Chapter 6 Chair Operations
Often, when students first acquire their wheelchairs, they receive little or no training on how to operate the chair. In the excitement of getting a new chair, many students forget the initial instructions given by the instructor or the person who delivered the chair. Some of the things described in this chapter may seem basic or obvious, but the instructor should not assume that the student knows all of them. It is beneficial to have the instructor present when the student accepts delivery of the chair, or have a lesson at the supplier’s office. Every chair is different, and both the student and the instructor can learn a lot by consulting with the supplier. Have a checklist or list of questions ready when the supplier demonstrates important features of the chair to the student. As most instructors know, it is important to demonstrate to the student how to operate the different features multiple times to retain the information. Some students may need to have the instructions written down for future reference. If family members or significant others are included in the lessons, they can help the consumer.
Manual Chairs
Propulsion
In a manual chair, propulsion happens when the consumer pushes forward on the rails attached to the wheels, pulls with her feet, or pulls with her hands on a doorframe, countertop, or wall. Specialized chairs may have one-hand drives or power assistance. Some consumers have a tendency to use the wheels to push, instead of the rails mounted on the wheels. This leads to the consumer becoming vulnerable to cuts and abrasions from debris that embeds in the wheels. In addition, wheel treads may cause blisters on the palms of the hands. If the consumer also suffers from neuropathy, she may not feel the cuts and blisters. This could cause serious damage before she realizes that she is hurt. When grasping the chair rails, it is better if the person pinches the rail between the thumb and index finger, instead of letting the fingers wrap around the rail. Damage to fingers may occur if caught between the rail and wheel, especially if the wheel is turning. For individuals who cannot grasp the rail, there are rails that have knobs every few inches that they can push against without having to grab the rails.
Straight Line of Travel
Some consumers find it difficult to maintain a straight line of travel. On flat ground, it is necessary to push both wheels the same distance with the same amount of force. Wheelchair users—who have sight—often push the wheels forward, release the wheel rails, and allow the wheels to roll freely until their hands grab again for the next push. Pushing at unequal rates will cause the chair to veer in the direction of the shorter push. The student should adjust the line of travel by applying friction to the wheel rail on the same side of the direction she wants to turn and pushing with more force on the wheel opposite of the direction she wants to turn, or by pushing with just one hand. The student can also change the line of travel by shifting her body weight and leaning to one side or the other; however, not all students are successful at this.
Pushing a manual chair in a straight line can be difficult without reference points. In safe, familiar environments without drop-offs, wheelchair users with blindness can reduce veering by making sure that the two wheels rotate the same distance with each push. To reduce the chances of veering off course, the student should limit the distance covered in each push, grasp the wheel rail in the same location with each hand, stop the push in the same location with both hands, and not allow the wheels to roll freely as the hands reach back for the next push. Students who have varying ranges of motion or strength in each arm may have difficulty pushing the wheels the same distance at the same rate.
Watch video CO6a: Chair Operations: Manual Chairs: Maintaining a straight line of travel.
Cane Use
If the student needs a cane to help maintain safety or orientation, there are three methods from which to choose for travel in a manual chair.
The first method requires the student to alternate sweeping the cane with pushing the chair. Depending on the length of the cane, she may be able to give the chair two or three pushes between sweeps with the cane. While pushing the chair, the student can store the cane in one of three ways:
- tuck it under a leg;
- put the tip on the footplate and lean the cane on the shoulder; or
- hold the cane in her hand while grasping the wheel rail, if she has the dexterity in her hands. (Due to their lightweight and thin design, NFB canes are well suited for trying to hold the cane in the hand and push at the same time.)
The student should use caution when on an incline or when stopping, as the hand with the cane will not be able to grasp the wheel rail as tightly.
Watch video CO6b: Chair Operations: Manual Chairs: Using a cane.
The instructor should check that the student does not roll too far forward without sweeping the cane. The front wheels should not roll past where the cane tip has cleared, before the student makes the next sweep. The longer the cane, the farther the student will be able to roll between sweeps of the cane. Pushing the cane straight ahead, without side-to-side movement, may result in a student not detecting an obstacle or drop-off to either side of the chair.
The student should adjust the arc width of the cane when making turns.
The second method requires the student to push one wheel at a time, alternating wheels, while she sweeps the cane with the other hand. She can do this one of two ways: switch the cane from one hand to the other, as she alternates the hand with which she pushes; or she can keep the cane in one hand and use the other hand to push on both sides. To push with one hand on both sides, the chair should have the armrests removed or have tube armrests. This allows the student to reach below and grasp the wheel rail. Careful cane position (see chapter 5, Cane Techniques) is important, in case the cane tip hits an obstacle and injures the student.
Watch video CO6c: Chair Operations: Manual Chairs: Pushing opposite wheels with one hand.
The third method requires the student to use her legs (if able). The student will travel in a straighter line if she pushes the wheel rails in short strokes and uses both legs as if walking while sitting down; one hand is used to propel the chair and the other to sweep the long white cane. As the hand pushes forward, one foot stays planted on the ground and the knee bends; the other foot moves forward as the hand pushing the wheel comes to a stop. Then, the feet remain stationary as the hand reaches back to grasp the wheel rail again. When the hand pushes forward again, the front foot draws back and the rear foot moves forward. If the legs are strong enough, they may be able to propel the chair without hand use. The cane may be more than one stride ahead of the chair. The instructor should determine on which side the cane should touch the ground by the length of the student's stride. If the cane is an even number of strides ahead, the cane should arc to the same side as the foot moving forward, instead of the standard cane technique.
Watch video CO6d: Chair Operations: Manual Chairs: Using both legs.
A student who has use of only one leg will travel in a straighter line if she uses the opposite hand to push the chair. The hand pushes forward on the wheel rail at the same time the foot draws back.
Watch video CO6e: Chair Operations: Manual Chairs: Using one leg.
To keep gravity from moving a chair that is on an incline, the foot should reach forward first, then the hand should reposition on the wheel rail. The hand and foot move together to move the chair forward. The cane should sweep to both sides with each stride.
With both foot techniques, the line of travel will be straighter if the chair comes to a stop before the foot moves. As the student’s technique becomes more proficient, she will travel with greater speed. Some students become proficient enough to keep the chair continually rolling while the foot and hand reposition for the next push. Some consumers get to the point where their legs appear to be running. The student should learn how fast she can travel and still be able to react to information from the cane about obstacles and hazards.
Turning
There are six different ways to navigate turns in a manual chair. It is important for the student to learn each type of turn.
- Pivot in place to the right
- Pivot in place to the left
- Pivot on one wheel turning right and moving forward
- Pivot on one wheel turning right and moving backward
- Pivot on one wheel turning left and moving forward
- Pivot on one wheel turning left and moving backward
To pivot in place, the student pulls backward on the wheel rail with one hand while she pushes forward on the other wheel rail with the other hand. The chair pivots over a spot between the two large wheels. To pivot in place, both wheels must move the same distance with each push, otherwise the chair will drift in one direction or the other.
To pivot on one wheel, the student reaches and grasps as far forward as she can on one wheel rail with the arm fully extended and locked. The extended arm does not move during the turn. With the other wheel, she pushes forward or pulls back to make the turn, pivoting on the wheel held by the locked arm. Turning right will cause the chair to pivot over just the right wheel, while turning left causes the chair to pivot over the left wheel. (See chapter 8, Navigating Tight Spaces and Doors for more information on turning.)
Watch video CO6f: Chair Operations: Manual Chairs: Six types of turns.
