achieving individual potential
through a codified programme of
wheelchair skills training
• Schemes of work for complex
needs, beginners and advanced
users
Wheelchair Skills Training
Whizz-Kidz delivers
approximately 72 courses to 750
children and young people
40 schemes will be held within the
school environment
Involvement of school staff
promotes a ‘carry-over’ effect of
skills taught
Wheelchair Skills Training
Wheelchair trainer coordinators are
wheelchair users themselves, which raises
aspirations of the participants and provides
them with valuable role models.
Running these courses in schools
increases staff confidence and gives them
the chance to see the equipment in use.
Wheelchair Training Tips
Manual Wheelchair – Moving forward on a flat surface
1. Grasp the hand-rims and push
evenly with both hands.
2. Position hands at 11 o’clock for
starting the stroke.
3. Release hands at 2 o’clock for
finishing the stroke.
4. Use smooth strokes matching the
speed of the moving wheel.
5. Avoid jerky accelerations that could
cause the wheelchair to tip over
backwards.
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Registered Charity No. 802872
Wheelchair Training Tips
Manual Wheelchair – Moving forward on a flat surface
6) Lean forward to avoid lifting the front
wheels off the ground.
7) Push with longer, less frequent
strokes, allowing coasting where
possible.
8) Ask the user to touch their middle
fingers onto the axles during
recovery phase to reinforce a
circular propulsion pattern.
Wheelchair Training Tips
The recovery path of the stroke can be:
a) along the handrim
b) below the handrim
c) above the handrim
d) below and above the handrim
Below the hand-rims is commonly recommended.
Manual Wheelchair – Stopping
The rate of slowing can be controlled by how hard the hand-rims are
gripped. The hand-rims should run through the wheelchair user’s hands.
If the wheelchair user stops too quickly, they may tip over forwards. To
prevent this, the wheelchair user should lean back whenever they are
required to stop quickly.
Wheelchair Training Tips
Manual Wheelchair – Turning whilst moving forward
1) When turning around an object
(e.g. a corner wall), the turn
should not begin until the axles
rear wheels have reached the
object.
2) Slow down the inside wheel.
3) Push harder on the outside
wheel.
4) Break a turn down into its parts:
driving straight, turning, then
driving straight again.
Wheelchair Training Tips
Power Wheelchair – Moving forward on a flat surface
1) Don’t overcrowd the user. One person only taking charge and giving
instructions.
2) Driving the wheelchair in circles is an acceptable first time movement.
3) It is acceptable for the child to bump into things initially. If a child
persists in doing so intentionally, the instructor should consider greater
rewards for following instructions.
4) Power wheelchairs may be rear-, front- or mid-wheel- drive. This affects
the drive path and ease of moving wheelchair forward.
5) If the user is over-correcting when driving, changing the contact point
with the joystick may improve the fluidity of the driving.
6) If the user’s hand control is limited then alternative access can be
considered.
Wheelchair Training Tips
Power Wheelchair – Stopping
• The first instruction that a first time power chair user should understand
is ‘stop’.
• Explain to the child or young person that when the command to stop is
given, it must be acted upon.
• Demonstrate the command, and use a hand gesture to accentuate this.
• Make sure the user is clear on this instruction before they move the
wheelchair for the first time, and provide clear praise when this is
followed.
References
Butler C (1986) Effects of Powered Mobility on Self-Initiated Behaviours of Very
Young Children with Locomotor Disability Developmental Medicine & Child
Neurology Vol 28: 325-332
Hobson DA, Molenbroek JFM (1990) Anthropometry and Design for the Disabled:
Experiences with Seating Design for the Cerebral Palsy Population Applied
Ergonomics Vol 21(1): 43-54
Judge S (2002) Family-Centered Assistive Technology Assessment and
Intervention Practices for Early Intervention Infants and Young Children Vol 15(1):
60-68
Long T, Huang L, Woodbridge M, Woolverton M, Minkel J (2003) Integrating
Assistive Technology Into an Outcome-Driven Model of Service Delivery Infants
and Young Children Vol 16(4): 272-283
Nisbet PD (2002) Assessment and Training of Children for Powered Mobility in
the UK Technology and Disability Vol 14: 173-182