Initiating Movement

The first rule for pushing someone in a wheelchair is to ask permission and make sure the consumer is ready to be pushed. If possible, the guide should make sure that the consumer's feet and hands are in a safe position to be pushed. Sometimes, the consumer will rest her hands on the push bars of the wheels while sitting in place. If the surface is sloped, either the guide or the consumer will have to hold onto something or apply the brakes to keep the chair from moving with gravity. Remember, each time movement is reinitiated, the guide should confirm that the consumer does not have a foot on the ground or a hand in a place where it could get caught by doorframes, tables, chairs, or parts of the wheelchair. When stopping, if the guide plans to let go of the manual chair, he should let the consumer know, or even ask the consumer to apply the brakes. Otherwise, if the consumer is sitting on a slope and the guide lets go, the chair may move on its own.

Some people with electric chairs or scooters don't mind if another person operates the controls of the chair and/or helps steer. Once the techniques are learned, this can be the easiest way to guide consumers who use electric chairs or scooters. First, ask the student to turn the power/speed control to a low setting. The chair controls are very sensitive and are more difficult to control from the side than from the seat. If the speed is set to where the guide can walk comfortably while moving the joystick or speed lever to the full speed forward position, it will be easier to drive the chair with a fluid motion. When the speed controls are set too high, the student may be thrown forward and backward in the chair. If the joystick is pushed only half or two-thirds of the way forward, the chair may start and stop with a jerking motion. Some people don't mind if the guide adjusts the speed control, but again, ask first. Never change the chair settings without the consumer's permission.

Watch Video HG3a: Human Guide: Chair speed controls.

In the beginning, guides may have a difficult time operating electric wheelchairs or scooters from the front. The guide should be at the student's side and face the same direction that the student is facing. Once familiar with the chair's controls, it is possible to drive from the front, but at first it is too easy to make mistakes and cause the student to be thrown around within the chair.

On most electric scooters, the throttle control lever on the right-hand side is the easiest from which to guide. Facing the same direction as the student, the guide pushes the drive lever forward to initiate forward movement. It is much more difficult to walk on the left-hand side of the scooter and have to pull the throttle control lever backward (to initiate forward movement) while trying to walk forward.

Watch Video HG3b: Human Guide: Throttle control levers on a scooter.

Another method to initiate movement is to have the student hold the guide's arm while she controls the chair's movements herself. This takes practice and requires that the student have adequate arm strength, flexibility, and awareness of the guide's arm movements. Some people can hold the guide's arm but do not have fast enough reactions to respond to movements of the guide's arm in a timely manner. Instead of holding at the elbow, it is easier for the student to put her hand on top of the guide's forearm, which is held parallel to the floor. This allows the guide to point his arm in the direction they want to turn. This facilitates smooth turns, especially turns toward the wheelchair user. If the student is holding the guide's arm and does not react to the guide stopping, the guide can lift his arm, raising the student's hand to shoulder level. This movement reinforces the signal to stop.

As happens in Video HG3c, the wheelchair user may touch the wall when stopping her chair in a tight or narrow space. While it is best not to touch the wall, it may be unavoidable at times; so the student should travel slowly and proceed with caution.

Watch Video HG3c: Human Guide: The stop signal.

For manual chairs, the forearm position allows the guide to help pull the chair, while the student pushes the wheel on the opposite side of the guide with her other hand. The student in a manual chair may want to place her grasping hand in the crook of the guide's elbow; this allows the guide to assist more with chair propulsion. If the chair is unintentionally turning away from the guide, the guide should slow down so that the student's free hand, the one turning the wheel on the opposite side of the guide, can keep pace. If the chair is turning toward the guide, the student can either decrease the rate with which she is pushing (turning the wheel with the opposite side hand) or can apply pressure to the guide's arm. This will push away and straighten the chair. If she keeps her elbow rigid and pushes on the guide's forearm, similar to a football running back stiff-arming a tackler, the pressure on the guide's arm will keep the chair from turning toward the guide. Some students have the ability to turn their manual chair by using a stiff arm on the guide's arm and rotating the lower body to turn the manual wheelchair in the desired direction.

Watch Video HG3d: Human Guide: Stiff arm turns in a manual chair.

Finally, if the student has sufficient vision and adequate reaction times, she can visually follow her guide. Make sure that the student observes the guide's movements and is not just blindly tagging along.

By picking a particular spot on a guide's body to follow, such as a belt or the transition from shirt to pants, many people can detect the drop or rise at stairs or ramps.

Remind students not to cut corners. Humans handle corners more sharply than wheelchairs. Both beginning and longtime wheelchair users need to remember to use landmarks when making turns. (See chapter 8, Tight Spaces and Doors.)

Following Distance

To check the following distance for a student who visually follows a guide, have the student follow as the guide walks down the hall. If the guide randomly adjusts speed or stops suddenly, the student should neither come close to running into the guide nor be significantly behind the guide. If the consumer comes close to running into the guide, she needs either to reduce her power/speed control or follow at a greater distance. (WARNING: Watch out for beginners. Until the student has had enough practice to be consistent when stopping, she may run into the guide. The instructor may want to start with other tasks related to chair propulsion as described in chapter 6, Chair Operations). Instead of following directly behind the guide, the student may need to follow a line of travel just to the side of the guide, but maintain focus on the guide instead of her own path. Once the student becomes proficient at stopping when the guide stops, she can follow directly behind again.

Turning

Often, visually impaired wheelchair users have a harder time maintaining their position at the side of their guides than their ambulatory peers. Generally, as the guide turns, the consumer will follow the elbow through the turn. For wheelchair users, the size of the chair makes it harder to keep the appropriate distance and position. Some chairs have wider turning radii than those to which the guide is accustomed.

When the turn is to the guide's side, the guide may need to make a wider turn, move sideways, or even back up a step to allow the wheelchair to make its turn. For tight turns with the manual chair, the guide may need to back up while the student holds the opposite side wheel in place. The guide then pulls the chair, causing the nearside wheel to move backward and creating a turn toward the guide.

Watch Video HG3e: Human Guide: Manual chair pivot turn toward the guide.

When the guide initiates the turn toward the student's side, or away from the guide, the guide moves his arm away from his body, which allows him to step across in front of the wheelchair. Most students and consumers find it easier to point across their body with the guiding arm; this indicates the need to turn, and it allows the student to control the speed of the turn.

Watch Video HG3f: Human Guide: Pivot turn away from the guide.

If the student turns with too wide of an arc, the guide's arm will bring the student's hand (the one grasping the guide's arm) toward the student's face. This usually gets the student's attention, causing her either to stop or to turn more sharply. If the student stops and does not have room to continue the turn, due to a drop-off, wall, or other obstacle, she can finish the turn backing up. The guide should raise his arm to indicate the stop, and then keep his hand up, moving it backward slightly to indicate the need to back up. Once the student has backed up far enough, the guide brings his arm down and they complete the turn. If turning toward the student, the guide's arm should extend across the student to indicate the desire to turn toward her.

Watch Video HG3g: Human Guide: Backing up to complete a turn in an electric wheelchair.

With a manual chair, the student facilitates a turn away from the guide by pulling backward on the far wheel rail, while pulling on the guide's arm to keep the wheel closer to the guide from also going backward. Once the opposite side wheel starts moving backward, the guide moves forward at an angle in the direction of the desired turn. This creates a forward movement of the wheel closer to the guide, making an even sharper turn (pivot-in-place turn). To turn toward the guide, the student stops, grasps the wheel farther from the guide, and holds it in place. The student's arm holding the guide is kept rigid so that when the guide backs up, the near wheel starts moving backward. Once they have turned far enough, the student can start pushing the far wheel forward to finish the turn.

Watch Video HG3h: Human Guide: Backing up to complete a turn in a manual wheelchair.

Most electric scooters, especially the four-wheel models that are safer for outdoor travel, have extremely wide turning radii. The procedure of backing up to finish a sharp turn is very common. In fact, turning around in a hallway often requires a three-point turn. When turning left, the student turns the tiller as far as possible to the left and continues moving forward as space allows. The guide should stop with room to spare in case the student pushes the throttle control lever the wrong way when attempting to back up. The student then turns the tiller as far to the right as possible before backing up. To back up with the right hand, the student should push the throttle control lever back toward herself. Once she has backed up far enough to clear the obstruction, the student turns the tiller back to the left to finish the turn. The process is the same when the guide is driving.

Watch Video HG3i: Human Guide: Making a 3-point scooter turn.

Narrow Passages

Unless the chair is being pushed, or the student is following the guide visually, there is only one way to negotiate narrow passages: The guide must get in front of the chair and walk backward through the narrow space. This requires a lot of practice when done with electric wheelchairs and scooters and should be practiced in a wide open space until the guide becomes consistent with driving the chair in a straight line while standing in front, facing the chair. To begin, always set the speed control on electric chairs and scooters at a low setting. It is very difficult for the guide to drive slowly enough to prevent running over himself with the chair. The guide must line the chair up with the narrow passage, step in front, face the chair, and then slowly walk backward through the opening. The guide will need to watch both sides of the chair and adjust the line of travel to make sure the chair doesn't hit the barriers to either side. If the student is driving the electric chair or scooter and holding onto the guide's arm, the guide should hold his forearm horizontal across the front of the chair. This allows the student to move her hand to a comfortable position on the guide's arm, ideally the center of the forearm. The student should have her arm fully extended when grasping the guide's arm.

Watch Video HG3j: Human Guide: Navigating narrow passages with an electric wheelchair and scooter.

If the chair is manual and there is not a threshold, the arm positions are the same as on an electric wheelchair. If there is a threshold, the guide holds his arm in the same manner, but the student reaches over the guide's arm to allow for a stronger grip. The stronger grip allows the guide to help pull the chair over the threshold, and it gives the student something solid against which to pull. Once the guide is in front, the student may want to stop pushing the wheel and move her arm to her lap to keep it from hitting the doorframe. If the guide and students are reaching across their bodies, the student may choose to slide her grasp down to just above the guide's wrist. If the student still has trouble getting over the threshold, she may need to release the guide's arm and grasp the doorframe for better leverage. To back through a narrow passage, the student slides her hand to the front of the guide's forearm so he can push against it. When passing through a spring-loaded doorway, the guide may need to change hands so that his free hand is closer to the door. The student may need to have her free hand be the one farther from the door so that she can grab the doorframe to help pull her over the threshold.

Watch Video HG3k: Human Guide: Navigating narrow passages with a manual wheelchair.

Navigating Doorways

Strategies for traveling through doorways depend on a number of factors.

• Direction the door opens (in vs. out, right vs. left)
• Type of chair
• Physical abilities of the consumer
• Guiding technique

No matter which guide method is used, there are techniques to make passage through doorways easier.

Push Doors — Manual Wheelchairs

Manual wheelchairs should be driven straight up to the center of a push door. The student, if able, should lean forward and push the door open; the guide pushes the chair and takes over the door when it comes within reach. The guide should be prepared to give verbal cues about the location of the doorknob. With practice, students will find the doorknob themselves; but for learning purposes and when expediency is needed, the guide may provide verbal prompts.

Watch Video HG3l: Human Guide: In a manual wheelchair using arms to push a door open.

There are doors that do not require that the handle be pushed to open the door. In this case, the guide can push the student to the door and the student can push the door open with her feet.

Watch Video HG3m: In a manual wheelchair using feet to push a door open.

If the student cannot assist with opening the door, the guide may push her straight up to the door, step to the side of the chair, and push the door open. The guide then pulls the chair's armrest to start the chair through the open doorway. The guide steps behind and resumes pushing. This requires the guide to lean forward while pulling the chair across his midline, potentially straining his back. Extreme caution should be used with this technique.

Watch Video HG3n: In a manual wheelchair pushing a door open with no assistance.

If the student does not have enough trunk control to lean over or enough ability in her arms, the guide may choose to turn around and back through the door. The student may hear to which side the door opens and use a modified upper-forearm protective technique. The arm should extend to the side of the chair, parallel to the floor, with the elbow bent. The elbow should not be bent to the point where it sticks out farther than the hand. Some students learn to use their hands to hold the door away from the wheelchair, but others use their forearms. Take care that the student does not get her fingers caught between the door and the frame. If the student is holding the guide's arm, the guide turns around and backs through the door. They may have to change hands so that both the guide and the student have their free hands on the same side as the door. If the door has a threshold, the student may want the other hand free to pull on the doorframe and assist with clearing the threshold. If the student cannot help hold the door when backing through, the guide has to get to the end of the door, hold it open with his foot, and spin the chair back around before letting go of the door.

