Assisting Students Who Use Wheelchairs

Guidelines for School Personnel

Michael F. Giangreco, Irene McEwen, Timothy Fox, and Deborah Lisi-Baker

From

Quick-Guides to Inclusion

Ideas for Educating Students with Disabilities, Second Edition

Michael F. Giangreco & Mary Beth Doyle Editors

Quick-Guides to Inclusion: Ideas for Educating Students with Disabilities (2nd ed.) © Michael F. Giangreco, 2007 Available through Paul H. Brookes Publishing Co., Baltimore, 1-800-638-3775

Some students who use wheelchairs are quite capable of getting around with their own manual or power chair. Even when students are very good at using their wheelchairs, they will occasionally find themselves in situations where they need assistance. Other students may need more help, such as transferring in and out of their wheelchairs or moving from place to place. If you see a student struggling to overcome a barrier, such as trying to open a heavy door to enter a room, don’t automatically assume that the student needs or wants your help. Your best bet is to do the same thing you would do if you saw any student you thought could use some help. First, ask if the student wants your assistance. If the answer is “Yes” then you can ask, “What kind of help would you like?” Most students who need this kind of occasional assistance can effectively communicate what they need and exactly what would be helpful. Students who have limited language skills, lack a formal language system, or rely primarily on nonsymbolic forms of communication (e.g., facial expressions, vocalizations, pointing) may have difficulty communicating, especially with people who don’t know them well. In these cases, if you really want to help, you have to be willing to look and listen. Students who have been in their wheelchairs for too long without a break, for example, may make certain sounds or move in ways that suggest they are uncomfortable. You have to interpret those nonsymbolic communications the best you can. You might guess the message is “I want to get out of this chair!” If the student smiles or gives a sigh with relief after getting out of the chair, you can feel reasonably sure you interpreted the communication correctly. Over time, and with information provided by people who know the student well, you can become increasingly skillful in interpreting a student’s nonsymbolic communication. You can also create language boards or use computer programs to make it easier for a student to communicate wants and needs.

Changes in position are not only necessary for physical or health reasons. Changing positions can also be important to allow students with disabilities to participate in classroom activities. If the class moves from an activity where everyone is seated at desks to one where they are on the floor, for example, the student who uses a wheelchair should be supported to join classmates on the floor. The student may need a little or a lot of support to be comfortable and stable while he is out of his wheelchair. Supports can be as sophisticated as a specialized floor sitting device or as simple as a wall to lean against, a pillow, or a friend to sit next to. As a general rule, the supports provided should meet the student’s need, but in a manner that allows the student to participate in the activity and fit into the group. In other words, use the most typical support that works before using something unnecessarily specialized.

A student’s physical therapist or occupational therapist can recommend general guidelines for how often a student should change positions. Of course, therapists are not around all of the time, so it is most important to listen to the student and encourage the student to communicate needs for position changes. In general, however, if a student is comfortable, avoid removing a student from a well-fitted wheelchair for positioning in specialized equipment that provides less adequate support and limits opportunities for participation in school activities. To help a student move to and from a wheelchair, you must learn how to make those transfers safely and comfortably for the student and for yourself. Before attempting to transfer a student, be sure to consult someone who knows the student well to learn how to help him or her. You might be able to check with the student, parent, teacher, physical therapist, or occupational therapist. Most students can assist with one or more steps involved in a wheelchair transfer. Always expect students to assist as much as possible with every step of a transfer. Be sure to give students enough time to do what they are capable of doing. Specific steps in the transfer will vary depending on where the student is transferring. An assisted transfer to the floor, for example, will be different than a transfer to a couch. Young children, because of their size, tend to be easier to transfer. Because young children are easier to lift, the tendency is to do too much for the student. If young students are not allowed to learn and practice the skills they need to use in transferring, as they grow older and heavier the task of transferring becomes more difficult. Every opportunity to practice transferring is an important opportunity for learning. With each transfer the student can be practicing the communication, social, and movement skills involved. Learning to transfer independently, or with as little assistance as possible, can allow students more independence in their daily lives and can open opportunities that may otherwise be limited. Because of the inherent risks in transferring students to and from their wheelchairs, both to the student with a disability and the persons providing assistance, it is always advisable to err on the side of caution. For example, trying to transfer a student by yourself, when a two-person transfer makes more sense, can result in either the student or you being injured. A physical therapist can show you how to help a student transfer safely and minimize the risk of injury to the student and your own back.

