IMPAIRED WHEELCHAIR MOBILITY
Limitation of independent operation of wheelchair within environment
• Impaired ability to operate a manual or power wheelchair on curbs,
even surfaces, uneven surfaces, and/or an incline or a decline
• Cognitive impairment
• Environmental constraints
• Impaired vision
• Deﬁcient knowledge
• Limited endurance
• Depressed mood
• Musculoskeletal impairment
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Physical regulation
• Pharmacological function
The patient will
• Have no complications associated with impaired wheelchair mobil-
ity, such as skin breakdown, contractures, venous stasis, thrombus
formation, depression, alteration in health maintenance, and falls.
• Maintain or improve muscle strength and joint ROM.
• Achieve the highest level of independence and safety possible with
regard to wheelchair use.
• Express feelings regarding alteration in ability to use wheelchair.
• Participate in social and occupational activities to the greatest
• Demonstrate understanding of techniques to improve wheelchair
SUGGESTED NOC OUTCOMES
Ambulation: Wheelchair; Balance; Mobility Level; Muscle Function
INTERVENTIONS AND RATIONALES
Determine: Assess wheelchair status: Seat is wide and deep enough
to support thighs, low enough for feet to touch the ﬂoor, yet high
enough to allow easy transfer from bed to chair; the back is tall
enough to support upper body; brakes on wheels lock; and seat belt
is present (may attach at waist, hips, or chest). Assessment ensures
chair meets patient’s physical needs (identiﬁes need for modiﬁcation),
promotes comfort, and prevents injuries (e.g., falls).
Assess patient’s level of strength in arms, and if chair is easy for
patient to operate when weak. This determines the need for a
motorized wheelchair to help maintain mobility and independence.
Identify patient’s level of independence using the functional mobil-
ity scale. Communicate ﬁndings to staff to promote continuity of
care and preserve the documented level of independence.
Monitor and record daily evidence of complications related to
impaired wheelchair mobility. Patients with neuromuscular dysfunc-
tion are at risk for complications.
Assess patient’s skin on return to bed and request a wheelchair
cushion, if necessary, to maintain skin integrity.
Perform: Perform ROM exercises for affected joints, unless
contraindicated, at least once per shift. Progress from passive to
active ROM as tolerated. This prevents joint contractures and mus-
Inform: Explain to patient location of vulnerable pressure points and
instruct to shift and reposition weight to prevent skin breakdown.
Ensure patient maintains anatomically correct and functional body
positioning to promote comfort.
Demonstrate techniques to promote wheelchair mobility to the
patient and family members and note the date; have them perform a
return demonstration to ensure continuity of care and use of proper
Attend: Encourage patient to operate her wheelchair independently
to the limits imposed by her condition to maintain muscle tone,
prevent complications of immobility, and promote independence in
self-care and health maintenance skills.
Encourage attendance at physical therapy sessions and reinforce
prescribed activities on the unit by using equipment, devices, and
techniques used in the therapy session. To maintain continuity of
care and promote patient safety.
Manage: Refer patient to a physical therapist to enhance wheelchair
mobility and rehabilitation of musculoskeletal deﬁcits.
Help patient identify resources for maintaining highest level of
mobility (e.g., community stroke program, sports associations for
people with disabilities, and the National Multiple Sclerosis Society)
to promote reintegration into the community.
SUGGESTED NIC INTERVENTIONS
Exercise Promotion: Strength Training; Exercise Therapy: Balance;
Exercise Therapy: Muscle Control; Positioning: Wheelchair
Gavin-Dreschnack, D., et al. (2005, April–June). Wheelchair-related falls: Cur-
rent evidence and directions for improved quality care. Journal of Nursing
Care Quality, 20(2), 119–127.