Watch Video HG3o: Using a manual wheelchair and backing through a push door.

Push Doors — Electric Wheelchairs

If the student has an electric wheelchair, the guide should steer the chair straight up to the door and then turn to step in front of the student and walk backward through the door. The guide needs to get his hand on the door side free to hold the door open. For doors that open to the same side as the joystick, the guide can hold the door open and drive the chair past the door. For doors that open on the side away from the joystick, the student will need to help with the door. If the student doesn't have the dexterity to hold the door open with her hand, she can use an elbow or forearm to hold the door open or let the door slide back and rest on the chair as she goes through. If the student is holding the guide's arm, the guide will still step in front and turn to face the student. The student slides her hand down to the guide's wrist. If the door opens to the joystick side, the student sticks her elbow out to hold the door open. If the door opens to the other side, the guide can hold the door open until the student passes all the way through.

Watch Video HG3p: Human Guide: Using an electric wheelchair with a push door.

Push Doors — Scooters

Strategies to navigate doorways in scooters depend on the direction the door opens (push versus pull or right versus left), physical abilities of the student, whether the student is holding the guide's arm, or whether the guide is driving.

With push doors, the chair should be driven straight up to the center of the opening. The guide steps in front of the chair and turns to face the student. If the student is holding the guide's arm, and the door opens to the right or to the side from which the student is driving, the student maintains contact with the guide's arm as they back through the doorway. The guide holds the door open as long as possible. The student can't help with the door because she needs one hand to hold the guide's arm and the other to drive. If necessary, release the door to be caught by the armrest or back of the chair as the student passes through the doorway.

Watch Video HG3q: Human Guide: Using a scooter with a push door.

For doors that open to the left or to the side opposite of the hand driving, the guide should switch arms so the hand closer to the open door is free to hold the door. The student should hold the guide's forearm near the wrist to make it easier for the guide to adjust the student's line of travel. The guide should lean forward and back up to increase the distance between himself and the front of the scooter. As the scooter passes the door, the guide turns and changes arms again.

Watch Video HG3r: Human Guide: Using a scooter with a push door that opens to the left.

When the guide operates the controls, the scooter should be driven straight up to the center of the doorway. The guide turns around to back through the door. The student helps hold the door open. If the door opens to the student's side, the guide does not have to change hands. The student holds the door open until the doorway is cleared.

If the door opens to the guide's side, the guide steps in front and faces the student, but then changes hands to drive. The student holds the door open until the doorway is cleared.

Watch Video HG3s: Human Guide: Using a scooter with a push door when the guide drives.

Pull Doors — Manual Wheelchairs

When a guide pushes a manual wheelchair to a pull door, the student can assist with the door. Push the chair up to the handle side of the door and turn the front of the chair slightly to the right; this puts the student's left hand closer to the door. Once the student grasps the door and starts to pull it open, pull the chair backward and gradually turn the feet to face the opening doorway. Once the door is perpendicular to the wall, and the student faces the opening, the guide releases the left handle and grasps the open door. The student puts her left hand on the door and either stiff-arms the door to keep the chair from turning left into the door, or uses a patting pattern to push away the door each time the hand comes in contact with it.

Watch Video HG3t: Human Guide: Going forward in a manual wheelchair and pulling a door open.

If there is not room for the chair at the side of the door, the guide can push the chair up at an angle with the student's feet pointing into the corner. When the student grabs the handle, the guide pulls the chair back to allow the door to pass the corner of the chair. The student passes the door to the guide, and the guide pushes the student through.

Watch Video HG3u: Human Guide: No room for a manual wheelchair when pulling a door open - Option 1.

Another alternative is to push the chair toward the door, but just before reaching it, turn the chair 180 degrees, in the direction of the door hinges, to put the back of the chair to the door. The guide opens the door and holds it with his back as the two continue to turn in the same direction to complete a 360-degree turn. The guide and student pass forward through the doorway.

Watch Video HG3v: Human Guide: No room for a manual wheelchair when pulling a door open - Option 2.

The guide may choose to approach the doorway with the side of the chair to the doorway, open the door, and then turn the chair to face the door and push the student through. The guide holds the door open with his foot as he uses both hands to turn the chair. If the guide struggles when turning the chair with the handles, he can grab the armrest or the front corner of the seat to initiate the turn.

Watch Video HG3w: Human Guide: No room for a manual wheelchair when pulling a door open - Option 3.

If the student is unable to assist with the door, the guide may step to the side of the chair, open the door, reach behind the chair to the handles, and push the chair through. Or, if there is room to the side of the door, the guide may grab the door and pull the chair back as he opens the door, then turn the chair to face the opening and push the chair through the door. Another option is for the guide to open the door, grab the armrest to start pulling the chair through, and then step behind the chair as it passes.

Watch Video HG3x: Human Guide: In a manual wheelchair pulling a door open with no assistance.

If the student is holding the guide's arm, the guide will need to step in front of the student and back through the door. If the student can help with the door, she can put up her hand or an elbow, or allow the door to drag along the side of the chair. If the floor is smooth, the student will want to have the hand on the door side free. If the chair hangs up on the threshold, the student can reach out to the doorframe with both hands and use the doorframe to pull herself through the door. If the manual chair won't climb the threshold going forward, turn the chair around and proceed backward over the threshold. It is easier to navigate thresholds as well as other obstacles, such as large cracks, with the bigger back wheels in the lead. To back over a crack or threshold, have the student lean forward or shift her weight over the front of the chair to reduce the chance that the chair will tip over backward when it hits the crack or threshold. A student in a manual chair may not be able to assist with the door. In this situation, the guide can turn the chair far enough that he can reach the door handle, then back up and turn the chair to face the opening as the door is opened. The chair may have to be turned 90 degrees from the line of travel, parallel to the closed door, to allow the guide to reach the handle. There must be enough room to the handle side of the door for the chair to sit clear of the door swing arc. The guide may need to use his foot, and then an elbow to hold the door open as the chair passes through the opening. If there is not adequate room to the handle side of the door, the guide may have to step in front of the chair to open the door, and then pull the chair past himself through the opening.

