Introduction to module #2

Welcome back! I hope that everyone had a great week and enjoyed your first online discussion session. If you are having any technical difficulties with anything, please contact the research team member you have been in contact with.

During this module, we will: (project GET WISE)

(G) Continue to set goals today (and throughout the program)
(E ) During the online discussion session, the exercise program will be reviewed
(T) Today we will begin to discuss ways to improve transfer skills and increase safety

(W) and improve basic wheelchair/scooter skills
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(E) Finally, methods in which the environment can be a positive and negative influence on falls will be discussed.

First up, we will discuss transfer and wheelchair skills

Introduction to transfer skills and wheelchair/scooter skills

Now we are going to start talking about transfer and wheelchair/scooter skills. As discussed previously, this is an important component of GET WISE. Information on transfer and wheelchair/scooter skills will be discussed frequently during this education program. Please remember that when you are practicing any transfer and wheelchair skills associated with this program, please make sure that you have a care partner with you.

Falls commonly occur when performing transfers and while driving or propelling a wheelchair or scooter. Frequently, environmental factors, such as slippery floors or cracks in the sidewalk, influence the fall. Personal factors, such as being distracted, muscle weakness or spasticity are also related to transfer and wheelchair/scooter falls.

It is useful to be aware of the most common locations and activities associated with falls for individuals with MS, but many activities are unique to the individual. Therefore, in this program, you will learn transfer and wheelchair/scooter skills that cover a lot of different situations and also are generalizable/applicable to many situations.

If a person has difficulty performing a transfer or has limited wheelchair or scooter skills, he or she may have trouble engaging in individualized activities, such as visiting friends, going shopping, etc. Even having a fear of falling can also significantly limit a person’s ability to engage in these types of activities.

We recognize this program builds upon what you already know; and “unlearning” habits associated with less than optimal transfer and/or wheelchair/scooter skills can be difficult. The process of changing learned behaviors takes time, so we need to be patient with ourselves and each other and be supportive.

We will now start to talk more specifically about transfers. Please turn to page 33 of the program manual.

What is a transfer?

A transfer is a movement from a wheelchair or scooter to/from a desired surface. Transfers are critical for performance of necessary activities of daily living and doing desired activities in your home and community. A transfer can be performed either completely independently or with the assistance of assistive technology and/or a care partner.

Why is learning how to properly perform a transfer important?

• Transfers are used frequently! You need to transfer to perform even very basic activities of daily living, such as getting out of bed in the morning, using the toilet, or getting into a car.
• Falls often occur during transfers, especially when people rush through the activity or transfer on slippery or unstable surfaces.
• In addition to preventing falls, using proper transfer techniques will help prevent the development of upper extremity injuries.

Tips for success:

Please see the information below for some tips to help make your transfers as safe and
efficient as possible:

• Take a time-out before your transfer! It is easy to get into a routine with your transfers. On one hand, this is a good thing because it makes our movements more efficient, but it is still important to pause before each transfer to make sure everything is set up correctly and pay attention during each step of the transfer. Before you transfer, take a brief ‘time-out’ to make note of any potential problems. This step is very important to prevent falls!
• Set up the transfer! If you set yourself up to transfer correctly, the rest of the transfer will be easier and go smoothly. Instructions on how to set up the transfer will be provided in the next section.
• Think about how your body is feeling. Are you tired or have increased spasticity? If so, ask yourself if you can wait to perform the transfer until you are feeling better or if you can perform the activity in another way.
• Check the surface your feet are on and where you will be transferring to. Is it wet or slippery? Are there any obstacles that might get in your way? If possible, try to change the conditions of the surfaces (dry and stable). If not possible, try to find another place to perform your transfer.