Stopping
Students should always practice caution when stopping a manual chair. Ideally, a student should travel on flat terrain or at a pace that allows the chair to stop on its own when not pushed. If the student is traveling too fast or is on an incline, she will need to use her feet, hands, or both to stop the chair. To use the feet to stop, instruct the student to extend a knee beyond 90 degrees before the foot hits the ground. If the knee is at 90 degrees or less, the chair may roll over the foot, damaging the knee, foot, or ankle. To use the hands to stop, pinch the wheel rails between the thumb and index finger; avoid grabbing the wheels. If the student is uncertain that she can grasp the rails without getting her fingers caught, she should fully extend her fingers and swing the arms down and in, toward the chair, pressing the palms of the hands against the rails. The arms should angle forward so the hands will hit the rails and not the spokes. Some chairs are equipped with longer brake handles or have brake handle extensions. If using the brake handles to stop the chair, the student needs to pull back on both handles together or the chair could go out of control.
Watch video CO6g: Chair Operations: Manual Chairs: Stopping.
Electric Wheelchairs
Propulsion
Onboard computers control electric wheelchairs. The control box usually includes a joystick, mode button or speed dial, horn, and level of charge indicator. Joysticks have different plates underneath them that limit their movements. Some plates form a circle, and the joystick can move freely through 360 degrees. Other plates have a shape similar to a baseball diamond. There are notches that line up to go straight back, to pivot in place while turning right, and to pivot in place while turning left. Across the top or front of the plate, an arc runs from the 10 o’clock position, past the 12 o’clock position, to the 2 o’clock position. This arc makes it easier for the student to make fine adjustments when traveling straight forward. If the plate does not line up correctly, contact the supplier to have it adjusted. It is possible to replace one plate with a different style of plate (e.g., one with notches).
The chair’s maximum speed can be adjusted by changing the chair mode setting, or if available, turning down the speed knob. Most electric wheelchairs have different modes from which the student can choose. Each mode is a different combination of speed and power settings. Mode 1 is usually the slowest setting. Mode 5 (or the highest number) is usually the fastest or most powerful. The supplier can adjust the modes to meet the needs of the consumer. Within a single mode, it is possible to adjust the forward and turning speeds separately. If the student’s chair regularly turns past the desired stopping point, reduce the turning speed but leave the forward speed at its current setting. For example, if mode 5 is 100% power in the forward direction, reduce the power in the turning directions from 80% to 50% to make turns easier to control. Speed reduction equals power reduction. In grass, soft dirt, thick carpet, or on steep inclines, the lower settings may not have enough power to push the chair. The student will need to switch to a higher mode until she finishes navigating the difficult area.
Straight Line of Travel
While it might seem simple to push the joystick straight forward or straight back and drive in a straight line, it is much harder than it looks. There are several things that can facilitate chair control:
- Turn down the power.
- Use a larger joystick.
- Drive with a palm instead of fingers.
- Push the joystick as far as it will go, instead of pushing it only part way.
- Position the joystick on the side with the student's dominant hand.
Turning
Consumers in electric wheelchairs need to practice each of the six types of turns. It is helpful to have the student apply the clock-face concept to the joystick. For most electric wheelchairs, push the joystick to the 12 o'clock position to travel straight forward. Straight back is the 6 o’clock position. Pushing the joystick to 3 or 9 o’clock will cause the chair to turn with one wheel going forward and the other drive wheel going backward, pivoting in place. The axis of the pivot should be the student’s torso.
Watch video CO6h: Chair Operations: Electric Wheelchairs: Pivoting in place.
More difficult to find are positions on the “clock face” that will cause the wheelchair to pivot on one wheel. To turn right while moving forward, push the joystick to a position between 1 and 2 o’clock.
To turn right while moving backward, push the joystick to a position between 4 and 5 o’clock.
To turn left while moving forward, push the joystick to a position between 10 and 11 o’clock.
To turn left while moving backward, push the joystick to a position between 7 and 8 o’clock.
Watch video CO6i: Chair Operations: Electric Wheelchairs: Pivoting on one wheel.
To be able to make a specific type of turn is critical when using physical landmarks to indicate when to initiate turns. This, in turn, is vital to navigating tight spaces successfully, such as curb ramps, store aisles, and bus interiors.
