Sunday, October 16, 2011

WHY IS KNOWING YOUR WHEELCHAIR IMPORTANT?

Here is useful extract of information by Mr Gary Karp from Christopher Reeve Foundation (Wheelchair user since 1973, Writer of the book "Life on wheels") who delivered a webinar on 10th August 2011. I attended it and sharing the information part by part. Any queries are welcome.


WHY IS KNOWING YOUR WHEELCHAIR IMPORTANT?
Greater complexities of the wheelchair these days regard to design complexities --> Greater mobility is helped by the modern day's wheelchairs -->Critical to independence of the patient and aids in activities of daily living --> Critical to health and lifestyle of the patient.


IMPORTANT PARTNERSHIPS
YOU (Make choices) --> Therapist (Knowing and assessing your body) --> Wheelchair Dealer (Product and information).



Wheelchairs have come a long way from that giving rise to modern folding and sophisticated advances.
Important points to consider while choosing a wheelchair is


1. Adjustable- It's important that the wheelchair user gets used to the chair. He should get a feel of the chair, get used to it. It may be difficult for a person with recent injuries as there can be problem with coping with the injury.


2. Customised – Anyone can get the chair customised as the patient has to spend maximum time in the wheelchair.



CHOOSING WELL-
It's important to know what is right for you. It is important not to get influenced by what people say. Choice should be made on the basis of lifestyle and activities along with level of injury.
It should help you to become more independent and team collaboration of you, therapist and dealer.

MOBILITY TOOL-
PREREQUISITES OF WHEELCHAIRS-

- EFFICIENCY OF ENERGY- It's important that energy consumption using a wheelchair is optimum and not exhausting for the user. Energy preservation is a vital element for choice of wheelchair.

- SAFETY- It is important to be stable in the chair and to be safe in your chair. Control of your chair and knowing your chair so that you can safely propel it is vital.

- COMFORT- It is vital that you are comfortable in your chair as you spend most part of your day in the chair.

- MASTERY- Mastery of wheelchair is key thing to get used to the chair and try to learn extra skills liking tipping and tilting to clear obstacles.

So which chair should be used?? FOLDING OR RIGID??
Many people suggest going for folding wheelchairs. But it is important to understand characteristics of both the chairs before making final choice.

FOLDING CHAIRS-
Folding chairs weigh more than rigid ones mainly because of the mechanism of folding which increases weight. Therefore they require more energy to drive them and increase energy expenditure.
Folding chairs move better on uneven or irregular surfaces due to their flexibility.
They have a fixed back angle due to their design which is specific in order of the chair.
They have removable footrest which assists in transfer of the patient better.
It collapses horizontally so it is narrower and can be stored in small space.

RIGID CHAIRS-
INTEGRATED FRAME- These chairs have integrated frame. Footrest is usually not removable as the footrest is the part of the frame.
QUICK RELEASE WHEELS- This feature may be common to both the types of wheelchairs. It is important because it helps to break the frame, by removing the wheels.
ULTRA LIGHT WEIGHT- Goes very lighter.
VERY ENERGY EFFICIENT- Not heavy due to weight of the frame or folding mechanism. This chair goes a long distance with a simple push. This is important because it avoids repetitive stress injuries to shoulder and elbows of the wheelchair users.
MORE ADJUSTIBILITY- Changes the back angle that allows different angles of inclination.

There are many dealers coming up with various new wheelchairs and new innovations. It is important to be updated about that and ask the dealers for brochures and information regarding the chairs on their websites or by meeting them personally to understand the changes and features of new upcoming wheelchairs.

HIGHEST PRIORITY IS FOR THE PRESSURE DISTRIBUTION.
Because wheelchair users spent most of the time on chairs, there is a high chance of pressure sores mostly on your buttocks (ischial tuberosities of the hip bone). So cushions are important for pressure relief.

CUSHIONS-
Types of cushions-
AIR CUSHION- Simple or ROHO cushions filled with air.
Gel cushion (Both the cushions are prone to leakage, especially gel leakage may be embarrassing causing persons trousers to be wet embarrassing the patient)
Polyurethane cushion- This cushion has honey comb pattern which aids in pressure distribution.
Sculpting/ Amending cushion

Some cushions have a bump in the middle to keep legs in abduction while some of the have bumps in the sides to adduct the legs.

MEASUREMENTS OF THE CHAIR-
From the seat to the floor- Minimum safety should be considered.
2 and half inches from the floor to the sole +sole to the bottom of the thigh – cushion thickness.

It is important to have full contact with the back and the cushion. The thighs should be in full contact with the cushion.
The back should be in full contact with the backrest and the spine should be erect and in good position while taking the measurements. This position is important because the contact of the spine with the back rest is an important factor for propulsion of the chair along with upper extremity function.

