Best Practice Guidelines for Use of
Mobility Equipment within the
Educational Environment
Department for Education Project
2011 – 2013
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Outline of Presentation
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Introduction
Advantages of independent mobility
Educational outcomes of independent mobility
Posture and seating
Wheelchair skills training
Risk assessments
Transitional stages
Transportation
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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.
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Introduction
• Number of disabled children using
assistive technology has
increased by 60% (Long et al
2003)
• Wheelchair as means to
independence (Wiart et al 2003)
• More prominent existence of
wheelchairs in educational milieu
• Developments in assistive
technology provides increased
opportunities for inclusion
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Advantages of Independent Mobility
Children learn more about their
world through movement
• Interaction with people,
objects and environment
• Development of cognitive,
emotional and psychological
skills
• Sense of achievement and
autonomy, leading on to
further exploration
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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 access to a wheelchair 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)
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Educational Outcomes of
Independent Mobility
Educational outcomes:
Section 351 of Educational Act 1996:
• Specified National Curriculum
standards
• Attainment of formal
qualifications
• Friendships that will be made
• Acceptable social behaviours
that will be shaped
1. Promotes the spiritual, moral,
cultural, mental and physical
development of pupils at the
school and of society.
2. Prepares pupils at the school
for the opportunities,
responsibilities and
experiences of adult life.
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Educational Outcomes of
Independent Mobility
Achievement of educational outcomes for
disabled children requires:
• An inclusive attitude
• Adaptation of curriculum
• Provision of right equipment at the right time
• Including the children, parents, staff in decision
making to reduce anxieties, increase confidence,
and facilitate inclusion
• Facilitate skills in the environment they are used
• School staff to be involved in wheelchair skills
training to be able to reinforce skills
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Posture and Seating
What is posture?
The way we hold ourselves.
Three aims of seating intervention:
1. Maximise function
2. Minimize secondary complications
3. Facilitate comfort
(Pope 2007)
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Posture and Seating
Good posture:
Poor posture can lead to:
1. Energy efficient
2. Enables function
3. Does not cause damage
(Pope 2007)
• Contractures and deformities
• Pressure ulcers
• Reduced function
• Respiratory difficulty and
infections
• Urinary tract infections
• Digestive difficulties
• Discomfort and pain
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Posture and Seating
Key stone pelvis
•Posterior pelvic tilt
•Anterior pelvic tilt
•Pelvic obliquity
•Pelvic rotation
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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. Impede access to wheels or joystick
3. Impact upon accessibility (i.e. doors)
Seat width too narrow:
1. Create rotational deformities
2. Cause discomfort
3. Increased risk of pressure areas
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Wheelchair dimensions - depth
The seat depth should be slightly shorter than the upper leg length.
Seat depth too long:
1. Posterior pelvic tilt, slumping in the seat, sliding out of seat, pressure and
shear
2. Increases overall frame length
3. Impede transfers
Seat depth too short:
1. Increased pressure on buttocks
2. Anterior pelvic tilt, drag on legs
3. Postural adaptation to have more base of support
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Wheelchair Skills Training
A vital part of providing disabled
children with wheelchairs means
making sure they know how to use
them to their full potential
• How to get the most of the
wheelchair
• Improving confidence and
independence
• Achieving individual potential
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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
• Increases teaching staff confidence
and gives them the chance to see the
equipment in use.
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Basic 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.
6. Lean forward to avoid lifting the front wheels off the ground.
7. Push with longer, less frequent strokes, allowing coasting where
possible.
8. Touch middle fingers onto the axles during recovery phase to reinforce
a circular propulsion pattern.
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Wheelchair Training Tips
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.
Manual Wheelchair – Turning whilst moving forward
1. The turn should not begin until the axles rear wheels have reached the
object (e.g. corner / wall)
2. Slow down the inside wheel.
3. Push harder on the outside wheel.
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Wheelchair Training Tips
Power Wheelchair – Moving and stopping
1. One person only taking charge and giving instructions.
2. The first instruction that a first time power chair user should understand
is ‘stop’.
3. Driving the wheelchair in circles is an acceptable first time movement.
4. It is acceptable for the child to bump into things initially.
5. Consider greater rewards for following instructions.
6. Power wheelchairs may be rear-, front- or mid-wheel- drive. This affects
the drive path and ease of moving wheelchair forward.
