Cours 2 : Wheel Chair Ambulation & Transfers

Question 1

What is the story of the first wheelchair models?

Answer 1

Chariots with spoked wheels began back in 1300 B.C China. However, the first dedicated wheelchair was in the 16th century. Invalid’s chair, designed for use by King Philip II of Spain. Reclining back and moveable armrests and footrests. It had four small wheels, one on each corner leg.

Question 2

What is the big step in the wheelchair models?

Answer 2

Steven Farffler, young German watchmaker invented a chair that could be independently propelled. It was a chair mounted on a 3-whelled chassis with attached handles on both sides of the front wheel used to propel the chair forward. Mr. Farffler, who is believed to have paraplegia, created the wheelchair himself when he was only 22 years old.

Question 3

When does the folding chair makes the scene and what is particular about the chair?

Answer 3

With the 1932 invention of the first folding chair. Manufacturing company : Everest & Jennings (it became possible to easily transport one’s wheelchair to different locations.

The development of the folding chair was spurred on by the desire of Everest to have a unit that was collapsible and could easily be transported in an automobile

Question 4

Who are the types of wheelchair users?

Answer 4

Absence or loss of lower extremity (due to trauma or surgery)

Arthritis : pain in joints, usually reducing range of motion and causing weakness

Multiple Sclerosis : disease causing progressive muscular weakness, loss if muscular control and difficulty in walking

Paraplegia : impairment in motor and sensory function of the lower limbs

Stroke : lesion to the brain causing paralysis on one side of the body

Quadriplegia : impairment in motor and sensory function of the upper and lower limbs.

Diabetes : metabolic disease in which a person has high blood glucose ; often results in neuropathy and limb loss

Cerebral Palsy : damage to the motor area of the brain prior to brain maturity

Question 5

How to Choose a Wheelchair - fitting?

Answer 5

• Most important component- you want to fit snuggly to your chair and not too tight and cause skin breakdown.
• Equal parts of the wheelchair
  Look and feel like an extension of the body
• Shouldn’t be no large gaps between you and any part of your body and the chair : the smaller, lighter and more compact the chair is, the easier it’s going to be independent to get around

Question 6

How to Choose a Wheelchair - taper?

Answer 6

Narrowing of your chair in relationship to your body

For most people, the hips are wider Thant the feet so it’s important to find a chair that tapers from the front of the seatdown to your foot plate (keeps your feet in place but will also compliment your silhouette of your body and draw eye to your body and not the chair

Question 7

How to Choose a Wheelchair - center of gravity?

Answer 7

Placement of the axle from the front and the back of your chair

The further back the axle is placed, the more evenly the weight is distributed between your back wheels and front casters, resulting in a smoother rise

Finding balance : most chairs comes with an adjuster to see what fits the best

Question 8

How to Choose a Wheelchair - wheel size ?

Answer 8

Size : 24 inch or 25 inch : the difference won’t be detrimental to it’s performance

You want to make sure that you sit in a comfortable position from the floor

Make sure that you’re able to reach objects above your head swell as objects that are on the floor

Good rule of thumb : when you’re sitting in your chair, places yours arms neck to your side. Fingertips should reach the axles or center of your wheels

Question 9

How to Choose a Wheelchair - wheel type ?

Answer 9

Carbon fibre spokes create a very lightweight wheel and cooler options to add fun + personality to your chair

Aluminum spoke wheels can be very good option (some wheels come with an adjustable handrails that collapse and allow you to fit in smaller spaces

Outfitting wheel with your tires there’s many options to choose fromsolid tires which prevent puncture + tires with tubes that are more lightweight and there are also different textures with tires that complement different terrains –> Rough terrain = choose thicker and more knobby tires

Chair use inside = smoother and thinner tires

Question 10

How to Choose a Wheelchair - seat back?

Answer 10

Hard backs = more stable + better posture but more weight to the chair

Soft upholstered = lightweight and can be adjusted bu velcro straps and reinforced with leather

High level of injury, that does not mean that your seat back has to be at your neck

Right amount of posture + promoting proper posture and muscle development

Question 11

How to Choose a Wheelchair - accessories?

Answer 11

You can get many accessories but extra features comes with the extra weight

2 must have accessories = rigid side guards : bolted in the frame of your chair and are less likely to break or fall out than removable side guards

Side guards protect your clothes from getting dirty and slim your waist (grow several inches + hop on the side to get what you need)

Breaks : they can help with transfers and if you are sitting on uneven surfaces (scissor breaks underneath - its less noticeable)

You dont have to worry about hitting your thumb.

Question 12

What are the characteristics of the Manual Wheelchair?

Answer 12

Footrests : support feet and lower legs (can be fixed or folding)

Armrests : support arms when the people is not moving. Fit is important because armrest position can alter the way the wheelchair is propelled.

