29th Annual RESNA Conference Proceedings

Gross Drive Wheel Movement on Manual Wheelchairs and Its Affect On Elders Ability to Perform ADL Activities

Randy Bernard, MA. Clint Cope, MA. & Jong Phil Kim, MS

CATEA, Georgia Institute of Technology, Atlanta Georgia


Elderly individuals propel their manual wheelchairs very differently than most other wheelchair users. This study looked at the different methods in which the elderly propel; hands, feet & a combination of the two. Due to the reduction in the range of motion of many elders we also wanted to look at how propulsion was effected by the gross movement of the drive wheel, front, rear, and mid wheel configurations. We conducted an ADL study using the Wheelchair Skills Test (1) to tease out the difference between propulsion type and wheel configuration. We found that both the test rear and mid drive wheelchairs out performed the front wheel drive chair as well as the participants current wheelchair. We also found that the combination propellers, on average, completed each ADT task quicker that that of the other types of propulsion.


Elderly, wheelchair, ADL, propulsion, Wheelchair skills test.


Numerous studies have been conducted to look at the wheelchair community as it relates to the healthy, young, active spinal cord injured population but very little research has been done to look at propulsion or maneuverability on the elderly population. There are different tests used to determine wheelchair ADL skills such as the Wheelchair Physical Function Performance, Continuous Scale Physical Functional Performance, Wheelchair Users Functional Assessment, Assessment of Motor and Process Skills, Functional Independence Measure and the Wheelchair Skills tests.

One method used to evaluate wheelchair users' ability to perform specific ADL's is the Wheelchair Skills Test (WST) developed by Lee Kirby. The WST was designed to simulate different ADL activities in a clinical setting. Many studies have been conducted using the WST. In studies conducted by Kirby (2-4), he looked at the efficacy and practicality of the WST based on the outcomes of participants as well as feedback those individuals conducting the tests. It was found that no adverse incidents occurred, it was well tolerated by the participants, and proved to be both reliable and a valid test method even when performed by an untrained caregiver. If the WST protocol is followed as documented (1), then highly reproducible results can be expected and can be validated across studies.


•  How does the gross movement of the main drive wheel; rear wheel, front wheel, and mid wheel drive of a wheelchair affect the propulsion and maneuverability of elderly user?

•  Does propulsion type, hand, foot or combination, have an affect on maneuverability?


We recruited 16 participants, 2 foot propellers, 3 arm propellers, and 11 combination propellers, between the ages of 65 to 90 who live in a nursing home or an assisted living facility and who use a manual wheelchair as their main mode of transportation. All participants could propel independently/bilaterally by means of arm propelling (AP) using their hands to propel, leg propelling (LP) using both of their feet to propel on the floor, and combination propellers (CPG) use of hands and feet to propel.

We chose to use the Wheelchair Skills Test (WST) to evaluate the ADL performance of each participant. The wheelchair skills test is broken into three categories; basic, intermediate, and advanced. For our test we will only require the participants to perform 5 of the basic skills and 2 of the intermediate skills. The skills included; level locomotion (roll forward/backward), turns in place, moving turns, turns 3-point, parallel parking, and door (open away/towards object). These tests were select because they were best in evaluating maneuverability.

Prior to testing, each participant was measured, seat height, depth, and width, to insure proper fit for testing. For arm propellers the seat height was adjusted so the users hands were at 12:00 over the axle, their arms were at 60 ° -80 ° flexion (5). For leg and combo propulsion the seat to floor height was adjusted for each user to maintain correct seating posture while allowing the user to use their legs for propulsion.

During the study we collected times for each task. For our test we not only want to determine if the participant could complete a task, but also to see how fast they completed each task. This timed data allowed us to see differences between wheelchair configurations and propulsion types.

Each participant was required to only perform the test with their current method of propulsion. Each participant performed the 7 wheelchair skills 4 times, one time per wheel configuration and once with their current wheelchair.


The data was analyzed both parametrically and non-parametrically to see the differences between configurations. We first looked at the results for each task with wheel location as the variable.

  • Level Locomotion: By parametric method, middle is best and rear is second. Friedman test says that the middle is significantly better than only the front.
  • Turns in Place: By parametric method, the middle is the best and significantly better than only the rear, front is second and rear is the worst.
  • Moving Turn: By parametric method, current is best, rear is second, middle is third and front is worst. Middle is significantly better than only front. Rear is not significantly better than middle.
  • 3 Point Turn: By parametric method, rear is best, Current is second, middle is third and front is worst. Middle is significantly better than only front.
  • Parking Parallel: By parametric method, Rear is best, Middle is second and Front is worst. the treatment is not significant and no chair type is significantly different from each other
  • Door Open-Away: By parametric method, Rear is best, middle is second and front is worst. Rear is significantly better than only front while middle is not significantly better than Front and Current.
  • Door Open-Toward: By parametric method, rear is best and middle is second. The treatment effect is not significant and no chair type is significantly better than any other chair type.

We also looked at propulsion type compared to one another as a whole and for each task. We found that in every case the combination propellers time to complete each individual task was faster than the other modes of propulsion. Because of the total number of participants we were not able to determine if the results were statistically significant. When looked at as a whole, across all tasks and wheel configurations, the combination propellers average time was faster than that of the hand or foot propellers. Though the difference was not significantly different it does show the trend of the combination propellers ability over the other methods of propulsion.


The study does start to show the affect of wheel position as well as propulsion type on the ability of the elder population's ability to maneuver a manual wheelchair. The most compelling data we uncovered was that the mid-wheel drive manual wheelchairs times were almost equal to that of the current rear wheel drive chair for all tasks. It was also interesting to see that the combination propellers times were better, on average, than that of the other propulsion methods as well as made up the majority of elder participants. Though the data didn't show the difference to be statistically significant, the combination propellers times were faster. Due to the small number of participants and the even smaller number of hand and foot propellers we were not able to predict if the results of the study were valid. That being said, we began to see a trend in the results. The high number of combination propellers was not planned but rather the make up of the current nursing home and assisted living facility wheelchair population.

There are implications to wheelchair design as it relates to the elder population. Since so many of the participants in this and other studies we have conducted use their feet to assist in propulsion, more thought and effort should be put forth towards the design of more appropriate wheelchairs with this population in mind.


This research is supported by the U.S. Department of Education, NIDRR, Grant # H133E030035.


  1. Kirby RL, Dupuis DJ, Macphee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, Macleod DA, Bonaparte JP (2004). The wheelchair skills test (version 2.4): measurement properties. Archives of Physical Medicine and Rehabil. , Vol. 85, No. 5, 794-804.
  2. Aissaoui R, Arabi H, Lacoste M, Zalzal V, Dansereau J. (2002). Biomechanics of manual wheelchair propulsion in elderly: system tilt and back recline angles. Am J Phys Med Rehabil . Feb;81(2):94-100.
  3. Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, MacLeod DA (2004). The manual wheelchair-handling skills of caregivers and the effects of training. Arch Phys Med Rehabil. Dec;85(12):2011-9
  4. Best KL, Kirby RL, Smith C, MacLeod DA (2005). Wheelchair skills training for community-based manual wheelchair users: A random controlled trial. Arch Phys Med Rehabil. Dec;86(12):2316-23.
  5. Kirby RL, Swuste J, Dupuis DJ, MacLeod DA, Monroe R (2002). The Wheelchair Skills Test: a pilot study of a new outcome measure. Arch Phys Med Rehabil. Jan;83(1):10-8.


Randy Bernard, MA.
Georgia Institute of Technology
490 10 th Street
Atlanta, GA 30318

This should be in the right column.