Wheel Chair

Wheel Chair
Khalil Ahmad
Team
Patient Rehabilitation
Engineer Occupational Therapist Physical Therapist Rehabilitation Technology Supplier Speech and Language Pathologist Rehabilitation Physician
Goals
Maximize
functional independence in
ADLs Minimize the risk of secondary injuries Correct or accommodate skeletal deformities Assure comfort Promote positive self image
Manual Wheelchair Components Labeled

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
17. 18. 19. 20. 21. 22. 23. 24. 25. 26.
Click on name to magnify

1. 2. 3. 4. 5. 6. 7. 8. 9. Push handle bracket tube Backrest Swing-away, padded armrest Pneumatic tire Aluminum handrim Aluminum wheel rim Spokes Rear wheel hub Release axel 10. 11. 12. 13. 14. 15. 16. 17. 18. Axel plate Frame High wheel lock Swing-away release Caster housing cover Caster plate Caster housing Seat cushion Seat sling 19. 20. 21. 22. 23. 24. 25. 26. X-Hinge Swing-away foot rest Crossbrace Caster fork Caster wheel Caster tire Flip-up foot rest Heel loop
Anatomy of a Manual Wheelchair
D. Michael McKeough, PT, EdD Associate Professor Department of Physical Therapy 2007 All rights Reserved
Push handle bracket tube Backrest Swing-away, padded armrest Pneumatic tire Aluminum handrim Aluminum wheel rim Spokes Rear wheel hub Release axel Axel plate Frame High wheel lock Swing-away release Click on name to highlight structure
Caster housing cover Caster plate Caster housing Seat cushion Seat sling X-Hinge Swing-away foot rest Crossbrace Caster fork Caster wheel Caster tire Flip-up foot rest Heel loop
Push handle bracket tube Backrest Swing-away, padded armrest Pneumatic tire Aluminum handrim Aluminum wheel rim Spokes Rear wheel hub Release axel Axel plate Frame High wheel lock Swing-away release
Push handle bracket tube Backrest Swing-away, padded armrest Pneumatic tire Aluminum handrim Aluminum wheel rim Spokes Rear wheel hub Release axel Axel plate Frame High wheel lock Swing-away release
Manual Wheelchair Components Labeled

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
17. 18. 19. 20. 21. 22. 23. 24. 25. 26.
Click on name to magnify

1. 2. 3. 4. 5. 6. 7. 8. 9. Push handle bracket tube Backrest Swing-away, padded armrest Pneumatic tire Aluminum handrim Aluminum wheel rim Spokes Rear wheel hub Release axel 10. 11. 12. 13. 14. 15. 16. 17. 18. Axel plate Frame High wheel lock Swing-away release Caster housing cover Caster plate Caster housing Seat cushion Seat sling 19. 20. 21. 22. 23. 24. 25. 26. X-Hinge Swing-away foot rest Crossbrace Caster fork Caster wheel Caster tire Flip-up foot rest Heel loop
Manual Wheelchair

The proper selection and design of a wheelchair depends on the abilities of the user and on the intended uses Manual wheelchairs are much easier to transport because of their lighter weight Manual wheelchairs generally require less maintenance. Manual wheelchairs offer a degree of physical exercise that can benefit the wheelchair user. Physical exertion can lead to upper-limb injuries upperand pain. it may be possible to prevent these injuries through the appropriate selection and configuration of the wheelchair and with the appropriate training of the user
Pressure
mapping
Deformity

Incorporate a design that accommodates for the problem rather than trying to affect a change in the physical status of the users
Limb

function
Facilitate components of normal movement in a developmental sequence Maximize stability to enable function
Supine

Flexibility of pelvis, trunk and lower extremities Determine presence of pelvic obliquity and rotation Hamstring flexibility
Pelvic Deformity
Pelvic Obliquity Anterior Pelvic Tilt
Posterior Pelvic Tilt
Seated

Measurements Note effects of gravity on posture Need for support Alignment of spine Tone, motor control Misalignments Effects of external supports
Optimal Seating Position

Pelvis 90-100 90Trunk

Support natural curves Knees 90-105 90Ankles 90 Shoulder flex 30 Elbow flex 60
Lower Extremities

Upper Extremities

Head
Supports
Contacts

against the body that
Provide a stable surface Distribute weight Maintain desired position Reduce extraneous movement Block reflex patterns Decrease tonal influences
Supports
Named
according to placement and body
part

Lateral thigh support Posterior head support
Support Systems
Categories
of supports based on the amount of contact they make with the body

Planar Contoured Aggressively contoured Molded (custom contour)
Components
Linear
or contoured supports that are separate from the seat and back
AttendantAttendant-Propelled Chairs
Not all wheelchairs are propelled by the person sitting in the wheelchair.. individuals with severe disabilities are unable to propel a wheelchair or control a power wheelchair. The primary consideration in the attendant-propelled attendantchair is that the wheelchair has two users: the rider and the attendant. If the wheelchair is propelled solely by attendants with no assistance from the rider, then there may be no need for the larger drive wheels If the occupant will be sitting in the chair for prolonged periods of time, then attention must be paid to comfort. For this reason, attendant-propelled chairs often have attendanttilt-intilt-in-space as an option.

Wheelchair Foam cushions

inexpensive very
lightweight won't leak can be cut to fit individual needs wear out quickly lose shape over time
Wheelchair Gel cushions:

contoured
for postural support have inserts for leg stabilization very comfortable absorb less impact are heavy may leak more expensive
Wheelchair Air cushions:

inflate
to users specific needs are lightweight distribute pressure evenly can be modified are waterproof may leak or puncture higher maintenance more expensive
RECLINE AND TILT-IN-SPACE TILT-IN Relieve
pressure, manage posture, provide comfort, and help with personal care activities Recline helps to stretch hip flexors and also assists with attending to catheters, toileting, and dependent transfers Because reclining the seat back creates shear, the user often shifts in the wheelchair into a sacral-seated position sacral-

For a patient who is unable to reposition without help, adding tilt may help the user reposition independently Tilt-inTilt-in-space keeps the hip and knee angles constant when tilting the back Unlike reclining systems, the position of the user is maintained in the tilt seating system. Subjects unable to independently shift weight, or with pain as a result of prolonged sitting, need to be considered for this option Tilt-inTilt-in-space should be strongly considered in individuals with progressive disorders. An individual with amyotrophic lateral sclerosis may find it easy to perform weight shift and repositioning at an initial evaluation, but this can change quickly, leading to the need for modifications
FRAMES

There are two basic frame types: folding and rigid. Within these two frame types, there are a number of different varieties. The most common type of manual wheelchair frame is the folding cross-brace frame . crossWhen viewed from the back of the frame, the cross members form an X. The chair is folded by pulling upward on the seat upholstery. Cross-member Crossfolding mechanisms are simple and easy to use.
FOOTRESTS

Footrests may be fixed, folding, swing away or elevating. The footrests must provide sufficient support for the lower legs and feet, and must hold the feet in proper position to prevent foot drop or other deformities. It is essential to assess limitations in knee and foot range of motion. Some users have very tight hamstrings, requiring that the feet be positioned closer to or under the front edge of the seat. This is difficult to accomplish in most configurations. Extending the knees out to accommodate the standard design of the footrest position in front of the seat results in a sitting posture with a posterior pelvic tilt and a tendency to slide forward in the seat. This is commonly seen in elderly people in nursing homes using depot-type wheelchairs. depot-
The feet must remain on the footrests at all times during propulsion, and therefore some type of cradle is recommended. The feet should not be pinched, trapped, or scratched by the footrests during normal driving activities or when transferring. The frame should be selected and configured so that the feet sit firmly upon the footrests, with shoes on, without lifting the upper legs from the seat cushion. Care must be taken that sufficient ground clearance is maintained. Elevating leg rests can be used for people who

can not maintain a 90-degree knee angle or 90who need their legs elevated for venous return. Elevating leg rests make the wheelchair longer and heavier. This also has the effect of making the wheelchair less manoeuvrable by increasing the turning radius. Therefore, if elevating leg rests are needed, a power wheelchair should strongly be considered
ARMRESTS AND CLOTHING GUARDS

Armrests provide a form of support and are convenient handles to hold onto when the rider leans to one side or the other. Armrests are also helpful when attempting to reach higher places. Armrests are commonly used to perform a pushpushup to assist with seat pressure relief. This helps to improve blood flow to the lower extremities and reduces the risk of developing a pressure ulcer.
There are three basic styles of armrests: wraparound, fullfull-length, and desk-length. desk Wraparound armrests mount at the back of the wheelchair onto the frame below the backrest in most cases. Wraparound armrests are popular among active wheelchair users. The most significant drawback of this design is that the armrest does not serve as a side guard to keep the rider's clothing away from the wheels. Full-length and desk-length armrests are similar in Fulldeskdesign, the main difference being the length of the armrest.

