How to safely assist patients using gait training wheelchairs

For many patients recovering from injuries, surgeries, or conditions affecting mobility, gait training wheelchairs are more than just tools—they're bridges back to independence. Whether you're a caregiver, a family member, or a healthcare professional, knowing how to safely assist someone using these wheelchairs can make all the difference in their comfort, progress, and confidence. Let's walk through the essentials, from preparation to practice, with practical tips to keep both you and the patient safe.

Understanding Gait Training Wheelchairs: What Makes Them Unique?

First, let's clarify what a gait training wheelchair is. Unlike standard wheelchairs, these are designed specifically to support patients as they relearn to walk. They often have features like adjustable armrests, removable footrests, and lightweight frames to balance stability with mobility. Some even come with built-in handles for caregivers to guide movement, or brakes that lock securely during transfers. Think of them as a "training wheels" phase for walking—providing just enough support to build strength without overwhelming the patient.

Step 1: Preparation—Setting the Stage for Safety

Before you even help the patient into the wheelchair, preparation is key. Rushing this step can lead to slips, strains, or discomfort, so take 5–10 minutes to get everything ready. Here's what you need to do:

Assess the Patient's Readiness

Start by talking to the patient. How are they feeling today? Are they experiencing pain, dizziness, or fatigue? Gait training requires focus and physical effort, so if they're having a low-energy day, it might be better to reschedule. Also, check their medical chart or ask their therapist: Are there movement restrictions (e.g., "no bending at the waist")? Any recent changes in their condition? This info will shape how you assist them.

Adjust the Wheelchair to Fit

A poorly adjusted wheelchair is a safety hazard. Take time to tweak these settings:

• Seat height: When the patient's feet are on the floor, their knees should bend at a 90-degree angle. If the seat is too high, their feet won't touch the ground; too low, and their knees will strain.
• Armrests: They should support the forearms without forcing the shoulders up (which causes tension). Adjust them so the elbows are slightly bent.
• Footrests: Ensure they're at a height where the feet rest flat, not dangling. If the patient can't reach the floor yet, the footrests will keep their legs stable during movement.
• Brakes: Test the brakes! They should lock firmly and release smoothly. Never skip this—unlocked brakes are a leading cause of wheelchair-related falls.

Clear the Path and Gather Supplies

Look around the area where you'll be moving. Remove clutter (toys, rugs, loose wires) that could trip either of you. If training indoors, ensure the room is well-lit—shadows make it hard to see uneven floors. If outdoors, avoid gravel or slopes until the patient is more confident. Also, grab any supplies you might need: a water bottle (dehydration worsens fatigue), a small towel (for sweat), and a call bell (in case they need to stop suddenly).

Step 2: Transferring the Patient—From Bed to Wheelchair (and Back)

One of the trickiest parts of gait training is moving the patient between surfaces, like from their bed to the wheelchair. This is where proper technique prevents injury—both to the patient and to you (caregivers often strain their backs from improper lifting!). Here's how to do it safely:

Option 1: Stand-Pivot Transfer (For Patients with Some Weight-Bearing Ability)

If the patient can bear weight on at least one leg and stand briefly, this method works well. Here's the step-by-step:

1. Position the wheelchair: Place it next to the bed, at a 45-degree angle to the patient's hips. Lock the brakes and fold up the footrests.
2. Help the patient sit up: Stand beside the bed, place one arm under their shoulders and the other behind their knees. Gently lift and pivot them to a sitting position on the edge of the bed. Let them dangle their legs for 30 seconds to prevent dizziness (this is called "orthostatic hypotension"—a common issue after lying down).
3. Stand and pivot: Have the patient place their hands on your shoulders (or on the bed for support). Bend your knees (don't bend at the waist!) and wrap your arms around their waist. On the count of three, help them stand, then pivot slowly toward the wheelchair. Guide their legs into the chair first, then lower them gently onto the seat.

Option 2: Using a Patient Lift (For Patients with Limited Mobility)

For patients who can't bear weight or are too heavy to lift manually, a patient lift is a game-changer. These devices use slings and hydraulic or electric power to transfer patients safely. Here's the basics:

• Place the lift sling under the patient (follow the manual for correct positioning—usually under the shoulders and thighs).
• Attach the sling to the lift's hooks, ensuring it's secure (double-check for frayed straps!).
• Use the lift's controls to raise the patient slowly, then maneuver the lift so the patient is positioned over the wheelchair.
• Lower them gently into the chair, then detach the sling (or leave it in place if transferring back soon).

