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WHEELCHAIRS

WHEELCHAIRS. MANUAL WHEELCHAIR COMPONENTS FRAME AND AXLE WHEELS AND TIRES HAND RIMS/ WHEEL LOCKS GRADE AIDS CASTERS/ARMRESTS/LEGRESTS SEAT AND BACK. FRAME AND AXLE. FRAME MATERIAL MAY DETERMINE THE WEIGHT AND DURABILITY OF THE WHEELCHAIR

Samuel
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WHEELCHAIRS

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  1. WHEELCHAIRS • MANUAL WHEELCHAIR COMPONENTS • FRAME AND AXLE • WHEELS AND TIRES • HAND RIMS/ WHEEL LOCKS • GRADE AIDS • CASTERS/ARMRESTS/LEGRESTS • SEAT AND BACK

  2. FRAME AND AXLE • FRAME MATERIAL MAY DETERMINE THE WEIGHT AND DURABILITY OF THE WHEELCHAIR • WEIGHT IS IMPORTANT IN TERMS OF LOADING WC INTO THE CAR

  3. FRAME TYPE • RIGID FRAME IS MORE STABLE FOR ACTIVE USER • MAKE SURE PATIENT CAN LOAD THIS INTO THE CAR

  4. FOLDING FRAME • FOLDING FRAME IS EASIER TO STORE AND TRANSPORT • NEWER LOCKING SYSTEM FOR FOLDING FRAME IMPROVES RIGIDITY AND MAINTAINS BALANCE • SOME FRAMES HAVE FLEXIBILITY IN PLACEMENT OF REAR WHEELS WITH AN ADJUSTABLE AXLE PLATE

  5. WHEEL AND TIRES • WHEEL SIZE AFFECTS • OVERALL HEIGHT • ROLLING EASE • TRANSFERRING IN AND OUT OF CHAIR • UE MECHANICS OF PUSHING

  6. WHEEL TYPE • SOLID SMOOTH WHEELS • BEST ON • SMOOTH • HARD • INDOOR SURFACES

  7. WHEEL TYPE • THREADED PNEUMATIC TIRES • GIVES SMOOTHER RIDE • EASIER MANUEVERABILITY ON ROUGH TERRAIN,WET OR ICY SURFACES

  8. WHEEL TYPE • FLAT TIRES CAN BE MINIMIZED • WITH THORN RESISTANT TUBES • OR ADDITION OF LATEX GEL

  9. HAND RIMS • VERY SMALL DIAMETER • SMOOTH RIMS FOR HIGH SPEED RACING • LARGE • TO MAXIMIZE MANEUVERABILITY AND POWER

  10. HAND RIMS • MODIFICATIONS • IMPROVE GRIPPING • BY ADDING COATING • INCREASE TUBE SIZE • CHANGING SHAPE • ADDING RIM PROJECTIONS

  11. WHEEL LOCKS • WHEEL LOCKS= BRAKES • POSITION HANDLES TO PROVIDE EASY ACCESS • BUT NOT INTERFERE WITH WC PROPULSION

  12. WHEEL LOCKS • BRAKE EXTENSIONS FOR PATIENTS • WITH U.E. DYSFUNCTION • OR POOR BALANCE

  13. WHEEL LOCKS • FOR ACTIVE USER • WITH LONG PUSHING STROKE • POSITION BRAKES LOWER DOWN • TO PREVENT INJURY TO FINGERS AND THUMBS

  14. GRADE AIDS • SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM ROLLING BACKWARD • CAN BE SELECTIVELY ACTIVATED WHEN GOING UPHILL

  15. GRADE AIDS • FOR PATIENTS WHO HAVE DIFFICULTY GOING UP INCLINES • DON’T USE GRADE AIDS IN STRONG PUSHERS • MAY BE ACTIVATED IN WHEELIES

  16. CASTER • THE SMALL WHEELS FOUND USUALLY IN FRONT OF THE CHAIR

  17. CASTER • HARD SMALL CASTERS ALLOW EASIEST TURNING • SMALLEST 4” CASTORS GOOD FOR SPORTS BUT CAN’T BE USED WELL OUTDOORS

  18. CASTER • LARGE PNEUMATIC CASTERS ARE LESS LIKELY TO GET STUCK ON UNEVEN OR SOFT GROUND • MAKE SURE THEY DON’T HIT FOOT OR FOOT PLATE

  19. CASTERS • PLACING THE CASTER TO REAR OF CHAIR • DECREASES TURNING RADIUS • INCREASES THE TENDENCY TO TIP FORWARD

  20. CASTER • CASTER LOCKS • NECESSARY FOR ABSOLUTE STABILITY OF CHAIR IN TRANSFERS

  21. ARMRESTS • AID IN TRANSFERS • WEIGHT SHIFTS • REDUCE ISCHIAL PRESSURE • BY CARRYING THE WEIGHT OF THE ARMS AND MAINTAINING TRUNK BALANCE

  22. ARM RESTS • NEED STURDY SUPPORTIVE ARMREST FOR THOSE WITH MARGINAL PRESSURE MANAGEMENT • PATIENTS WITH T6 OR ABOVE INJURY NEED THEM FOR STABILITY IN SITTING

  23. ARMRESTS • NEEDED IF PATIENT HAS • LAPBOARD • ARM TROUGH • BALANCED FOREARM ARTHOSIS • ATHLETIC WC USERS MAY WANT TO ELIMINATE ARM RESTS

