WHEELCHAIRS

WHEELCHAIR
• 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.
 FUNCTIONS
• Serves as a functional aid
• 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.
• Has a psychological value
 INDICATIONS

• Subjects who cannot walk

• Walking is either inadvisable or impossible
 Contraindications
• 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
 W/C PRESCRIPTIONS DEPENDS ON THE FF:

• Age, size & weight • Cosmetic features

• Disability & prognosis • Options available
• Functional skills • Service
• Indoor / outdoor use
• Coast
• Portability /
accessibility
• Level of acceptance
(Environment).
• Reliability / durability
 IMPORTANCE OF PROPER
MEASUREMENTS
• IMPORTANCE OF GOOD MEASUREMENTS:
❖ Too narrow seat: ❖ Too shallow seat:
•Uncomfortable •Less area of contact
•Difficult access •More pressures over soft tissues
•Developing pressure sores •Less support to feet & legs
•Poor balance
❖ Too wide seat: ❖ Too deep seat:
•Leaning to one side •Restricted leg circulations
•Promoting scoliosis •Extended leg / forward slide in the chair
•Difficult propulsion •Difficult propulsion.
 PARTS OF W/C:
• BACK REST
– HEIGHT
– From SEAT to:
•BASE OF
AXILLA: Subtract
4”
•INFERIOR
ANGLE OF
SCAPULA:
Subtract 2”
• Parts of wheelchair: – Seat sling type/commode
– Push handle type
– Back rest – Seat rails
– Back tube – Caster wheels
• Back post – Foot plate/foot rest
• Anti-tipping lever – Leg/calf rest
– Wheel tire – Cross brace***
– Push handle/rim
– Wheel break/lever
– Clothing guard
 PARTS OF W/C:
• SEAT
• If increase - Scoliosis
– DEPTH
• If decrease - Pressure in the
• From BACKREST to POPLITEAL Greater Trochanter
FOSSA: Subtract 2”
– HEIGHT
• If increase pressure in popliteal
• From POPLITEAL FOSSA to HEEL:
fossa: Sacral Sitting as compensation
Add 2”
may occur
• If increase pressure: Pressure in ischial
• If decrease: Fall Forward
tuberosity
– WIDTH
• If decrease - Slide forward
• From WIDEST portion of
BUTTOCKS: Add 2”
• ARMREST
– HEIGHT
• From SEAT to ELBOW
DISTANCE: 90o elbow
flexion

• LEG REST
– HEIGHT (Length)
• From POPLITEAL
FOSSA dowh to the heel:
Add 2”
• WHEEL/TIRE
– DIAMETER = 22’ or 24'
– WIDTH = 1’
• PUSH HAND RIM
DIAMETER = 18- 20”
• FOOTREST/ FOOT PLATE
– HEIGHT = 2” clerance from
the floor
– HEEL LOOP/ TOE LOOP –
For LE spasticity
HAND RIM PROJECTIONS:
❖ OBLIQUE = (C5) SH FLEXORS
❖ VERTICAL = TENODESIS EFFECT
❖ HORIZONTAL / FRICTION = ELBOW EXTENSION
• CASTERS
– DIAMETER = 5”/ 8”
•SMALL SIZED = 3”
(function : easy turning )
•LARGE SIZED = 12” (
function for rough
surface)
 WHEELCHAIR OPTIONS AND ACCESSORIES
• Crutch / cane holder
• Anti-tipping device
• Hill-holder device
MANUAL WHEELCHAIR
Prior to purchase, it is important that
careful consideration is given to:
• Abilities and limitations of the user
• Abilities and limitations of the carer
• Environments that the wheelchair will be
used
• Transport needs
• Budget
 TYPES OF MANUAL WHEELCHAIRS

Rear Wheel Drive

-Have large wheels on the back and
swiveling castors at the front.
-The rear wheels are generally removable
via a quick-release axle to help with
transport and storage.
-Push rims are usually metal, however to
assist with gripping these can be rubber
coated.
Transit
-Have small rear wheels (approx 30 cm
in diameter) and are ideal for those that
cannot push themselves.
-useful if the person in the wheelchair is
likely to injure themselves or their carer
by grabbing the wheel
-easier to get into a car, but more
difficult for the carer to push up curbs or
over grass.
One Arm Drive
Allow to propel oneself using
one hand by either:
-A push-pull lever action or
-Two push rims located on
one side of the chair, with
the inner rim attached to the
opposite wheel.
Amputee set up
Accommodates for the
change in the centre of
gravity of a person with an
amputation. Other
accessories such as a
stump support are also
available.
 Measuring for a Wheelchair
• Sip and Puff
– For C4 SCI patients
 POWERED / MOTORIZED / ELECTRIC WHEELCHAIR