In the next sections we will show you how to properly perform a transfer. We have two different versions of the education materials:

1. Independent transfer: This material provides information on how you properly perform a transfer without assistance. If you perform transfers independently, please see page 35 and watch the video ‘Independent transfers instructions.’ If you perform a stand pivot transfer, please watch the ‘independent transfer video.’ Some additional instructions will be provided about these types of transfers at the end of the video.
2. Assisted transfer: It is very important to learn how to effectively work with a care partner if you receive assistance during transfers. This material provides information on how to perform a transfer and how care partners can properly and safely provide assistance. If you need someone’s help when you perform a transfer, please see page 39 and watch the video ‘Assisted transfer instructions’

Independent Transfer

Additional information to add after the independent transfer video

Set-Up Phase:

Step 1: Position Your Chair
While you still want to get close to the surface you are transferring to, make sure that you have adequate room to maneuver your feet if you take a few steps when you transfer.

Step 2: Chair Set Up
If you use your arm rests to push up from the chair, please don’t remove them. You will have to decide if the arm rests are more useful to push up from or if they potentially might get in your way during the transfer. Please talk with the trainer to make this determination.

Step 3: Feet and Body Positioning
No change.

Step 4: Hand and Shoulder Positioning
Depending on how you perform the transfer, it might be safer for you to keep both hands on your chair to help you push up from. Then move one hand to the surface you are transferring toward. It is still critical to use a handgrip if one is available.

Flight Phase:

You will not need to use the head hips relationship.

End Phase:

No changes. Continue to exercise care when sitting down.

Assisted Transfers

Influence of the Environment

Welcome back. We are now going to talk about how your environment can have an influence on your fall risk.

Living with potential fall hazards in the environment is a reality we all have to live with, but there are strategies you can use to manage your fall risk. Falls prevention starts with paying attention, being aware of your surroundings, and identifying potential fall risks around you.

A recent study found several environmental factors contribute to falls among people living with MS who were full-time wheelchair users.

Those environmental influences included:

• Cluttered environments
• Weather
• A bad set up for wheelchair activities
• Steep incline and decline
• Moving objects (e.g. Bus)
• Surface condition:
  • Slippery floor
  • Cracks or bump on a street
  • Narrow sidewalk
  • Unexpected obstacles
  • Carpet

This ability to know your capability, and to compare it to the demands of the environment is an important skill! We are going to take a look at a few pictures now and identify some potential hazards.

The first picture is a bathroom that is fairly common in many homes. (Project picture of ‘before bathroom) This same bathroom has now been modified (Project the picture of the ‘after’ bathroom). You can see several modifications have been made to make this bathroom safer. Some of these items include:

• Low rise to enter.
• Higher shelving for shower items (to avoid bending over).
• This is accessible for the individual it was made for, but there are a number of other modifications that could be made based on personal need. Maybe a shower chair/tub transfer bench, an anti-skid mat on the floor, a handheld shower, a grab bar, a long-handled sponge, or a curbless walk-in shower.

Next up is a very common hazard that we often see in our community. (Project the picture of the broken sidewalk) For some people this would not be too much of a problem, for others though, it would be very challenging.

When we think about what makes an environmental hazard, it is the combination of the person and the environment. As a result, it is very important to know your own capabilities.

Now, let’s take a look at the steps to manage identified environmental hazards.

Once you have identified fall risks in your surroundings, the next step is to make a plan of action.

Environmental risk factors fall in one of two categories:

The first is Environmental hazards requiring immediate action: These are hazards you have to manage in the moment. Example: You are at a friend’s house and need to use the bathroom. You typically use a grab bar to help you transfer to the toilet, but there isn’t one and the toilet is quite low.

The second is Environmental hazards requiring long-term planning: These are hazards, typically in your home, that require you to take a series of steps over time to address the problem. We saw an example in the “before and after photo” from the bathroom.

For environmental hazards that require immediate action, you can use the “Stop, Plan, Act” strategy.

• Stop: Pay attention, assess the environment, identify situations that could be unsafe.
• Plan: Determine safe options to address the unsafe situation. Select the best plan for you.
• Act: Move forward with your safety plan.

During the discussion session this week we will examine different environments and put this plan into action.

For environmental hazards that require long-term planning, we are going to learn about a strategy called action planning. An action plan is a way to break down a large goal of yours into small, manageable steps.

