wheelchair description

1. WHEEL CHAIRS
Dechen Tshomo
BOT final year

2. Introduction
• Wheel chair is a mobility aid consisting of seating system and
mobility base combined to provide a primary means of mobility
for someone with a permanent or progressive disability or short-
term orthopaedic condition in which walking is impaired

3. Wheelchair functions:
It is a functional aid which can
Provide protection
Support and stabilise the body,
Stimulate activities
Afford locomotion while maintaining immobilised one or another part of the body
to perform ADL.
 influence total body positioning
 prevents problems associated with poor posture, including pressure sores,
respiratory difficulties, discomfort,
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.

4. Indications
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.

5. • 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.
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.

6. Parts of wheel chair
• wheelchair is a combination of a postural support system and mobility base that are
joined to create a dynamic seated environment
• The postural support system is made up of the surfaces that contact the user’s
body directly. This includes ;
• the seat,
• back, and foot supports,
• any additional components needed to maintain postural alignment.
• Maintenance of postural alignment may require such additions as a head support;
lateral supports for the trunk, hips, and knees; medial support for the knees; and
upper extremity (UE) support surfaces, as well as straps (e.g., anterior chest or
pelvis) needed to keep the user interfaced with the support surfaces.
• The mobility base consists of :
• the tubular frame,
• armrests
• foot supports,
• wheels

8. • PARTS
• 1.Frame: either rigid or folding.rigid frame is one and are lighter while folding
frames are heavier(convenient for storage)
• 2.Tyres: selection of tyres depends on the use of chair:solid,hard polyurethane
tyres with smooth tread are designed for indoor use as its best for smooth
surface.Pneumatic(air filled) tyres provide shock absorption and provide smooth
ride outdoor on uneven or rough terrain

9. • 3.wheels: two types: solid magnesium or cast wheel and wheels with spokes
—solid cast wheel never looses shape or need adjustment
—spoke wheels are lighter but are easily broken and becomes shapeless
—wheel size varies depending on the user’s size and weight.
—two sizes available; 12” and 18”diameer
smaller wheel requires more pushing than the larger ones
4.brakes: there is separate brake for each wheel.
brakes are applied when stopping,when the person is being transferred in and out of the c

10. 5.caster:2 casters in-front of the wheel,revolves in all the directions.
casters are pneumatic,semi pneumatic or solid and may have locks
6 Push rims (hand rims):types of push rims depends on the users grip
3 types: standard metal rim:when grip is not a problem
friction rim:additional grip(friction tape or foam tubing)
rims with projections:knob are place at intervals ,gives better grip and

11. 7.foot rest: maintain the feet in neutral position and prevent deformities like equinus
may be fixed or movable,leg strap or heel loop can be added
8.Tilt bar:projects from the back of the frame,used by the individual who is pushing the wheel chair to clear a
door step or kerb.

12. 9.Back rest:high wheel chair back provides trunk support and are ideal for high level quadriplegic and CP
with poor sitting balance.
—-low wheel chair back provide greater freedom for movement mostly used by low level SPI patient
—-angle of back rest can be adjusted and in some WC it is detachable.chest strap can be attached
9.Arm rest:provide arm support,may be fixed or adjustable in height .may be partial or full
length.environmental control units,trays keyboards…can be attached
additional components:
head rest,clothes guard,anti tip bars

14. Types of Wheelchair
1 Manual self-propelled wheelchairs
2 Manual attendant-propelled wheelchair
3 Powered wheelchairs
4 Mobility scooters
5 Single-arm drive wheelchairs
6 Reclining wheelchair
7 Standing wheelchairs
8 Sports wheelchair
9 Wheelchair stretchers
10 All-terrain wheelchair
11 Self-balancing wheelchairs
12 Smart wheelchairs
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2

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17. 1211

18. • The WC team
• contributes to the wheelchair prescription decision making.
• It is important that all those concerned with the person’s present and future
function be a part of this team.
• The team may include the wheelchair user, therapists, family members,
caregivers, nurses, physicians, educators, vocational counsellors, and a
qualified rehabilitation technology supplier. To ensure that the most suitable
device is obtained
• Team members contribute to the examination reports and letter of medical
necessity
• Once the chair is supplied, the appropriate team members are responsible for
adjusting and fitting the final device, as well as teaching the patient and any
caregivers how to use and maintain the unit to ensure optimal long-term
performance.

19. • Role of OT
• are usually responsible for evaluation, measurement, and selection of a
wheelchair and seating system for the client.
• They also teach wheelchair use,safety and mobility skills to clients and
their caregivers.
• Education and training
• Equipment Provision and Trial
• Funding
• Equipment Maintenance/Inventory Management
• Environmental Modifications
• Equipment Recommendations

20. 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
Cost
Level of acceptance (Environment).
cognitive level

21. • wheel chair assessment
• The therapist must know the client and have a broad perspective of the client’s
clinical, functional, and environmental needs.
• Careful assessment of physical status must include the following:
• the specific diagnosis, the prognosis, and current and future problems (e.g., age,
spasticity, loss of range of motion [ROM], muscle weakness, reduced endurance)
that may affect wheelchair use.
• History Taking ,Strength and Endurance ,Sensation and Skin Integrity
• Additional client factors to be considered in assessment of wheelchair use are ;
• cognitive function, and visual and perceptual skills ,Functional Abilities
• Functional use of the wheelchair in a variety of environments must be
considered.
• Health Status(Poor positioning of the pelvis and trunk can increase the risk of
developing urinary tract and respiratory infections)
• Environmental Issues and Transportation
• Before the final prescription is prepared, collected information must be analyzed
for an understanding of advantages and disadvantages of recommendations
based on the client’s condition and how all specifics will integrate to provide an
optimally effective mobility system.

