Wheelchairs and wheelchair Wheelchairs and wheelchair management. Chpt 11,p149 management. Chpt 11,p149

SPINAL CORD INJURIESSPINAL CORD INJURIES

Ilse LombardIlse Lombard

Wheelchair selectionWheelchair selection

Selecting the most Selecting the most appropriate appropriate wheelchair can be a wheelchair can be a daunting task when daunting task when faced with the huge faced with the huge variety of cost, type, variety of cost, type, size and size and accessories. accessories.

Wheelchair selectionWheelchair selection

Wheelchair selectionWheelchair selection

Use of wheelchairUse of wheelchair Mode of transferMode of transfer TransportTransport The userThe user

Types of wheelchairTypes of wheelchair

ManualManual WeightWeight BackrestBackrest Rear wheelsRear wheels Front castorsFront castors FootplatesFootplates

Types of wheelchairTypes of wheelchair Power drivePower drive This classification is largely dependent on the This classification is largely dependent on the

power of the motor and the combination of front power of the motor and the combination of front and rear wheels.and rear wheels.

1.1. The indoor power-drive chair tends to have four The indoor power-drive chair tends to have four solid tires.solid tires.

2.2. The indoor/outdoor power-drive chair has The indoor/outdoor power-drive chair has pneumatic rear tires with solid front tires.pneumatic rear tires with solid front tires.

3.3. The outdoor/indoor and outdoor power-drive The outdoor/indoor and outdoor power-drive chairs tend to have pneumatic tires on all four chairs tend to have pneumatic tires on all four wheels to be able to cope with rugged terrain.wheels to be able to cope with rugged terrain.

Power drivePower drive

Types of wheelchairTypes of wheelchair

HybridHybrid RecliningReclining Stand-upStand-up Sports chairSports chair Pediatric chairPediatric chair

Wheelchair accessoriesWheelchair accessories

Anti tipping leversAnti tipping levers ArmrestsArmrests BackrestsBackrests BrakesBrakes Brake extensionsBrake extensions Push rimsPush rims Elevated leg restsElevated leg rests

Wheelchair maneuversWheelchair maneuvers

BASIC MOVEMENTS WITHIN THE BASIC MOVEMENTS WITHIN THE WHEELCHAIRWHEELCHAIR

To manipulate the brakesTo manipulate the brakes To remove the armrestTo remove the armrest To pick up objects from the floor . To reach To pick up objects from the floor . To reach

down to the footplates.down to the footplates. To give maximum stability, the small front To give maximum stability, the small front

wheels must point forward, as this prevents the wheels must point forward, as this prevents the chair tipping onto the footplates, and the brakes chair tipping onto the footplates, and the brakes must be applied. must be applied.

Wheelchair manoeuvresWheelchair manoeuvres To manipulate the brakes To manipulate the brakes To reach the right brake:To reach the right brake: 1. Hook the left elbow behind the left chair handle.1. Hook the left elbow behind the left chair handle. 2. Lean forward and to the right, allowing the left biceps 2. Lean forward and to the right, allowing the left biceps

to lengthen as the trunk movement occurs.to lengthen as the trunk movement occurs. To release the brake, use flexion of the elbow and To release the brake, use flexion of the elbow and

shoulder to push the lever forward with the palm of the shoulder to push the lever forward with the palm of the hand or the lower part of the supinated forearm (Fig. hand or the lower part of the supinated forearm (Fig. 11.6A, B). To apply the brake, pull the lever back using 11.6A, B). To apply the brake, pull the lever back using the right biceps and either the extended wrist or the the right biceps and either the extended wrist or the supinated forearm (Fig.11.6C, D).supinated forearm (Fig.11.6C, D).

Wheelchair maneuversWheelchair maneuvers

To remove the armrestTo remove the armrest Most armrests now tend to flip-up Most armrests now tend to flip-up

Wheelchair maneuversWheelchair maneuvers To reach down to the To reach down to the

footplatesfootplates This position will be This position will be

necessary to adjust the necessary to adjust the footplates, to empty thefootplates, to empty the

urinal or for adjustments urinal or for adjustments when dressing:when dressing:

1. Lean forward on the 1. Lean forward on the elbows on the armrests.elbows on the armrests.

2. Change the position of the 2. Change the position of the arms one by one and lean on arms one by one and lean on the forearms on the thighs.the forearms on the thighs.

