THAT IS ONE item checked off my bucket list – doing a wheelchair wheelie. That means balancing on the rear wheels of a wheelchair.
Over the course of the last week, we had the pleasure of hosting the good people from the Wheelchair Skills Program (WSP) as part of the Ministry of Health’s (MOH) Healthcare Manpower Development (HMDP) Visiting Expert program. It was an exciting week bringing together therapists across different areas of practice in Singapore for shared learning.
The powered mobility workgroup with Dr Kirby Lee and Ms Cher Smith from the Dalhousie University Wheelchair Research Team
The WSP was developed by the Dalhousie University Wheelchair Research Team using methodology based on extensive motor-learning literature. The WSP is a set of assessment and training protocols related to wheelchair skills, including the Wheelchair Skills Test (WST), the Wheelchair Skills Training Program (WSTP) and related materials. You can read more about it via the website link.
When we first invited Dr Kirby Lee and Ms Cher Smith over to Singapore, we had conducted a learning needs analysis with our colleagues. There were learning gaps as to the assessment, training and prescription of wheeled mobility – that includes both manual and powered wheelchairs as well as powered scooters. As clinicians, we grappled with essential skills and knowledge to guide us in the process. I have previously written about the issue with powered mobility in a separate blogpost. The challenges faced by clinicians is a multifaceted one – involving the therapist’s skills and knowledge, therapist-client-vendor relationships, built accessibility, the healthcare structure and available funding systems.
Learning needs exercise
One of my favourite aspect of the programme was the manual wheelchair skills training workshop that we had on Saturday. It gave me a chance to understand exactly how the researchers and trainers incorporate the use of motor-learning principles in the WSP.
I have never been able to do a wheelie. And frankly, I never had the need to teach a patient wheelie skills partly because the patient population I work with are mostly elderly and most often for powered mobility use. But looking back, it could also be ignorance on my part as to how essential a wheelie skill can be when overcoming obstacles in the built environment. Getting over low kerbs or gaps in the MRT train platform requires that the front wheels of the wheelchair be unloaded for easier manoeuvring.
Learning a wheelie skill involve 3 phases: 1) Take-off phase, 2) Balance phase, and 3) Landing phase.
We started off learning how to “pop” over lines which became a fundamental skill for the take-off phase. That is basically unloading the front castors for a brief while. The training involved us being paired in twos, with your partner standing behind acting as a spotter. I found this very useful, and the WSP advocates for the use of spotter straps to minimise the risk of rear tipping.
In the balance phase, Cher had helped tip my wheelchair back into a balance position and gave me a sense of how much tilt is needed later. Bricks were added in front of and behind the rear wheels to reduce the degree at which the rear wheels can move. This allowed me to experiment moving my hands up/down the hand rims to find the extent of tilt for an ideal balance point, and I still felt safe.
It then progressed to moving the bricks a few cm away from the rear wheels. This allowed a small amount of forwards/backwards movement and again, for me to experiment moving my hands up/down the hand rims to get my equilibrium right.
The WSP recommends that the wheelchair be moved to a surface with medium rolling resistance (eg. on 5 cm of foam) for practicing take-off and balance phases. The soft surface allows the learner to perform a “slow-motion” wheelie.
I was surprised that I could immediately do a wheelie on my first trial when I got onto the foam mat! Kept looking back and Cher was reassuring “It’s all you now”. And that’s when I realised how I had just learnt a motor skill implicitly simply through earlier graded trials and my personal discovery. As a trainer, Cher did very little talking and just let me experiment in a safe environment (the brick aspect).
Wow, wow, wow. Lightbulb moment!
The landing phase requires the user to simply pull back on the wheels or lean forward to gently bring the front wheels to the ground.
Pretty soon we were putting together our wheelie skills into the obstacle course of manoeuvring over kerbs and simulated MRT platform gaps. Motor skills learning incorporates skills acquisition → skills retention → skills transfer. We were doing all that within a span of an hour.
That’s my ecstatic face at getting a wheelie right!
All in a day’s worth of good learning and sharing. For me, it was also about broadening perspectives and forward reflecting how the workgroup can streamline our current wheelchair training program.
Do check out the Wheelchair Skills Program (WSP) website – love love love how their background research is extensive and resources are made available for free.