Wheelchair Curb Climbing: Randomized Controlled Comparison of Highly Structured and Conventional Training Methods R. Lee Kirby, MD, FRCPC, Sean Bennett,

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Wheelchair Curb Climbing: Randomized Controlled Comparison of Highly Structured and Conventional Training Methods R. Lee Kirby, MD, FRCPC, Sean Bennett, BSc, Cher Smith, BSc, Kim Parker, MASc, Kara Thompson, MSc Archives of Physical Medicine and Rehabilitation Volume 89, Issue 12, Pages 2342-2348 (December 2008) DOI: 10.1016/j.apmr.2008.04.028 Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 In the approach phase (A), the wheelchair user approached the 15cm-high curb squarely, rapidly, and with the hands ready to apply forward forces on the hand rims at the appropriate moment. In the caster-pop phase (B), the wheelchair user accelerated the rear wheels, causing the casters to lift from the surface. In the rear-wheel-ascent phase (C), the wheelchair user leaned forward and applied another push to the hand-rims. Once on the curb (D), the wheelchair user sat upright. Throughout the skill, the single spotter held a spotter strap loosely in the right hand and held the left hand near the wheelchair user's shoulder. Archives of Physical Medicine and Rehabilitation 2008 89, 2342-2348DOI: (10.1016/j.apmr.2008.04.028) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Intervention versus control groups with respect to training time, success rate, spotter interventions, and perceived difficulty. Mean + SD values are shown. Only the training time difference was statistically significant (P=0.042). Archives of Physical Medicine and Rehabilitation 2008 89, 2342-2348DOI: (10.1016/j.apmr.2008.04.028) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 The wheelchair's casters failed to clear the curb during the caster-pop phase, causing the wheelchair to stop abruptly and tip forward. The rear spotter held a spotter strap to prevent a full rear tip. The forward spotter prevented a full forward tip or the wheelchair occupant falling from the wheelchair. Archives of Physical Medicine and Rehabilitation 2008 89, 2342-2348DOI: (10.1016/j.apmr.2008.04.028) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 The wheelchair struck the curb with the right rear wheel first. When this wheel ascended the curb before the left one, the spotter was required to intervene to prevent a full lateral tip. Archives of Physical Medicine and Rehabilitation 2008 89, 2342-2348DOI: (10.1016/j.apmr.2008.04.028) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions