Wheelchair Orientation & Mobility

Chapters:

1. Introduction
2. Navigating Tight Spaces
3. Navigating Doors
4. Curb Ramps
5. Timing on Street Crossings
6. Transportation
7. Working With Physical and Occupational Therapist

CHAPTER 1: Introduction

CRAWFORD: If anybody gets any one thing out of this, it's keeping somebody safe. That's probably the most important task we have. We want them to learn, but we want them to do it safely, and it differs based on the instructor, the student, the type of chair, the environment you may be in.

If I'm assessing somebody who's in an electric chair with a joystick, first thing I want to know is how am I going to stop that person if they're about to drive off a cliff or about to run into a wall, and then I need to practice that. You should practice that inside before you get out there, about to drive off of the Grand Canyon. Do it someplace where it's safe, it's quiet, the student can be relaxed, they're not all stressed out, but they also need to feel that.

NARRATOR: In a video clip, a woman is operating a motorized wheelchair on a sidewalk. A mobility instructor walks just behind the chair and observes the woman navigate. As she veers towards the curb, the instructor grabs the rear of the chair. He tilts it back and pulls the chair onto the sidewalk.

CRAWFORD: You're going to be able to use 90%, 95% of what you already know. Most of it is the same, because you're looking at the same end objective. The similarities are that you need to cover all the same things. The person still has to come in and out of a doorway, they still have to go down a hall, they still have to be able to find the third door on the right, if that's the office they're looking for.

NARRATOR: In a video clip, a dark-haired young man in a motorized wheelchair drives through a doorway and makes a left-hand turn as he makes his way to a classroom.

CRAWFORD: They still have to be able to recognize and stop when they get to curbs or street crossings. They need to be able to cross the street at the appropriate times. Most of the skills that you teach somebody who's on their feet are going to be the same skills you teach somebody here in a wheelchair. A person in a wheelchair is just going to have to do it a little different sometimes.

CHAPTER 2: Navigating Tight Spaces

CRAWFORD: One of the most important things you work with is learning how to navigate a tight space, because it's going to come up not just when you're trying to go between two cones or between two chairs, but when you try and go down a sidewalk and turn down a ramp or something, you're navigating a tight space.

Trying to get through a doorway is navigating tight spaces. And that may seem real simple to some people, but it's not. It's actually very difficult for a lot of people, especially if they've never driven a car. A lot of what we've learned about backing up and all that, we've learned it driving cars, so a lot of my students didn't have that.

NARRATOR: In a video clip, we are following a young man in a motorized wheelchair as he makes his way down a narrow aisle in a store. He maneuvers a tight right turn while avoiding the store counter on one side and shelves of merchandise on the other.

CRAWFORD: When I'm teaching tight spaces, I always practice first with just putting down two chairs in an open space, and have the person practice just driving straight through the chairs, back and forth, back and forth.

And you'd be amazed how many people have trouble with just backing up in a straight line, because when you take that joystick or you start pulling back on your wheels, the front castors have to turn around, and when they turn around, the chair does a wiggle, and as it wiggles, they don't always necessarily get back to straight if you don't have that visual information saying, "Okay, I know this is straight." So even just going straight forward or straight back is important.

NARRATOR: In a video clip, a young man in a green ball cap drives his motorized chair down the sidewalk. On his right is a fence, and on his left is a car which is parked with its wheels on the sidewalk. He must keep his chair very straight to avoid hitting either the car or the fence as he passes between them.

CRAWFORD: So even just going forward and backwards through two chairs is a... is an important place to start. Then I usually have them start turning through the chairs — going forward, pulling up to it, and then turning left to go through the chairs, or say, right to go through the chairs. Most people have a hard time making that turn without either hitting the chair on the far side or the chair on the near side, and that's very important.

I have a bad reputation at the center for having the door frames be torn up because of my students trying to go in and out of the doorways. So we found that it's much easier on the training center to start by doing it between two chairs. And pulling forward through is the first step, but then you also have to be able to back through those openings.

