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VR Series #11: Wheelchair Training

I recently noticed an interesting article in the November edition of the Archives of Physical Medicine and Rehabilitation, Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review by Jean-Francois Lam et al from the School of Rehabilitation, University of Montreal, Montreal, QC, Canada [2018;99: 2313-41]

The idea was to provide a comprehensive description of the current state of knowledge regarding the use of virtual technology for wheelchair skills training. A collection of peer-reviewed studies and long conference proceedings were examined in order to extract relevant data and build a number of tables in order to look at the characteristics of the training, equipment and technology, intervention characteristics, outcome measures and outcomes.

By way of background more than 65 million people worldwide require a wheelchair for mobility. That number is growing. Wheelchairs, whether manual or powered can provide users with the opportunity to accomplish many every day activities. I still remember a presentation which the amazing Martyn Ashton gave at one of DWF's recent catastrophic injury conferences about the use of technology, exoskeletons and the downhill MTB that he currently rides.

Notwithstanding all that technology what Martyn came back to time and time again was the fact that his wheelchair was the most important piece of equipment. Keep that thought in mind and take onboard that to fully benefit from the use of wheelchairs users need adequate training to develop the necessary skills in propulsion techniques, transfers and  manoeuvring.  

Despite their being a significant amount of evidence as to the benefits of future skills training there is an awful lot of progress which still needs to be made in terms of optimising the training which is provided. In Canada only 20 out of 68 Canadian rehabilitation centres reported using validated wheelchair skills training program. That training was focused primarily on basic mobility skills rather than the more advanced skills required for community mobility. In the US and the UK provision of training is also low: ranging between 11 and 55%.

A variety of barriers have been identified and reported in the literature with both lack of time and lack of resources being the two most commonly perceived issues.

Use of less conventional training methods such as virtual technology e.g. where the user interacts with the virtual world via a human-machine interface have seen a growth since the late 1990s. The use of virtual technology for future skills presents potential advantages to traditional training methods and may also be used to supplement traditional skills training.

It may:

  • require less time to switch or modify tasks;
  • integrate the capacity for systematic delivery and control of stimuli;
  • represent better the nature of the context and the nature of the tasks being performed;
  • integrate self guided exploration and independent practice;
  • record complete naturalistic performance;
  • provide automatic real-time performance feedback;
  • cue stimuli to support error-free learning;
  • provide gaming factors to enhance motivation;
  • cost less;
  • be safer for the user and the therapist;
  • use less space and equipment;
  • mean that clinicians need not be present or present during all the wheelchair users training in order to provide feedback or to ensure the wheelchair user's well-being.

There is an awful lot of data in the study, an awful lot! But whilst there were many differences between the individual studies one thing that comes out loud and clear is the lack of use of universal outcome measures. The use of a standardised outcome measure for wheelchair skills may provide a better representation of the user's capacity to perform wheelchair skills ranging from basic indoor skills to more advanced community skills. The Wheelchair Skills Test [WST] has versions for both manual wheelchair skills and powered wheelchair skills and both versions have demonstrated reliability and validity. The WST can be reviewed at the Archives of Physical Medicine and Rehabilitation 2002; 83:10-8.

The importance for insurers? Well it seems to me that:

  • a properly trained wheelchair user has the potential to be more engaged in community activities and employment, and
  • use of standardized outcome measures can help to ensure that the right kit (and only the right kit) is provided to aid that user.

Last but by no means least for anyone interested in Martyn's exploits [Warning: these will open YouTube] on his MTB check out Martyn Ashton Rides Whistler or the now classic Road Bike Party



For more information please contact Ian Slater, Partner, DD 0161 603 5066 M 07798 700494 Ian.Slater@dwf.law


This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.