Wheelchairs

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Wheelchairs
Wheelchair
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Wheelchair

• It is a mobility orthosis, providing appropriate
  support to allow maximum functional mobility. It
  is a combination of a postural support system and
  a mobility base, that are joined to create a
  dynamic seated environment.

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Wheelchair functions

• It is a functional aid which can
• Provide protection
• Spare the heart
• Support and stabilize the body,
• Stimulate activities
• Afford locomotion while maintaining immobilized
  one or another part of the body to perform ADL.
• It enables many patients to move about without
  undue effort.
• Psychological value
• Stimulating greater interest in ones
  surroundings and a greater desire to keep moving.

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Common cases that could need wheel chairs

• Those who need wheelchairs are those who
  either should not or
• cannot walk, walking is either Inadvisable or
  Impossible.

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• Inadvisability of ambulation may be because of
• Contraindications to weight-bearing
• Interference with wound healing
• Prior to ambulation,
• Inadequate safety in walking , or
• Deficiency of the patients judgment.
• In all of these conditions, the restriction
  against walking may be temporary.

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• Deficiency in ambulation
• results usually from the involvement of both
  lower limbs by one or more of such conditions as
• Absence of an essential part,
• Paralysis.
• Deformity,
• Pain on weight bearing,
• In coordination.
• In all of these conditions, the use of wheel
  chair may be permanent.

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Contraindications limitations

• Trunk weakness
• Postural defects.
• Disc and nerve root compressions
• Low back pain due to strains, sprains.
• Ischial decubitus ulcer.
• Surgical or postoperative conditions of the
  pelvis
• Vertebral fractures
• Certain fractures of the pelvis.
• Fractures of the proximal part of the femur.

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Types of Wheelchair

1. Standard wheelchair
2. Standard light weight wheelchair.
3. Ultra lightweight transport wheelchair.
4. Bathroom wheelchair.
5. Reclining back rigid frame sports chair.
6. Tennis chair.
7. Heavy duty pediatric wheelchair.
8. Power wheelchair

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Components of the wheelchair

• Wheelchair frame stationary or foldable.
• Seat and cushion
• Arm rests fixed or adjustable. Stationary or
  removable.
• Leg rests adjustable or removable
• Foot rests
• Restraints chest belts

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Wheel chair options and accessories

• Caster locks
• Casters are the small front wheels locks are
  sometimes selected to allow the patient to lock
  the casters out to the side (90 dgrees for side
  transfers) or to the front (180 degrees for front
  or back transfers) to provide a larger base of
  support during transfers.
• Crutch / cane holder
• It is a small cup at the base of the wheelchair
  with a strap at the top to allow transportation
  of these ambulatory aids.
• Anti-tipping device
• Placed on the back tipping lever, these devices
  prevent the patient from tipping backwards in the
  chairs, but also limit going up curbs.

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• Hill-holder device
• A mechanical brake that allows the chair to go
  forward, but automatically brakes when the chair
  goes in reverse. It is useful for patients who
  are not able to ascend a ramp or hill without a
  rest.

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Hemiplegics chair

• A chair that is designed to be low the ground,
  allowing propulsion with the non involved upper
  and lower extremity. Use low seat measurements.
  Some therapists do not choose to use these chairs
  since they feel it reinforces abnormal reflexes.
  The patient must have good perceptual motor
  skills.

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Amputee chair

• For patients who have bilateral lower extremity
  amputation, the wheelchair has to be modified by
  placing the axis of the rear wheels back
  approximately 2 inches to increases the base of
  support in this direction. Without the change,
  the seated amputee has a high and posterior
  center of gravity compared to a non amputee and
  the chair could tip backwards more easily.

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• Lock extensions
• Metal tubes placed over the standard lock to make
  it easier to lock the rear wheels appropriate for
  someone with arthritis or upper extremity
  weakness.
• Wheel / rim covers
• Using covers made of plastic or other material
  for increasing grip friction. It is common for
  patients who have a spinal cord injury or
  arthritis.
• Rim projections
• Pegs placed vertically, obliquely or horizontally
  that allow patients with poor hand function to
  propel the chair. Horizontal or oblique pegs can
  widen the chair and may limit maneuvering in the
  home.

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• Detachable footrest
• Needed for stand / pivot transfers.
• Elevating leg rest
• Raise the lower legs to assist with lower
  extremity circulation, edema prevention and
  orthostatic hypotension.
• Removable arm rests
• Needed for side transfers.
• Adductor cushion or pommel
• A cushion placed between the knees to try and
  control for adductor spasticity or contractures.
  Sometimes the entire seat unit is tilted backward
  10-15 degrees to help control for extensor
  spasticity or thrusting.

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Standard wheelchair measurements for proper fit
Average adult size Instructions Part
19.5 - 20.5 inches Measure from the users heel to the popliteal fold and add 2 inches to allow clearance of the footrest Seat height / leg length
16 inches Measure from the users posterior buttock, along the lateral thigh, to the popliteal fold, then subtract approximately 2 inches to avoid pressure from the front edge of the seat against the popliteal space Seat depth
18 inches Measure the widest aspect of the users buttocks, hips or thighs and add approximately 2 inches this will provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel. Seat width
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16 - 16.5 inches Measure from the seat of the chair to the floor of the axilla with the users shoulder flexed to 90 degrees and then subtract approximately 4 inches. This will allow the final back height to be below the inferior angles of the scapulae. (Note this measurement will be affected if a seat cushion is to be used. The person should be measurement while seated on the cushion or the thickness of the cushion must be considered by adding that value to the actual measurement.) Back height
9 inches above the chair seat Measure from the seat of the chair to the olectanon process with the users elbow flexed to 90 degrees and then add approximately 1 inch. Armrest height
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Wheelchair prescription depend upon many factors

• Age, size weight
• Disability prognosis
• Functional skills
• Indoor / outdoor use
• Portability / accessibility
• Reliability / durability
• Cosmetic features
• Options available
• Service
• Coast
• Level of acceptance (Environment).

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Additional considerations

• Adult standard wheelchair specifications include
  seat width 18 inches, seat depth 16 inches
  and seat height 20 inches. Hemi-height
  wheelchairs have decreased seat height (17.5
  inches) to allow for propulsion using the
  unaffected foot.
• Reclining wheelchairs allow intermittent or
  constant reclined positioning.
• Tilt-in-space wheelchairs allow for a reclined
  position without loosing the required 90 degrees
  of hip flexion and 90 degrees of knee flexion.
  The entire chair reclines without any anatomical
  changes in positioning

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Importance of good measurements

• Good measurements has to be considered to avoid
  many problems
• Too narrow seat
• Uncomfortable.
• Difficult access.
• Developing pressure sores.
• Too wide seat
• Leaning to one side.
• Promoting scoliosis.
• Difficult propulsion.

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• Too shallow seat
• Less area of contact
• More pressures over soft tissues
• Less support to feet legs
• Poor balance
• Too deep seat
• Restricted leg circulations
• Extended leg / forward slide in the chair
• Difficult propulsion.