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					 Goals of
Wheelchair
Prescription
Goals of
Wheelchair
Prescription




               Maximization of efficient
                 independent mobility
Goals of
Wheelchair
Prescription




               Prevention or minimization
                    of deformity or injury
Goals of
Wheelchair
Prescription




                      Maximization of
               independent functioning
Goals of
Wheelchair
Prescription




               Projection of a healthy, vital,
                    attractive “body image”
Goals of
Wheelchair
Prescription




               Minimization of short-term
               and long-term equipment
                                      cost
Wheelchair
Indications
Indications to
wheelchair use




                 Inadvisability of ambulation
Indications to
wheelchair use




                 Impossibility of ambulation
Indications to
wheelchair use




                 Additional means of
                          locomotion
Indications to
wheelchair use




                 Promotion of performance in
                           ADLs, sports and
                       recreational activities
  Wheelchair
Contraindications
Contraindications
to wheelchair use




                    Pressure sores
Contraindications
to wheelchair use




                    Surgical and post-operative
                        conditions of the pelvis
Contraindications
to wheelchair use




                    Vertebral fractures
Contraindications
to wheelchair use




                    Disc or nerve root
                         compression
Contraindications
to wheelchair use




                    Certain types of
                     low back pain
Contraindications
to wheelchair use




                    Weakness of the trunk
                                 muscles
Wheelchair
Side-effects
Side-effects of
wheelchair




                  Tendency towards too much
                            dependence on it
Side-effects of
wheelchair




                  Astasia-abasia
Side-effects of
wheelchair




                  Psychological problems
                   secondary to improper
                  wheelchair prescription
Factors in
Wheelchair
 Selection
Factors in
selection of
wheelchairs




               Nature of disability
Factors in
selection of
wheelchairs




               Age
Factors in
selection of
wheelchairs




               Weight
Factors in
selection of
wheelchairs




               Indoor use or outdoor use
Factors in
selection of
wheelchairs




               Patient’s comfort
Factors in
selection of
wheelchairs




               Patient’s abilities
Factors in
selection of
wheelchairs




                 Functions and services
               expected from wheelchair
Factors in
selection of
wheelchairs




               Safety
Factors in
selection of
wheelchairs
               $



                   Appearance and cost
Factors in
selection of
wheelchairs




               Collapsibility and portability
Wheelchair
 Types
Standard adult
wheelchair
                 • Designed for persons
                   who weigh less than
                   200 pounds
                 • Limited use on rough
                   surfaces and vigorous
                   functional activities
Bariatric adult
wheelchair
                  • Constructed for
                    persons weighing
                    more than 200
                    pounds
                  • For patients who
                    perform vigorous
                    functional activities
Pediatric wheelchair
                       • Designed for patients
                         that are too small to fit
                         in standard adult
                         wheelchairs
                       • Variations: junior w/c,
                         child w/c and growing
                         w/c
Externally powered
wheelchair
                     • The chair is propelled
                       by a deep-cycle
                       battery system
                     • Controlled in different
                       ways: joystick, sip-
                       and-puff control, chin
                       piece or mouth stick
Sports wheelchair
                    • A low-profile
                      wheelchair
                    • Low back
                    • Tilted camber
                    • Small handrims
                    • Adjustable axles
Reclining wheelchair
                       • Used for persons who
                         need to recline at
                         some time while they
                         are in the chair
                       • Semi-reclining – 30º
                       • Fully reclining –
                         horizontal
                       • Headrest
                       • Elevating legrests
Wheelchair
  Parts
A