Weight : manual = 15 to 60 lbs / motorized = 50 to 250 lbs

Tires : most commonly air filled (pneumatic) and therefore lightweight + require maintenance and can puncture

Wheel locks : act as parking brakes, important for transfers = not used during ambulation + can get in the way during propulsion (many individuals choose to remove them)

push Rims : variety of push rims with different friction coatings and shapes

Question 13

How can you slow down while descending a ramp?

Answer 13

By putting pressure on the wheel chair and not put the wheel lock on.

Question 14

What are the characteristics of the manual wheelchair (backrest)?

Answer 14

Height depends on strength of trunk muscles

Back height : support vs freedom of movement
- Shoulder height if needs harness (poor trunk control)
- Within 2” of lower scapula : for moderate support
- lower OK for active users (good trunk control)
- Sling backrests are the most common (but provide little postural support)

Question 15

The height of the wheelchair back primarily depends on what?

Answer 15

Strength of trunk muscles

Question 16

What can be the additional features on the manual wheelchair?

Answer 16

• Anti-tippers
• Grade aids : keep the chair from rolling backward
• Caster wheels (front wheels)

Question 17

What are the characteristics of the manual wheelchair (seat height and width)?

Answer 17

If the seat is too tight = can cause pressure sores if the seat is too wide = can be difficult to reach hand rims and propel the wheelchair + prevent the wheelchair from manoeuvring through small spaces

Question 18

How to adjust the seat height?

Answer 18

Let your hands dangle at your side when sitting in the chair : your fingertips should reach the chair’s axle

Question 19

What is the rear axle position?

Answer 19

Allows the center of gravity to be adjusted appropriately for each individual and reduces the effort required to propel the wheelchair

Rear axle position can have an effect on shoulder joint forces and push frequency

Question 20

What Is camber?

Answer 20

Angle of the wheel with respect to the chair

Increase base support = more stable

Help to protect hands

Too much camber can make it hard to fit through doorways

Question 21

What is the best method to propel a wheelchair in a safe and efficient manner?

Answer 21

Use longer stroke that limit high impact on the push rim : lower forces, low risk of injury and fewer pushes

Larger contact angle : angle between where the hand is and contacts the handrail and where the handrail releases

Push stroke should be smooth to avoid injuring nerves in the hand

Approach hand rim from below to match arch and speed of the handrail and apply force smoothly to insure smooth transition and minimize impacts throughout stroke.

Reaches farther back and extends his arms father forward to access more of the handrail.

Question 22

Why is chair transfer one of the most important components for independent living in paraplegics?

Answer 22

You don’t want to wait for people to help you all the time. Trying to be independent

Question 23

Wheelchair transfers from chair to the floor?

Answer 23

• Sit on the edge of the seat with feet on the floor
• Lean your trunk forward
• Place your non dominant fist on the floor and your dominant hand on the front frame of the chair
• Slowly ease yourself to the floor and swing your rear away from the chair (most advanced users will push the wheelchair back while siting on the floor)

From the chair to the floor = easy

Question 24

Wheelchair transfers from floor to the chair - forward facing method?

Answer 24

In kneeling position facing your chair (1), use your arms (non dominant fist on the floor and dominant hand on the seat back) to bring your knees up to the foot plate (2) (same as footrest)

Then bring your dominant hand to the front of the chair frame and use both arms to push your body up while rotating your trunk and pelvis (3) until your rear is in your chair (4)

more difficult and less practical vs rear facing method (chair tends to tip forward).

Question 25

Wheelchair transfers from floor to the chair - rear facing method?

Answer 25

Feet positioned at 45° front the chair (1)

Feet placed as close to your bottoms as possible, use your chin (or a strap) to hold knees in place. Place non dominant fist on the floor and dominant hand on the front of the chair frame (2)

Use both arms to push your legs and body up while rotating your trunk and pelvis to be aligned with the chair (3 and 4)

For weak trunk. muscles, use your hand and arm muscles to extend your trunk and reach a vertical position (5 and 6)

Question 26

You’re starting a new adapted exercise program in your center involving sitting exercises for wheelchair users. Sylvia, who is one of your participants, would rather do the exercise session in a regular chair and asks for help. .How would you help her transfer from her wheelchair to the chair knowing that, she is hemiparectic the right side of her body is very weak or paralyzed

Answer 26

Support the strong side
Transfer toward her stronger side
Communicate with the person
Be attentive to your back
You want the person close to you

Question 27

Is helping for transfer a regular procedure in KCEP settings?

Answer 27

It varies from one center to another

Question 28

Transfer : wheelchair to chair - steps

Answer 28

** Make sure your footing is stable. The patient should always wear a special belt for you to grip **

1) Explain the procedure
2) Lock the wheels of the chair
3) Stand as close to the person as you can (why?). You can’t have a straight back if you are not close to the person. Wear a mask is the person is sick
4) Grip the person’s belt
5) lift as the person pushes up
6) Pivot the person around

USE YOUR LEGS AS MUSCH AS POSSIBLE

Keep he person’s weaker knee between your legs