Please now turn to page 48 of the manual “Action Planning Form”. We are going to talk more specifically about what action planning involves.

Step one of an action plan is to consider a manageable goal that you are confident of accomplishing within a week.

Next, you’ll identify a small step you can take towards your goal and think specifically about what you will do and when you will do it.

The third step is to figure out what will help you succeed. Maybe you will set a reminder on your phone to remind you to get started on your first action step.

Finally, you will rate your confidence in your ability to achieve your goal within a week or so. You should be an eight or higher in your confidence.

Key part of the action plan:

• The first step is to consider a manageable goal that you are confident of accomplishing in a week.
• Your level of confidence should be an eight or higher, or you should possibly reconsider the goal.
• The action plan helps you break down a bigger task into manageable, thought out steps.

There are 10 copies of blank action plans in your supplemental folder. If you need more, please feel free to make copies or print one from the study website.

Remember that simple, inexpensive additions to the environment can often make a difference in safety and possibly prevent a fall.

To further help you with making changes to your home, the National Multiple Sclerosis Society has developed a brochure on fall proofing your home and environment. You can access this on the NMSS’s website. A link to the brochure is available on the iROLL study website.

Please take some time to look over this brochure. We would like you to complete the “Fall proofing your home and environment” checklist on pages 9 through 16 in the booklet over the course of the next week. We hope this activity will support your personal assessment of your environment.

We will be talking about funding options for home modifications/equipment in a future session. In the meantime, please turn to page 50 in your participant manual. There you will find:

• Examples of home modifications
• Home modifications and fall prevention resources

Session #2 Journal Entry

We are now going to discuss the journal entry for this week. Please turn to page 55 in your manual.

As a reminder, you will be asked to make a journal entry every week. Your journal entry will be tied to items discussed during the education session.

The journal entries will help you think about the information that was presented during the education sessions and help you integrate what you have learned into your everyday life.

For this week, please describe an environmental hazard that might increase your fall risk in your home. Then, write about your experiences regarding your first action plan. What efforts did you make to complete your first action plan and how did it go? If you could not complete your first action plan, what prevented you from completing the task? Please try to complete this activity prior to the online discussion session.

Wheelchair/Scooter Skills Overview

We are now going to go more deeply into wheelchair and scooter skills. Please turn to page 56 of your manual.

The ability to push or drive your wheelchair/scooter effectively is necessary to allow you to safely and successfully navigate a variety of environments in your home and community. Having good wheelchair/scooter skills is also very important when it comes to preventing falls. There are a variety of wheelchair/scooter skills related to the daily activities you perform, such as pushing or driving your wheelchair/scooter over even and uneven surfaces, navigating narrow environments, going up/down curbs, etc. Before we get into specifics, first we will talk about why learning how to properly perform wheelchair/scooter skills important.

Why is learning how to properly perform wheelchair/scooter skills important?

• Falls often occur while pushing or driving a wheelchair/scooter. Specifically, falls frequently occur when people drive or push their wheelchair/scooter in a hurry, while not paying attention to the surrounding environment, or going up and down a steep ramp.
• Good wheelchair/scooter skills are needed to perform necessary daily activities such as getting to the bathroom, shopping for food, and going to doctor’s appointments.
• Good wheelchair/scooter skills will also help you get out into the community and do the activities you wish to do. For example, if you would like to go to the library but are unsure how to navigate a ramp, it might be difficult or scary for you to get into the building. If you learn how to push/drive up a ramp, you might feel more confident going to the library.
• With good wheelchair/scooter skills, you might also be able to do more things by yourself and will not need to rely on a care partner to assist you as often.
• Knowing how to use a wheelchair/scooter correctly will give you the ability to manage unexpected items such as a crack in the sidewalk or other unexpected situations.