Armrests can be fixed or height adjustable. Armrests are either removed or flipped back. The hands and arms must clear the armrest in order to reach the push rim. This can force the user into excessive abduction at the shoulder, which could be a risk factor for injury
WHEEL LOCKS

Wheel locks act as parking brakes to stabilize the wheelchair when the rider transfers to other seats and when the rider wishes to remain in a particular spot. When locked, they keep the wheelchair stable to allow the rider to push things from the chair. HighHigh-lock brakes, which are located near the front corner of the seat, are most common, however, location can vary. High-lock brakes require the least Highdexterity to operate. Extension levers can be added for people with limited reach or minimal strength. Wheel locks may be push to lock or pull to lock.
TYRES

The most common type of tire is pneumatic. These tires are lightweight and provide cushioning against impact and vibration from rolling over surfaces. This cushioning may increase rider comfort and improve wheelchair durability. Pneumatic tires are recommended for outdoor usage. Pneumatic tires require maintenance and they can puncture. An alternative to pneumatic tires is solid inserts. These foam inserts fit into the pneumatic tire and replace the airair-filled inner tube that would normally be there. A less viable alternative is solid tires. These tires require no maintenance and are low in cost. Unfortunately, they make for an uncomfortable ride as all ground shocks are transmitted to the wheelchair user.
Anti tippers
Anti
tippers are often placed on wheelchairs to assure they do not tip over backward. These can inhibit the ability to climb curbs, but they do offer a measure of safety. It is suggested that these be ordered for all wheelchairs and then have the user take them off when they are comfortable with the stability of the chair.
Push Rims

A number of different push rims are currently available, and new styles are likely to be introduced into the market. Anodized aluminum rims are the current standard on most K0004 and K0005 chairs. Less expensive chairs may come with plastic push rims. For individuals with difficulty gripping the rim, alternative rims should be considered. These can include vinyl-coated rims, rims with projections , and vinylrims wrapped with surgical tubing. All of these rims have the advantage of increased friction, making it easier to push the chair forward. Unfortunately, this increased friction can lead to burns when the wheelchair user attempts to slow down the chair.
Wheels

The standard wheels on lightweight and ultralightweight wheelchairs have spokes. Plastic wheels can be used on low-end chairs. lowThese increase weight and decrease performance. HighHigh-end wheels are now available with flexible spokes or with graphite and composite materials. These wheels can be easier to maintain than standard spokes and also offer improved aesthetics.
Caster Wheels
Caster wheels are available in a variety of shapes and sizes. Pneumatic wheels are larger than solid casters and may interfere with the footrests when turning. Pneumatics offer the advantage of easier propulsion over rough terrain and increased shock absorption. Many wheelchair users are using narrow Rollerblade type wheels, which can get caught in sewer grates. These wheels reduce rolling resistance and allow quicker turns. Adding frog-legs can provide shock adsorption. This frogdevice adds an elastomer shock absorber in series with the caster as a means of reducing vibration exposure

Push Handles

Push handles, also known as canes, are attached to the back of the chair with the primary purpose of making it easier for an assistant to propel the wheelchair. Canes can also be used by the wheelchair occupant to help with pressure relief. The wheelchair user can hook the arm around the cane and pull to raise the contralateral hip, even in the absence of strong triceps muscles. Canes can also be used to hang a book bag or backpack onto the back of the chair.
GradeGrade-Aids
Grade-Aids Grade-
are devices that attach to the wheel and allow it to roll forward, but not back. they can make it easier to roll up a hill. These should be considered for individuals who have upper-limb weakness and who uppermust negotiate hills.
Rear Wheel Camber

