Introduction to Wheelchairs

Question 1

Describe a standard wheelchair

Answer 1

• <200 lbs limit
• limited use on rough surfaces
• not designed for vigorous activities
• chair weighs about 35 lbs
• patient is able to self propel using both UE, adequate LE ROM, & sitting ability for comfortable sitting

Question 2

Describe a heavy duty wheelchair

Answer 2

• > 200 lbs or for a patient who performs vigorous activities

Question 3

Describe an ultralight rigid wheelchair

Answer 3

• 12-30 lbs total weight
• efficiency in propulsion & reduction in trauma in the upper extremity
• up to 300 lbs weight limit
• patient is highly active with no need for postural supports & used commonly in sports

Question 4

Patient characteristics for a hemiframe wheelchair

Answer 4

• patient is able to self propel using the LEs

Question 5

Patient characteristics for a one hand drive frame wheelchair

Answer 5

• patient is able to self propel using one UE

Question 6

Patient characteristics for an amputee frame wheelchair

Answer 6

• patient is able to self propel, but center of gravity is shifted posteriorly due to amputation

Question 7

Patient characteristics for a power wheelchair

Answer 7

• patient is not able to self propel, but is safe to operate a power mobility device
• patient may have transfer, sitting and/or UE limitations

Question 8

Patient characteristics for a geri chair

Answer 8

• patient is not able to self propel
• requires assistance from a caregiver to push them in a WC

Question 9

Patient characteristics for a reclining frame wheelchair

Answer 9

• patient is unable to sit upright due to pain, ROM restriction, vitals, or poor trunk support

Question 10

Patient characteristics for a backward tilt in space frame wheelchair

Answer 10

• patient is unable to sit upright or perform weight shifts, but also has issues with sliding out of the WC or extensor tone

Question 11

Pros and Cons of foam cushions

Answer 11

Pros: lightweight & cheap, customizable, stable base, breathable, readily available
Cons: not moisture resistant, increases temperatures, hard to clean, poor durability, loses support, not a good long term option

Question 12

Pros and Cons of air cushions

Answer 12

Pros: lightweight, easy to clean, compartments allow for pressure distribution, best for pressure
Cons: difficult to transfer/less stable, high maintenance

Question 13

Pros and Cons of gel cushions

Answer 13

Pros: great immersion & envelopment, pull sheet away, easy to clean, adjusts to body
Cons: heavy, localized areas of increased gel/hardness, can leak, expensive

Question 14

Define immersion

Answer 14

• placing a body part into fluid

Question 15

Define envelopment

Answer 15

• ability to form fit around a person’s boney prominences

Question 16

How much weight can an ultra lightweight, standard lightweight, and heavy duty frames hold

Answer 16

Ultra lightweight: about 250 lbs
Standard lightweight: 250-300 lbs
Heavy duty: 350-850 lbs

Question 17

Describe a posterior axle

Answer 17

• moves center of gravity anterior to axle resulting in a more stable WC, but more difficult to push

Question 18

Describe an anterior axle

Answer 18

• moves center of gravity over axle & unweight the front of the chair resulting in a more unstable WC & much easier to push

Question 19

Describe the relationship between shoulder injuries and WC axle position

Answer 19

• efficient WC propulsion is related to the vertical alignment of the shoulder to the axle of the wheel
• avoid excessive anterior position of the shoulders if able to prevent injury

Question 20

Define camber

Answer 20

• the inward angle of the wheel relative to the vertical position
• typical WC is 3 degrees

Question 21

Describe front wheel drive

Answer 21

• “pull” the WC
• good maneuverability over obstacles

Question 22

Describe mid wheel drive

Answer 22

• “push” the WC
• tight turning radius but can get stuck on obstacles

Question 23

Weight of different wheelchairs

Answer 23

Lightweight/ultralight: 15-25 lbs
Steel framed WCs: >50 lbs
Standard WC: about 45 lbs

Question 24

How to fit a wheelchair

Answer 24

Seat height: measure heel to popliteal fold & add 2” if no cushion present
Leg length: allow 2” from the floor
Seat depth: measure posterior buttocks to popliteal fold & subtract 2”
Seat width: measure widest aspect of the buttocks, hips, or thigh & add 2”
Back height: measure buttocks to inferior angle of scapula
Armrest height: measure seat of chair to olecranon process with elbow flexed to 90 degrees & add 1”

Question 25

Describe the 2 finger test for wheelchair fitting

Answer 25

• 2 fingers should be able to fit under the patient’s distal thigh, between end of seat & patient’s popliteal, between the greater trochanter & WC, and between the back of WC & inferior angle of scapula

Question 26

How to fall backwards in a wheelchair

Answer 26

• grab opposite armrest with one hand
• tuck chin to chest
• semi flexed trunk position is maintained
• free arm reaches forward for the hand rims

Question 27

How to get up from falling backwards in a wheelchair

Answer 27

• remain in the WC
• lock to rear wheels
• place one hand on the floor behind the chair while holding the opposite armrest
• walk the hand on the floor forward while keeping the head & trunk flexed

Question 28

How to fall forward in a wheelchair

Answer 28

• reach forward with both UEs
• when hands contact the floor, elbows are flexed to absorb some of the force of the fall
• attempt to turn or pivot the pelvis to land on one hip