Next, I will cover some general tips for safety while using your wheelchair or scooter:

• Fasten your seat belt! The seat belt will help you to stay in your chair if you accidently hit an unexpected obstacle such as a bump or a curb.
• Control your speed! Even if you are in a hurry, push or drive your chair at a reasonable speed. Wheelchair/scooter users frequently report that falls occurred because they were pushing or driving the chair too fast and hit an obstacle.
• Check the pathways you often travel to make sure they are clear and accessible. Ask your care partner to arrange the furniture in your house to create a clear path. Also, keep the floors clear of small items. Random obstacles such as a dog, toys or electrical cords can cause a fall.
• Maintain your wheelchair/scooter regularly! Wheelchair/scooter malfunctions, such as broken seat belts, wheel locks (brakes) or footplates, are associated with falls. Regular wheelchair/scooter maintenance can help prevent these problems from occurring. This concept will be discussed further during Session #5 (Page 130).
• Don’t drive or push your wheelchair/scooter when you are intoxicated. It is extremely dangerous. If you have consumed alcohol, ask someone who has not been drinking to take you to where you want to go.

During this education program, you will learn and review how to perform important wheelchair/scooter skills, ranging from basic skills to more complicated tasks. Today, we will start with basic wheelchair/scooter skills. Over the next two weeks, we will also cover intermediate and more complex skills.

Different tracks have been developed for manual and power wheelchair users. If you primarily use a manual wheelchair, please review the information related to manual wheelchair use. If you use a power wheelchair or scooter, please review the power wheelchair/scooter information. If you alternate between both types of devices, feel free to watch both sets of education.

Please remember – when you are practicing any of these skills, please make sure you have a care partner with you to help spot you.

Video 2h (Manual Wheelchair Skills Education/Basic)

Today you will learn and review some basic wheelchair skills to allow you to safely and successfully navigate a variety of environments in your home and community. We will discuss how to push your wheelchair on a flat surface, reach for an object, pick up an object off of the floor, and go through a hinged door.

Pushing a wheelchair on a flat surface

The ability to push your wheelchair effectively requires a combination of good propulsion technique and optimal wheelchair design. A physical or occupational therapist who specializes in wheelchair seating can ensure that your wheelchair is set up for optimal propulsion. This topic will also be discussed further during week #5 (page 123). Learning how to perform this basic skill correctly will help you to prevent falls and upper extremity injuries from occurring.

The first skills that we will be talking about is pushing on a flat surface. While you are pushing on a flat surface you should focus your attention in the direction of travel, avoiding distractions to either side, but remain alert to potential hazards and control your speed.

In addition, you should also consider good propulsion techniques. While this isn’t directly related to falls, these tips will help to preserve your shoulder function making it easier for you to get out into the community and enjoy your daily activities.

• Begin the push with your hands on the upper back part of the hand rim.
• Use long, smooth strokes.
• Do not rush your stroke. Take your time moving the wheel forward and try to keep in sync with the speed of the wheel.
• Release your grip toward the front of the wheel.
• Once you have released the wheel, let your hand gently relax and return to the upper back of the wheel.
• Push less often by using longer pushes.
• The overall shape of your propulsion technique should be an oval, as pictured here.

The next skill we will discuss is reaching for an object out of your range. You may often have to reach upward or forward for a light switch, elevator button, or to get an object out of a cupboard. Reaching and leaning reduce stability and puts you at risk of falling out of the wheelchair.

Here are some general tips to reduce the frequency of falls and injury while reaching for an object.

• Position your wheelchair close to the object you are reaching for.
• Reach to the side instead of reaching forward, if possible.
• Secure the seatbelt.
• Engage wheel locks/brakes before you begin reaching.
• Stabilize yourself with one hand holding onto the armrest or wheel as you reach for the object with the other.
• Use a reaching aid (please see picture on page 60) if it is available.

If you stand up to reach for an item,

• First apply the brakes and clear the footrests out of the way.
• Please DO NOT stand on your footrest. The extra weight on the footrests may cause the chair to tip and a fall to occur.
• Keep one hand on the wheelchair to maintain your balance.