Before the student makes a turn in an electric wheelchair, she should determine if there is adequate space to turn without hitting a wall, furniture, or other obstacle. As the wheelchair turns, the caster and anti-tipper wheels will swing out wider than the space originally occupied by the chair. Frequently, when students turn, the back of the wheelchair hits whatever was beside the chair prior to the turn. A pivot in place causes the rear of the wheelchair to swing wider than if the chair pivoted on one wheel while moving forward.
Watch video CO6j: Chair Operations: Electric Wheelchairs: Avoiding obstacles during turns.
The distance needed to execute a turn depends on the make and model of the wheelchair and the type of turn used. Practice with a classroom chair or other movable obstacle placed to either side of the wheelchair. Move the obstacle farther and farther away until there is adequate distance for the wheelchair to make the turn. Baskets and backpacks increase the distance needed to turn.
Watch video CO6k: Chair Operations: Electric Wheelchairs: Practicing turns with moveable obstacles.
After practicing with something moveable, the student should practice with walls. If she cannot turn away from the wall, instruct her to turn the wheelchair toward the wall and back up a little before attempting to make the turn again. The distance to the side that the wheelchair will swing out reduces if the student makes the turn by pivoting on the wheel farthest from the obstacle.
Watch video CO6l: Chair Operations: Electric Wheelchairs: Practicing turns with walls.
If the student turns the wheelchair to face an obstacle that was previously close to the side of the chair, she may want to pivot on one wheel while moving backward. Most wheelchairs must be 8-12 inches from an obstacle to be able to turn away from it by pivoting in place.
Stopping
Electric wheelchair brakes engage when the consumer releases the joystick. The supplier can adjust the rate at which the brakes engage. If the chair stops too gradually, the student will need to travel very slowly to keep the chair from traveling too far after she releases the joystick. If the chair is set to stop too rapidly, the student may jerk forward each time she releases the joystick.
Scooters
Propulsion
On a scooter, the throttle-control lever controls rate and direction of motion. The lever is usually a single metal bar hinged at the center. To initiate motion of a scooter, move the throttle-control lever. Scooters available for use at retail outlets, such as grocery stores, are often vastly different from personally owned scooters. This section only addresses personally owned scooters.
To move forward, the student should use the thumb on her right hand to press the right side of the throttle-control lever. Another way to move forward is to have the student use the thumb of the left hand to pull the left side of the throttle-control lever back or toward the student. On a few models, consumers must push both sides forward for forward movement; but on most, the lever is one continuous piece of metal. Movement of the left lever, either forward or backward, results in the opposite direction of travel from the same movement of the right lever. This concept is difficult for most people, so students should practice in a safe environment before they move outdoors or navigate tight spaces.
Watch video CO6m: Chair Operations: Scooters: Forward and backward motion.
It is helpful to give directions to the student with the scooter turned off. The instructor should give random directions, such as “forward, right hand,” “backward, right hand,” “forward, left hand,” and “backward, left hand,” until the student consistently moves the throttle-control lever in the correct manner. Once the student is consistent with the scooter turned off, turn the scooter on and practice in slow motion. While this may seem like a basic exercise, it is critical that the student master it. The student cannot afford to make mistakes with the throttle controller when she is in a crowded environment or sitting at the edge of a curb. (Many consumers get confused about directional controls from time to time, but practice increases the efficiency with which they respond to their mistakes.)
Straight Line of Travel
One major advantage of using a scooter is that the “T” shape of the tiller and handlebars provides the student with feedback about how straight she holds the wheels. With time and practice, the student uses muscle memory to feel when the wheels point straight ahead. At first, students may need to use both hands to learn what “straight” feels like, but most initially can use one hand to drive and the other hand to sweep a cane.
Tillers are adjustable. A tiller should lean toward the student so that her arm is in a comfortable position for driving. If the tiller is too far forward, the student will have to lean forward to reach the controls; this results in pulling back, causing the scooter to turn to the right (toward the hand that is driving). Additionally, the student may have trouble with turns to the left because she has to lean forward as the handle moves away from her body. If the tiller position is too close to the student, she may have trouble with turns in either direction because the handlebars will not clear her body.