NARRATOR: In a photograph, we see a young man in a blue sweatshirt in a motorized wheelchair attempting to exit a small office. Without enough space to turn around, he is shown backing out of the office.

CRAWFORD: A lot of places you get into, you're going to get into it in the chair, and it's going to be tight enough that you don't have room to turn around to back back out. Had a student go into a library, was going down the aisles of the library, got to a pillar. There wasn't room to turn around, so she had to back out of the aisles.

Same student went to a bank. She took the ramp up to the bank, got to the top of the ramp, there's a big, huge pillar, she couldn't get around to either side. She had to back back down the crosswalk... the switchbacks to get back to the bottom of the ramp. She called me up after she did that. This was long after she graduated. She called me back up and said, "Scott, I though you were crazy "when you made me back all around the training center, but now I understand why." And it's just real important that they get that and they get it down pat so that they're, again, not having to think about that-- "Which way do I go?" That they can worry about the environment and not falling off the curb or whatever... wherever it is they need to go.

CHAPTER 3: Navigating Doors

CRAWFORD: When you're navigating doors, you have to think about a lot more things when you're in a wheelchair than you do when you're on your feet, because it makes a big difference if the door is opening to the right or to the left or whether it's a pull door or a push door.

In the wheelchair, especially if you have joystick or a scooter, when that door is coming up, is it opening up to the joystick side, you have a totally different logistics than if it's coming to your free hand side, which makes it a lot easier. Or push versus pull — a push door, it's easier. You just drive right up into the middle of it and then you have to be able to reach that handle somehow.

NARRATOR: In a video clip, a young man drives straight up to a closed door and signs for assistance in opening the door. An instructor steps in to pull the door open, and he signs to the young man, asking him to move back slightly to allow the door to swing open.

CRAWFORD: But pull doors, especially, a lot of times, a student gets up to the door, and when they... once they get a hold of the handle, the chair is blocking the door. So there's a lot of tricks to getting through doors, especially with the pull doors.

CRAWFORD: The first suggestion for pull doors is to not pull up to the door, to pull up beside the door so you can reach it a little bit easier, and then once you get the door open, you have to turn to face the door. And then what a lot of people don't do is they don't push the door all the way open, they turn too soon.

Going back to navigating tight spaces, if they're not worrying about turning in that opening, they have to push that door all the way open so they can get to landmarks on their body that they should learn. Like somebody may learn, "Okay, once my shoulder's even with the frame, I can make a 90-degree turn and cut through."

So if you can get to a pull door that's got room to the side of it, you pull up to the side and then you pull it open. If you don't, you may have to pull up to the door sideways so you can get a hold of the handle and maybe drive with your other hand, or in some cases, we've had to put something on the door... pull up to it, put something on the door that you can twist it with, and then back up and then you drive through.

NARRATOR: In a video clip, a young man operating a motorized chair and an instructor with short, dark hair make their way down a sidewalk and approach a storefront door.

The young man stops his wheelchair parallel to and slightly back from the door opening. When the instructor pulls the door open, the young man moves the chair forward and turns it 90-degrees to the left to enter the doorway.

The instructor assists him in moving over a raised threshold.

CRAWFORD: There's a lot of different ways to do doors, and each one depends on the person, depends on the type of chair. That's a never ending, evolving process of figuring out how is this person going to be able to do a particular door?

CHAPTER 4: Curb Ramps

CRAWFORD: Curb ramps are a big issue for wheelchair users in several different ways. Either the presence or absence of them is the probably the first thing, because if you don't have a curb ramp, somebody may drive down a sidewalk, get to the curb, and say, "Well, I can't get down into the street."

So what do they do? Do they stop... solicit assistance, and stop somebody to help them down the curb? Do they turn around and drive back to a driveway and then drive back up the street to get to the corner again to try to cross? So if there is or isn't a curb ramp, that's the first question. Second question is, "If I am going to have to drive back and find a driveway to get out into the street," you're trying to figure out, "Okay, which street "has more room so that I'm not driving down the street "where the cars are eight inches from the curb?

