A physical therapist is teaching a patient with T4 ASIA A SCI how to fall safely backward in a manual wheelchair. Which instruction should the therapist give?

A physical therapist is teaching a patient with T4 ASIA A SCI how to fall safely backward in a manual wheelchair. Which instruction should the therapist give?

• A. Extend both arms out to the sides to break the fall
• B. Tuck the head and hold the wheels or armrests so the push handles absorb the impact
• C. Lean forward as far as possible to counteract the backward momentum
• D. Grab the push rims and apply maximum braking force

Answer: (B)

Protecting the head while using the wheelchair’s structure to absorb the shock is the safest approach when a backward fall occurs. For someone with a thoracic-level complete spinal cord injury, trunk control may be limited, so bracing with the torso isn’t reliable. Tucking the chin protects the head/neck from impact, and holding onto the wheels or armrests allows the back and frame (the push handles) to take the force of the fall instead of the arms or head. Extending the arms to break the fall can lead to shoulder injuries, leaning forward doesn’t counteract backward momentum and can worsen tipping, and grabbing the push rims to brake can lock the wheels or cause a sudden, unsafe movement.

Protecting the head while using the wheelchair’s structure to absorb the shock is the safest approach when a backward fall occurs. For someone with a thoracic-level complete spinal cord injury, trunk control may be limited, so bracing with the torso isn’t reliable. Tucking the chin protects the head/neck from impact, and holding onto the wheels or armrests allows the back and frame (the push handles) to take the force of the fall instead of the arms or head. Extending the arms to break the fall can lead to shoulder injuries, leaning forward doesn’t counteract backward momentum and can worsen tipping, and grabbing the push rims to brake can lock the wheels or cause a sudden, unsafe movement.