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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

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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 AND AXLE
  • FRAME MATERIAL MAY DETERMINE THE WEIGHT AND DURABILITY OF THE WHEELCHAIR
  • WEIGHT IS IMPORTANT IN TERMS OF LOADING WC INTO THE CAR
frame type
FRAME TYPE
  • RIGID FRAME IS MORE STABLE FOR ACTIVE USER
  • MAKE SURE PATIENT CAN LOAD THIS INTO THE CAR
folding frame
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
wheel and tires
WHEEL AND TIRES
  • WHEEL SIZE AFFECTS
    • OVERALL HEIGHT
    • ROLLING EASE
    • TRANSFERRING IN AND OUT OF CHAIR
    • UE MECHANICS OF PUSHING
wheel type
WHEEL TYPE
  • SOLID SMOOTH WHEELS
  • BEST ON
    • SMOOTH
    • HARD
    • INDOOR SURFACES
wheel type7
WHEEL TYPE
  • THREADED PNEUMATIC TIRES
    • GIVES SMOOTHER RIDE
    • EASIER MANUEVERABILITY ON ROUGH TERRAIN,WET OR ICY SURFACES
wheel type8
WHEEL TYPE
  • FLAT TIRES CAN BE MINIMIZED
    • WITH THORN RESISTANT TUBES
    • OR ADDITION OF LATEX GEL
hand rims
HAND RIMS
  • VERY SMALL DIAMETER
    • SMOOTH RIMS FOR HIGH SPEED RACING
  • LARGE
    • TO MAXIMIZE MANEUVERABILITY AND POWER
hand rims10
HAND RIMS
  • MODIFICATIONS
    • IMPROVE GRIPPING
      • BY ADDING COATING
      • INCREASE TUBE SIZE
      • CHANGING SHAPE
      • ADDING RIM PROJECTIONS
wheel locks
WHEEL LOCKS
  • WHEEL LOCKS= BRAKES
  • POSITION HANDLES TO PROVIDE EASY ACCESS
  • BUT NOT INTERFERE WITH WC PROPULSION
wheel locks12
WHEEL LOCKS
  • BRAKE EXTENSIONS FOR PATIENTS
    • WITH U.E. DYSFUNCTION
    • OR POOR BALANCE
wheel locks13
WHEEL LOCKS
  • FOR ACTIVE USER
  • WITH LONG PUSHING STROKE
    • POSITION BRAKES LOWER DOWN
    • TO PREVENT INJURY TO FINGERS AND THUMBS
grade aids
GRADE AIDS
  • SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM ROLLING BACKWARD
  • CAN BE SELECTIVELY ACTIVATED WHEN GOING UPHILL
grade aids15
GRADE AIDS
  • FOR PATIENTS WHO HAVE DIFFICULTY GOING UP INCLINES
  • DON’T USE GRADE AIDS IN STRONG PUSHERS
    • MAY BE ACTIVATED IN WHEELIES
caster
CASTER
  • THE SMALL WHEELS FOUND USUALLY IN FRONT OF THE CHAIR
caster17
CASTER
  • HARD SMALL CASTERS ALLOW EASIEST TURNING
  • SMALLEST 4” CASTORS GOOD FOR SPORTS BUT CAN’T BE USED WELL OUTDOORS
caster18
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
casters
CASTERS
  • PLACING THE CASTER TO REAR OF CHAIR
    • DECREASES TURNING RADIUS
    • INCREASES THE TENDENCY TO TIP FORWARD
caster20
CASTER
  • CASTER LOCKS
    • NECESSARY FOR ABSOLUTE STABILITY OF CHAIR IN TRANSFERS
armrests
ARMRESTS
  • AID IN TRANSFERS
  • WEIGHT SHIFTS
  • REDUCE ISCHIAL PRESSURE
    • BY CARRYING THE WEIGHT OF THE ARMS AND MAINTAINING TRUNK BALANCE
