Wheelchairs

Wheelchairs

1.W/C Components

2.Types of wheelchairs

3.Wheelchair operation

4.Wheelchair Propulsion

Wheelchair Components

Wheel Locks

•One of the most important safety features

•Devices that stabilize the wheels of a wheelchair

–After the wheelchair has been stopped

–They operate differently than brakes, which stop a moving wheel.

–Must be engaged whenever pt is moving into or out of W/C

Wheelchair Components

Wheel Locks - USE

General Safety

• Wheel locks must be engaged whenever an individual is moving into or out of a wheelchair.

• Engaging wheel locks on the rear wheels prevents forward motion and backward motion of a wheelchair.

• Wheel locks must make secure contact with tires to prevent movement of the wheels.

Wheelchair Components

Pelvic Positioners

• Devices that stabilize a patient’s pelvis in the proper position while seated in a wheelchair.

–Not intended to be used to prevent a patient from falling out of a wheelchair

–Not intended to be used as a restraint to keep a patient from getting out of a wheelchair unexpectedly

•they are part of a positioning system

Wheelchair Components

Caster Wheels

• small front wheels on a wheelchair

–standard solid rubber

•durable

–pneumatic

•air filled to provide a smoother ride

Wheelchair Components

Drive (Push) Wheels

• large rear wheels of a wheelchair

• types

–standard spokes made of aluminum

–“Mag”

•8 thicker struts made of magnesium

–used for propulsion

•standard solid rubber

•pneumatic

–with or without a treads

Wheelchair Components

Drive (Push) Wheels (continued)

–outer hand rims for propelling

•with projections

–add weight and width

–make maneuvering in small places more difficult

•non slip coating

–more lightweight

–quick release

•for ease of transport into or out of a car

Wheelchair Components

Armrests

• full length

–the height is the same along the entire length of the armrest

• desk length

–the height of the arm rest is split into two heights so that the wheelchair can be rolled up to a desk and the back of the arm rest is higher, supporting the elbow

•the arm rest is removable so that it can be reversed to make transfers easier by placing the higher portion in the front

Wheelchair Components

Foot plates & Foot rests

• a patient’s foot rests on foot plates

• heel loops constructed of cloth or webbing attach to foot plates and prevent the feet from sliding off the foot plates and under the wheelchair

• foot plates may be raised to allow patients to transfer safely in and out of a wheelchair

• Foot rests are fixed or removable & distance from seat to footplate can be adjusted

• pivoting foot rests can be removed to provide more room for safe transfers into and out of a wheelchair

Wheelchair Components

Legrests:

-usually elevating

A calf pad cushions the calf & supports the leg

Wheelchair Components

Anti-Tipping Devices

-small extensions attached to the lower horizontal support bar

-used to prevent accidental backward tipping

-must permit some tipping, so front casters can roll up over doorsills, curbs, etc.

Types of Wheelchairs

Standard W/C: comes with basic features

Reclining Back W/C: pt unable to sit upright for too long

TYPES OF WHEELCHAIRS

Tilt-in-Space W/C: has a fixed seat-to-back angle, even when reclined

One-Arm Drive W/C: patients with one functional UE

Wheelchair

Folding a wheelchair

•raise the footplates

•pull up on the front and back aspect of the cloth seat

Wheelchair

Opening a folded wheelchair

•push down on the seat

Wheelchair Operation

All W/C users should be taught how to:

-operate wheel locks

-remove & replace armrests

-swing away, remove & replace footrests/plates

-elevate & lower the footplates

Self Propulsion with Bilateral UE

1. Grasp handrims at top of wheels (12 o’clock)

2. Push forward (to go forwards) or pull backward (to go backwards) with equal force on each wheel

3. To turn: hold one handrim stationary & push or pull on the opposite handrim

4. To turn more quickly: push one handrim forward while simultaneously pulling backward on the other

Self Propulsion with one UE & one LE

1.Grasp handrim at 12 o’clock & push forward or pull back, using the foot to push or pull simultaneously

2.The foot can also act as a “rudder” to assist with turning while the user holds the handrim

Self Propulsion with Bilateral LE

A method in which the patient uses the heels and soles of both feet to propel forward and backward. Can use the feet as a “rudder” to turn left or right.