  24. ARM RESTS • TYPES • FIXED • ADJUSTABLE • REMOVABLE • SWING AWAY

  25. LEG RESTS • TO PROVIDE PROTECTION • PROPER POSITIONING • MAXIMUM BALANCE • WEIGHT BEARING OF LE

  26. LEG RESTS • SUPPORT THE FOOT TO MAINTAIN CIRCULATION • KEEP THE ANKLE IN NEUTRAL POSITION • SHOULD NOT BE SO HIGH IT FORCES WEIGHT BACK ON ISCHIAL TUBEROSITIES OR SACRUM

  27. LEG RESTS • TYPES • STANDARD • SWING AWAY • REMOVABLE

  28. LEG RESTS • ELEVATING • MAY HELP WITH EDEMA • ALTER ACCESSIBILITY • MAKES TURNING MORE DIFFICULT

  29. ELEVATING LEG RESTS • NEED CALFPADS • MORE EXPENSIVE • NEED A SPECIFIC DIAGNOSIS TO JUSTIFY

  30. LEG RESTS • PATIENTS WITH A LOT OF SPASTICITY • MAY NEED A LARGE FOOTPLATE • WITH PROPER FOOT RESTRAINT SYSTEM

  31. SEAT AND BACK • BACK SUPPORT • WC BACK • SHOULD BE HIGH ENOUGH TO SUPPORT • LOW ENOUGH TO GIVE AS MUCH FREEDOM AS POSSIBLE

  32. BACK SUPPORT • PATIENTS WITH ABNORMAL TRUNK CONTROL ABOVE T8-10 • BUT GOOD HEAD CONTROL • BACK SHOULD COME UP WITHIN 2” OF THE LOWER EDGE OF THE SCAPULA

  33. BACK SUPPORT • IF BACK TOO LOW • IT CAN CAUSE INCREASED PRESSURE AT UPPER EDGE OF BACK • WHEELING EFFICIENCY IS DECREASED SECONDARY TO POOR STABILIZATION OF THE SHOULDER GIRDLE

  34. SEAT TYPE • IF PATIENT HAS POOR MUSCLE CONTROL • SPASTICITY • DEFORMITY • THEY NEED A SOLID SEAT OR BACK OR BOTH

  35. SEAT TYPE • A STABLE SEAT AND LUMBAR SURFACE • PREVENTS SACRAL SITTING

  36. SACRAL SITTING • LEADS TO SACRAL AND ISCHIAL PRESSURE SORES • INCREASED KYPHOSIS • NECK AND UPPER BACK STRAIN

  37. WHEELCHAIR STABILITY • DEPENDS ON REAR AXLE POSITION • IF REAR WHEELS ARE MOVED FORWARD • CHAIR MOVES EASIER • WEIGHT SHIFT FOR WHEELIES IS EASIER

  38. WC STABILITY • IF REAR WHEELS ARE MOVED FORWARD • CHAIR TIPS BACKWARD MORE EASILY • ESPECIALLY WHEN GOING FAST OR UP RAMPS

  39. WHEELCHAIR STABLILITY • ANTITIP DEVICES PREVENT BACKWARD TIPPING

  40. WHEELCHAIR STABILITY • FOR LE AMPUTEES • MOVING REAR WHEEL POSTERIOR • KEEPS THE PATIENTS C.OF G. IN FRONT OF THE WHEEL • TO PREVENT TIPPING

  41. WHEELCHAIR STABILITY • RAISING THE SEAT • WILL LESSEN THE OVERALL STABILITY OF THE CHAIR • MOST COMFORTABLE AND STABLE SEATING • WITH SEAT TILTED BACK BY 3-5’’

  42. WHEELCHAIR STABILITY • CAMBER • THE ANGLE BETWEEN THE VERTICAL AXIS OF WHEELS AND A LINE PERPENDICULAR TO THE FLOOR

  43. CAMBER • CAN BE ADJUSTED 7” TO MAXIMIZE LATERAL STABILITY • WITHOUT MAKING THE CHAIR TOO WIDE • CAMBER IS ADJUSTED FOR SPORTS TO ALLOW QUICK TURNS • OR LONG LATERAL REACHES

  44. BIOMECHANICS OF SEATING • PELVIS • A KEY GOAL IN WC SEATING IS STABILIZING THE PELVIS • A LEVEL PELVIS IS NEEDED TO OPTIMIZE TRUNK CONTROL AND UE FUNCTION

  45. PELVIS • EVALUATION • LOOK FOR • ANTERIOR PELVIC TILT • POSTERIOR PELVIC TILT • LATERAL SYMMETRY • ROTATION • RESTRICTION IN ANY DIRECTION

  46. ANTERIOR PELVIC TILT • INCLINATION OF THE PELVIS IN THE SAGITTAL PLANE FORWARD OF ITS NEUTRAL POSITION • DUE TO THE HYPOTONICITY OF TRUNK MUSCULATURE

  47. ANTERIOR PELVIC TILT • SHORTENING OF LOW BACK EXTENSORS • TIGHTENING OF ILIOTIBILA BAND • TIGHT HIP FLEXORS

  48. POSTERIOR PELVIC TILT • DUE TO OVERACTIVITY OF HIP EXTENSORS • DUE TO TIGHT HAMSTRINGS • HYPOTONIC LOW BACK EXTENSORS

  49. POSTERIOR PELVIC TILT • LOSS OF LUMBAR LORDOTIC CURVE • AFFECTS SPINAL ALIGNMENT • AFFECTS FUNCTION

  50. POSTERIOR PELVIC TILT • TILTING OF PELVIS • MOVES C.OF G. POSTERIOR TO ISCHIAL TUBEROSITIES • INCREASES WT. BEARING THRU SACRUM

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