Next, we will discuss picking up an object off the floor. You may need to pick up an object from the floor or ground, such as a piece of paper or a key. Attempting to pick up objects from the floor by reaching down reduces stability and puts you at risk of falling out of the wheelchair.

Here are some general tips to reduce the frequency of falls and injury

• Position your wheelchair close to the object you are reaching for.
• Secure the seatbelt.
• Engage wheel locks/brakes before you begin reaching.
• Stabilize yourself with one hand on the push rim or arm rest as you pick up the object with the other hand.
• If you have weak trunk muscles, move the arms to the thighs one at a time, and then to the feet, placing the chest on the thighs to reach the ground.
• Pull the object up against one of the wheels to increase stability and make the task easier.
• Use a reaching aid if it is available.

If you are hesitant to reach down to pick up an object on the ground or to get an object off a high shelf because of poor sitting balance, a reacher can be a good option. A reacher enables you to easily reach an object in high places and pick up things off the ground without having to bend your body. You can buy a reacher at amazon.com, Target or Walmart.

To use a reacher, hold the handle and move the other end of the reacher in the direction of the item you wish to pick up. Once in position, squeeze the handle to grasp the item and move it to wherever you like.

Finally, we will discuss going through a hinged door.

You often have to open/go through a hinged door to perform necessary and desired activities in your daily life. However, while performing this activity, you can easily lose your balance and fall.

Here are some general tips to reduce the frequency of falls and injury

• Approach the door at an angle. This brings the door handle into reach and gives you enough space to clear the door with the front of your wheelchair.
• Stabilize yourself with one hand on the hand rim or arm rest as you reach for the door with the other.
• Pay attention if there are any obstacles (e.g. threshold) while passing through the door.

When pulling the door open

• Pull the door open with the hand closest to the door as you balance yourself with your other hand on the wheel.
• Keep the door open with your hand or elbow as you push your wheelchair through. If the door is especially heavy, pull on the door handle with one hand while pushing on the doorframe with the other.

To close the door

• You may gently swing the door closed behind you, moving the wheelchair quickly through the door and out of the way.
• Alternatively, turn around once through the doorway, reach forward, and pull the door towards you while backing away.
• Don’t put your fingers between the door and doorframe for any longer than necessary because you may get pinched when the door closes.

When pushing the door open

• Keep pushing one wheel forward with one hand as you push the door open with the other.
• While moving past the door, pay attention to avoid catching any clothing or body parts on the door handle or the surface of the door.

To close the door

• You may gently swing the door closed.
• Alternatively, turn the wheelchair around and push the door closed with the footrests.
• Back up to close the door using the rear wheel or other wheelchair part to push on the door.

Power Wheelchair Skills Education/Basic

Today you will learn and review basic power wheelchair and scooter skills that will allow you to safely and successfully navigate a variety of environments in your home and community. We will discuss how to drive your power wheelchair or scooter on a flat surface, reach for an object, pick up an object off the floor, and go through a hinged door.

First, we will discuss driving forward and backwards

The ability to drive your power wheelchair or scooter effectively is necessary to allow you to safely and successfully navigate a variety of environments in your home and community. Learning how to perform this basic skill correctly will help you prevent falls.

Here are some general tips to reduce the frequency of falls and injury

• Get to know your wheelchair or scooter:
  • How to control the joystick or throttle.
  • How to select drive modes and speeds.
  • If you have questions about how to operate anything on your chair, please ask the trainer or the vendor that sold you the wheelchair or scooter.
• Make sure that nothing is stuck in your wheels, such as the seat belt or other straps.
• Fasten the seat belt!
• Make yourself as visible as possible by wearing brightly colored clothing and something reflective at night. You might also want to consider putting reflective markers on your chair or scooter.
• Check the pathways you often travel to make sure they are clear and accessible.

While you are driving forward:

• Move the joystick or throttle forward gradually to achieve a smooth start.
• Pay attention in the direction of travel and remain alert to potential hazards. Avoid distractions whenever possible.
• Control your speed!