Watch Video HG3y: Human Guide: In a manual wheelchair pulling a door open using an arm lead and navigating a threshold.

Pull Doors — Electric Wheelchairs

If the guide is driving through pull doors, steer the chair to the knob side of the door, then step in front and open the door. If the student can grab the door, pass the door to her and steer the chair through the opening. On either side, the guide can hold the door open until the chair is almost all the way through. The door may swing closed and hit the back of the chair, but this shouldn't damage the chair.

If the student is holding the guide's arm, then she does not have a hand free to help with the door, so the guide needs to hold it open as long as possible. The guide switches hands to have the one nearer the open door free. The student slides her hand to the guide's wrist. The guide can turn sideways as the chair passes through the doorway to hold the door open as long as possible. If the door is on the joystick side, the guide will need to change back to the other side to continue walking.

Watch Video HG3z: Human Guide: In an electric wheelchair pulling a door open.

Pull Doors — Scooters

When teaching a student to pull a door open, it is easiest to direct the scooter to the handle side of the door. If the student is holding the guide's arm and the door opens to the guide's side, the guide will need to turn to face the student and change arms so that the guide's hand nearer the open door is free. As the student passes through the door, she drives the scooter over the threshold and past the guide.

Watch Video HG3aa: Human Guide: Pulling a door open while using a scooter - Door opens to guide's side.

If the door opens to the student's side, the guide does not change arms, but may have a harder time holding the door. As the scooter enters the doorway, the guide may have to lean over the front of the scooter to keep the door open. The student cannot let go of the tiller to help hold the door open; she must maintain forward movement. The guide may have to let the door swing closed to rest on the armrest or seatback as the scooter clears the threshold. If the door is approached from the side, have the student pull forward, straight toward the open door, until most of the scooter is in the opening. Keep the scooter away from the wall and it will be easier to turn. The student should turn the tiller as far as it will go to create the sharpest turn possible.

Watch Video HG3bb: Human Guide: Pulling a door open while using a scooter - Door opens to student's side.

When the guide is driving and the pull door is on the student's side, the guide backs through the door. Since the guide is driving, the student can put up a hand to hold the door open.

When a pull door opens to the student's side, direct the scooter to the handle side of the door. If the scooter is left far enough back from the wall, the guide can initially turn the tiller toward the door handle and pull forward until the front of the scooter is centered in the opening. The tiller is then turned to face the door opening. Since the guide is driving, the student puts her hand up to hold the door open until she passes the threshold.

Upon pulling up to the door, if the scooter is too close to the wall, the guide may have to turn the tiller to point away from the doorway. Back the scooter up to turn the front of the scooter toward the open door. The tiller is then turned to face the door handle and the scooter is pulled forward until the nose of the scooter is in the middle of the opening. Once there, the tiller is turned to face the opening and the guide drives forward through the doorway. The student holds the door open until the scooter passes the threshold.

Watch Video HG3cc: Human Guide: Pulling a door open when the guide is driving.

Changing Sides

If it is necessary to change sides when guiding a wheelchair user, it is best to break contact, walk to the other side of the wheelchair, and reinitiate contact. There are a few situations where this is not practical. Electric wheelchairs should be guided only from one side. Scooters can be guided from either side, but it is definitely easier to guide from the side that allows the person who is operating the throttle control lever to use the right side of the lever. When the chair is on a hill or slope, the student may need to apply the brakes, hold the wheels, or do something else to keep the chair from moving when the guide breaks contact to change sides.

In some cases, the area being traveled may be too narrow for the guide to walk around to the other side of the chair. An example is a narrow sidewalk or hallway where there is only room for the chair and one person beside it; the chair is along the edge of the path. The guide directs the student away from the edge first, changes sides, and switches arms.

About Face

For those unfamiliar with standard Orientation and Mobility techniques, performing an About Face means that the guide and consumer turn to face each other, change arms, and then turn again to complete a 180-degree turn. The technique is valuable for turning around in cramped environments. Performing the About Face procedure in a wheelchair can be very difficult, depending on the type of chair.

The About Face places the guide on the wrong side of an electric wheelchair for guiding. Scooters need a lot of room to turn 180 degrees. Use a three-point turn if needed.

To perform the About Face with a manual chair, follow these steps:

1. Give the prompt to start an About Face.
2. The student and guide turn to face each other. To do this, the student pushes forward with her hand on the wheel opposite the guide, while she pushes forward with the other hand, which is grasping the guide's arm. (This initiates backward movement of the wheel closer to the guide.)
3. The student grasps the guide's free arm, releasing the arm she was holding at the beginning.
4. Simultaneously, the student pulls her wheel backward with her free hand, while she pulls back on the guide's arm. (This initiates forward movement of the wheel that ends up closer to the guide.)

In steps 2 and 4, the guide can assist with the turn by resisting the pull or push pressure from the student and by moving his arm to keep the movement going until 90-degree turns are completed.

Watch Video HG3dd: Human Guide: About Face in a manual wheelchair.

Curbs

Frequently, consumers encounter areas that have sidewalks without curb ramps. Some of these curbs can be independently and safely navigated, while others cannot. If a student cannot independently navigate a curb that does not have a curb ramp, she should use a spotter. (See chapter 9: Sidewalk Travel for determining the height of drop-offs and spotting at drop-offs.) In all cases, the wheelchair needs to ascend or descend the curb in a line of travel perpendicular to the line of the curb. The wheelchair may tip over if it hits the curb at an angle. If the student hits a curb or large crack, the chair may stop suddenly, throwing the student forward. If the student hits the curb at an angle, she may be thrown forward or sideways, or the chair could tip.

Always bring a student back to the drop-off that was missed and re-examine why the drop-off was not detected. The curb could have been missed due to going too fast, not attending, or not feeling the feedback from the cane.

