As key worker how do you respond to this question?

Prior to your goal review meeting with Alice you had discussed self propelling with your colleagues and had a review of the evidence.

Q. What did you find out about self propelling? Select Yes, No or Maybe for each of the statements below.

You explain to Alice that it has been suggested that the effort required to self propel a wheelchair may cause an increase in arm and leg stiffness but there is no clear evidence to support this. You have discussed this with the physiotherapist and she has agreed that she will closely monitor Alice for this. You feel that self propelling would allow Alice to be more independent, reduce the work load for her husband and allow her to go out socially. Additionally as she is doing other functional tasks throughout the day such as transferring and standing you do not believe that self propelling at this stage should negatively impact on her long term recovery.

After careful consideration and following your discussion with Alice, Alice agrees to have wheelchair self propulsion as a goal.

Q. What did you find out about self propelling? Select Yes, No or Maybe for each of the statements below.

Self propelling allows patients to be more functionally independent – Yes – the use of a wheelchair allows patients to move around their local environment.

Wheelchairs can be adjusted to optimise a patients seating position/posture – Yes – wheelchairs can be modified to offer additional support and to ensure that the hip, knee and ankle position is as near 90° as possible.

Self propelling increases tone and impacts on long term physical outcome – Maybe – this is a widely held clinical belief but there is no concrete evidence to support or refute this perception. It could be hypothesised that the increased effort required to self propel may increase a person’s tone but whether this tone is sustained remains unclear.

All patients can self propel – No – a number of factors need to be taken into account when assessing a patient’s ability to self propel. Patients with impaired cognition and visual perception may struggle to self propel. Patients who cannot sustain sitting balance are unlikely to be able to self propel and those with poor safety awareness may be more at risk when self propelling.

Routine early self propelling may reduce the stigma associated with wheelchairs and improve morale – Maybe – if using a wheelchair is routine practice within a unit then patients may not associate it with failure if they do not achieve walking. Some evidence has suggested that its use early may have beneficial impacts on morale.

Early self propulsion can prevent delayed discharge – Yes – if a patient will not reach independent walking and can already self propel then discharge is not delayed by having to learn how to self propel. The patient’s discharge plans can continue as previously.

For patients who do not achieve walking wheelchair mobility maybe the best alternative – Yes – the use of a wheelchair may provide a safe alternative mode of mobility for those patients who do not reach independent walking.

Under no circumstances should patients ever be allowed to self propel – No – there is no good quality evidence to support this. It needs to be considered that the early use of self propelling may be beneficial as much as detrimental. More research in this area is required.

Page last reviewed: 01 May 2020