While you are driving in reverse:

• Check behind you before you reverse. Consider the presence of moving objects, such as people or cars.
• Move the joystick or throttle backwards gradually to achieve a smooth start.
• Control your speed!
• Don’t drive in reverse for a long distance.

Scooter considerations:

• Be ready to drive the scooter before turning the power on.:
  • Place both hands on the handlebars (tiller) and position both feet on the platform. Make sure your feet are not hanging off the side of the scooter.
  • Fasten the seat belt!
• Use the same techniques as described above.
• Take some time to learn to use the throttle. Depending on your scooter design, you might use one hand to drive forward and another to drive backwards. Practice using the controls in a safe environment so that you fully understand how to use the device before you are in a challenging situation.
• Driving in reverse may be challenging due to the orientation of the throttle. Take the time to practice in a safe environment.

Next, we will discuss turning in place

Learning how to turn in tight spaces can give you confidence to maneuver in small spaces such as elevators and bathrooms.

Here are some general tips to reduce the frequency of falls and injury

• To make the tightest turn possible in a power wheelchair, point the joystick in the direction you want to turn. If you think of your controller as a clock with ‘12’ being straight ahead, point the joystick to either ‘3’ or ‘9’, depending if you want to turn right or left.
• Know your wheelchair configurations. The location of the drive wheels (e.g. rearwheel, mid-wheel or front-wheel drive) and seating configurations (e.g. foot rest) can affect the size of the turning radius. Before trying to maneuver in a tight space, become familiar with the turning radius of your chair.
• Control the speed for turning of the chair.
• The vertical axis of rotation for such a turn should be midway between the drive wheels.

Scooters however cannot turn in place in the same way that a power wheelchair can. To make a tight turn, you will need to move your scooter back and forth several times (“3-point turn”) to make a tight turn.

• Select the slower speed mode before maneuvering in tight spaces.
• Please note: scooters can easily tip over when making tight turns. Make sure that you are on a flat surface and moving slowly

Next, we will discuss reaching for an object out of your range

You may often have to reach upward or forward for a light switch, elevator button or to get an object out of a cupboard. Reaching and leaning both reduce stability and puts you at risk for falling out of the wheelchair.

Here are some general tips to reduce the frequency of falls and injury

• Position your wheelchair or scooter close to the object you are reaching for.
• Reach to the side instead of reaching forward, if possible.
• Secure the seatbelt.
• Turn the power off before you begin reaching.
• Stabilize yourself with one hand holding onto the armrest as you reach for the object with the other.
• Use your wheelchair functions. If your wheelchair has power seat functions (e.g. tilt, recline or seat elevator), this may be helpful.
• Use a reaching aid if it is available.

If you stand up,

• First turn the power off and clear the footrests out of the way.
• Please DO NOT stand on your footrests. The extra weight on the footrests may cause the chair to tip and a fall to occur.
• Keep one hand on the wheelchair to maintain your balance.

Scooter users can use the same techniques as described above but please note that scooters can tip over very easily. If possible, rotate your seat towards the object you are reaching for. Thus, you will be reaching forward for the object. Limit how far you reach forward. If you are able, rotate your seat and stand up to reach the object. Leaning while sitting on a scooter can be very dangerous! If you need to get out of the scooter, keep at least one hand on the scooter for balance.

Next, we will discuss picking up an object off the floor

You may need to pick up an object from the floor or ground, such as a piece of paper or a key. Attempting to pick up objects from the floor by reaching down reduces stability and puts you at risk of falling out of the wheelchair.

To reduce the frequency of falls and injury:

• Position your wheelchair close to the object you are reaching for.
• Secure the seatbelt.
• Turn off the power before you begin reaching.
• Stabilize yourself with one hand on the arm rest as you pick up the object with the other hand.
• If you have weak trunk muscles, move your arms to your thighs one at a time, and then to the feet, placing your chest on your thighs to reach the ground.
• If you have seat functions on your wheelchair, make sure you are fully upright and not tilted backwards.
• Use a reaching aid if it is available.

