How to Use a Wheelchair

What is a wheelchair?

A wheelchair is a chair with wheels for people who are not able to walk because of illness, injury, or disability. Wheelchair types include manual (self-propelled) and electric (power). Special pediatric wheelchairs are available that are sized to fit smaller children.

Pediatric cancer patients may use a wheelchair to get around more easily as they recover from surgery or illness. Other patients may need a wheelchair for long-term use to help with mobility in daily living.

A wheelchair is usually recommended by a health professional. A physical therapist or occupational therapist can identify the best type of wheelchair to meet patient and family needs.

Wheelchairs, walkers, crutches, and other mobility aids can increase independence and improve quality of life for both patients and families.

Benefits of a wheelchair

During cancer, patients may use a wheelchair for different reasons. A wheelchair may help patients to:

• Reduce risk of falls due to weakness, balance problems, or nerve damage
• Decrease pain or fatigue caused by walking or standing
• Limit weight bearing after surgery
• Get around safely after anesthesia or when taking medications that cause drowsiness or confusion

Types of wheelchairs

Different types of wheelchairs are recommended based on the needs of the patient and family. Some factors to consider include:

• Medical needs
• Patient age and size
• How long the wheelchair will be needed
• Wheelchair weight and ease of use
• Custom features and accessories
• Cost and insurance coverage

A manual wheelchair will meet the needs of most patients and families. Manual wheelchairs are lower cost and need less maintenance. They are pushed by a caregiver or wheeled by the patient (self-propelled). Power wheelchairs are good for patients who do not have the upper body strength to propel the chair themselves. Power chairs can be expensive, so they are usually not for short-term use.

Types of manual wheelchairs include standard wheelchairs, reclining wheelchairs, and custom wheelchairs.

Tips for wheelchair safety

• Ensure proper fit of the wheelchair by working with a trained health professional.
• Always lock the wheels and lift footplates before transferring to and from wheelchair.
• To avoid backwards tipping, do not place heavy bags or other items on the back of the wheelchair.
• Do not remove anti-tipping bars from the rear of wheelchair.
• Keep loose objects away from wheels.
• When sitting in the chair, do not over-reach in any direction, as this could cause the chair to tip over.
• Watch for curbs, inclines, and declines, and stay in control of the wheelchair.
• Check wheelchair parts and have regular maintenance.

Blisters and pressure sores from wheelchair use

It is important for patients and families to watch for blisters and pressure sores that can develop from use of the wheelchair. Patients who self-propel their wheelchair may develop blisters on hands or fingers from repeated friction against the hand rims. Strain of the hand, elbow, or shoulder may also occur. Some wheelchair users may choose to wear gloves to protect their hands. For long-term users, ergonomic hand rims can help improve comfort and reduce strain.

Sitting in the wheelchair for long periods of time can also cause pressure sores. These sores can develop at any point of contact between the skin and chair surface. Some of the common places for pressure sores to develop in wheelchair users include the spine, sacrum, buttocks, ankles, and heels. Patients who are less mobile and stay in one position are at higher risk.

Check the skin regularly for blisters or sores. Be sure to let a care team member know about any skin changes. Special care may be needed for children who have treatment side effects such as skin problems, nerve damage (peripheral neuropathy), or increased risk of infection.

How to use a manual wheelchair

Manual wheelchairs can be pushed by a caregiver or propelled by the user using the hand rims of the back wheels. Practice is needed to learn to self-propel a wheelchair. However, even younger children can become skilled at using a wheelchair.

The following tips provide basic information on using a wheelchair. However, your care team can provide specific information and training based on your wheelchair type and mobility needs.

Going forward in a wheelchair — To self-propel forward, grip the wheelchair hand rims near the back of chair. Push forward and down on the hand rims, and then let go. Move hands back to the starting position and repeat the motion.

Turning a wheelchair — To turn right, push forward on the left hand rim to propel the left wheel forward while slowing down or stopping the right wheel. To turn left, propel the right wheel forward while holding still or slowing down the left wheel.

Going backward in a wheelchair — To go backwards, grip the hand rims near the front of the chair. Push back and down to move the wheels backward. Anti-tips bars can be placed on the back of the wheelchair near the back wheels prevent backward tipping.

Stopping a wheelchair — To stop the wheelchair, grip the hand rims and use friction to slow them down. If the rims are wet, pinch the tire instead. Be careful, as this friction creates heat that can burn the hands, especially when on a slope or stopping suddenly.

Going up and down curbs or small steps in a wheelchair — The safest way to go up and down curbs is with caregiver assistance. If the user needs to negotiate a curb independently, more training and practice will be needed under supervision of a trained healthcare professional.

• To go up a curb, the caregiver should position the wheelchair directly facing (perpendicular to) the curb or small step, with the front wheels near the edge of the curb. The caregiver should use the handles to lean the wheelchair backward just enough for the front wheels to clear the curb or step and then. push forward so that the front wheels are placed on the curb. Continue pushing forward while lifting up on the handles until the rear wheels roll up the curb or small step. This may take added force to meet the resistance of the step.
• To go down a curb, it is best to go down backward. The caregiver should position the wheelchair perpendicular to the curb or small step with the rear wheels near curb. Slowly lower the rear wheels down the curb while leaning the wheelchair slightly backwards to allow the front wheels to clear the curb. Gently lower the front wheels to the ground.

Going up and down ramps in a wheelchair — Take care to maintain control when going up or down ramps or slopes. If going up a ramp independently, the user should lean slightly forward and use quick, short pushes to help momentum. When going downhill, maintain friction on the hand rims to control speed. A caregiver should always assist on steep slopes. Keep the wheelchair straight when going up or down slopes so that the chair does not tip over.

Locking the wheelchair — All wheelchairs have locks on each rear wheel. Locks allow for safety transferring to and from the wheelchair and during transportation. These locks may be referred to as “brakes”. However, the locks do not function the same as a brake and are meant for locking the wheelchair for safety and not for slowing the wheelchair. Custom wheelchairs, including adaptive stroller wheelchairs, may have locks placed on the back of the wheelchair that are more convenient for caregiver use.

Using public transportation in a wheelchair — Wheelchair anchors and lap belts can be added to wheelchairs if needed for public transportation purposes. Please discuss this with your therapist, Assistive Technology Professional (ATP), or Seating and Mobility Specialist (SMS).