arm rests
ARM RESTS
  • NEED STURDY SUPPORTIVE ARMREST FOR THOSE WITH MARGINAL PRESSURE MANAGEMENT
  • PATIENTS WITH T6 OR ABOVE INJURY NEED THEM FOR STABILITY IN SITTING
armrests23
ARMRESTS
  • NEEDED IF PATIENT HAS
    • LAPBOARD
    • ARM TROUGH
    • BALANCED FOREARM ARTHOSIS
  • ATHLETIC WC USERS MAY WANT TO ELIMINATE ARM RESTS
arm rests24
ARM RESTS
  • TYPES
    • FIXED
    • ADJUSTABLE
    • REMOVABLE
    • SWING AWAY
leg rests
LEG RESTS
  • TO PROVIDE PROTECTION
  • PROPER POSITIONING
  • MAXIMUM BALANCE
  • WEIGHT BEARING OF LE
leg rests26
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
leg rests27
LEG RESTS
  • TYPES
    • STANDARD
    • SWING AWAY
    • REMOVABLE
leg rests28
LEG RESTS
  • ELEVATING
    • MAY HELP WITH EDEMA
    • ALTER ACCESSIBILITY
    • MAKES TURNING MORE DIFFICULT
elevating leg rests
ELEVATING LEG RESTS
  • NEED CALFPADS
  • MORE EXPENSIVE
  • NEED A SPECIFIC DIAGNOSIS TO JUSTIFY
leg rests30
LEG RESTS
  • PATIENTS WITH A LOT OF SPASTICITY
    • MAY NEED A LARGE FOOTPLATE
    • WITH PROPER FOOT RESTRAINT SYSTEM
seat and back
SEAT AND BACK
  • BACK SUPPORT
    • WC BACK
      • SHOULD BE HIGH ENOUGH TO SUPPORT
      • LOW ENOUGH TO GIVE AS MUCH FREEDOM AS POSSIBLE
back support
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
back support33
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
seat type
SEAT TYPE
  • IF PATIENT HAS POOR MUSCLE CONTROL
  • SPASTICITY
  • DEFORMITY
    • THEY NEED A SOLID SEAT OR BACK OR BOTH
seat type35
SEAT TYPE
  • A STABLE SEAT AND LUMBAR SURFACE
    • PREVENTS SACRAL SITTING
sacral sitting
SACRAL SITTING
  • LEADS TO SACRAL AND ISCHIAL PRESSURE SORES
  • INCREASED KYPHOSIS
  • NECK AND UPPER BACK STRAIN
wheelchair stability
WHEELCHAIR STABILITY
  • DEPENDS ON REAR AXLE POSITION
    • IF REAR WHEELS ARE MOVED FORWARD
      • CHAIR MOVES EASIER
      • WEIGHT SHIFT FOR WHEELIES IS EASIER
wc stability
WC STABILITY
  • IF REAR WHEELS ARE MOVED FORWARD
      • CHAIR TIPS BACKWARD MORE EASILY
      • ESPECIALLY WHEN GOING FAST OR UP RAMPS
wheelchair stablility
WHEELCHAIR STABLILITY
  • ANTITIP DEVICES PREVENT BACKWARD TIPPING
wheelchair stability40
WHEELCHAIR STABILITY
  • FOR LE AMPUTEES
    • MOVING REAR WHEEL POSTERIOR
      • KEEPS THE PATIENTS C.OF G. IN FRONT OF THE WHEEL
      • TO PREVENT TIPPING
wheelchair stability41
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’’
wheelchair stability42
WHEELCHAIR STABILITY
  • CAMBER
    • THE ANGLE BETWEEN THE VERTICAL AXIS OF WHEELS AND A LINE PERPENDICULAR TO THE FLOOR
camber
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
biomechanics of seating
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
pelvis
PELVIS
  • EVALUATION
    • LOOK FOR