If a scooter or electric chair does not have solid handles on the back, the guide cannot help lift the chair up to the curb or lower it off the curb. The guide should spot the driver while she navigates the curb. The guide puts a hand on each corner of the seatback to stabilize the chair as it goes up or down while he sits back to use his own body weight to counterbalance the wheelchair. The chair still has the potential to tip over, but this procedure reduces the risk. Be prepared to brace the chair if it goes off of the side of the sidewalk. Some consumers may choose to transfer out of the chair, have it lifted up or down, and then transfer back to the chair.

Watch Video HG3ee: Human Guide: Bracing a wheelchair at a drop-off.

For manual chairs and electric chairs that do have strong handles on the backrests, the guide and student must decide if they will attempt to negotiate the curb going forward or backward. It is easier to negotiate a curb going forward if the guide is strong enough to put the chair easily into a wheelie. If the guide is uncertain of his ability to lift the chair, it may be easier to go backward. In all cases, the guide is positioned behind the chair and helps raise or lower the chair. The student also helps by using the wheels to pull the chair or slow the descent.

Curbs — Manual Wheelchairs

If curbs have to be navigated with a manual chair, the guide should put the wheelie bars up and when finished, return them to the down position. The student can help by lifting or lowering the wheel rails as the two of them navigate the curb.

To ascend a curb when facing forward:

1. The guide puts the chair into a wheelie.
2. The chair is pushed forward until the large rear wheels hit the curb.
3. The front wheels are lowered to the sidewalk.
4. The guide lifts the handles and pushes forward.

To ascend a curb when facing backward:

1. The chair is turned around and the large wheels are backed against the curb.
2. The guide pulls back on the handles, without lifting, to put the chair into a wheelie.
3. The guide leans the chair back until it is balanced between wanting to fall forward and wanting to fall back, roughly a 45-degree angle.
4. The guide leans back and bends his knees. The guide should lift with his knees, leaving his arms fully extended. The guide should not lift straight up, but up and back at the same angle at which the chair is eaning.
5. As the chair ascends the curb, the guide steps back, keeping the chair in the wheelie position until the front wheels clear the edge of the curb.

To descend a curb facing forward:

1. Approach the curb and put the chair into a wheelie.
2. The guide pushes the chair up to the edge of the curb, making sure that both of the large wheels reach the curb at the same time.
3. As the chair starts over the edge, the guide steps forward with one foot and bends that knee as the chair descends. The chair should be lowered by bending the knees, not by bending over with the back. The arms should be fully extended during the whole process. If the elbows are bent before starting the descent, the chair may fall too quickly.
4. The front wheels should be lowered before pushing the chair forward away from the curb.
5. The guide should make sure that the student's hands are clear of the rails before he continues to push. Put the wheelie bars/anti-tippers back in the down position.

To descend a curb facing backward:

1. Approach the curb and turn the chair around.
2. The guide backs the chair to the edge so that the chair is perpendicular to the line of the curb and so that the wheels will hit the edge at the exact same time.
3. The guide grasps the handles and leans slightly into the chair.
4. Initially the chair is pulled backward, but as the chair starts over the edge, the guide also lifts up to keep the chair from descending too quickly. Once the large wheels hit the ground, the guide stops lifting and starts pulling back and pushing down on the handles to keep the chair in a wheelie.
5. Turn the chair to swing the front wheels off the curb.

Watch Video HG3ff: Human Guide: Ascending and descending curbs in a manual wheelchair.

If a curb is not navigated correctly, there is potential for both the guide and the student to become injured. The risk is greater when the person in the wheelchair is heavy.

If the wheelie bars are left down, it is likely that the chair will get stuck. The large wheels will be floating and all the weight will be on the wheelie bars. It is very hard to roll the chair on the wheelie bar casters. The guide may not be able to transition the student off of the curb and will have to push the student back on the curb.

If needed, teach the student to ask for assistance. Most consumers cannot reach their own wheelie bars. At a minimum, all students and consumers should be able to describe the process to their potential guides.

Watch Video HG3gg: Human Guide: Wheelie Bars.

If the guide is concerned about lowering the weight of the person in the chair, the student in the chair may be able to help. The student can help by grasping the wheel rails with fully extended arms and gradually bending the elbows, slowing the descent of the chair and reducing the weight being lowered by the guide. If the student leans forward, it helps to keep weight over the front wheels of the chair, lessening the burden on the guide and reducing the chances of tipping over backward.

To ascend the curb, if the guide cannot put the student in a wheelie facing forward, position the large wheels against the curb to provide a solid fulcrum point against which the guide can pull. If the guide struggles to initiate the wheelie, most likely she is pulling down more than back.

The person in the wheelchair should lean back so that the weight is distributed more to the rear of the chair. If the person in the wheelchair leans forward, the weight is distributed more toward the front.

It is important to lift in the plane parallel to the back of the chair. Lifting higher than the plane pushes the front wheels back to the ground. Pulling lower than the plane causes the chair to lean backward.

If the wheels are not even upon ascending the top edge of the curb, the wheelchair may rock, making it hard to maintain the balance point over the large wheels. It is a good idea to practice lifting an empty wheelchair up onto a curb to get the feel of the chair, the bend of the knees, and the angle of the plane in which to lift.

When trying to pull someone who is heavy up the curb, it is important that the wheelchair remain balanced over the large wheels, that the guide pull the chair along the plane that maintains that balance, and that the guide’s body move backward at the same rate as the chair. When lifting, guides should always lean back so their legs and body are parallel with the back of the chair. They should bend their knees and have their arms fully extended. Legs are much stronger than arms and should do most of the lifting; never lift using the back. As the chair comes up, the guide must take a step back and continue moving back while maintaining the angle of the wheelchair.

When finished, always remember to return the wheelie bars to the down position.

Watch Video HG3hh: Human Guide: Mistakes and corrections when ascending curbs.

Curbs — Electric Wheelchairs

It is possible to ascend and descend small curbs using an electric wheelchair. An electric wheelchair user must drive the chair in a manner that will help, not hinder or endanger, the guide. If the student lacks good control of the joystick, disengage the automatic brakes. If the wheelchair has wheelie bars or anti-tippers, they may need to be placed in the up position to allow the chair to ascend or descend the curb.

