WHEELCHAIR PROPULSION:

OVER OBSTACLES:

STAIRS

Greater than normal strength in anterior deltoids, biceps, brachialis, and/or brachioradialis, serratus anterior, latissimus dorsi, and triceps to ascend and descend stairs on buttocks
Greater than normal strength in anterior deltoids and in the biceps, brachialis, and/or brachioradialis, plus some strength in the middle and posterior deltoids and fully innervated upper extremities, to ascend in wheelchair
Greater than normal strength in anterior deltoids and biceps, brachialis, and/or brachioradialis, and some strength in middle and posterior deltoids to descend stairs in wheelchair holding the rail
Greater than normal strength in posterior deltoids and in the biceps, brachialis, and/or brachioradialis, and some strength in the anterior and middle deltoids, the serratus anterior, triceps, and hand musculature, plus some innervation in the upper extremities, to descend in wheelie

Greater than normal range in shoulder extension, and normal range in scapular abduction, adduction, downward and upward rotation, shoulder flexion and internal rotation, and elbow flexion and extension to ascend on buttocks and in wheelchair and to descend on buttocks. Also normal range in finger flexion to ascend and descend on buttocks.
Normal range in scapular abduction and upward rotation, shoulder flexion, extension, internal and external rotation, and elbow flexion and extension to descend in wheelchair holding rail
Normal range in scapular abduction and adduction, shoulder extension and internal rotation, elbow flexion and extension, and finger flexion to descend in wheelie

Ability to transfer between wheelchair and floor; position buttocks and legs on step; tilt wheelchair back, push wheelchair down to stabilize, position buttocks and legs, pull wheelchair up to upright position while sitting on a step; and transfer wheelchair up a step to ascend and descend stairs on buttocks; also ability to lower chair and transfer down a step to descend on buttocks
Ability to belt self into chair, lower chair in position to ascend, reposition hands while sitting in chair tilted back on steps, push on step while sitting in chair, and return chair to upright to ascend stairs in wheelchair
Ability to sit in chair and lower it down stairs while holding stair handrail(s) to descend in this position, and ability to glide forward and back, turn, position wheels at top of step, stabilize wheels against step, and descend step while in wheelie

Ascending Stairs on Buttocks - To perform this skill, which is slow but requires less strength than ascending in a wheelchair, the patient:

Transfers from the wheelchair to a low, or the lowest step; positions the buttocks securely on the step; positions the legs laterally, aligned with the body's midline, facing down the steps; bends the knees and leans them against each other; positions the chair by propping on one arm, grasping the chair with other hand, turning the chair so it faces away from the stairs with the rear wheels against the lowest step; tilts the chair back; and places the push handles on the highest step they will reach

Transfers up the stairs, one step at a time, by placing both hands on the next higher step, leaning back, pushing down to clear the edge of the higher step with the buttocks, and then depressing the shoulders and tipping the head forward, to lift the buttocks onto and place them well to the back of the next higher step
Positions the legs by flexing the knees and placing the feet flat on the lower step

Pulls the chair along, by placing the hand farthest from the chair on the next higher step, slightly lateral to the trunk, propping on this arm, leaning back, pulling the chair up a step with the other hand, and simultaneously bearing down on the push handle and holding the chair to keep it from falling

Repeats the processes of transferring up, positioning the legs, and pulling the chair up a step until the landing is reached, the chair is pulled onto the landing, righted away from the edge, and the patient transfers from the floor to the chair

Descending on Buttocks - To perform this skill, the patient reverses the steps used in Ascending Stairs on Buttocks.
Ascending in Wheelchair - To perform this skill, which is faster, cleaner, and safer for the skin than ascending on the buttocks, but requires fully innervated upper extremities, the patient:

Belts him/herself into the chair, by encircling the thighs and the chair seat with the belt
Backs up to the stairs, grasps the handrail(s) of the stairs, pulls on the rail(s) to tilt the chair back, and lowers him/herself until the push handles rest on a step
To ascend, places the hands on the step, just above the step on which the push handles rest, and pushes down forcefully to lift the buttocks and the wheelchair

Moves the hands one at a time to the next higher step, by balancing on one arm and moving the other arm (to prevent the chair from falling back down the stairs), and repeats the steps to ascend the stairs to the landing, where the chair is pulled away from the stairs and righted.

Positions the chair close to one rail at the top of the stairs and facing away from the stairs

Grasps the rail firmly (by placing the hand of the arm, closest to the rail, lower on the rail than the other hand), pulls on the rail to move the chair to the edge of the top step, leans the trunk forward as the tires move past the edge of the step, and controls the descent of the chair by maintaining a grasp on the rail and sliding the hands down the rail as the chair is lowered

In Wheelie - To perform this skill, which is fast, does not require handrails, and is safest for a small series of stairs in which the steps have large horizontal surfaces, the patient with fully innervated upper extremities:

Approaches the stairs in a wheelie and positions the wheels at the edge of the top step, and then pushes forward on the handrims until the tires are over the edge of the step and the chair begins to descend, at which point he/she grips the handrims and controls the chair's descent

As the wheels reach the next lower step, pulls back on the handrims, until the wheels press against the vertical surface of the higher step, to stabilize the chair. The process is then repeated until the chair is lowered down one step at a time