Step 3: Assisting During Gait Training—Guiding, Not Controlling

Once the patient is in the wheelchair, the training begins. The goal here is to support their movement while letting them take the lead as much as possible. Over-assisting can make them dependent; under-assisting can leave them feeling unsafe. Here's how to strike the balance:

Position Yourself Correctly

Stand behind and to the side of the wheelchair (about 12–18 inches away), with one hand on the back handle and the other ready to steady their arm or shoulder if needed. This gives you a clear view of their posture and allows them to see where they're going without feeling crowded.

Encourage Proper Posture

Remind the patient to sit up straight, shoulders back, and feet flat on the floor (or footrests). Slouching can strain the back and make balance harder. If they lean to one side, gently guide them back to center, saying, "Let's shift a little to your left—you're doing great!"

Move at Their Pace

Gait training is about progress, not speed. If they want to go slow, let them. If they pause, ask, "Need a break?" or "Shall we try taking a step forward?" Avoid rushing or saying, "Hurry up"—this increases anxiety. Instead, use positive reinforcement: "That's a strong step! Let's do one more."

Handle Stops and Turns Safely

To stop: Ask the patient to apply the wheelchair brakes (if they can). If not, you lock the brakes from behind. To turn: Guide the wheelchair gently with the back handle, keeping the turn wide and slow to avoid tipping. Warn the patient first: "We're going to turn right in a second—ready?"

Common Challenges and How to Fix Them

Even with preparation, things can go wrong. Here are solutions to the most common issues:

Problem: The Patient Slips Forward in the Chair

Solution: Check the seat depth. If the seat is too long, the patient will slide forward. Add a cushion or adjust the seat (some models have adjustable depths). You can also place a rolled towel behind their lower back for support.

Problem: The Wheelchair Feels Unstable During Movement

Solution: Ensure the tires are inflated (flat tires reduce stability) and the brakes are fully released before moving. If the wheelchair has anti-tip bars (small wheels at the back), make sure they're extended—these prevent tipping backward on inclines.

Problem: The Patient Gets Fatigued Quickly

Solution: Break training into short sessions (10–15 minutes) with rest breaks. Have a water bottle handy and watch for signs of overexertion: heavy breathing, sweating, or complaints of pain. It's better to end early than push too hard.

Step 4: Post-Training Care—Wrapping Up Safely

After training, the work isn't done. Proper post-training care helps prevent soreness and sets the stage for next time:

• Transfer back to bed or chair: Use the same safe transfer method (stand-pivot or patient lift) to move the patient to a resting position.
• Check for discomfort: Ask if they have any pain, especially in the hips, back, or shoulders. Adjust the wheelchair settings for next time if needed.
• Clean and store the wheelchair: Wipe down the seat and handles with a disinfectant wipe (germs love wheelchairs!). Fold or store it in a dry, accessible place.

Safety Checklist: A Quick Reference

Check When?	What to Do	Why It Matters
Before Training	Test brakes, adjust seat height/armrests, clear the path.	Prevents falls and discomfort during movement.
During Transfer	Bend at the knees, use a lift if needed, lock brakes.	Protects both patient and caregiver from injury.
During Training	Stand to the side/behind, guide gently, watch for fatigue.	Encourages independence while keeping the patient safe.
After Training	Transfer safely, check for pain, clean the wheelchair.	Reduces soreness and keeps the equipment in good shape.

Beyond the Wheelchair: Complementary Tools for Recovery

Gait training wheelchairs work best when paired with other tools. For example, an electric homecare nursing bed can make transfers easier by adjusting to a sitting position, reducing the strain of lifting. Some patients also benefit from using a gait rehabilitation robot alongside the wheelchair—these devices use sensors and motors to support specific movements, like lifting a leg or maintaining balance. Always ask the patient's therapist about complementary tools that might speed up recovery.

Final Thoughts: Patience, Practice, and Compassion

Assisting someone with a gait training wheelchair isn't just about physical steps—it's about building trust. Patients may feel vulnerable, frustrated, or scared, especially in the early stages of recovery. Your calm demeanor, clear communication, and willingness to adapt will mean more than any technique. Celebrate small wins: a few extra steps, a steady posture, or a smile when they realize, "I did that!"

Remember, safety first, but kindness always. With these tips, you'll not only help them move forward physically—you'll help them reclaim their confidence, one step at a time.