B
                         J
C

                         K
D
                         L
E                        M

F


G
                         N
H
                         O
I

    Identify the Parts
 Wheel
Assembly
Size variation (24 inch)
                     • For heavy patients
                     • For rugged use
                     • For motorized chairs
Size variation (20 inch)
                     • About the same
                       height as the seat
                     • Patient needs to
                       reach down to
                       operate the handrims
                     • Not indicated for
                       patients with short
                       limbs
                     • Propulsion is harder
                       and less rapid
Size variation (26 inch)
                     • Used for tall
                       individuals
                     • Slightly increases the
                       total wheelchair
                       weight
                     • Increase in speed is a
                       benefit
Tire variation (standard
tire)
                     • Solid rubber
                     • Requires no special
                       care during their long
                       life
Tire variation (pneumatic
tire)
                    • Must be regularly
                      checked for air
                      pressure
                    • Must be pumped from
                      time to time
                    • Requires more power
                      for propulsion
                    • Can be used only with
                      appropriate rims
Rim variation (wire spoke)
                    • Most commonly used
                    • Spokes may need to
                      be adjusted after
                      years of wheelchair
                      use
                    • Less aesthetic
Rim variation (aluminum composite)
                   • Due to advances in
                     technology, rims are
                     now stronger and
                     lighter
                   • Since aluminum is
                     malleable, designs
                     can vary depending
                     on the patient.
Rim variation (aluminum composite)
                   • Lighter
                   • Stronger
                   • More expensive
Rim variation (carbon composite)
                    • New technology
                    • Very strong and very
                      light
                    • Very expensive
Brake or lock
                • Important for safety
                • Prevents the
                  wheelchair from
                  rolling on an inclined
                  slope
                • Pull breaks and push
                  breaks
Handrims
           • 5 cm shorter in
             diameter than the
             entire wheel
           • Grip in a smooth
             handrim can be
             improved by a glove
           • Pegs, vertical and
             oblique projections
Caster Assembly
Caster size variation (5 inches)
                     • Small but lighter
                     • Difficult to operate on
                       rough, soft, irregular
                       ground
                     • Requires more
                       maintenance
Caster size variation (8 inches)
                     • Slightly heavier
                     • Pushes front rests
                       farther forward than a
                       small caster
                     • Adds ~3 inches to the
                       total chair length
Caster tires
               • Can be standard or
                 semi-pneumatic
               • Semi-pneumatic tires
                 are available for 8
                 inch casters
               • Needs to be reinflated
Caster locks
               • Locks that control the
                 caster, thus
                 increasing stability of
                 the wheelchair
               • Recommended
                 whenever stability is a
                 problem
Caster fork
              • Aside from the
                casters, caster forks
                can also be the first
                parts to replace in a
                wheelchair due to it’s
                position in front.
Seat Assembly
Notes on seat prescription
                    • Depth: 16 inches
                    • Width: 18 inches
                    • Height: 18 to 20
                      inches
                    • Most important factor
                      for comfort is DEPTH
Sling seat
             • A sagging seat tends
               to adduct the thighs
               and knees
             • A solid insert prevents
               this
Solid insert
               • A solid insert,
                 however, increases
                 the distance from the
                 floor to the seating
                 surface
Solid insert
               • A hard solid insert
                 makes transfer easier
                 for those who can
                 slide on and off the
                 seat
Hydraulic seat lift
                      • A device that allows
                        the patient to stand by
                        means of a pumping
                        assembly or an
                        electric motor seat
                        control
                      • Good sitting balance
                        is required to use this
Seat cushions
                • Used for greater
                  comfort in long sitting
                  hours
                • Decreases danger of
                  pressure sores
Back Assembly
Notes on backrest prescription
                    • Back of standard
                      wheelchair reaches
                      the inferior angle of
                      the scapula
                    • Back is usually of the
                      same material as the
                      seat for folding
Contoured backrest
                     • Provides support for
                       the lumbar spine
Zipper back
              • It is sometimes
                desirable for the
                patient to enter or
                leave the chair
                through the back
                rather than the front
              • Recommended for
                most quadriplegics
              • Often the best way for
                bowel emptying
Semi-reclining back
                      • Can be reclined as
                        much as 30 to 45
                        degrees
                      • The back must be
                        above the head
                      • Has elevating legrests
                      • 4 inches higher, 6
                        inches longer and 11
                        pounds heavier
Semi-reclining back
                      • More difficult to push
                      • Less portable
