basic understanding of the various parts of a wheelchair for prescribing to rehab patients

1. WHEELCHAIR
PRESENTER: DR KAUSTAV BASU THAKUR
MODERATOR: DR LONGJAM NILACHANDRA SINGH
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2. INTRODUCTION
• Any chair on wheels that can
be propelled either manually
or by power
• A properly prescribed
wheelchair-useful in
reintegrating a person with a
disability into the community
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3. HISTORY
• The first folding manual WC - US by Herbert Everest and
Harry Jennings in 1933
• In late 1970s and early 1980s, Marilyn Hamilton led way
in development of manual WC with custom fitting
• Today a plethora of powered and manual WC technology
• Challenge is matching client need to specific WC
technologies and components
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4. GOALS OF PRESCRIBING WC
• Maximize functional independence with ADL
• Minimize risk of secondary injuries
• Accommodate or correct skeletal deformities
• Ensure proper comfort
• Promote positive and unobtrusive self image
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5. INDICATIONS
• INADVISABILITY OF AMBULATION
Contraindications to weight-bearing
Interference with wound healing
Prior to ambulation
Inadequate safety in walking
Deficiency of the patient’s judgment
**In all of these conditions, the restriction against walking may be
temporary
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6. INDICATIONS contd
• IMPOSSIBLE FOR AMBULATION
 Congenital or traumatic LL amputees
 Paralysis
 Deformity
 Pain on weight bearing
 Incoordination
**In all of these conditions, the use of wheel chair may be permanent
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7. TYPES OF WC
MANUAL POWER
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8. ADULT MANUAL WHEELCHAIR
• Standard
• Standard Hemi
• Lightweight
• High strength lightweight
• Ultra lightweight
• Heavy duty
• Extra heavy duty
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9. BASIC WHEELCHAIR MEASUREMENTS
A: Seat height
B: Backrest height
C: Armrest height
D: Seat depth
E: Seat width
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10. COMPONENTS OF WC
• WC frame
• Seat & cushion
• Arm rests
• Leg rests
• Foot rests
• Restraints
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11. MANUAL WC ACCESSORIES
REAR WHEELS
• Indoor or outdoor terrain, activity level, maintenance,
weight, cost
• Mag wheel & spoked wheel
• 22,24,26 inches
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12. TIRES
• Solid rubber
• Pneumatic
• All terrain
• Kevlar
Outdoor-wider tire with a medium knobby treads
Indoor-smooth and lightly tread tire skin
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13. CASTER WHEELS
• Solid(polyurethane) and
pneumatic
• 2-8 inches in diameter
• Small- greater foot clearance and
agility
stuck crack and bumps
• Large- more security, easy roll
over rough surface
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14. PUSHRIMS
• Allow propulsion
• Control safety without
touching the tire
• Types
oStandard
oOne hand drive
oNatural fit
• ½ inch diameter
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15. BACK REST
• Basic upholstery fabric sling
• Fabric back with tension ties
• Firm back, minimum contour
• Contour-molded foam over hard back
• Hard back with softer foam/gel central region
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16. LATERALS
• Frame mounted pads
• Stabilises the trunk
• Accommodate or correct
deformities
Caution- Avoid undue pressure or
tissue compression
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17. ARMREST
• Standard WC: narrowest armrest
• Long term WC: removable &
height adjustable
• Provide GH joint support
• Perform push up for pressure relief
• Promote transfer
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18. ARM TROUGH
• Unable to lift/self stabilise arm
• Hollow cavity
• Protects arm from drifting into
wheels
• Made of polyurethane foam
• Improve joystick control
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19. FRONT RIGGING
• Includes footrests, leg rests & footplates
• Provide support to legs & feet
• May be removed on one or both sides
• Various types available
• Consider hamstring tightness
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20. HEAD REST
• Unstable neck posture
• Tilt & recline seat function
Foundation for head array
May restrict rear vision
Adds extra weight
↑perception of frailty
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21. SAFETY EQUIPMENTS
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SEAT BELT WHEEL LOCK
ANTITIPPER
GRADE AID

22. SETTING UP OF MANUAL WC
• Can be adjusted together/separately
• Seat dump—sloping downward of seat
• Too much seat dump:
Pelvis will rotate backward
Loss of lumbar-lordosis
Increase pressure on sacrum
Problem in transferring in and out
• Increase back angle- for stiffness of hip, trunk support
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SEAT & BACK ANGLE MEASUREMENT

23. REAR WHEEL CAMBER
• Angle of rear wheel tilt
• 8 degrees is the normal
• Increases access to pushrims
• Increases width of wc
• Wearing of inner side of tire
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24. HORIZONTAL AXLE POSITION
• Moving the axle forward moves the seat back
• Shift of COG over or slightly behind rear axles
• Forward axle position
- requires less muscle effort
- facilitates “popping a wheelie”
• Make WC more “tippy” and difficult push up ramp
• Delivered with the axle in the most rearward position
• Needs to be changed
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25. VERTICAL AXLE POSITION
• Raising the axle has the effect of lowering the seat, while
lowering the axle raises the seat
oBetter propulsion biomechanics by lowering the seat
height
oGreater stability in low position
oToo low - lead to shoulder impingement syndrome
oIdeal position - elbow angle 100- 120⁰
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26. SEATING & POSITIONING
• Comfortable, healthy, functional sitting posture
• Pelvis stabilization
• Cushion should be mounted onto a hard surface
• Secondary injuries can occur
• Pressure relieving seating system require in certain
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27. SEAT CUSHIONS
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Plain Rectangular foam
Contoured foam with skin Matrix of air filled
elastic capsules
Alternating air cell
inflation
Contour molded with gel
filled inserts