REAR TO THE FLOOR-
Higher the level of spinal cord injury, lesser there is control of the trunk and different body segments. Hence more is the height of the squeeze which is required to support the trunk. This thereby increases the dump angle.
This thereby increases the stability and balance of the individual in the chair. This improves spinal health but can be a hindrance to transfer of the patients.

SEAT DEPTH-
The seat depth should be such that it offers full support to the thighs.
If the depth is more, then it may be problem for clearance.
If the depth is too less, it increases the contact between the thighs and the cushion and may lead to pressure sores on the thighs.

SEAT WIDTH-
The width of the seat must be adequate to avoid twist and skin damage mainly at hips and greater trochanter. It is a vital aspect for the patient to reach the wheels of the chair.
If the width is too much then there can be excessive strain on the upper extremities by affecting the angle at which the tricep muscle works.
Also there is a chance of increase of rotational component from the trunk. If it's too narrow, the skin may rub to the sides of the wheelchair and may breakdown leading to sores.
However patients must try to maintain their weight, take care not to gain weight after wheelchair prescription which may lead to problems.

THE BACK-
Height of the back rest is critical. It is higher in patients with higher level of spinal cord injury mainly to support the torso. In such cases sometimes low back is compromised. As discussed already, contact with the back increases the strength and propulsion of the chair.

ANGLE of back rest needs to be considered.
ABILITY TO ROTATE- This back should not be high enough to avoid rotation.
LUMBAR SUPPORT- Swing back, which have special straps to tighten some areas and provide lumbar support.
MAIN WHEELS-
Size 22-26 inches
Larger wheels are easier to push. They need to be highly engineered to minimise moment of inertia and to make them lighter. They may have coloured spokes and tires for design.
SPOKES-
Metal spokes- Less expensive but heavy
Steel spokes- Shock absorbing capacity
Coloured spokes for design and decoration
TYRES-
Degrees of threading vary according to the conditions.
City wheelchairs need less treading while wheelchairs used in countryside need tougher wheels with higher tread. There are also puncture resistant tyres and Kevlar tyres.
Kevlar tyres are puncture resistant tyres. There are also tyres with airless inserts which may be more softer.
HANDRIMS-

Ø Standard rim.
Ø RINGS WITH KNOBS FOR QUADRIPLEGICS.
Ø COATED HANDRINGS.
Ø These days there are new designs that don't require you to touch the wheel and make them messy.


ARM RELATIONSHIP
Using triceps muscle – Axle height. Wheel size determines arm relationship.
Strongly related to the dump angle
You should bend your elbows. Though larger wheels are better for the chair but these wheels increase the use of triceps muscles.
Similar things happen if you sit high up on the chair.
The propulsion of the chair should be from 10 o clock position to 2 o clock position. It's essential to maintain grip and chair should exhibit combination of axle height and angle of the triceps muscle.

CENTRE OF GRAVITY OF THE CHAIR-
This component determines the tip ability of the chair. Tipp ability is the amount at which the chair tips or the front wheels come off the ground. Every chair should have some degree of tip ability to clear objects or uneven ground.
If the COG is forwards, there is excessive tendency of the chair to tip. Even gentle propulsion of the chair may result in the tipping of the chair.
If COG is backwards, more energy is required for the chair to tip. FORCE = Forward motion which is related to arm position.

CLOTHING GUARDS-
Clothing guards are essential component of the wheelchairs. They avoid risk of breakdown of skin mainly at the greater trochanter of the hips and outer aspect of the hips.

CASTERS-
They are available in various sizes and materials.
Small ones are more agile and they move really quickly and turn swiftly. They can feel the bumps and irregularity of the ground easily.
Larger wheels avoid big changes in the height of the ground. Most of these castors don't have air filled in them. However attention should be paid to hair in the castors.
It important to remove the hair from the castors as the hair may block the ball bearings and knock down the efficiency of the ball bearings.
These days many castors have shock absorbers which help in avoiding jerks and improve comfort. Large ones get caught easily. Also while turning they may rotate.
BRAKES-

Use the brakes while transfers. Non use of the brakes leads to straining of the back. There are various types of brakes.
1. Standard brakes
2. Push or pull brakes
3. Extender brakes
4. Scissor brakes
5. Hub or disc brakes in the wheels. They however do not fix the wheelchair at one place because of the flexibility of the wheels of the wheelchair.
6. Hill holder brakes- These are special brakes when used allow your chair to push forwards but not backwards.

FOOTRESTS-

They are integrated in the design in case of the rigid chair. They may be at different angles or adjustable. Some of them are special one which swings away.

SHOCK ABSORPTION-
This component has been included in some chairs which increases comfort and non bumpy ride.

CONCLUSION

So it is important to understand why choices are made. It is important to know your chair thoroughly well.
It helps to –
Maintain the chair
Maintenance is important of the chair because it is a machine and prone to wear and tear.
Understand everything you want to know about it.
Based on your use and lifestyle use the appropriate chair.
End of the lecture. Thank you Sir Gary Karp

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