      • ANTERIOR PELVIC TILT
      • POSTERIOR PELVIC TILT
      • LATERAL SYMMETRY
      • ROTATION
      • RESTRICTION IN ANY DIRECTION
anterior pelvic tilt
ANTERIOR PELVIC TILT
  • INCLINATION OF THE PELVIS IN THE SAGITTAL PLANE FORWARD OF ITS NEUTRAL POSITION
  • DUE TO THE HYPOTONICITY OF TRUNK MUSCULATURE
anterior pelvic tilt47
ANTERIOR PELVIC TILT
  • SHORTENING OF LOW BACK EXTENSORS
  • TIGHTENING OF ILIOTIBILA BAND
  • TIGHT HIP FLEXORS
posterior pelvic tilt
POSTERIOR PELVIC TILT
  • DUE TO OVERACTIVITY OF HIP EXTENSORS
    • DUE TO TIGHT HAMSTRINGS
    • HYPOTONIC LOW BACK EXTENSORS
posterior pelvic tilt49
POSTERIOR PELVIC TILT
  • LOSS OF LUMBAR LORDOTIC CURVE
    • AFFECTS SPINAL ALIGNMENT
    • AFFECTS FUNCTION
posterior pelvic tilt50
POSTERIOR PELVIC TILT
  • TILTING OF PELVIS
    • MOVES C.OF G. POSTERIOR TO ISCHIAL TUBEROSITIES
    • INCREASES WT. BEARING THRU SACRUM
posterior pelvic tilt51
POSTERIOR PELVIC TILT
  • TILTING OF PELVIS
    • INCREASED THE FORCE ON LUMBAR SPINE IN SITTING
    • INCREASES SHEARING AND FORCE OVER SPINE AND PELVIS
pelvic obliquity
PELVIC OBLIQUITY
  • SLANTING OF PELVIS IN THE FRONTAL PLANE
  • DUE TO
    • IMBALANCED POSTURE
    • MUSCLE TONE
    • SCOLIOSIS
    • HIP DISLOCATION
scoliosis
SCOLIOSIS
  • EVALUATION OF SEATING IS DIRECTED
    • TOWARD TYPE OF SUPPORT OR ACCOMODATION NEEDED
    • NOT A PRIMARY METHOD OF CONNECTION
kyphosis lordosis
KYPHOSIS/LORDOSIS
  • TRUNK SHOULD BE UPRIGHT
  • TRUNK SHOULD BE CENTERED OVER THE MIDDLE OF THE WHEELCHAIR
hamstrings
HAMSTRINGS
  • THE MOST IMPORTANT MUSCLE GROUP FOR OPTIONAL
    • POSITIONING
    • COMFORT
    • FUNCTION OF WC USER
hamstrings56
HAMSTRINGS
  • CROSS TWO JOINTS
  • TIGHTNESS CAN DRAMATICALLY
    • CHANGE POSITION OF PELVIS AND KNEES
    • CAN INCREASE POSTERIOR PELVIC TILT
      • THIS INCREASES SACRAL SITTING
hamstring tightness
HAMSTRING TIGHTNESS
  • CORRECTIONS
    • INCREASE LENGTH OF HAMSTRINGS WITH STRETCHING
    • TRY TO INCREASE AMOUNT OF KNEE FLEXION ALLOWED IN WC
      • BY POSITIONING FEET MORE POSTERIORLY THAN USUAL
hamstring tightness58
HAMSTRING TIGHTNESS
  • DON’T TRY TO STRETCH HAMSTRINGS BY INCREASING THE AMOUNT OF KNEE EXTENSION IN CHAIR
  • THIS MAY INCREASE POSTERIOR PELVIC TILT
hamstring tightness59
HAMSTRING TIGHTNESS
  • IF UNABLE TO INCREASE KNEE FLEXION
    • USE POSTERIOR WEDGE TO INCREASE HIP FLEXION
    • WITH A PELVIC WELL TO PREVENT SLIDING OUT OF CHAIR
slide60
HEAD
  • POSITION IN SITTING IS CRITICAL
  • BECAUSE OF INFLUENCE OF HEAD ON
    • PRIMITIVE REFLEXES
    • MUSCLE TONE
    • UE FUNCTION
    • SWALLOWING
    • VISUAL ORIENTATION
upper extremities
UPPER EXTREMITIES
  • UE FUNCTION AND STRUCTURE
    • AFFECT PROPULSION