TRANSFERRING FROM A WHEELCHAIR

The following steps offer a general sequence for transferring from a wheelchair. The specific steps can vary greatly from student to student, and the order may vary slightly.

1. Let the student know that it is time to transfer.
2. Always minimize the distance between transfer points. If the student is able, ask the student to move the wheelchair to the proper position for the transfer. If not, inform the student of your intention and move the chair into position yourself.

3. Once in position, have the student lock the brakes on the wheelchair. If necessary, lock the brakes yourself.
4. Remove equipment and supports that may get in the way. For example:
   • Remove the lap tray and any switches or other devices.
   • Loosen the foot straps and move the footrests to the side.
   • Remove the block (e.g., abductor block) from between the knees.
   • Remove any chest, shoulder, or head straps.
   • Remove or adjust one side support (e.g., arm rest) in some cases.
5. Ask the student to lean forward.
6. Unfasten the seat belt.
7. While still leaning forward from the trunk and hips, ask the student to slide forward in the chair and put his feet on the floor.
8. Ask the student to stand up—this may require your assistance. Most students, regardless of the severity of the disability, can bear some weight, particularly if the student has been expected to bear weight since a young age. The ability to support at least partial weight during standing is extremely important, and students need to practice whenever they transfer. Except in emergencies (which are rare), never lift a student who can support any of his own weight. For your own health and safety while assisting the student, be sure to maintain good body alignment (i.e., straight back, bending from the knees).
9. Assist the student to move to the other surface, as you have been shown, by a knowledgeable person (e.g., therapist, parent). Make sure the student is comfortably and safely positioned before moving away.
10. Release the brakes on the wheelchair and move it to an appropriate location until it is needed again.

TRANSFERRING TO A WHEELCHAIR

The following steps offer a general sequence for transferring to a wheelchair. The specific steps can vary greatly from student to student, and the order may vary slightly.

1. Let the student know that it is time to transfer.
2. Always minimize the distance between transfer points.

3. Make sure the brakes of the wheelchair are locked.
4. Make sure the wheelchair is free of any supportive equipment that might get in the way of a successful transfer (e.g., foot rests, blocks and straps, seat belt).
5. Assist the student in assuming a standing position next to the wheelchair, as you have been shown by a knowledgeable person (e.g., therapist, parent). Maintain proper body positions to minimize your own risk of back injury.
6. Assist the student to stand and then turn and sit on the edge of the seat.
7. Ask the student to lean forward and scoot as far back into the chair as possible. Many students need help to do this.
8. While the student is still leaning forward, make sure the student is all the way back in the chair and is centered (not closer to one side of the chair than the other); this is extremely important. If the student is not centered and all the way back in the wheelchair, the student’s posture will be poor. This will lead to discomfort and fatigue, and may limit head control and hand use.
9. While the student is still leaning forward, fasten the seat belt. Just like in a car or airplane, the belt should be secured snug and low across the lap to keep the student positioned properly. This is especially important for students who have difficulty repositioning themselves in their wheelchairs. Students who are able to reposition themselves will make their own adjustments to the seat belt’s tension.
10. Attach or fasten equipment and adjust the student’s positioning supports. For example:

• Adjust the footrests and position the student’s feet.
• Place and secure any blocks or supports (e.g., abductor block).
• Attach and secure any chest, shoulder, and head supports.
• Attach the lap tray and any switches or other devices.

11. Ask the student to release the brakes, and you are ready to go.

WHEELCHAIR MOBILITY

Many students can move their wheelchairs most of the time but may need help in some situations. Others need help most of the time, and some students need help all of the time. No matter how much help a student needs, always make sure students who are using their wheelchairs are wearing their seat belts and any other supports they might need to be comfortable and safe. Try to keep the following guidelines and ideas in mind.