Scooter considerations

• Use the same techniques as described above
• If possible, get out of your scooter before attempting to reach for something on the ground. Remember, scooters tip over very easily!
• If you need to get out of the scooter, keep at least one hand on the scooter for balance.

If you are hesitant to reach down to pick up an object on the ground or to get an object off from a high shelf because of poor sitting balance, a reacher can be a good option (figure 1). A reacher enables you to easily reach an object in high places and pick up things up from off the ground without having to bend your body.

To use a reacher, you hold the handle and move the other end of the reacher in the direction of the item you wish to pick up. Once in position, squeeze the handle to grasp the item up and move it to wherever you would like.

Finally, we will discuss going through a hinged door

You often have to open/go through a hinged door to perform necessary and desired activities in your daily life. However, while performing this activity, you can easily lose your balance and fall.

To reduce the frequency of falls and injury:

• Approach the door at an angle. This brings the door handle into reach and gives you enough space to clear the door with the front of your wheelchair.
• Stabilize yourself with one hand on the arm rest as you reach for the door with the other. It may be easier to simply grasp the door handle with the hand on the side away from the joystick and then back the wheelchair up, rather than doing all of the work with your arm.
• Pay attention if there are any obstacles (e.g. threshold) while passing through the door.

When pulling the door open

• Pull the door open with the hand on the side away from the joystick as you control the joystick with your other hand.
• Keep the door open with your hand or elbow as you drive your wheelchair through.

To close the door

• You may gently swing the door closed behind you, moving the wheelchair quickly through the door and out of the way.
• Alternatively, turn around once through the doorway, reach forward, and pull the door towards you while backing away.
• Don’t put your fingers between the door and doorframe for any longer than necessary because you may get pinched when the door closes.

When pushing the door open

• Push the door open with the arm on the side away from the joystick.
• While moving past the door, pay attention to avoid catching any clothing or body parts on the door handle or the surface of the door.

To close the door

• You may gently swing the door closed.
• Alternatively, turn the wheelchair around and push the door closed with the footrests.
• Back up to close the door using the rear wheel or other wheelchair part to push on the door.

Scooter considerations

• Use the same techniques as described above.
• The length of some scooters can make it difficult to reach door handles. As a result, you may need to get off the scooter to open/close a door.
• If you are off the scooter, don’t try to drive the scooter through the door. Use a rubber door stop to keep the door open or ask a care partner/bystander to help you.
• If getting on/off the scooter is becoming challenging, you may want to consider the use of a power wheelchair.

Goal Setting

In this segment we will be discussing the goal for the 2nd week of the session. Please now turn to page 69 in your manual.

For this week, we will be asking you to set a goal related to either the new transfer or wheelchair/scooter skills you learned. If you would like, feel free to write a goal about both transfers and wheelchair/scooter skills. Please think about the skills you learned today and what would be most helpful to your specific circumstances. Please remember to use the SMART goal format and write your goal in the space provided. We will talk about these goals during the online discussion.

Closing remarks

We are now going to wrap up the material for this module. Before we go, I would like to remind you of a few things:

• Respond to the journal question (page 55) regarding modifications to your environment and action planning.
• Complete one action plan (Blank sheets are available in your folder).
• Complete the “Fall proofing your home and environment” checklist on pages 9-16 of the minimizing Your Risk of Falls Brochure based on your review of your home.
• Continue doing the home exercise program 3x/week. (page 16).
• Use your exercise log to track your exercises. (folder).
• Set a goal regarding practicing transfer skills/practice the skills (page 69).

During the next module:

G – Goals from the previous session will be discussed and new goals will be set.
E – The exercise program will be reviewed,
T – Training will be provided on performance of complex transfer skills (toilet, vehicle, and bed).

W – Wheelchair/Scooter skills in challenging environments will be discussed.
I – Fall managements plans will be discussed which will help increase your confidence in your ability to recovery from a fall if one does occur.
S
E – We will discuss the use of assistive technology being part of your environment and how it can have a positive influence on fall prevention.