The Manual Wheelchair Training Guide

by Axelson P, Chesney D, Minkel J & Perr A
© 1998 by PAX Press, a division of Beneficial Designs, Inc.
P.O. Box 69
Minden, NV 89423-0069
Phone: 775.783.8822
paxpress@beneficialdesigns.com

Section 1.3

Asking for Help

Public awareness of access issues is constantly improving. Strides are being made every day toward the goal of universal access for people with disabilities. However, situations will still arise where you need help.

Everyone needs help now and then. The need for assistance varies from situation to situation and from person to person. It's difficult for many people to know when they should ask for help. Some ask more often than they need, while others fail to ask at all.

Defining "Assistance"

"Assistance" has many meanings. You may ask someone to push your wheelchair because a shoulder injury has temporarily made propulsion difficult and painful. You might need help reaching a package of corn chips on a high shelf at the store. You might need to be lifted up stairs, helped over loose gravel, pushed up a steep hill, or otherwise assisted with something you have a hard time accomplishing alone.

Independent Skills
Actions you can perform without help.

Supervised/Assisted Skills
Actions you can participate in but are uncomfortable doing completely alone. You might need occasional help or someone nearby "just in case." Being able to ask for and instruct others to help is very important.

Dependent Skills
Activities you can only perform with a lot of help.

Who can Help?

A variety of people are available to give you assistance when you need it. These roles vary in responsibility and commitment. The amount of help you need will depend on your abilities and the tasks you need to perform.

Spotter
This is a person who stands nearby to help if you need it. Recruit a spotter when learning a new skill and when you are not confident of your own abilities. This person is usually there to keep you from tipping over backward or falling forward out of your wheelchair. It is up to you to decide when you are uncomfortable with a maneuver and would like to use a spotter. You might even need more than one person when learning a new skill.

Assistant
A spotter becomes an assistant when you know you will need help or require more than an occasional hand. Assisting often involves pushing or lifting the wheelchair in some capacity (such as up a flight of stairs or over a curb too high to cross independently). An assistant might also be asked to perform other tasks such as picking up items you drop or getting things you cannot reach. In many cases an assistant is hired and trained by the wheelchair rider. These assistants are often referred to as personal care assistants (PCAs) and attendants.

Personal Care Assistant (PCA)

If you need help frequently or at regular times during the day, you may want to hire a personal care assistant. Some wheelchair users find it difficult to ask family members or friends to help because they feel they are burdening them. Relationships with family members or friends may become strained if they always feel responsible for helping you.

A potential advantage of a hired assistant is that he or she can help you with personal tasks such as bowel and bladder care and is generally not as emotionally involved with you.

It is the job of a hired assistant to provide the help you need in a given situation. You can train your professional assistant to do things the way you want. If the arrangement doesn't work out, you also have the freedom to replace the PCA.

Family and friends

Family and friends with whom you spend most of your time will need to spot or assist you on some occasions. It can be valuable to rely on people you are comfortable with when feeling strong emotions you don't want to express before strangers.

Do not assume family members or friends will always be comfortable helping you. Be sure to ask if they are willing to help. Make sure they know not to help you unless you request assistance. You probably have a good idea of which friends and family you can trust as assistants based on your familiarity with their personalities.

Co-workers or acquaintances

Co-workers or friendly acquaintances can also make good assistants when you need help at work. If you are on good terms with a co-worker, you may be comfortable casually asking for assistance (for example, "Hi, can you give me a push over this threshold? Thanks!").

People you meet after your injury may be more comfortable with you as a wheelchair user than friends or family still making the adjustment to your new circumstances.

Strangers

When you are alone, situations may arise where you need a stranger's assistance. For example, you may have dropped your car keys where you cannot reach them. In this case, you may need to ask someone you do not know for help.

Alternatively, you may be out with a friend and find yourself in a situation where the assistance of a second person is necessary. For example, you may need an additional person to help lift the front end of your wheelchair up some stairs.

How to Ask for Help

How you ask for help will vary from situation to situation. Ask for assistance in a way that allows the person to comfortably decline. Practice asking for assistance with a companion acting as a stranger. This will help you learn how to ask strangers for assistance as well as teach your companion to help only when necessary. This type of practice also helps you learn how to instruct others to safely assist you.

Remember that there can be many valid reasons for people to decline to help you. Some have disabilities that may not be visible, such as arthritis or heart disease, and they may be reluctant to disclose their condition to you. Other people's beliefs or customs may also prohibit them from assisting you.

Accept refusals to help gracefully. After all, you don't want help from a person who feels uncomfortable with the task, because their apprehension can increase the risk of injury for both of you.

Consider the following before asking a stranger for help:

• Do not ask for assistance from anyone you think might be a threat.
• Consider the people around you, and approach the ones who look prepared to provide some physical assistance.
• Body size is unimportant when performing most assisting skills. Do not assume a smaller person is not strong enough to help you.
• Ask for assistance from people involved in activities similar to your own. For example, if you are shooting baskets in the park and lose the basketball in a bush, ask another ball player for assistance.

Ask the jogger for assistance rather than the man in the suit. The person in the work-out clothes is less likely to worry about getting dirty or wrinkled.

If you enjoy challenging environments such as hiking trails, remember that this type of environment attracts a lot of people who, like yourself, are looking for an adventure. They may see helping you as yet another challenge and be very eager to assist.

• If there are few people around and you know you will need assistance soon (for example, there is a curb around the corner), ask someone if they would be willing to follow you to the place where you will need help.

• Try "Do you mind giving me a hand up this curb?" or "Could you help me down this steep curb cut? I can talk you through exactly what I need you to do."

Be clear and concise when giving instructions. Most of the skills in this manual include instructions you can give an assistant.

• You are in charge. Instruct your assistant not to do anything unless you specifically ask.
• Read Section 5.1 for more information about protecting the back. Make sure friends and family who frequently assist you read that chapter also.
• Tell your assistant where to stand.
• Indicate how to hold onto your wheelchair. (for example, "Please do not lift from the footrest because it might break off. Hold the frame next to my knees instead.")
• Give body mechanics instructions (for example, "Bend at your knees and keep your back straight.").
• Always instruct your assistant to move on your count of three to coordinate the efforts of all parties.
• Remember to thank your assistant for the help.

Describing Safe Body Mechanics

Since your spotter or assistant is being nice and helping you out, protect her/him by pointing out safe body positioning and mechanics. Section 5.1 contains additional information on safe body mechanics for helpers.

Always remind your helper to:

• Bend at the knees, not at the waist.
• Use legs for strength rather than the weaker muscles of the back or arms. This will help prevent back strain.
• Keep knees bent, not locked straight.
• Never twist at the waist. Instead, keep the torso facing the same direction as the hips and move the feet around to turn. This will help prevent back strain.
• Maintain a straight back. Hunching over or rounding at the shoulders can cause back strain.
• Keep breathing. Sometimes people hold their breath when they are involved in physical activity. When you hold your breath, you are more likely to tense your muscles. Tense muscles are significantly more prone to strain.

When You Do Not Want or Need Assistance

Who says human nature isn't inherently good? You will find that some people will try to help you even when you haven't asked. While such intentions may be virtuous, their actions can be very frustrating and, at times, even dangerous. An unexpected push may catch you off balance and cause you to fly out of your wheelchair.

Decline their premature efforts by saying something like, "Thanks, but I'd like to do this myself" or "Thank you, but it is actually easier for me to do this without assistance." More aggressive good Samaritans may need to be deterred by a sharper directive such as, "Please don't grab my wheelchair."

You may have to be assertive when telling people not to help.

Last Updated: February 5, 2001