Chapter 4 Hand Trailing and Protective Techniques

Wheelchair users who have a visual impairment use a variety of strategies to navigate successfully along walls. They use hands, elbows, canes, rods, and automotive curb feelers in one form or another. The only strategies that provide for obstacle or drop-off detection are cane techniques. Most wheelchairs extend beyond the average arm reach. The strategies discussed in this chapter are for use in safe, familiar environments. Prior to training, the student should know landmarks that identify where obstacles or drop-offs are located. Cane users use all of the standard techniques utilized by their ambulatory peers. Suggestions for cane users are included in the chapter on Cane Skills.

Manual Wheelchairs

A student in a manual wheelchair can trail the wall in several ways.

  1. If the student needs both hands to push the chair, the sweep-back method is a good beginning. The hand nearest the wall reaches out to touch the wall each time the student releases the wheel. Once the student pushes the wheel rail as far forward as possible, the arm rotates so that the palm faces the wall, with the fingers extended. The hand reaches forward, touches the wall, and slides backward (along the wall) until the elbow is bent 90 degrees and perpendicular to the wall. The hand then leaves the wall and grasps the wheel rail for the next push. This method is slow and meticulous. Since the chair is not moving when the hand touches the wall, it allows the student to explore as thoroughly as she wants and needs.

Watch video TPT4a: Trailing and Protective Techniques: Manual chair hand trailing: Sweep-back method.

  1. Patting is another method and a good option if the student needs both hands to push the chair. It is similar to the sweep-back method, but the student reaches up, pats the wall with a push, and quickly returns the hand to the wheel rail. It is faster than the sweep-back method. If the chair continues to roll, the student can maintain the pat-push along the wall. The student should not push the wheel rails more than twice without reaching up to pat the wall; otherwise, she may miss the location or item for which she is searching.

Watch video TPT4b: Trailing and Protective Techniques: Manual chair hand trailing: Patting method.

  1. Another method, when the student requires both hands to push the wheels, is the extended-elbow method. The student extends the elbow nearer the wall and allows it to brush along the wall as the wheelchair proceeds. She can maintain constant contact with the wall using the elbow or extend the elbow to touch the wall periodically.
  2. If the student has adequate arm and upper body strength, the stiff-arm method may be a good option. The student uses the hand farther from the wall to push on the wheel rail and the hand nearer the wall to maintain the line of travel while trailing the wall.

Watch video TPT4c: Trailing and Protective Techniques: Manual chair hand trailing: Stiff-arm method.

  1. Consumers describe this technique as “swimming” along the wall.
    1. The student starts with the outside hand (farther from the wall) on the wheel rail, just forward of the top of the rail. The inside arm (closer to the wall) extends forward with the palm and fingers against the wall.
    2. As the outside hand pushes the wheel rail forward, the inside arm exerts force laterally (away from midline or to the side). This keeps the chair from turning toward the wall. The student may be able to use the inside arm to help with propulsion, but its primary functions are to maintain the line of travel and provide information to the student regarding the wall.
    3. As the chair moves forward, the elbow of the inside arm bends and the hand remains stationary on the wall.
    4. When the inside arm comes back as far as it can, the consumer reaches forward, making contact with the wall again for the next stroke.

Watch video TPT4d: Trailing and Protective Techniques: Hand trailing: Swimming method.

Initially, the student may need to time the movements of the two arms; but as momentum builds, she may not need to keep the two arms in sync. The initial push may cause the chair to turn toward the wall. If so, as speed builds, the student takes two or three strokes along the wall with the inside arm for every push of the outside wheel rail. This technique allows students to move very quickly. Tell the student to slow down if she is traveling at an unsafe speed. Sometimes students feel that they can use landmarks to miss walls or detect corners, but they do not think about people who might be in their path or that someone else may have put something in their path.

Electric Wheelchairs

Electric wheelchair users employ different trailing strategies, which depend on whether they trail the wall on the same side as the joystick or the wall on the side opposite of the joystick. Listed below are several successful techniques.

Wall and Joystick on Opposite Sides.

  1. Standard method: Many electric wheelchair users trail the wall opposite the joystick by using the standard method. The inside arm reaches forward, palm facing the wall, and the hand maintains contact with the wall. The arm is not parallel to the line of the shoulders; the hand should be several inches lower than the shoulders. If the hand is too high, it could jam into a corner or a doorframe and too much of the shock would be absorbed in the student’s shoulder. Another common mistake is trailing with the fingers and hand flat against the wall, which leads to jammed fingers when they hit a protrusion. The palm may slide along the wall instead of the fingers. Always angle the fingers away from the wall to prevent jammed fingers.
  2. Swimming method: Instead of keeping the arm extended and the hand sliding along the wall, students may prefer to use the “swimming” arm movement previously described. The hand touches the wall and stays there as the elbow bends. Before the elbow bends to 90 degrees, the student releases the wall and re-extends the arm.
  3. Patting method: Another method is for the student to keep her arm extended with a slight bend in the elbow. The arm moves left and right, patting the wall with the hand.

Watch video TPT4e: Trailing and Protective Techniques: Hand trailing in an electric wheelchair: Wall and joystick on opposite sides.

Wall and Joystick on Same Side

  1. Some students successfully use the elbow of the arm controlling the joystick to follow the wall. They swing the elbow out and keep it against the wall, or they swing it back and forth to tap the wall. The swinging motion may lead to unwanted movement of the joystick, which causes the chair to swivel or surge.
  2. A slower method is to alternate between moving forward and sweeping the hand along the wall. The student starts, stops, and reaches up to check the wall. If she is looking for a doorway or light switch, she should only drive for a second or two before stopping to check the wall. If the student is just trying to maintain a straight path, she drives farther and just reaches up to tap the wall as needed. How far the student goes between reaches or stops depends on her ability to drive straight forward. The student should not attempt to drive too far between touches. If she drives too far, she may drift away from the wall, or she may miss a doorway or other marker with the next touch. To teach a student how far she can go between touches, follow these steps.
    1. Instruct the student to stop just before a door; ask her to drive forward while she counts aloud until she passes the far side of the door. If the student counts to six in the time it takes her to get from one side of the door to the other, then she should only count to four or five before stopping the chair to pat the wall.
    2. Repeat the test several times to build consistency and to establish an average number. The number will vary depending on the speed at which the chair is set.
  3. Some consumers have mastered the ability to drive an electric wheelchair by reaching across the body with the opposite hand, leaving the joystick hand free to trail a wall or hold open a door; however, this technique is much harder than it looks. A student may have a difficult time maintaining a straight line of travel. The body movement required to reach out with the other hand to touch the wall may be replicated by movement of the hand on the joystick. To have a steady hand on the joystick takes a lot of practice. Despite the difficulty, students should be encouraged to try driving cross-handed. They should start by practicing to drive in a straight line in an open area where they will not risk running into the wall or other obstacles.

Watch video TPT4f: Trailing and Protective Techniques: Hand trailing in an electric wheelchair: Wall and joystick on the same side.

Scooters

Scooters use the same methods as electric wheelchairs. However, instead of switching techniques based on which side the wall is in relation to the joystick, the scooter user can switch hands and have the hand closer to the wall free for trailing. If the wall the student is trailing is on the right side of the scooter, she can reach up with her right hand and drive with her left. Instruct the student to hold the left side of the tiller with her left fingers and extend the left thumb to the throttle control lever. The thumb maneuvers the throttle control lever toward the student. An alternative is for the student to reach across the tiller and use the right side of the throttle control lever with the left hand. This allows the student to squeeze the lever instead of pulling back. Initially, some students find it difficult to maintain a straight line of travel with the arm reaching across to the opposite side of the tiller; but with practice, many become very proficient.

Watch video TPT4g: Trailing and Protective Techniques: Hand trailing on right in a scooter.