    • WEIGHT SHIFT
    • TRANSFERS IN WC
upper extremities62
UPPER EXTREMITIES
  • PROPER ARM SUPPORT
  • MAY HELP UNWEIGHT THE ISCHIAL TUBEROSITIES
  • BY 25-35%
wc measurement
WC MEASUREMENT
  • SEAT WIDTH

1” WIDER THAN THE WIDTH OF THE WIDEST PART OF BUTTOCK

  • SEAT HEIGHT
    • 2” HIGHER THAN THE DISTANCE FROM THE BOTTOM OF THE HEEL TO THE POPLITEAL FOSSA
wc measurement64
WC MEASUREMENT
  • SEAT DEPTH
    • 1-2” LONGER THAN THE DISTANCE FROM THE POPLITEAL AREA TO THE BACK OF THE BUTTOCK
  • BACK HEIGHT
    • 2” LESS (MAY VARY) THAN THE DISTANCE FROM THE BOTTOM OF THE SCAPULA TO THE SITTING SURFACE
wc measurement65
WC MEASUREMENT
  • ARM HEIGHT
      • DISTANCE FROM THE BOTTOM OF THE BUTTOCKS TO THE ELBOW
seat type66
SEAT TYPE
  • SOLID SEAT, SOLID BACK OR BOTH
    • IF PATIENT HAS
      • POOR MUSCLE CONTROL
      • SPASTICITY
      • DEFORMITY
seat type67
SEAT TYPE
  • STABLE SEAT AND LUMBAR SURFACE
    • PREVENTS SACRAL SITTING
      • WHICH
        • CAUSES SACRAL STRAIN
        • ISCHIAL PRESSURE SORES
        • INCREASED KYPHOSIS
        • NECK AND UPPER BACK STRAIN
wc cushions
WC CUSHIONS
  • ANOTHER CHAPTER
  • A CONTOURED CUSHION WITH A FIRM BASE MAY BE THE BEST CHOICE FOR PRESSURE RELIEF AND TO PREVENT A PERSON FROM SLIDING FORWARD
wc weight
WC WEIGHT
  • USERS WHO NEED TO LOAD OWN WC INTO CAR
    • NEED FOLDING OR RIGID ULTRALIGHT FRAMES
  • LIGHTER, MORE EFFICIENT CHAIRS MAY NOT BE COVERED BY ALL INSURANCE CO.S
wc weight70
WC WEIGHT
  • HEAVIER CHAIRS
    • MORE PRACTICAL FOR
      • TEMPORARY USERS
      • SHORT DISTANCE MOBILITY
      • OBESE PATIENTS
wc weight71
WC WEIGHT
  • CONVENTIONAL Wc- 50 lb.
  • LIGHTWEIGHT WC- 40 lb.
  • ULTRA LIGHTWEIGHT WC- 15-28 lb.
wc prescription
WC PRESCRIPTION
  • DONE IN A MULTIDISCIPLINARY WC CLINIC
  • WITH P.T.
  • WC VENDOR
  • PHYSIATRIST
wc prescription73
WC PRESCRIPTION
  • OBTAIN
    • MEDICAL HISTORY
    • SURGICAL HISTORY
    • SEATING HISTORY
      • WHAT HAS WORKED OR NOT WORKED IN THE PAST
wc prescription74
WC PRESCRIPTION
  • CHECK PATIENT’S ABILITY TO DO WT. SHIFTS
  • IF UNABLE TO DO WT. SHIFTS PT. MAY NEED POWER RECLINE OR TILT IN SPACE SYSTEM
power recline systems
POWER RECLINE SYSTEMS
  • RECLINING MAY PRODUCE SHEAR DURING RECLINING
  • SYSTEM ADDS 1-2” TO SEAT HEIGHT
  • TILT IN SPACE PRODUCES BETTER REPOSITIONING WHEN UPRIGHT POSITION RESUMED
wc prescription76
WC PRESCRIPTION
  • TO JUSTIFY POWER RECLINING SYSTEM OR TILT-IN-SPACE SYSTEM
    • HAVE TO SHOW PATIENT UNABLE TO SHIFT WEIGHT
    • OR TRANSFER INDEPENDENTLY
    • AND DOESN’T HAVE SOMEONE TO ASSIST WITH THIS
wc prescription77
WC PRESCRIPTION
  • EXAMINE PATIENT IN SITTYING AND LYING SUPINE ON A FLAT SURFACE
  • CHECK
    • SPASTICITY
    • JOINT R.O.M.