"I want to drive down the street where the cars are six feet from the curb, hopefully." So you kind of got to analyze that and see which one has more space and then you go down that road, and usually, it's the smaller of the two roads. So the other... the next question is if it does have a curb ramp, is the curb ramp accessible? Is it too steep? How is it oriented?

Techniques for handling a curb ramp that are diagonal are going to be different from a curb ramp that is parallel to your line of travel, which is going to be different from a curb ramp that is perpendicular to your line of travel-- that you're having to pull up and then make a right. Does a curb ramp have an adequate landing at the top and at the bottom?

NARRATOR: In a video clip, a young man crossing a street in a motorized chair climbs from the street to the sidewalk via a diagonal curb ramp.

He circles around 180-degrees on the sidewalk, re-enters the curb ramp, and lines himself up to cross a street which runs perpendicular to his last crossing.

CRAWFORD: Another question in there is, when you're navigating a curb ramp, is it accessible? Is it too steep? Is it flat to where a blind person doesn't feel it? We see that a lot in Louisiana, where it's perfectly flat, so you're cruising along and you don't even know you've gotten into the road.

CHAPTER 5: Timing on Street Crossings

CRAWFORD: Timing a street crossing, probably the biggest issue is, "Do I have time to get across the street?"

And my first suggestion to anybody would be go read Dona Sauerburger's stuff on timing for crossing uncontrolled street crossings. I teach that to all of my clients; everyone that I see, not just wheelchair users, but all of them. Because you may hit an uncontrolled crossing where if you don't detect that that car is coming until they're three or four seconds away, even if it's all clear, you're not necessarily safe getting across that street.

So that's the first thing, is come up with methods so that they know how much time they have to cross the street. And that could be at an uncontrolled, it could be at a street light. ( "walk" signal chiming )

NARRATOR: In a video clip, we are facing a crosswalk and the sound of the "walk" signal is heard. From the right side of the picture, we see a young man in a motorized chair enter and cross the street, accompanied by an instructor with dark hair and glasses. After crossing, the young man directs his chair up a curb ramp and then takes a right turn down the sidewalk.

CRAWFORD: "How long is the light cycling if I hit the button, "versus how long is the light cycling if I don't hit the button?" Because for a lot of the wheelchair people, they'll hit the button, then have to go navigate the curb ramp.

While they're navigating the curb ramp, the cycle with the "walk" has gone through. So by the time they get in position to cross the street, they need to hit the button again. So what's the timing with the button, what's the timing without the button? Different chairs are going to move at different speeds.

Different people drive at different speeds. A lot of my students, they may have one speed that they go down sidewalks with, but they may have to bump the power up a notch or two when they're getting ready to cross the street.

NARRATOR: In a video clip, a young man accelerates his motorized chair across a crosswalk, leaving his instructor several steps behind as he reaches the other side of the street.

CRAWFORD: Another question is hills. Somebody who normally crosses a street just fine, if they're having to go uphill to cross that street, it may take them an extra three or four seconds to get across.

CHAPTER 6: Transportation

CRAWFORD: Transportation is a big issue in that you can't just go hop in somebody's car. Most of the students that I work with that have power chairs also have a manual chair, so that if they are just going in a friend's car, they can just use the manual chair and they can fold that up and put it in the trunk.

Busses-- it's been the law since 1990 that the busses have lifts and that the lifts work. It's 2009, and I'd say 20% of the time in my hometown, the lift doesn't work on the bus.

So then what do you do?

What's the next step from there?

People have to get to doctor's appointments, and that many not be where the busses go. It may be outside the city limits in our case, and paratransit won't take you outside of the city limits in our town, so they have to be able to come up with cabs or other van services that have lifts, or they need to come up with other transportation modes for themselves like either a manual chair or something like that that they can use to get in and out.

