Wheelchairs
1
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
 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 the subjects who cannot walk.
walking is either
• Inadvisable or
• Impossible.
•
Inadvisability of ambulation may be because of
– Contraindications to weight-bearing
– Interference with wound healing
– Convalescence 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.
2
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.
 Proximal part of the femur.
Types of Wheelchair
1.
2.
3.
4.
5.
6.
7.
8.
Standard wheelchair
Standard light weight wheelchair.
Ultra lightweight transport wheelchair.
Bathroom wheelchair.
Reclining back rigid frame sports chair.
Tennis chair.
Heavy duty pediatric wheelchair.
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
3
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.
4
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.
5
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
6
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.
7
Standard wheelchair measurements for proper fit
Part
Instructions
Average adult
size
Seat height Measure from the user’s heel to the popliteal fold
/ leg length 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 16 inches
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 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.
Back
Measure from the seat of the chair to the floor of the
height
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.)
Armrest
Measure from the seat of the chair to the olectanon
height
process with the user’s elbow flexed to 90 degrees
and then add approximately 1 inch.
8
18 inches
16 - 16.5 inches
9 inches above
the chair seat