      • HIP FLEXION
      • HAMSTRING TIGHTNESS
      • POPLITEAL ANGLES
wc prescription78
WC PRESCRIPTION
  • CHECK PELVIS
  • LOOK AT HOW THIGHS AND FEET WILL BE POSITIONED
  • EVALUATE THE NEED FOR HEAD AND BACK SUPPORTS
wc prescription79
WC PRESCRIPTION
  • LOOK AT SEAT CONFIGURATION
  • EVALUATE HOW WEIGHT SHIFTS WILL BE DONE
wc prescription80
WC PRESCRIPTION
  • BASED ON CLINIC EVALUATION
  • DEVELOP A PRECRIPTION
  • DEVELOP A LETTER OF MEDICAL NECESSITY FOR INSURANCE CO.
  • DISCUSS PRESCRIPTION WITH PATIENT
  • HAVE HIM SIGN IT AFTER DISCUSSION
power chairs
POWER CHAIRS
  • FOR INDIVIDUALS WHO CANNOT PROPEL A MANUAL WC
    • DUE TO
        • WEAKNESS
        • POOR ENDURANCE
        • CARDIAC OR RESPIRATORY LIMITATIONS
        • LIMB ABSENCE
        • PARALYSIS
        • DEFORMITY
power chairs82
POWER CHAIRS
  • INDIVIDUALS MUST HAVE NECESSARY
    • COGNITIVE FUNCTION
    • JUDGEMENT
    • VISION
  • TO SAFELY DIRECT POWER CHAIR
power chair
POWER CHAIR
  • SELECT CHAIR ON SAME PRESCRIPTION PRINCIPLES AS MANUAL
power chair84
POWER CHAIR
  • CONSIDER WHERE THE CHAIR WILL BE USED
  • MAY NOT BE PRACTICAL
    • IF PATIENT LIVES IN A TRAILER
    • OR DOESN’T HAVE A VAN TO TRANSPORT IT
wc power bases
WC POWER BASES
  • TYPE I
      • DIRECT DRIVE MOTORS
      • SMALL BALLOON TIRES
      • MORE DURABLE
      • BETTER ABLE TO TRAVERSE ROUGH TERRAINE
      • SHORT BASED
      • INCREASED EASE OF TURNING IN SMALL SPACES
wc power bases86
WC POWER BASES
  • TYPE II
    • DRIVE POWER LINKAGES
    • LARGE REAR HARD RUBBER TIRES
    • SMALL FRONT PNEUMATIC TIRES
    • ATTAIN HIGHER SPEEDS
    • PROVIDE MORE STABILITY
wc checkout
WC CHECKOUT
  • DO NOT HAVE WC DELIVERED DIRECTLY TO PATIENT
  • HAVE IT DELIVERED TO CLINIC
    • P.T. CAN CHECK IT TO MAKE SURE IT FITS THE PRESCRIPTION
    • CHAIR CAN BE RETURNED IF SOMETHING IS WRONG OR MISSING
    • HAVE P.T. CHECK OUT PATIENT IN WC TO MAKE SURE IT FITS AND THEY CAN USE IT CORRECTLY
wheelchairs88
WHEELCHAIRS
  • COSTLY
  • OFTEN COMPLICATED
  • EVALUATE PATIENT IN WC CLINIC OR BY SKILLED P.T.
    • IF PATIENT IS HARD TO FIT
    • TO MAKE SURE THEY GET APPROPRIATE WC