3 Put one hand at a time 3 Put one hand at a time down to the feet, leaning the down to the feet, leaning the chest on the thighs.chest on the thighs.

Wheelchair manoeuvresWheelchair manoeuvres

To regain the upright position, patients without To regain the upright position, patients without triceps must (1) throw the stronger arm back triceps must (1) throw the stronger arm back over the backrest and hook the extended over the backrest and hook the extended wrist behind the chair handle, and (2) pull the wrist behind the chair handle, and (2) pull the trunk upright by strongly extending the wrist trunk upright by strongly extending the wrist and flexing the elbow.and flexing the elbow.

Patients with good functioning triceps pull Patients with good functioning triceps pull the trunk upright by hooking one or both the trunk upright by hooking one or both extended wrists underneath the upper, outer extended wrists underneath the upper, outer edge of the armrest(s).edge of the armrest(s).

WHEELCHAIR MANOEUVRESWHEELCHAIR MANOEUVRES

INITIAL AND ADVANCED INITIAL AND ADVANCED WHEELCHAIR MANOEUVRESWHEELCHAIR MANOEUVRES

When putting the wheelchair in When putting the wheelchair in motion in any direction, the position of motion in any direction, the position of the head and shoulders is important. the head and shoulders is important. They are used to reinforce the action They are used to reinforce the action of the arms, whether to gain greater of the arms, whether to gain greater momentum or to act as a brake.momentum or to act as a brake.

WHEELCHAIR MANOEUVRESWHEELCHAIR MANOEUVRES

Patients start moving the chair by pushing on Patients start moving the chair by pushing on the tires. Paraplegic patients may progress to the tires. Paraplegic patients may progress to using the wheel rims, particularly outside, but using the wheel rims, particularly outside, but many patients with tetraplegia continue to use many patients with tetraplegia continue to use the tires because they find the purchase easier the tires because they find the purchase easier and the push more effective. Pushing gloves and the push more effective. Pushing gloves (see Fig. 8.2f) are used by tetraplegic patients to (see Fig. 8.2f) are used by tetraplegic patients to protect the skin from callus formation and protect the skin from callus formation and abrasions due to friction or injury.abrasions due to friction or injury.

Advanced manoeuvres: paraplegic Advanced manoeuvres: paraplegic patientspatients

To balance on the rear To balance on the rear wheelswheels

To mount and descend a To mount and descend a curbcurb

To 'jump' the chair To 'jump' the chair sidewayssideways

To mount and descend a To mount and descend a flight of stairs in a high flight of stairs in a high performance wheelchairperformance wheelchair

To transfer a wheelchair To transfer a wheelchair into a car.into a car.

To balance on the rear wheelsTo balance on the rear wheels

Balance and movement on Balance and movement on the rear wheels are useful to the rear wheels are useful to facilitate independent travel facilitate independent travel over rough ground, e.g. over over rough ground, e.g. over grass, sand and also in grass, sand and also in negotiating curbs or a step.negotiating curbs or a step.

This technique is safe only This technique is safe only for patients with a good grip, for patients with a good grip, i.e. for patients with lesions i.e. for patients with lesions at T1 and below. In a well-at T1 and below. In a well-adjusted lightweight adjusted lightweight wheelchair patients with wheelchair patients with lesions at C6 may also lesions at C6 may also manage it. Anti-tipping manage it. Anti-tipping levers are used initially. levers are used initially.

To balance on the rear wheelsTo balance on the rear wheels

There are three There are three maneuvers involved:maneuvers involved:

To tilt the chair onto To tilt the chair onto the rear wheelsthe rear wheels

To balance the chair To balance the chair on the rear wheelson the rear wheels

To move and turn the To move and turn the chair on the rear chair on the rear wheels.wheels.

To balance the chair on the rear To balance the chair on the rear wheelswheels

PracticalPractical

1.1. To reach down to the footplatesTo reach down to the footplates

2.2. To manipulate the brakesTo manipulate the brakes

3.3. To remove the armrestTo remove the armrest

4.4. To balance on the rear wheelsTo balance on the rear wheels

5.5. To mount and descend a curbTo mount and descend a curb

6.6. To 'jump' the chair sidewaysTo 'jump' the chair sideways

7.7. To mount and descend a flight of stairs in a To mount and descend a flight of stairs in a high performance wheelchairhigh performance wheelchair

8.8. Ramp up and downRamp up and down

Car readjustmentsCar readjustments