Powered wheelchairs are

useful for people who have
difficulty or are unable to
self-propel a manual
wheelchair.
• FOR PATIENTS WITH
SCI (C1 – C4)
• JOY STICK
• SIP AND PUFF (C4 SCI)
• The selection of a powered wheelchair requires
careful consideration of a number of factors
including:
– User physical skills to control the wheelchair
– Users size and build
– User postural support needs
– User cognitive, perceptual and visual skills
– Environments in which it will be used
Carer’s needs
– Transport needs.
 TILT – IN – SPACE WHEELCHAIR

• FOR PATIENTS WITH

EXTENSOR SPASTICITY
• FOR PRESSURE RELIEF
 AMPUTEE WHEELCHAIR
• FOR PATIENTS WITH UNILATERAL
AND BILATERAL KNEE
AMPUTATIONS
• POSTERIOR DISPLACED WHEELS = 2
in
 RECLINING WHEELCHAIR

• FOR PATIENTS WITH

POSTURAL INSTABILITY
AND PRESSURE RELIEF
 HEMI WHEELCHAIR

• CVA patients (Hemiplegia)

• LOW SEAT: 17.5
 SPORTS WHEELCHAIR

❖ LOW BACK REST, LOW

SEAT
❖ RIGID FRAME, HIGH
CAMBER
❖ LIGHT FAST
❖ HANGER ANGLE = 80 – 90
degrees
Transportation of
People Seated in
Wheelchairs
• Whenever possible and practical, it is strongly
recommended that wheelchair occupants transfer out of
their wheelchair onto a vehicle seat and use the vehicle
seatbelt system.
• This is generally the safest mode of transport.
Transportation requirements should be considered by a
therapist during the assessment process and prescription
of a wheelchair.
 Risk Assessment
• should be completed by a therapist to • Consideration:
determine the most appropriate method of
transportation. – how a client transfers
• The therapist should clearly document the – postural support needs
process and clinical reasoning during
assessment and prescription – type of vehicle
– clinical needs vs. crash safety
– use of equipment
– carer requirements
– compliance of
wheelchair/seating/restraints.
• There are presently no specific • Wheelchairs that met
legal requirements stating which
types of wheelchairs can or cannot these standards have
be used in a vehicle. However, for been “Crash Tested” to
people who need to stay seated in withstand crash forces
their wheelchair for transport, it is
strongly recommended that the (48km/h at 20g) in an
wheelchair used complies with accident.
standards: “Wheeled mobility
devices for use as seats in motor
vehicles”.
 Seating Systems

• general requirements recommended to maximize safety:

– Back support should ideally be at shoulder height

– Head support mounted to the wheelchair or to the vehicle
– Postural Support Devices (eg. lateral supports) should be integrated into
the seating system whenever possible
– Wheelchair cushions should be of minimal weight and secured to the
wheelchair
– Ancillary items (eg. trays) should be removed from the wheelchair during
transport
 Wheelchair tie-down and occupant restraint system
(WTORS)
• Very crucial for the safety of the consumer • four-point strap system
– attach to specified tie-down points on the wheelchair
• secure the wheelchair firmly to the floor of the • Alternatively a docking system may be used
vehicle
• The occupied wheelchair should face forwards
during transportation***
• wheelchair user must also be restrained
independently of the wheelchair, using an
occupant restraint system
– lap/sash belts that attach to the vehicle and are separate to any postural
harnesses used.
• Always check that
restraints are appropriate
for the weight of the
wheelchair and user.
Heavy duty restraints are
required for wheelchairs
over 120kg
 Vehicles
• There are a variety of cars, vans, minibuses and
multi-purpose vehicles that can be modified to enable
transport of people seated in wheelchairs.
• Modifications:
– lowering the vehicle floor
– raising the roof line
– raising the door height
– installation of WTORS anchorages.

• Vehicles should only be completed by an approved vehicle

modifier
• All modified vehicles need to be approved by the Department
of Transport of WA before use.
• Entry in and out of the vehicle should be
quick and require minimal effort
• Accomplished via:
– Fixed ramp
– removable ramp
– lift system
• There are also minimum clearance spaces
required around the wheelchair, user and
WTORS in the vehicle.
– This reduces the potential for injuries during a
crash