To ascend a curb in an electric wheelchair with handles:

1. The student faces the curb.
2. When the front wheels hit the curb, the guide pulls back on the handles as the student drives forward. This creates a wheelie for the front wheels to climb the curb.
3. When the rear wheels hit the curb, the guide pushes forward and lifts up to help the back wheels climb the curb.
4. If there is an obstacle in front of the student, the guide must be ready to perform an emergency stop.

To descend a curb in an electric wheelchair with handles:

1. The guide makes sure that the wheelchair is perpendicular to the curb, with its back to the drop-off.
2. The guide grabs the seatback handles.
3. As the student backs up, the guide braces the chair by lifting slightly as the rear wheels drop off. The student drives slowly and stops when the back wheels hit the ground.
4. The guide pushes down and pulls back on the handles as the student again backs up to bring the front wheels off of the curb.
5. Rear-wheel-drive chairs can be brought into a wheelie to back the front wheels off of the drop-off.

Without handles, the procedures are essentially the same; however, the guide grasps the corners of the seatback instead of the handles. He will also change slightly the way he pushes or lifts the chair.

To ascend a curb in an electric wheelchair without handles:

1. The guide grabs the corners of the seatback and pulls back until the front wheels climb the curb. It may help for the student to stop once the front wheels are up.
2. The guide pushes forward and up on the seatback to help the bigger mid or rear wheels up the curb. The guide should be ready to stop the chair in case the student fails to stop once the rear wheels are up.

Troubleshooting:

One wheel climbs the curb and the other wheel doesn't or is slower to climb the curb.

Response: The guide braces the wheelchair by holding the seatback corners.

The chair struggles when climbing the curb.

Response: The guide needs to extend his arms, tighten his abdominal muscles to support his own back, and assume a seated "in the air" position. This allows the guide's body weight to pull back on the chair, which helps to facilitate the climb.

The curb being climbed is not perpendicular to the line of travel.

Response: The student repositions the chair to be perpendicular to the line of the curb. If crossing with near parallel traffic, the student may need to pull up to the angled portion of the curb to wait for traffic in the parallel street to clear; turn to reposition the chair. If the student must drive into the street, it is important to make sure there is room at the side of the street for the chair and the guide. It also helps to wait for a gap in traffic before pulling into the street and turning.

To descend a curb in an electric wheelchair without handles:

Small or sloped curbs can be descended facing forward, but larger curbs must be negotiated by backing off the curb.

1. The student backs the chair to the edge of the curb.
2. The guide grabs the top corners of the seatback and pushes forward and up as the chair starts over the edge.
3. When the large wheels drop off, the guide switches to pull back and down on the seatback to slow the descent of the front wheels.

Troubleshooting:

The drive wheels end up off the ground while the chair sits on the casters and anti-tippers.

Response: The guide pulls the chair backward to get it to move.

To drive off curbs facing forward, the guide grabs the two corners of the seatback and pulls back and down as the front wheels go off of the drop-off. In reality, it is almost impossible for the guide to pull back hard enough on the seatback to pop the electric wheelchair into a wheelie. The purpose of pulling backward is to slow the descent of the chair and to keep it from tipping over.

Not all guides can perform these techniques, and taller curbs may not be navigable. What is or is not navigable depends on the height of the curb, the design of the chair, and both the guide's and the student's skills. The guide and the student should start with smaller curbs and build up to larger ones.

Watch Video HGii: Human Guide: Ascending and descending curbs in an electric wheelchair.

Stairs

Stair navigation is possible for people in manual chairs with handles on the back. For all other chair types, the wheelchair user transfers out of the chair; the guide carries the chair up or down the stairs and then carries or assists the person in some other way up or down the stairs. Some part-time wheelchair users are able to walk up or down stairs on their own or with assistance from the guide. For any of these techniques to work, the guide must be strong enough to execute the technique safely and repeatedly for each stair or level change. The guide does not lift all of the person's weight when ascending stairs with a manual chair. He lifts the person for each riser in the stairway and keeps the chair in the leaned-back position for the extended period it takes to ascend the stairs. Before an attempt to ascend stairs is made, the guide and the student should practice on curbs. If they struggle ascending the curb, they should not attempt stairs. The guide may also practice with an empty chair before attempting curbs or stairs with a person in the chair.

Many wheelchair users without visual impairments have learned to navigate stairs and escalators safely and independently. It is not recommended that wheelchair users with vision impairments try to navigate stairs or escalators without assistance. If they do attempt this, it should only be with the consent of and very close supervision from a Physical Therapist or Occupational Therapist.

Ascending Stairs in Manual Wheelchairs

One Assistant/Helper

1. Flip the wheelie bars to the up position.
2. Approach the staircase and turn the chair around so that both back wheels hit the floor riser at the same time. The guide, with his back to the stairs, ascends the first step and then places one foot on the second step.
3. The guide pulls the chair into a wheelie and leans the chair back until the seatback is parallel with the ascent of the stairs and the wheelchair is balanced on the large rear wheels.
4. The guide bends at the knees and pulls the wheelchair parallel to the line of ascent, lifting with his legs and not with his back. The guide pulls the chair up onto the stair while he steps up with one foot to the next stair. The student helps to climb the stairs by pulling up on the wheel rails. The student's arms are fully extended before the guide starts to pull the chair up and bent when the chair is on the next stair. The student should resume full arm extension before the guide pulls her up again.
5. The guide continues to alternate his step up to the next stair with pulling the chair up, keeping it tilted back.
6. Once the chair has reached the top stair, the guide makes sure that the front wheels are clear from the lip of the top stair tread before he lowers the front wheels down.
7. The guide makes sure that the student's hands are clear of the rails and that he puts the wheelie bars/anti-tippers back in the down position before he continues to push the wheelchair.

Caution: The consumer should try to not lean forward or backward suddenly because it may cause the chair to overbalance one way or the other.

Watch Video HG3jj: Human Guide: Ascending Stairs.