Pushing a student’s wheelchair without permission is like rudely shoving a student who can walk. Always ask permission to move students who can move their own wheelchairs. If you see a student you think needs assistance, you might ask, “Can I help you back up?” If a student can’t move her own wheelchair, let her know that you are going to move her: “It’s time to go to lunch now; are you ready?” Pause to allow the student a moment to get ready to go. Then, before moving her wheelchair, let her know your intentions by saying something like, “Here we go!” Turning off a student’s power wheelchair to prevent the student from moving about is inappropriate. It is like tying a student who walks in a stationary chair. If the student is being mobile in a way that is perceived as problematic, address the behavior as you would a similar situation with a student who can walk. Consider the intention of the student’s behavior. Is the student trying to tell you the lesson is boring, he wants to escape the situation, or he is more interested in something else across the room? Once you figure this out, do something constructive to address the behavior. Remember that a manual wheelchair is a mobility device—it is not an exercise device. If propelling a wheelchair is difficult for a student, don’t ask the student to push the wheelchair simply for exercise or because you think it will be character building. Students who use wheelchairs should be able to get around as easily as their classmates who walk and run. A power wheelchair may be necessary. If a student with a manual wheelchair needs help to keep up with friends, try to teach a responsible friend to help, rather than having an adult help all the time. Clear this approach with the student and family, and make sure the student helper is oriented to safe and respectful ways to offer assistance to people who use wheelchairs. Talk with students when you push their wheelchairs, just as you would if you were walking with a student who does not use a wheelchair. In some situations, where the space is wide, flat, and smooth enough (e.g., wide hallways), you can actually push a student’s wheelchair while walking beside it, rather than from behind the chair. This is not possible in all situations. It is most likely to be an option when the person providing assistance is quite a bit larger than the person in the wheelchair, thus allowing the person to adequately control the wheelchair with one hand. Use your judgment, and only walk beside while pushing a student’s wheelchair in situations where it normally is courteous to walk side by side. This would not be a good idea when the halls are crowded between classes at a high school, for example, but would be appropriate if the student using a wheelchair and a peer were running an errand while the halls are empty.

OTHER WHEELCHAIR MOBILITY TIPS

1. Push students in wheelchairs forward up ramps. Go down steep or long ramps backward, particularly if the student is not able to lean back. Imagine what might happen if you lost your grip on a student’s wheelchair and he were headed down a long ramp, unable to stop himself—it’s not a pleasant thought!

2. To help a student go up a curb (if no curb cut exists), first move the student in the wheelchair forward until the front (small) wheels are near the curb. Let the student know you plan to tip the chair back slightly to get up the curb. Then tip the wheelchair onto its back wheels by pushing down on the push handles while stepping down on one of the tip bars (near the ground, inside the wheels) with your foot. Push the chair forward and put the front wheels on the sidewalk (some students can push on the hand rims or power their chair to help). When the back wheels almost reach the curb, lift the chair by the push handles and roll the back wheels up onto the sidewalk (some students also can help during this step).

3. To help a student go down a curb (if no curb cut exists), first move the student in the wheelchair backward until the back wheels (the large ones) are near the edge of the curb. Let the student know you plan to tip the chair back slightly to get down the curb. Then move the wheelchair back by holding onto the push handles and supporting the wheelchair while rolling the back wheels down the curb (some students can help by holding the had rim to slow the descent). Roll the wheelchair back until the front wheels are near the edge of the curb. Still holding onto the push handles, slowly roll the front wheels down the curb. Turn around and you are on your way.

4. When curbs, stairs, or other barriers exist, consider joining together with people who have disabilities to advocate for changes (e.g., curb cuts, ramps, elevators) that allow universal access. Although you may have been prompted to think about these barriers because of a student you know who uses a wheelchair, these types of changes can allow better or easier access for many other people (e.g., a parent with an infant in a stroller, a delivery person with a heavy load, a person who is temporarily on crutches, or an elderly person who has difficulty with stairs).

5. When assisting students in their wheelchairs on the playground or ball fields, it is often advisable to tip the wheelchair slightly onto the large rear wheels. As in all cases, always let the student know what you plan to do before doing it. When running the bases in a softball game or running on a field while playing “Ultimate Frisbee,” for example, the small wheels of a wheelchair often get caught in the ruts and uneven surfaces. This can cause the wheelchair to tip forward unexpectedly. This is a prime situation where having the seat belt fastened is critical—without it the student can easily be thrown from the wheelchair. So let the student experience the faster than normal speed of running the bases and playing in the field by tipping the chair on its rear wheels and maintaining a safe speed.

Make sure every member of the school team, including the student and the student’s parents, is aware of these general guidelines. More importantly, make sure those providing assistance understand the individual needs and preferences of the student. It is helpful to document a student’s mobility needs and preferences in writing or with photos to orient school personnel, classmates, and friends in the safe and respectful ways to offer assistance.

Excerpted from Quick-Guides to Inclusion: Assisting Students Who Use Wheelchairs by Michael F. Giangreco Ph.D., Mary Beth Doyle Ph.D. www.brookespublishing.com