22. Wheelchair Measurement Procedures

25. seating principles
Principle 1: Stabilize Proximally to Promote Improved Distal Mobility and Function
Principle 2: Achieve and Maintain Pelvic Alignment
Principle 3: Facilitate Optimal Postural Alignment in all Body Segments, Accommodating for Impairments in Ra
Principle 4: Limit Abnormal Movement and Improve Function
Principle 5: Provide the Minimum Support Necessary to Achieve Anticipated Goals and Expected Outcomes
Principle 5: Provide the Minimum Support Necessary to Achieve Anticipated Goals and Expected Outcomes

26. Following are the goals of a comprehensive seating and positioning assessment.
Prevention of Deformity
Providing a symmetric base of support preserves proper skeletal alignment and discourages spinal curvature and other body
deformities.
Tone Normalization
With proper body alignment, in addition to bilateral weight bearing and adaptive devices as needed, tone normalization can
be maximized.
Pressure Management
Pressure sores can be caused by improper alignment and an inappropriate sitting surface. The proper seat cushion can
provide comfort, assist in trunk and pelvic alignment, and create a surface that minimizes pressure, heat, moisture, and
shearing—the primary causes of skin breakdown.
Promotion of Function
Pelvic and trunk stability is necessary to free the upper extremity for participation in all functional activities, including
wheelchair mobility and daily living skills.
Maximum Sitting Tolerance
Wheelchair sitting tolerance will increase as support, comfort, and symmetric weight bearing are provided.
Optimal Respiratory Function
Support in an erect, well-aligned position can decrease com- pression of the diaphragm, thus increasing vital capacity.
Provision for Proper Body Alignment

27. Wheelchair Safety
1. Brakes should be locked during all transfers.
2. The client should never weight bear or stand on the foot plates, which are placed in the “up” position
during most transfers.
3. In most transfers, it is an advantage to have footrests removed or swung away if possible.
4. If a caregiver is pushing the chair, he or she should be
sure that the client’s elbows are not protruding from the armrests and that the client’s hands are not on the hand rims. If approaching
from behind to assist in moving the wheelchair, the caregiver should inform the client of this intent and should check the position of the
client’s feet and arms before proceeding.
5. To push the client up a ramp, he or she should move in a normal, forward direction. If the ramp is negotiated independently, the client
should lean slightly forward while propelling the wheelchair up the incline.
6. To push the client down a ramp, the caretaker should tilt the wheelchair backward by pushing his or her foot down on the anti-tippers to its
balance position, which is a tilt of approximately 30 degrees. Then the caregiver should ease the wheelchair down the ramp in a forward
direction, while maintaining the chair in its balance position. The caregiver should keep his or her knees slightly bent and the back straight.
The caregiver may also move down the ramp backward while the client maintains some control of the large wheels to prevent rapid
backward motion. This approach is useful if the grade is relatively steep. Ramps with only a slight grade can be managed in a forward
direction if the caregiver maintains grasp and pull on the hand grips, and the client again maintains some control of the big wheels to prevent
rapid forward motion. If the ramp is negotiated independently, the client should move down the ramp facing forward, while leaning backward
slightly and maintaining control of speed by grasping the hand rims. The client can descend a steep grade by traversing the ramp slightly
back and forth to slow the chair. Push gloves may be helpful to reduce the effects of friction.161
7. A caregiver can manage ascending curbs by approaching them forward, tipping the wheelchair back, and pushing the foot down on the
anti-tipper levers, thus lifting the front casters onto the curb and pushing forward. The large wheels then are in contact with the curb and roll
on with ease as the chair is lifted slightly onto the curb.
8. The curb should be descended using a backward approach. A caregiver can move himself or herself and the chair around as the curb is
approached and can pull the wheelchair to the edge of the curb. Standing below the curb, the caregiver can guide the large wheels off the
curb by slowly pulling the wheelchair backward until it begins to descend. After the large wheels are safely on the street surface, the
assistant can tilt the chair back to clear the casters, move backward, lower the casters to the street surface, and turn around.161

28. Guidelines for Using Proper Mechanics
The therapist should be aware of the following principles of basic body
mechanics4:
1.Get close to the client or move the client close to you.
2.Position your body to face the client (face head on).
3.Bend the knees; use your legs, not your back.
4.Keep a neutral spine (not a bent or arched back).
5.Keep a wide base of support.
6.Keep your heels down.
7.Don’t tackle more than you can handle; ask for help.
8.Don’t combine movements. Avoid rotating at the
same time as bending forward or backward.

29. • Transfer Techniques
• Transferring is the movement of a client from one surface to another.
• This process includes the sequence of events that must occur both before and after
• if it is assumed that a client has some physical or cognitive limitations, it will be nec
• it is important for therapist to know basic techniques with generalised principles an
• some of the techniques include the stand pivot, the bent pivot, and one- person an

30. Stand Pivot Transfers
The standing pivot transfer requires the client to be able to come to a standing position and pivot on both feet. It is mo
A, Therapist stands on client’s affected side and stabilizes client’s foot and knee. She assists by guiding client forw

31. Bent Pivot Transfer: Bed to Wheelchair
The bent pivot transfer is used when the client cannot initiate or maintain a standing position. A therapist often
prefers to keep a client in the bent knee position to maintain equal weight bearing, provide optimal trunk and
lower extremity support, and perform a safer and easier therapist-assisted transfer.

32. Sliding Board Transfers
Sliding board transfers are best used with those who cannot bear weight on the lower extremities and who have paral

33. THANK YOU