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Getting a Manual Wheelchair Over a Threshold Using the Momentum Method: A Descriptive Study of Common Errors

      Abstract

      Objectives

      To (1) document the success of learners' attempts to overcome a threshold in a manual wheelchair while using the momentum method; (2) describe the frequency and nature of any errors observed; and (3) compare the characteristics of participants who were or were not successful on their first attempts.

      Design

      Cross-sectional, observational study following Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

      Setting

      Indoor obstacle course in a rehabilitation center.

      Participants

      Able-bodied students (N=214) learning the threshold skill.

      Intervention

      Participants attempted to get over the Wheelchair Skills Test (WST) threshold (2cm high, 1.5m wide, and 10cm in the line of progression) in a manual wheelchair.

      Main Outcome Measures

      From each participant's video recording of the first attempt, we assigned a WST score for the skill and described any errors noted.

      Results

      The WST scores for the first attempts were “pass” for 16 (7.5%), “pass with difficulty” for 100 (46.7%), and “fail” for 98 (45.8%). Eventually, requiring up to 6 attempts, 203 participants (94.9%) were successful (pass or pass with difficulty). Twenty-six different error types were identified. With the use of logistic regression analysis, the odds ratio of failing on the first attempt for women versus men was 2.71 (95% confidence interval, 1.23–6.00) (P=.0138).

      Conclusions

      Only about half of able-bodied people learning the threshold skill using the momentum method are successful on their first attempts, although almost all are successful with further practice and feedback. During the first attempts, there are a wide variety of errors, primarily in the popping phase of the skill. Those who are successful on their first attempts are more likely to be men. These findings have implications for the assessment and training of the threshold skill.

      Keywords

      List of abbreviations:

      WST (Wheelchair Skills Test)
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      References

        • Morgan K.A.
        • Engsberg J.R.
        • Gray D.B.
        Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives.
        Disabil Rehabil Assist Technol. 2015; 3: 1-11
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 335: 806-808
        • Kirby R.L.
        • Smith C.
        • Parker K.
        • et al.
        The Wheelchair Skills Program manual. Dalhousie University, Halifax, Nova Scotia, Canada.
        (Available at:) (Accessed March 14, 2017)
        • Borg J.
        • Larsson S.
        • Ostergren P.O.
        • Rahman A.S.
        • Bari N.
        • Khan A.H.
        User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.
        BMC Health Serv Res. 2012; 12: 330
        • Giesbrecht E.M.
        • Miller W.C.
        • Eng J.J.
        • Mitchell I.M.
        • Woodgate R.L.
        • Goldsmith C.H.
        Feasibility of the Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial.
        Trials. 2013; 14: 350
        • Sakakibara B.M.
        • Miller W.C.
        • Souza M.
        • Nikolova V.
        • Best K.L.
        Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study.
        Arch Phys Med Rehabil. 2013; 94: 1031-1037

      References

        • World Health Organization
        Guidelines on the provision of manual wheelchairs in less resourced settings.
        WHO Press, Geneva2008 (Available at:) (Accessed March 14, 2017)
        • Greer N.
        • Brasure M.
        • Wilt T.J.
        Wheeled mobility (wheelchair) service delivery: scope of the evidence.
        Ann Intern Med. 2012; 156: 141-146
        • Borg J.
        • Larsson S.
        • Ostergren P.O.
        • Rahman A.S.
        • Bari N.
        • Khan A.H.
        User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.
        BMC Health Serv Res. 2012; 12: 330
        • Toro M.L.
        • Eke C.
        • Pearlman J.
        The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia.
        BMC Health Serv Res. 2016; 16: 26
      1. Dynamic PubMed search for published papers regarding the wheelchair skills training.
        (Available at:) (Accessed March 14, 2017)
        • Keeler L.
        • Kirby R.L.
        • Hayden J.
        The effectiveness of the Wheelchair Skills Training Program (WSTP) compared to other training on wheelchair-related skills in adult wheelchair users: a systematic review.
        in: Proceedings of the European Seating Symposium. 2016 June 13-15 (Dublin (Ireland))
        • Sawatzky B.
        • DiGiovine C.
        • Berner T.
        • Roesler T.
        • Katte L.
        The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper.
        Am J Phys Med Rehabil. 2015; 94: 313-324
        • Kirby R.L.
        • Bennett S.
        • Smith C.
        • Parker K.
        • Thompson K.
        Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods.
        Arch Phys Med Rehabil. 2008; 89: 2342-2348
        • Kirby R.L.
        • Smith C.
        • Seaman R.
        • Macleod D.A.
        • Parker K.
        The manual wheelchair wheelie: a review of our current understanding of an important motor skill.
        Disabil Rehabil Assist Technol. 2006; 1: 119-127
        • Kirby R.L.
        • Smith C.
        • Parker K.
        • et al.
        The Wheelchair Skills Program manual.
        (Dalhousie University, Halifax, Nova Scotia, Canada. Available at:) (Accessed March 14, 2017)
        • Kirby R.L.
        • Dupuis D.J.
        • MacPhee A.H.
        • et al.
        The Wheelchair Skills Test (version 2.4): measurement properties.
        Arch Phys Med Rehabil. 2004; 85: 794-804
        • MacPhee A.H.
        • Kirby R.L.
        • Coolen A.L.
        • Smith C.
        • MacLeod D.A.
        • Dupuis D.J.
        Wheelchair Skills Training Program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 41-50
        • Best K.L.
        • Kirby R.L.
        • Smith C.
        • MacLeod D.A.
        Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial.
        Arch Phys Med Rehabil. 2005; 86: 2316-2323
        • Routhier F.
        • Kirby R.L.
        • Thompson K.
        Efficacy and retention of the French Canadian version of the Wheelchair Skills Training Program for manual wheelchair users: a randomized controlled trial.
        Arch Phys Med Rehabil. 2012; 93: 940-948
        • Rushton P.
        • Kirby R.L.
        • Miller W.C.
        Manual wheelchair skills: objective testing versus subjective questionnaire.
        Arch Phys Med Rehabil. 2012; 93: 2313-2318
        • Charbonneau R.
        • Kirby R.L.
        • Thompson K.
        Manual wheelchair propulsion by people with hemiplegia: within-participant comparisons of forward versus backward techniques.
        Arch Phys Med Rehabil. 2013; 94: 1707-1713
        • Hosseini S.M.
        • Oyster M.L.
        • Kirby R.L.
        • Harrington A.L.
        • Boninger M.L.
        Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 2237-2243
        • Kirby R.L.
        • Worobey L.A.
        • Cowan R.
        • et al.
        Wheelchair skills capacity and performance of manual wheelchair users with spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 1761-1769
        • Coolen A.L.
        • Kirby R.L.
        • Landry J.
        • et al.
        Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students.
        Arch Phys Med Rehabil. 2004; 85: 1160-1167
        • Kirby R.L.
        • Crawford K.A.
        • Smith C.
        • Thompson K.J.
        • Sargeant J.M.
        A wheelchair workshop for medical students improves knowledge and skills: a randomized controlled trial.
        Am J Phys Med Rehabil. 2011; 90: 197-206
        • Giesbrecht E.M.
        • Wilson N.
        • Schneider A.
        • Bains D.
        • Hall J.
        • Miller W.C.
        Preliminary evidence to support a “boot camp” approach to wheelchair skills training for clinicians.
        Arch Phys Med Rehabil. 2015; 96: 1158-1161