Camber is the angle of rear wheel tilt Angling the rear wheels so the top is tilted inward & the bottom outward Most w/c generally have 8 degree of camber Brings the wheels inward and close to the body which enables the arm to access more of the push rims Reduces shoulder abduction because the wheels are closer to the body Increases lateral stability Protects the hand when pushing in tight areas
Wider
wheelchair which can be problematic in tight areas Diminished traction & uneven tire wear
Tilt
and recline are also available in manual wheelchairs. For the most part, these chairs are only used for patients who require attendant control. As in recline, tilt-in-space greatly reduces tilt-inpressure on the ischial tuberosities by shifting the pressure to the back. Research supports the combination of these interventions .
PowerPower-Assisted Wheelchairs

Provides a power assist when desired, but allows the user to push the wheelchair PowerPower-assisted wheelchairs have force/momentforce/momentsensing push rims that provide an additional torque to the rear axle proportional to the applied moment. Such devices have potentially important benefits, such as enabling people normally provided with power wheelchairs to self-propel a wheelchair despite obstacles selfsuch as steep ramps. Using power assists, lower oxygen consumption and heart rate. For individuals with upper-limb pain or tetraplegia, the upperpowerpower-assisted wheelchair may prove to be a good compromise between a manual wheelchair and a power wheelchair
Scooters

Scooters are a good option for certain individuals. These devices typically have a single front wheel for steering and two drive wheels in the back. Possibly because scooters are available to help shoppers in many large department stores, they seem to have a greater degree of social acceptability than wheelchairs. Steering is accomplished via hand bars that are intuitive to users who have previously used a bicycle. Seating is provided in a chair having foam padding typical of a car seat. The backrest height ends at the level of the shoulder blades, which allows for unencumbered rotation of the trunk.
In general, scooters are a reasonable option for individuals who retain some ability to ambulate, such as those with cardiopulmonary disease limiting the ability to walk. Scooters are a poor option for individuals with progressive neuromuscular disorders because they have few options to accommodate progressive disability. They are also a poor choice if one needs to stay in the chair all day because seating options are limited.
Power Wheelchair Training

Wheelchair users can first practice basic manoeuvres in controlled environments that meet Americans with Disabilities Act (ADA) Accessibility Guidelines. They should practice negotiating uneven surfaces and slope transitions They should gradually tackle more challenging environments, such as steep grades and step transitions The rider should always practice with an appropriate lap belt and chest support in place, and a spotter (therapist) to assist if needed. By setting up and practicing in safe environments, users can experience the limits of the lateral stability, as well as the front and rear stability of their chair so that they have a better understanding of its performance limits.
PEDIATRICS

In many ways, the seating and mobility needs of children with disabilities are similar to those of adults. Children seek comfort, stability, and function, and there is no one perfect position for every activity or situation. There is a tendency to be aggressive with children and force them to sit upright with many postural supports in the hope of preventing or delaying deformities. It is important to seek out input from both the child and the caregivers who will be dealing with the seating system on an hourly basis.
Several variables in system design need to be considered with children 1. developmental status 2. mobility 3. growth 4. age-appropriate activities, age5. school, 6. therapies, 7. the environment, and family issues. 8. Children not only change in size, but their disability often changes as they grow, even in non progressive disorders such as cerebral palsy.
Basic wheelchair dimension

Seat height-2 inches higher than the distance heightfrom the bottom of the heel to the popliteal area Seat width- 1 inch wider than the widest part of widththe hip Seat depth-1to2 inch longer than the distance depthfrom the popliteal area to the back of the buttock Back height- 2 inches less than the distance heightfrom the bottom of scapula to the sitting surface Arm rest height- distance from bottom of buttock heightto the elbow
West Midlands Rehab Centre
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Wheel Chair

Manual Wheelchair Components Labeled

Click on name to magnify

Anatomy of a Manual Wheelchair

Manual Wheelchair Components Labeled

Click on name to magnify

Pelvic Obliquity Anterior Pelvic Tilt

Posterior Pelvic Tilt

Optimal Seating Position

Pelvis 90-100 90Trunk

against the body that

according to placement and body

Lateral thigh support Posterior head support

Planar Contoured Aggressively contoured Molded (custom contour)

Wheelchair Foam cushions

Wheelchair Gel cushions:

Wheelchair Air cushions:

RECLINE AND TILT-IN-SPACE TILT-IN Relieve

ARMRESTS AND CLOTHING GUARDS

Rear Wheel Camber

Power Wheelchair Training

Basic wheelchair dimension

West Midlands Rehab Centre

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RECLINE AND TILT-IN-SPACE TILT-IN Relieve