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What it measures:

Manual wheelchair skills 2 total scores for version 4.1: safety and performance; safety component added to help clinicians identify completion of a skill based on patient judgment Psychometrics of WST 4.2 are being reviewed

Target Population:

  • People using manual wheelchairs for community locomotion (spinal cord injury, stroke, elderly)
  • People with spinal cord injury

Professional Association Recommendations

Recommendations from the APTA Neurology Section’s SCI EDGE Taskforce are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.


  • Reasonable to use, but limited study in target group in acute and subacute levels of acuity
  • Recommended for chronic level of acuity
  • Reasonable to use, but limited study for AIS classifications A/B and C/D
  • Not recommended that students learn to administer the tool or receive exposure to the tool
  • Recommended for use in intervention research studies

Normative/Reference Data

Community manual wheelchair users (Lindquist et al, 2010):

Mean WST 4.1 score for performance=80.1% (±8.5%); range= 63.3%-100.0%

Mean WST 4.1 score for safety=98.0% (±2.8%); range=89.7%-100.0%

Chronic SCI (Lemay, 2012) - mean scores by level of injury:

All levels (C4-L2) combined=80.7±11.8

Tetraplegia (C4-C8)=72.1±7.9

High paraplegia (T1-6)=82.8±9.1

Low paraplegia (T7-L2)=84.0±12.4

Ceiling and Floor Effects

Manual Wheelchair Users (Lindquist, 2010):

Possible ceiling effect for safety score with mean score of 98%±2.8% (range=89.7%-100%)

Chronic SCI (Lemay, 2012):

Ceiling effect:

83% of study participants had score of 100% on safety subscale (range=87.5%-100%)

No issues noted for performance subscale (mean performance score = 80.7%±11.8%)

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