NARRATOR: In a series of photographs, a young man in a motorized wheelchair and a woman in a black coat wait at a bus stop. We can see a bus approaching the stop.

In the next photo, the young man is maneuvering his chair onto the bus via a ramp which has been lowered to allow him access to the bus.

CRAWFORD: When you're talking about transit, the students need to know what's available, what hours that runs, what are the limits of that transportation service. They need to be able to tell somebody else how to take their chair apart, because it's nice that I might have a scooter that breaks up into little, bitty pieces, but I'm going to be sitting in the car while you're taking that scooter apart and putting it in the trunk, and then you're going to have to put that scooter back together again.

So it may be nice that I, the instructor, know how to take the scooter apart and put it back together, but the student needs to be able to know how to tell a cab driver or a friend or their little aunt from Pasadena how to do that so that they can still use their equipment, you know, even if they're just travelling with friends and stuff.

That's an important part of the training, too, is that the student knows everything they can about how to operate the chair, how to take it apart, put it together. If it... if somebody puts it together for them and it's not running, okay, what are some key things he might want to check to make sure that it's still running?

Did the battery wires really get connected good?

Did the wire that comes from the controller get flipped over and is now backwards?

So they have to know how to do all those things that somebody else may do for them, but they need to be able to describe it to somebody who's just coming to help them out.

CHAPTER 7: Working With Physical and Occupational Therapist

CRAWFORD: I'd say 80% or 90% of the students that I've worked with that had power chairs or scooters, it was just dropped off by a salesman, and they received no real training on how to navigate doorways, how to cross streets, making sure that they're safe on the sidewalks.

Usually, the deliveryman just brings it by, plops it down, "This is how you turn it on, this is how you go forward, this is how you go backwards, and this is how you charge it." If a student hasn't had an assessment from PT or OT, they should probably get one, because that PT or OT may be able to help you get them out of the chair.

PHYSICAL THERAPIST: Up, up, up, up, up.

Good job.

NARRATOR: In a video clip, a young boy in a wheelchair is working with a physical therapist. She assists him in moving from the chair to a standing position, and then transitioning to a seated position on a nearby bed.

CRAWFORD: It's nice that we're teaching them how to use the chair, but it's even better if we can take somebody who needed the chair all the time and we get them to where they don't need it all the time. And the PTs and OTs can help with that. They can give them the kind of assignments or exercises to do that may help them build up their strength.

Another good example is I worked with a PT one time with a student who had a spinal cord injury, and I was expecting the woman to be able to reach forward, grab a door, pull it open, or to be able to reach out and touch something on the counter and come back.

But when I went to the PT with one of her appointments, the PT was able to explain to me that because of where the injury was, the woman had no trunk control. So once her body went beyond the balance point, she had no way to get it back up unless she let go of what she was doing and pushed it back up with her arms.

That's something that they're going to know. That's their specialty. O&M instructors aren't going to know that stuff, and it can be very valuable in making somebody be as successful as they can, and it helps keep us from having expectations that the client really can't meet because of something physical, not just because they don't choose to or don't want to.

NARRATOR: In a video clip, we see the same young boy and the physical therapist. With some assistance from the therapist, the boy makes his way from the bed back into his wheelchair.

CRAWFORD: My advice is to, if you get somebody in a wheelchair, go with them to some PT sessions. If they're not receiving PT or OT at the time, try and get it set up to where you can at least just go do one meet and consult with them, if not more.

A lot of the stuff that I've developed working with people, when I've taken it into the PTs and shown them, "Hey, look at this cool thing we're doing," they've been able to say, "Oh, well, here, I can make it better this way." So going to PTs and OTs, they're just going to take what we do, make it better.

It's going to help protect us so that we're not taking somebody beyond their abilities, and the big thing is we don't want to get anybody hurt. Try to help, but at least don't harm them. So going to the PTs and OTs just helps make sure that you don't do that.