Trailing With Electronic Travel Aides

Electronic Travel Aides (ETAs) are effective tools for trailing with all three types of chairs. ETAs can be handheld, worn on the head, hung around the neck, mounted to the chair, or strapped to the body. (It is possible to modify a sport strap used for MP3 players to carry ETAs.) ETAs, when pointed at a wall, provide feedback about the distance between the ETA and the wall. To start, point the ETA forward. As the student moves forward, she sweeps the ETA back and forth from the front to the side where the wall is located. This movement helps the student recognize obstacles in front of the chair as well as help maintain the distance between the chair and the wall. If held at the correct angle to the wall, many ETA users pick up doorframes of closed doors. If the student always holds the ETA in the same hand, whether the wall is to the right or to the left, she may need to work on how to determine accurately the distance for each side. For example, if the student holds the ETA in the right hand or has it mounted on the right side of the chair, while she trails the left wall, the distance from the ETA to the wall will be greater than if both the ETA and the wall are on the right side of the chair.

Trailing With Mini Canes

Some wheelchair users successfully trail with mini canes (e.g., rods, sticks, folded canes) that measure about 12 to 24 inches. Mini canes are made of wood, aluminum, fiberglass, or anything else that a teacher, student, or consumer can find; but weight should be a top consideration. For individuals who cannot grasp the handle, they use special sleeves or loops to help keep the handle on the hand. The consumer can use the mini cane on the side with the free hand, or she can reach across the body to trail a wall on the same side as the joystick. Students who do not have the dexterity to use long canes, but can hold a short rod, are able to use a mini cane to identify corners and doorjambs. Teachers use mini canes to help teach orientation and spatial awareness to students who cannot drive their own chairs.

Watch video TPT4h: Trailing and Protective Techniques: Trailing with mini canes.

Curb Feelers

A common question is, "How can I use curb feelers to trail a wall?" The answer is, "Curb feelers are not effective or safe to use when trailing a wall." The problem with curb feelers is that they are an on/off signal about the presence of a wall. They indicate that a wall is there; they do not indicate how far the wheelchair is from the wall. Students, who use curb feelers to maintain contact with a wall, consistently hit the wall because they cannot tell if they are 6 inches or ½ an inch from the wall. Some students may be able to pick up pitch differences to indicate moving closer to the wall, but that would be an extremely rare occurrence. Curb feelers can break off if they catch between doors and doorframes. Curb feelers are effective tools for the identification of openings, such as corners or open doorways. They may also act as an auditory cue when they hit doorframes or other trim pieces.

Standard and Modified Upper Forearm Protective Technique

To form the standard upper forearm protective technique when walking, follow these steps:

  1. Raise the arm to shoulder height and extend it out in front of the body—pointing straight ahead.
  2. Bend the arm so that the forearm is across the chest, and touches the opposite shoulder with the fingertips.
  3. Move the hand approximately 12 inches away from the shoulder; visualize a ruler placed lengthwise between the shoulder and the hand.
  4. Spread the fingers apart and curl the fingers; keep the wrist straight as you turn the palm outward so that it faces away from the body.

For a wheelchair user, the standard upper forearm protective technique described above is effective in locating some overhanging hazards and to partially protect the upper body, but is ineffective for walls or poles. When the arm is in the standard position, the footrest of the chair extends beyond the arm’s reach. To reach objects in front of the chair, instruct the student to use the modified upper forearm protective technique:

  1. Lean forward slightly in the chair.
  2. Reach the arm straight out.
  3. Curl fingers.

One modification for overhanging hazards begins with the standard upper forearm protective technique. Once the student is in the standard position, instruct her to rotate the shoulder 45 degrees so the forearm crosses in front of the face instead of being on the same plane as the shoulders. Wheelchair users can use this modified upper forearm protective technique to protect themselves when they bend over to pick up objects from the floor. Before a student bends over, instruct her to turn off and or lock the wheels of the scooter or wheelchair. The student rotates the shoulder 90 degrees and points the fingers to the sky. As the student turns at the waist to bend over, the arm should remain in front of the face, with the palm rotated away from the student.

Another modification for cane users is to switch the cane to a pencil grasp and draw the tip back toward the front of the chair; the cane is in a vertical position. The hand slides down the shaft of the cane so that the handle extends up to protect the face from low obstacles. The student should practice moving the whole arm side to side to sweep a path that covers the width of the chair, not just at the base, but also at head level.

Watch video TPT4i: Trailing and Protective Techniques: Modified upper forearm protective technique: Cane users.

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