Inclusion Criteria (wheelchair user):

• be seventeen (17) or older
• be a manual wheelchair user, living in a long-term-care facility;
• be expected to require the long-term use of a wheelchair (at least four [4] hours/week for at least eight [8] weeks), as reported by a clinical therapist;
• be competent to give informed consent (as indicated by a Mini Mental State Examination score of 20 or higher) or have a proxy with power of attorney willing to provide consent,
• have the verbal endorsement of the clinical therapist (if any) to participate;
• have the written permission of the attending physician to participate;
• be willing to take part in the study, including signing the consent after carefully reading it.

Exclusion Criteria (wheelchair user):

• have an unstable medical condition (e.g. angina, seizures), as determined by the attending physician, house staff or ERN;
• have an emotional or psychiatric problem of a type or extent that might make participation unpleasant, as determined by the attending physician, house staff or ERN.

Inclusion Criteria (caregiver):

• be seventeen (17) or older;
• provide at least part-time [at least one (1) hour/week] wheelchair-handling care for a wheelchair user in a long-term-care facility;
• be willing to take part in the study, including signing the consent form after carefully reading it.

Exclusion Criteria (caregiver):

• have an unstable medical condition (e.g. angina, seizures), as indicated by self-report;
• have an emotional or psychiatric problem of a type or extent that might make participation unpleasant, as indicated by self-report.