Manual wheelchair users gradually face fewer postural stability and control challenges with increasing rolling resistance while maintaining a rear-wheel wheelie

Teaching manual wheelchair users to perform wheelies using various rolling resistances is expected to facilitate learning of this advanced wheelchair skill. However, limited scientific evidence is available to support this approach. This study aimed to measure and compare postural stability and control requirements when maintaining a stationary wheelie on different rolling resistances. Eighteen manual wheelchair users with a spinal cord injury performed in a random order and maintained four 30-second wheelies on four rolling resistances: natural hard floor (NAT), 5-cm thick soft foam (LOW), 5-cm thick memory foam (MOD), and rear wheels blocked by wooden blocks (HIGH). All wheelies were performed over a large instrumented force plate to continuously record the center of pressure (CoP). To quantify postural stability, resultant and directional time- and frequency-domain CoP measures were computed and compared across all four rolling resistances. All resultant time-domain measures confirmed increased postural stability from NAT to LOW and from MOD to HIGH rolling resistances. Most time-domain measures confirmed a shift in postural control from an anticipatory to a predominantly compensatory strategy, accompanied by increased reliance on proprioceptive feedback, especially from NAT to LOW and from MOD to HIGH rolling resistances. Postural stability gradually increased with various rolling resistances while maintaining a stationary wheelie, whereas the postural control strategy shifted from an anticipatory to a reactive strategy. Blocking the rear wheels is recommended when first teaching this advanced wheelchair skill. Rapid progression on foam and natural surfaces is advocated to refine learning and enhance proper postural control strategies.