7. If the user is over-correcting when driving, changing the contact point
with the joystick may improve the fluidity of the driving.
8. If the user’s hand control is limited, then alternative access can be
considered.
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Risk Assessment
School environment
Size and type of wheelchair prescribed
is based on user’s needs, therefore the
environment needs to be adapted:
• Access to buildings and play areas
• Steps
• Steepness of ramps
• Doorways and corridors
• Turning space
• Toileting and changing facilities
• Storage and charging
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Risk Assessment
Use of harnesses and belts
“…should never be provided for the
purpose of preventing problem
behaviour, although, in extreme
circumstances, they might be used to
manage risks.” DOH 2002
• Multidisciplinary risk assessment
• Documentation in care plan
• Wheelchair providers policy will
probably state for ‘postural use
only’ but will not be in a position to
monitor
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Risk Assessment
Manual Handling
• Legislation indicates best practice for
pushing / pulling of wheelchairs (HSE,
revised 2004)
• Risk assessment for moving and handling
• Slings left in situ might impact on postural
and pressure management
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Wheelchair provision during
transitional stages
Whizz-Kidz endeavours to pre-empt key transitional stages within a child
and young person’s life, so that the right mobility equipment is provided at
the right time.
Primary School- to move from a buggy to a wheelchair
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Independence
Interaction with peers
Element of growth in equipment
Low seat to ground height
Wheelchair provision during
transitional stages
Secondary School – to move towards powered mobility
• Should be planned in proceeding 12 months
• Powered mobility for less efficient selfpropellers
• Increase independence
• Conserve energy
• Risers for accessing alternative school
environment
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Wheelchair provision during
transitional stages
Adulthood – further education, employment, socialising
• Additional features onto
powered wheelchairs i.e.
lights, indicators, increased
speeds
• Promote independence
• Improve social, educational
and employment interactions
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Support during transitional stages
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Ambassador Clubs
Kidz Unlimited
Skillz for Life
Camp Whizz-Kidz
Work Experience Placements
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Guidance on the use of transport
services
Minimum standards which are advocated for a user who travels in
their wheelchair in a vehicle:
• Users should transfer into vehicle seats if possible
• Users should not travel with the wheelchair at an angle or facing
sideways
• Wheelchair brakes should be on and power switched off
• Headrest should be provided
• Wheelchair needs to be tied down and user is appropriately restrained
(Guidance on the Safe Transportation of Wheelchairs MDA 2001)
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Guidance on the use of transport
services
According to the MDA 2001:
“… in the small number of injuries and fatalities recorded, investigations
reveal that the cause is rarely attributed to a piece of faulty equipment.
The majority are the result of inappropriate, inadequate or incorrectly
used equipment.”
Main problems include:
1) Lack of consistent communication
2) Lack of product information
3) Inadequate training
4) Inappropriate use of Wheelchair Tiedown and Occupant Restraint
Systems
5) Not securing unoccupied wheelchairs
6) Incorrect use of tail lifts / ramps
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Further Information
Whizz–Kidz webpage
 News and Resources
 Guidance for Schools and Families
http://www.whizz-kidz.org.uk/newsandresources/guidance-forschools-and-families/
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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
Department for Education and Skills (2004) Five Year Strategy for Children and
Learners: putting people at the heart of public services London: HM Government
Department of Health (2002) Guidance for restrictive physical interventions: How to
provide safe services for people with learning disabilities and autistic spectrum
disorder London: Department of Health
Education Act (1996) (c.56) London: HMSO
Health and Safety Executive (2004) Manual Handling Operations Regulations 1992
(revised)
Health and Safety Executive (2011) Five Steps to Risk Assessment London: Health
and Safety Executive
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References continued
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
Medical Devices Agency (2001) Guidance on the Safe Transportation of
Wheelchairs Belfast: Northern Ireland Adverse Incident Centre
Nisbet PD (2002) Assessment and Training of Children for Powered Mobility in the
UK Technology and Disability Vol 14: 173-182
Pauline Pope (2007) Severe and Complex Neurological Disability: Management of
the Physical Condition Amsterdam: Elsevier
Wiart L, Darrah J, Cook A, Hollis V, May L (2003) Evaluation of Powered Mobility
Use in Home and Community Environments Physical and Occupational Therapy in
Paediatrics Vol 23(2): 59-76
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