Clinician Propulsion on Level Surface

1.Use the push handles to move and control the W/C.

2.To turn the chair, hold one push handle still and push on the other.

3.Do not push the chair & then release the handles. You should always maintain control of the chair.

4.Start & stop the chair smoothly

5.Use caution moving through doorways

6.Stay to the right side of the corridor

7.If you need to tip the chair back on its rear wheels, first inform your patient.

Clinician Propulsion – Ascend a single

elevation (CURB) forwards

1.Position the chair facing the curb

2.Elevate the caster wheels by standing behind the chair & using 1 foot to push down & forward on one tipping lever while pushing down & back with both hands on the handles

3.Move the chair forward on its rear wheels until they contact curb lip & the caster wheels are above curb surface.

4.Carefully lower caster wheels onto curb surface

5.Roll the chair forward so the rear wheels ascend the curb & all 4 wheels are on the upper level of the curb

Clinician Propulsion – Descending a single

elevation (CURB) Backwards

1.Position the chair so rear wheels are close to edge of curb

2.Stand behind chair & control the chair as it slowly rolls backward, with the rear wheels first, over the curb, while the caster wheels remain on the upper surface of the curb

3.You can use your thigh or the lateral hip against the back of the chair to help control the descent of the chair

4.When the rear wheels contact the street, turn the chair 90 degrees or back it up until the caster wheels clear the curb

5.Lower caster wheels to the surface

Clinician Propulsion –

ascending a flight of stairs

1.Two clinicians are needed

2.One stands behind the chair, one to the side of the chair

3.The rear wheels contact the bottom step, elevate the caster wheels, maintain this tipped position as you pull the chair up the stairs

4.The second person is standing on the side of the chair holding the frame (not a removeable part)

5.Move one step at a time

6.Person behind the chair verbally “leads”

7.At top of steps, either back up or turn 90 degrees, then lower caster wheels

Clinician Propulsion – descending a flight

of stairs

1.Safest with 2 clinicians, but can do with one

2.Position caster wheels as edge of top step, tip chair on rear wheels and maintain this tipped position throughout

3.On command of the leader, everyone retards the motion of the rear wheels down each step

4.Stop the chair on each step to avoid developing momentum

5.Lower the chair onto its caster wheels at the bottom

Clinician Propulsion - Slopes

ASCENDING

-can push chair forward on all 4 wheels

-can push chair forward tipped back on the rear

wheels

-can pull chair backwards tipped back on rear

wheels

DESCENDING

-can elevate caster wheels, tipping chair back

on rear wheels and retarding the motion going

down the slope

-can leave all 4 wheels in contact with ground

and descend backwards

Clinician Propulsion

Elevators: can enter forward or backward, safer to enter forward (to reduce risk of LE injury if doors close early) and exit backwards (as rear wheels less likely to get caught in space between elevator and floor

Escalators: Avoid unless it is an extreme emergency

You are responsible for:

•the safety of the person in the

wheelchair

•making sure that the patient is

securely seated in the chair and that his

or her dignity is preserved

TAKE OUT A PIECE OF PAPER

Choose one of the following scenarios and draw (stick figures is okay) the correct way to do it:

- ascend curb with wheelchair

- descend curb with wheelchair

- ascend stairs with wheelchair

- descend stairs with wheelchair

- ascend steep hill with wheelchair

- descend steep hill with wheelchair

Put your name on it and place it in the bin up front

Review of Today’s Lecture

Components

Types of W/C

Patient Propulsion with Bilateral UE

Patient Propulsion with one UE & one LE

Up a curb

Down a curb

Up a slope

Down a flight of stairs

Looking Ahead

Next Lecture: Therapeutic Exercise

QUESTIONS????

Minor, M.A., Minor, S., (2006), Patient Care Skills, 6th ed. Pearson Prentice Hall: Upper Saddle River, NJ.

Pierson, F.M., (1999), Principles and Techniques of Patient Care, 2nd ed. W.B. Saunders Company: Philadelphia.