Wheelchair

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 30-05-2017 1

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 30-05-2017 2

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 30-05-2017 3

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 30-05-2017 4

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 30-05-2017 5

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 30-05-2017 6

7. TYPES OF WC 30-05-2017 7

8. ADULT MANUAL WHEELCHAIR Standard Standard Hemi Lightweight High strength lightweight Ultra lightweight Heavy duty Extra heavy duty 30-05-2017 8

9. BASIC WHEELCHAIR MEASUREMENTS A: Seat height B: Backrest height C: Armrest height D: Seat depth E: Seat width 30-05-2017 9

10. COMPONENTS OF WC WC frame Seat & cushion Arm rests Leg rests Foot rests Restraints 30-05-2017 10

11. MANUAL WC ACCESSORIES REAR WHEELS Indoor or outdoor terrain, activity level, maintenance, weight, cost Mag wheel & spoked wheel 22,24,26 inches 30-05-2017 11

12. TIRES Solid rubber Pneumatic All terrain Kevlar Outdoor-wider tire with a medium knobby treads Indoor-smooth and lightly tread tire skin 30-05-2017 12

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 30-05-2017 13

14. PUSHRIMS Allow propulsion C ontrol safety without touching the tire Types Standard One hand drive Natural fit ½ inch diameter 30-05-2017 14

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 30-05-2017 15

16. LATERALS Frame mounted pads Stabilises the trunk Accommodate or correct deformities Caution - Avoid undue pressure or tissue compression 30-05-2017 16

17. ARMREST Standard WC: narrowest armrest Long term WC: removable & height adjustable Provide GH joint support Perfor m push up for pressure relief Promote transfer 30-05-2017 17

18. ARM TROUGH Unable to lift/self stabilise arm Hollow cavity Protects arm from drifting into wheels Made of polyurethane foam Improve joystick control 30-05-2017 18

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 30-05-2017 19

20. HEAD REST Unstable neck posture Tilt & recline seat function Foundation for head array May restrict rear vision Adds extra weight ↑perception of frailty 30-05-2017 20

21. SAFETY EQUIPMENTS 30-05-2017 21 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 30-05-2017 22 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 30-05-2017 23

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 30-05-2017 24

25. VERTICAL AXLE POSITION Raising the axle has the effect of lowering the seat, while lowering the axle raises the seat Better propulsion biomechanics by lowering the seat height Greater stability in low position Too low - lead to shoulder impingement syndrome Ideal position - elbow angle 100- 120⁰ 30-05-2017 25

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 30-05-2017 26

27. SEAT CUSHIONS 30-05-2017 27 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 arc semicircular single looping over double looping over 30-05-2017 28

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 30-05-2017 29

30. AMPUTEE CHAIR Rear wheel axle back 2 inches Amputee axle adapters Seat board with amputee extension Front rigging removed 30-05-2017 30

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 30-05-2017 31

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 30-05-2017 32

33. CONVENTIONAL POWER WC Not programmable Have very basic seating with limited sizes available Appropriate for limited indoor use 30-05-2017 33

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 30-05-2017 34

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 30-05-2017 35

36. HEAVY DUTY INDOOR-OUTDOOR POWER WC L arge-diameter drive wheels with heavily treaded tires Four drive wheels to climb obstacles and rough terrain Can support weight >250 lb Power seating options 30-05-2017 36

37. Input Methods Joystick Sip and Puff Head Array Voice control 30-05-2017 37

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 30-05-2017 38

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 30-05-2017 39

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 30-05-2017 40

41. Paediatric wheelchair Similar to adult WC but smaller Seat width/ depth < 14 inches Adjustable frames or kits to accommodate growth 30-05-2017 41

42. Prerequisites Good upper limb strength Able to lift buttock 2” from bed surface Stable trunk balance Hand eye coordination Good cognition 30-05-2017 42

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 30-05-2017 43

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 30-05-2017 44

45. COMPLICATIONS Pressure ulcer Nerve compression at wrist Overuse injury to muscles , tendons and ligaments Shoulder impingement syndrome 30-05-2017 45

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 30-05-2017 46

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 30-05-2017 47

48. THANK YOU 30-05-2017 48