PRS presents wheelchair propulsion training at the Geriatric Conference in Boston, MA in May, 1999.

Yaffa Liebermann, PT Geriatric Clinical Specialist Director/Owner

Meyrav Dror, OTR Rehabilitation Supervisor

Wheelchair propulsion is a comprehensive treatment procedure, which affects the client's physical well being and daily living skills, as well as contributes to increased rehabilitation outcomes. Wheelchair propulsion is a simple treatment that is easy to apply and is extremely effective as a rehabilitation process. It is contributory to the treatment of the geriatric populations in various settings such as subacute care, nursing home, home care, hospital and assisted living. The patient may have only partial use of the body, yet may be able to achieve significant independence in locomotion through wheelchair propulsion, and by doing so improve quality of life.

As therapists we have the knowledge and the ability to instruct the patient in wheelchair propulsion, a treatment which is recognized by Medicare and is reimbursable through HCPCS code 97542. This activity requires a combination of coordination, motor planning and strength. Mastering it results in a proud and happy patient, who does not need help from others to come and go as he/she pleases.

Documentation is based on quantified measures: distance, time, location, endurance, and assistance provided. Our notes can help nursing to complete MDS V2.0 section G1e "Locomotion on Unit: How resident moves between locations in own room and adjust corridor on same floor. If in a wheelchair, self sufficiency once in a chair." And section G1f "Locomotion off Unit: How resident moves to and returns from off unit locations (e.g., areas set aside for dining, activities, or treatments). If facility has only one floor, how resident moves to and from distant areas on the floor. If in a wheelchair, self sufficiency once in a chair." Each documented difficulty would trigger a quality indicator resulting in modification of MDS ADL level.

The benefits of wheelchair propulsion cover a vast range of clinical areas:

• Postural Alignment
  • Symmetric body posture with no discrimination between healthy and affected side, placing bilateral sides equally in the wheelchair.
  • Feet on floor will promote proper posture.
• Weight Bearing when feet on floor.
  • Normalizes tone : decreases high tone and increases low tone
• Muscle Strength
  • Increased strength due to anti-gravity muscle movement.
• Skin Integrity
  • Blood flow increases enabling accelerated healing of skin.
• Decreased Medical Complications
  • Conditions associated with aging and/or with deconditioning such as Edema and Osteoporosis decrease through activation of limbs (Edema reduction) and weight bearing on bones (Osteoporosis control).
• Trunk Control And Total Body Strength
  • By the involvement of trunk and extremity muscles in propulsion, an exercise response is promoted.
  • Increased control promotes better sitting, standing and gait functions.
• Preparation For Gait Training
  • Repetitive movement of the feet on the floor can simulate gait without having to involve full weight bearing at a stage where clinically and psychologically the patient may not yet be ready.
• Cardio Vascular Benefits
  • Blood returns from lower extremities contributes to normalizing blood pressure, thus decreasing risk of orthostatic hypotension.
• Increased Functional Activity Tolerance
• Sensation Stimulation
  • Proprioceptive and tactile return from feet denotes to the patient the relation between the feet and the floor.
• Restraint Reduction
  • Increasing free choice and ability to reach desired destination.
• Quality Of Life
  • Increased through locomotion in the immediate environment, promoting better self care as well as socialization.

Before proceeding with the wheelchair propulsion exercises review the following:

• Color of the patient's face. If the following exist postpone exercises:
  • Too pale or too red
  • Excessive sweat
• Breathing Pattern. If the following exist postpone exercises:
  • Pattern too quick
  • Patient demonstrating difficulty
• Cardiac condition
  • Upper extremities activities increase heart work.
• Propulsion Methodology
  • Propelling with feet and hand confuses the patient. Use only one method at exercise initiation.
• Propulsion Distance
  • First day start with 10 to 15 feet, and progress slowly each day, with plenty of resting time upon any signs of fatigue.

Years of experience with the geriatric population has demonstrated the benefits of independent wheelchair propulsion to the resident's quality of life. Once achieving independence through wheelchair propulsion, the residents have the ability to increase their functional capacity and number of active hours beyond the operating hours of the rehabilitation and/or activity departments this ultimately creates a lively and uplifting atmosphere.

Integrating this simple, yet comprehensive, treatment will benefit the geriatric population in many aspects of life. Self propulsion enables less burden on families, promotes socialization, and vibrant activity with self pride as equal partners in the facility's social arena.

In closing, the following poem was written by Ann McNeil, a resident of King James Care Center in Middletown, New Jersey (printed with the author's permission) and summarizes wheelchair propulsion's benefit to the resident.

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