28. WHEELCHAIR PROPULSION
• Depends on weight of wheelchair
• Quality & set up, strength of patient
• Propulsion technique: 2 phases - Push phase & Recovery phase
o arc
o semicircular
o single looping over
o double looping over
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29. HEMIPLEGIC CHAIR
• Low seat height
• Arm trough
Keeps forearm in level position
• No foot plate for non affected side
• Double push rims on non affected
side
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30. AMPUTEE CHAIR
Rear wheel axle back 2 inches
Amputee axle adapters
Seat board with amputee extension
Front rigging removed
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31. POWER ASSISTED WC
Mobility assistance
Help weakness, muscle paralysis,
overuse, fatigue
Decrease - upper limb risk of
injuries
Difficult to transport-↑weight
Types - stand alone power unit
power add on devices
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32. POWER WHEELCHAIR
• Ideal for those who do not have the strength/stamina to propel
a manual wc
• Grouped into four broad categories:
Conventional power wheelchairs
Folding and transport power wheelchairs
Combination indoor-outdoor power wheelchairs
Heavy-duty indoor-outdoor power wheelchairs
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33. CONVENTIONAL POWER WC
• Not programmable
• Have very basic seating with
limited sizes available
• Appropriate for limited
indoor use
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34. FOLDING & TRANSPORT POWER WC
• Designed for easy disassembling to
facilitate transport
• Usually compact for indoor use
• Less stability or power to negotiate
obstacles outdoors
• Good trunk and upper body control
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35. Combination Indoor-outdoor Power WC
• For mobility indoors (home, school,
work) and in community with finished
surfaces
• Equipped with standard proportional
joysticks and standard programmable
electronics
• Standard or rehabilitation seating
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36. HEAVY DUTY INDOOR-OUTDOOR POWER WC
• Large-diameter drive wheels with
heavily treaded tires
• Four drive wheels to climb obstacles
and rough terrain
• Can support weight >250 lb
• Power seating options
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37. Input Methods
• Joystick
• Sip and Puff
• Head Array
• Voice control
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38. Scooters
• Provide intermittent mobility
• Requires good arm strength, trunk
balance & ability to transfer
• Steered with a tiller
• Thumb levers used to drive
• Three or four wheeled scooter
• Cost less & easy to disassemble
• Wide turning radius
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39. Stand up Wheelchair
• Advantages:
Physiologic, practical & psychological
• Complex mechanism
• High COG so increased chance of fall
• Safe only on perfectly flat and smooth
flooring
• Properly strapped and secured to the
seat and seat back
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40. Sports wheelchair
• Designed for racing, rugby, tennis ,basketball
• Lightweight materials, very aggressive axle position and
camber
• Only one wheel in front for quick turns and maneuver
enhancement
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41. Paediatric wheelchair
• Similar to adult WC but smaller
• Seat width/ depth < 14 inches
• Adjustable frames or kits to accommodate growth
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42. Prerequisites
Good upper limb strength
Able to lift buttock 2” from bed surface
Stable trunk balance
Hand eye coordination
Good cognition
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43. Factors in wheelchair selection
 Age & weight
 Disability & prognosis
 Functional skills
 Indoor / outdoor use
 Portability / accessibility
 Reliability / durability
 Cosmetic features
 Options available
 Service
 Cost
 Level of acceptance
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44. Wheelchair prescription
• Particulars of patients
• Size : adult, intermediate,
small
• Types: fixed back, semi
reclining
• Brakes: lever, toggle
• Foot rest: detachable, non
detachable
• Foot plates: regular, large
• Heel loops: right, left
• Armrest: padded, removable
• Wheels size: 22-26 “, spokes,
mag-wheel
• Tires: regular, pneumatic
• Axle: regular, heavy duty
• Hand rims: regular, vertical
• Front caster: 2-8 ” regular,
pneumatic
• Cushion
• Back rest
• Color
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45. COMPLICATIONS
• Pressure ulcer
• Nerve compression at wrist
• Overuse injury to muscles , tendons and ligaments
• Shoulder impingement syndrome
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46. PRESSURE ULCER ISSUE
• Coccyx, ischial tuberosity, greater
trochanter
• Push up and leaning to side or
forward periodically
• Tilt - rotating entire body in
sagittal plane - Redistribute
effects of gravity away from
buttock on to the back
• Reclining - angle between back
and seat
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47. PRESSURE MAPPING TOOL
Thin mat with pressure sensor
connected to computer
producing topography of
pressures
Helpful in comparing
pressure relieving qualities of
various cushions
Biofeedback for effective
weight-shifting technique
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48. THANK YOU
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