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* 1. What type of wheelchair do you use for everyday mobility?

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* 2. Do you use the seatbelt in your wheelchair?

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* 3. Do you feel that you know your capabilities and limitations in a wheelchair?

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* 4. Do you feel that you take appropriate safety measures to avoid injury when completing activities of daily living (ADLs)?

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* 5. Do you feel that you have the necessary equipment to help you perform ADLs safely?

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* 6. Gender:

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* 7. What is your age?

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* 8. Years post injury?

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* 9. Level of Injury:

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