Watch video CO6n: Chair Operations: Scooters: Adjusting the tiller.
In most cases, it is best for the student to use the right hand on the tiller for driving and leave the left hand free to sweep the cane. If she is not using a cane, she should keep both hands on the tiller. Driving with the right hand allows the thumb to squeeze the throttle-control lever on the handle. Driving forward with the left hand requires the thumb to pull the lever back toward the student’s torso. As this is an odd motion, it will quickly fatigue the thumb. When a student pulls back on the throttle-control lever, there is a tendency to pull the handle bar back on the left side; this results in a veer to the left. Some students attempt to drive in a straight line by grasping the left-hand throttle-control lever and using the whole hand to pull it back. This does not work well, as they are rarely able to drive straight.
Scooters do not normally have speed or power modes like electric wheelchairs. Most scooters have a knob to adjust the speed. Turn the knob clockwise to make the scooter go faster; turn it counterclockwise to make it go slower. The ideal situation for a student is to use a 60-inch cane and turn the knob to half power. This allows the student enough time to react to her cane before she hits whatever the cane has touched. This ability varies from student to student, and the Orientation and Mobility instructor should assess this skill.
Turning
The main disadvantage while making a turn on a scooter is the wide turning radius. For reasons unknown, students tend to switch their driving hand from the right side of the tiller to the left when they turn and back up or during left turns. It is possible to make all turns by keeping the right hand on the right side of the tiller. The right hand pushes the tiller forward to turn left and pulls it back to turn right.
Stopping
The procedure for stopping a scooter is very similar to stopping an electric wheelchair. Release the throttle-control, or allow it to return to the neutral position, and the electronic brakes will apply automatically. On inclines, the scooter may roll farther than it would on a flat plane before the brakes apply automatically. If the chair appears to be rolling too far before stopping, consult the user manual to see what the stopping distance should be or contact the supplier to check the brakes. Just like electric wheelchairs, the supplier can adjust the stopping distance.
Brakes
Most manual wheelchairs, and some electric ones, have levered bars for brakes. The bars press into the larger wheels using pressure and friction to prevent the chair from moving. In most cases, the student should be able to engage and disengage the brakes on her own. On some chairs, such as transport chairs, the brake levers are not within reach and must be engaged or disengaged by an attendant.
Brake extender bars are available to make it easier for students to reach the lever. The added length also gives the person more leverage, decreasing the pressure or strength needed to engage or disengage the brake levers. One drawback is they also make it more likely that the brakes will engage or disengage accidentally. If after brushing a doorframe or other obstacle the chair seems harder to push or wants to turn, the brake lever may have caught on an obstacle and accidentally engaged. Crowded environments can also cause accidental brake problems. When people squeeze past a person in a wheelchair, their pant legs, purses, or briefcases can bump the lever and cause it to engage or disengage.
It is possible to push manually most scooters and electric wheelchairs. Many have a mechanism that disengages the motor. Once the motor reengages, it may be necessary to turn the electric wheelchair and scooter off and on again before the joystick will function. Often, these mechanisms are very difficult to reach from the seated position in the chair. They are usually in the rear or on the side near the rear of the chair. Again, it is very important that the student be able to engage or disengage the motor herself, or at least be able to describe accurately the process to someone offering assistance.
Watch video CO6o: Chair Operations: Brakes.
Sometimes the levers are on the electric motor that drives the wheelchair or scooter. Generally, for chairs with this type of lever, the brakes apply automatically when the student releases the joystick or throttle-control lever. As stated at the beginning of the chapter, the rate at which the brakes apply are adjustable by the manufacturer or service agent. Chairs should not be set to brake too quickly, because the student will be jerked forward each time she releases the joystick or throttle-control lever. If the chair suddenly turns to the right or left when the student releases the joystick, this may mean that the brake on the opposite side of the turn is not engaging, or the brakes are not engaging at the same rate. In addition, if the chair turns each time the student tries to stop on an incline, the brakes may not be functioning properly.
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