                      • Due to its tilting
                        design, the posterior
                        sacral tissues
                        contributes in
                        developing decubitus
                        ulcers
Fully-reclining back
                       • May be fixed in any
                         position between the
                         vertical and horizontal
                       • Wheelchair mode vs.
                         Stretcher mode
                       • Anti-tipping devices
                         and a headrest
                         should be present
Arm Assembly
Functions of armrest
                       • Gives support to the
                         patient’s forearm and
                         hands
                       • Helps maintain trunk
                         balance
                       • Offers support upon
                         standing up
                       • Can be used to
                         practice sitting push-
                         ups
Arm-rest cover
                 • May be bare or
                   covered
                 • For patients with
                   sensory deficits
                   armrests should be
                   padded to reduce the
                   risk of pressure sores
Variations (adjustable arms)
                    • Height of the armrest
                      can be adjusted
                    • High armrests for
                      patients with
                      emphysema and
                      asthma
Variations (removable arms)
                   • Arms that can be
                     lifted out of their
                     sockets
                   • Permits paraplegics
                     and others to enter or
                     leave the chair
                     sideward
Variations (swing-away arms)
                   • Arms that can be
                     lifted out of their
                     sockets
                   • Permits paraplegics
                     and others to enter or
                     leave the chair
                     sideward
Variations (armless wheelchair)
                    • Lighter and may be
                      wheeled closer to a
                      table
                    • Permits no support of
                      the forearm and hand
                    • Allows more freedom
                      of movement while
                      sitting
                    • Makes lateral
                      transfers easier
Desk arm
           • Arm cut away at its
             front corner so that a
             chair may approach a
             table 6 inch closer
             than a standard chair
           • Desk arms allow
             patients to reach
             utensils and tools
             easier in a more erect
             position
Arm lock
           • Locks that function in
             order for the chair to
             be lifted by its arms
           • Useful for carrying the
             patients thru
             stairways
Tray or lapboard
                   • Frequently attached
                     to the armrests for
                     eating, reading,
                     writing and other
                     activities
                   • Favors good posture
Suspension arm slings
                   • In order to protect
                     weak shoulder
                     muscles or permit
                     exercise and other
                     activities, the forearm
                     can be suspended by
                     a sling mechanism.
Multi-link mobile arm support
                    • Allows significantly
                      greater range of
                      motion for feeding
                      and facial hygiene.
                    • Poor grade deltoid
                      muscle required.
                    • Has lifting power with
                      the help of rubber
                      bands.
Safety belts
               • Attached to the back
                 for additional support
                 especially if the trunk
                 muscles are weak
Foot and Leg
  Assembly
Notes on foot-rests and leg-rests
                    • The height of the
                      footrest can be
                      adjusted ~6 inches
                      according to the leg
                      length
                    • Ideally, one footrest
                      for each foot
                    • Can be hinged up for
                      patient participation in
                      wheelchair propulsion
Elevating leg-rests
                      • Requires a leg panel
                        to support the calf
                      • Used in patients with
                        a cast or knee
                        extension contracture
                      • Used to encourage
                        knee extension
Without foot-rests
                     • Gives freedom to the feet
                       when used for wheelchair
                       propulsion
                     • About 5 inches shorter
                       thus easily maneuverable
                       in bathrooms and
                       elevators
                     • Less stable than standard
                       wheelchair when patient
                       jerks into standing
Swinging detachable foot-rests
                    • May be swung out of
                      the way and can be
                      detached
                    • Removable footrests
                      are heavier than fixed
                      footrests
                    • It becomes lighter
                      upon removal of the
                      footrest
Other Wheelchair
   Accessories
Commode attachment
                • Solid insert with a
                  hole, removable toilet
                  pan and cover
Anti-tipping device
                      • Two curved bars to
                        prevent wheelchair
                        from tilting forward
                        and backward
                      • Used in cases where
                        both limbs are
                        elevated
Sliding board
                • Smooth board of
                  polished wood
                • Basic sliding board is
                  ¼ inch thick, 8 to 12
                  inches wide and 2 to
                  3 feet long
                • Used to bridge the
                  gap of transfer
                  between WC seat and
                  bed
Miscellaneous
                •   Pockets
                •   Cup holders
                •   Ashtrays
                •   Safety belts
                •   Harnesses

				
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posted:8/15/2011
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