Descending Stairs in Manual Wheelchairs

One Assistant/Helper

1. Flip the wheelie bars to the up position.
2. The guide puts the chair into a wheelie.
3. The guide pushes the chair forward until the back wheels are at the edge of the top stair.
4. The guide keeps his arms fully extended as he pushes the chair off the edge of the top stair. The student bends her elbows before starting the descent and gradually lets her elbows straighten through the descent, or she starts with the arms fully extended and lets the wheel rails slide through her hands slowly.
5. Once the back wheels land on the second stair, the guide stops the descent and takes his first step. The guide may have an easier time stepping down if he turns his body slightly sideways. His foot steps down between the wheels of the wheelchair.
6. The guide continues to alternate lowering the chair one stair at a time with his step down.
7. The guide makes sure that the student's hands are clear of the rails and that he puts the wheelie bars/anti-tippers back in the down position before he continues to push the wheelchair.

Watch Video HG3kk: Human Guide: Descending Stairs.

Two Assistants/Helpers

If the chair is too heavy for the guide to manage, he can use one or more assistants. The procedure for the guide behind the chair is the same as described above. The assistant in front of the chair is there to spot the guide, but can also help to lift or lower the chair. The danger is that the person in front may lift farther or faster than the person behind the chair. This causes the chair to tip farther back, possibly overbalancing it onto the person behind. It is also important not to lift the chair completely off the stair. The assistant in front should never lift from a piece of the chair that is detachable. The footplates and armrests of many chairs are removable and can come off when used to lift the chair. The frame just above the front caster wheels is a good place from which to lift, but the assistant should make sure that the wheels do not pinch his fingers.

Watch Video HG3ll: Human Guide: Ascending and descending stairs with two helpers.

Escalators

Yes, escalators! Wheelchair navigation on an escalator is much easier than it sounds. It should, however, only be done in emergencies or when there are no other options available except for stairs. Manual wheelchair users without vision impairments independently navigate escalators. It is not recommended that wheelchair users who have a visual impairment do so without someone to spot for them. The student who uses an electric chair or scooter must be able to drive onto the escalator independently. The guide can help the student line up to the escalator, but the student must drive straight on and manipulate the chair in the correct direction to keep the chair wheels up against the escalator risers. The guide (spotter) should move to the back of the wheelchair before the student drives onto the escalator.

If the Orientation and Mobility specialist is not absolutely confident that the consumer's safety can be maintained, the instructor should contact a Physical Therapist, Occupational Therapist, or another O&M instructor who is experienced in teaching these skills. Most emergency personnel will not know how to handle these situations and may need instruction as well.

Ascending Escalators in Electric Wheelchairs and Scooters

The student approaches the escalator and pulls up to the edge of the moving plates.

1. The guide stays behind the chair, waiting for the student to move forward.
2. As the student pulls forward, she will feel a bump when the front wheels go over the floor plate edge and a second bump when the back wheels go over it as well.
3. Once the back wheels are over the floor plate edge, the student stops driving forward and waits to feel the chair start to lean back. When she feels the lean, she pulls forward again to position the wheels of the chair up against the risers of the escalator stairs.
4. The student releases the joystick or power lever to allow the brakes to engage.
5. As the chair starts to lean back, the guide puts his hands on the back of the seat to stabilize it. Alternatively, the guide may choose to lean forward against the seatback; this allows him to hold the escalator rails for safety.
6. The guide and student ascend the escalator. When the student feels the chair start to lean forward, she gets her hand ready to drive forward.
7. Once the chair is nearly flat, the student starts driving forward off the escalator. The guide verbally prompts the student to start moving forward and to turn left or right. The guide pulls on the back of the chair to change its line of travel. (See chapter 7 on Monitoring Consumer Safety.)
8. The student continues to drive forward until she feels four bumps: two for the chair to transition from the moving stairs to the escalator floor plate and two for the chair to pull off the floor plate and onto the floor.

Watch Video HG3mm: Human Guide: Ascending escalators in electric wheelchairs and scooters.

Descending Escalators in Electric Wheelchairs and Scooters

Again, all escalators should be avoided whenever possible; only use them in emergencies. That being said, descending escalators are more difficult to navigate than ascending ones. While ascending escalators are navigated facing forward, descending ones are navigated backward, keeping the wheelchair facing uphill. There is a risk that the student will drive too far backward to get onto the escalator and drive off of the step, hitting the guide who is spotting. As on up escalators, the guide must be behind the chair to catch it if it tips backward. Most scooters and electric wheelchairs use the same strategies to navigate escalators.

1. The guide helps the student line up with both the guide's and the student's backs to the top of the escalator.
2. The guide steps onto the escalator and starts walking in the direction opposite to the movement of the escalator, essentially walking in place.
3. When ready, the guide prompts the student to back up onto the escalator floor plate. The student backs very slowly onto the escalator. If the student uses a cane, he swings it to the side and lets it slide down the escalator wall.
4. When the student feels the chair start to lean backward, he changes directions and drives forward to pull the wheels up against the riser.
5. Once the chair stops moving forward, the student takes his hands off the joystick or power lever to engage the brakes.
6. The guide puts his hands on the back of the chair to stabilize it and to make sure that it doesn't tip backward. Alternatively, the guide may choose to lean forward against the seatback; this allows him to hold the escalator rails for safety.
7. The guide and student descend the escalator. When the student feels the chair start to return to being level instead of leaning backward, he prepares to move backward.
8. While standing on the escalator, the guide puts one foot slightly behind the other, lifting the heel and keeping the ball of the foot on the stair. When the bottom of the escalator is reached, the floor plate slides under the rear foot and hits the ball of the foot. The guide simply drops his heel onto the floor plate at the bottom of the escalator and steps off.
9. The guide gives a verbal prompt to the student to back up before the rear wheels hit the floor plate. The rear wheels of the scooter are kept from rolling by the brakes until the throttle control lever is pressed, initiating backward movement. If the wheels are not moving when the floor plate is hit, the escalator may stop due to built-in safety mechanisms that protect people who have shoe laces or loose clothing that get stuck between the floor plate and the moving stairs of the escalator.
10. When the student feels the chair bump the floor plate at the bottom of the escalator, he backs off the escalator. The guide moves quickly out of the chair's direction of travel.

Watch Video HG3nn: Human Guide: Descending escalators in electric wheelchairs or scooters.

