Wheelchairs

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.

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 one’s surroundings and a

greater desire to keep moving.

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.

• 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 patient’s judgment.

• In all of these conditions, the restriction against walking may be temporary.

• 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.

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.

Types of Wheelchair

1. Standard wheelchair2. 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

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

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.

• 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.

Hemiplegic’s 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.

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.

• 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.

• 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.

Standard wheelchair measurements for proper fit

Part Instructions Average adult size

Seat height / leg length

Measure from the user’s heel to the popliteal fold and add 2 inches to allow clearance of the footrest

19.5 - 20.5 inches

Seat depth Measure from the user’s 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

16 inches

Seat width Measure the widest aspect of the user’s 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.

18 inches

Back height Measure from the seat of the chair to the floor of the axilla with the user’s 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.)

16 - 16.5 inches

Armrest height Measure from the seat of the chair to the olectanon process with the user’s elbow flexed to 90 degrees and then add approximately 1 inch.

9 inches above the chair seat

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).

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

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.

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.