Ascending Escalators in Manual Wheelchairs

The procedures for ascending escalators in manual wheelchairs are very similar to those for electric wheelchairs and scooters. The only real difference is how the student gets on the escalator. This should be done only in emergency situations, or when there are no other options available except for stairs. Some manual wheelchair users without vision impairments navigate escalators independently. It is not recommended that visually impaired wheelchair users do so without the help of a spotter. Students should get a feel for being moved by the escalator by positioning themselves at the end of the escalator (on the floor plate) and grabbing the handrails; the moving handrails will move them forward, off of the floor plate.

1. The student positions herself on the landing in front of the escalator, facing forward.
2. The student reaches up and lightly places her hands on the moving rails of the escalator, letting the rails slide through her hands. The guide is positioned directly behind the chair.
3. Either the guide pushes the chair onto the moving portion of the escalator, or the student tightens her grasp on the moving rails and the rails pull her onto the escalator. If the latter option is used, the guide does not grab the wheelchair handles until after the chair starts moving.
4. The guide steps on behind the student. The guide keeps one hand on the chair handle and one on the handrail of the escalator.
5. As the chair starts to lean back, the student pulls on the handrails to push the large wheels up against the riser of the stair.
6. The guide and the student ascend the escalator. If the student is holding the handrails tightly, she will be pulled off the moving part of the escalator onto the floor plate at the top. If not, the guide is ready to push down the handles and push the chair forward when it reaches the end of the moving portion. The downward pressure helps to make sure the front caster wheels don't hang up on the floor plate at the end of the moving portion.
7. If the student is holding the rails, she should not let go until the rails start to curve down. The guide should not push forward until the student lets go. If the student lets go too soon, the chair may stop, leaving the guide no room to step off the escalator.

Note: If the student does not hold onto the rails, the guide must push her straight onto the escalator. He needs to make sure that they both keep moving at the transition from the stationary floor plate to the moving stairs. If uncertain about their balance, the guide pushes the chair on and as soon as the escalator starts to pull the chair away, he reaches for the handrail with one hand. Leaning forward, toward the chair, is better than leaning back and pulling back on the chair. Pulling back on the chair could lead to it tipping over backward.

Additionally, not all wheelchairs fit onto all escalators. To see if a chair will fit, back onto the escalator without going all the way on. The escalator is narrowest at the floor plate just before the moving stairs. If the wheels fit between the sides of the escalator at the floor plate, the chair should fit all the way up.

Watch Video HG3oo: Human Guide: Ascending escalators in manual wheelchairs.

Descending Escalators in Manual Wheelchairs

Students should get a feel for being moved by the escalator by positioning themselves at the end of the escalator (on the floor plate) and grabbing the handrails; the moving handrails will move them forward, off of the floor plate. Before the guide and student approach the escalator, position the wheelie bars in the up position. The guide and student then position themselves on the floor plate in front of the escalator, facing backward.

1. The guide steps onto the escalator and starts walking in the direction opposite to the movement of the escalator, essentially walking in place.
2. The student reaches up and allows the moving rails of the escalator to slide through her hands. It is important to keep the arms fully extended.
3. The guide gives the student a prompt that he is ready for the student to come back.
4. The student grasps the moving handrails tightly, causing the chair to be pulled backward onto the escalator.
5. The guide lightly grasps the handles on the back of the chair to make sure it doesn't tip over backward. If the guide is concerned about his own balance, he can grasp the chair with one hand and the handrail with the other.
6. The student pulls back on the handrails when the chair starts to lean back; this action pulls the wheelchair forward and the large wheels up against the riser of the stair.
7. The guide and the student descend the escalator. At the bottom, when the chair starts to tilt forward, the guide slides one foot back, keeping the toe on the ground and the heel up. When the foot reaches the end of the escalator, the plate will hit the ball of the foot and the guide can put his weight down on that foot and step off.
8. The student continues to grasp the handrail until the chair is all the way off the escalator. The guide keeps holding the handles, but should not pull back until the student lets go.
9. Once off the escalator, the guide returns the wheelie bars to the down position.

Note: If the student does not hold the rails going down, the guide still backs the chair onto the floor plate and to the edge of the moving stairs. When the guide steps on, he will need to have a tight hold of both handles and pull the chair backward evenly. Once the chair is on the escalator and starts to lean back, the guide should push forward to keep the large wheels up against the riser of the stairs. To get off, the guide puts one hand on the handrail. With practice, navigation of escalators is relatively easy. However, it is very difficult to locate places to practice. Most businesses are understandably concerned about liability issues. Do not practice without getting permission first; it can lead to ill will with the business owner. One suggestion is to offer to train the business personnel as well as the student. Public entities can be softened up by offering to conduct a sensitivity training and including the escalators in the training. Once the business owner sees how easy it is to use the escalators in a wheelchair, it might be easier to get permission to bring a student to practice. It may also help to offer the training outside of business hours so that the training does not interrupt regular business.

Watch Video HG3pp: Human Guide: Descending escalators in manual wheelchairs.

Navigating Cross Slopes

Sidewalks, driveways, and streets that slope to the side (cross slopes) can be very difficult for wheelchair users to navigate. Students who use manual chairs and normally hold the guide's arm may choose to switch and be pushed across the slope.

If a student chooses to grasp the guide's arm, she can push or pull on the guide's arm to help keep the chair moving in a straight line. If the guide is on the uphill side, the student pulls the guide's arm as if trying to pull it across the student's body. The student can also rotate her trunk to twist the front wheels toward the guide. If the guide is on the downhill side, the student pushes on the guide's arm as if trying to push the guide to the side. She can also rotate her trunk to twist the front wheels away from the guide.

The guide pushing a manual wheelchair may have to push harder with the hand that is on the downhill side of the slope. If the slope is severe enough, the guide may have to push forward harder with the downhill hand and actually pull back with the hand on the uphill side.

For electric wheelchairs crossing a side slope, the student may need to push the joystick slightly to the uphill side instead of straight ahead. Scooters are not usually affected by cross slopes.

For all the chairs, crossing driveways closer to the inside shoreline (side closer to the buildings) may reduce the steepness of the slope. Often, driveways have a more severe slope at the street edge and are flatter on the inside shoreline. For that reason, a person guiding a consumer in a manual chair may choose to change sides and walk on the side closer to the street.

Proper Trademark Notice and Attribution

MARTA® is a registered trademark of Metropolitan Atlanta Rapid Transit Authority.

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