Wheelchair Flashcards
means of transportation or mobility, but they also provide support, safety, and stability to enable the user to perform functional activities
wheelchair
Factors Associated with the Selection of a Wheelchair Type and Components
- Patient’s impairment, activity limitations, and participation restrictions
- Patient’s age, size, stature, and weight
- User’s functional skills or preference
- Portability/accessibility
- Reliability/durability
- Expected use or patient needs of the wheelchair (e.g., indoors, outdoors, recreation, transfer needs, ability to transport the chair)
- Temporary versus permanent use of the wheelchair
- Potential or prognosis for change in the patient’s
condition, especially as it affects mobility - Mental and physical condition or capacity of the
patient - Cosmetic features
- Options available
- Service
- Cost
Designed for persons who weigh less than 200 lb and for limited use on rough surfaces; not designed for vigorous functional activities
standard adult
Constructed for persons who weigh more than 200 lb or for those who perform vigorous functional activities
heavy duty adult
Designed to be lightweight, may have a rigid or folding frame, and can be made with titanium in a rigid or folding frame; weighs from 12 to 30 lb; benefit is efficiency in propulsion and reduction in cumulative trauma in the upper extremities; weight capacity to 300 lb
ultralight wheelchair
Designed for persons with a body build smaller than that of an adult but larger than that of a child
intermediate or junior
Designed to permit adjustments in the frame to accommodate the growth of the user
growing
Designed for persons up to the approximate age of 6 y
child or youth
Constructed for use indoors, with the larger drive wheels placed at the front of the chair and the caster wheels at the rear; it functions better in confined areas but is more difficult to propel and makes it more difficult for the user to perform many functional activities
indoor
The seat is lowered approximately 2 inches to allow better use of the user’s lower extremities to propel the chair; however, the lower seat may make it more difficult for the user to perform a standing transfer
hemiplegic
The rear wheel axles are positioned approximately 2 inches posterior to their normal position to widen the base of support of the chair and compensate for the loss of the weight of the user’s lower extremities
amputee
Two hand rims are fabricated on one drive wheel, and the two drive wheels are connected by a linkage bar; the smaller hand rim propels the near drive wheel, the large hand rim propels the far drive wheel, and when both rims are moved simultaneously, both wheels are propelled
one-hand drive
The chair is propelled by a deep-cycle battery system, and various types of controls are used to operate the chair (e.g., a joystick, a chin piece, or a mouth stick)
externally powered
A low-profile, fixed frame, lightweight (15-24 lb) chair with features such as a low back, canted rear wheels, fixed or adjustable axles, and fixed or adjustable seat and backrest; it can be bought or customized for various sports activities
sports
Used for persons who need to partially or fully recline at some time when they are in the chair; the chair may be a semireclining or fully reclining chair; semireclining chairs recline to approximately 30 degrees from vertical, and fully reclining chairs can recline to a horizontal position; elevating leg rests and headrest extensions are necessary components for these chairs
reclining
- Measure from the user’s heel to the popliteal fold, and add 2 inches to allow clearance of the footrest
- 19.5 to 20.5 inches
seat height/leg length
- Measure from the user’s posterior buttock, along the lateral thigh, to the popliteal fold; then subtract approximately 2 inches to avoid pressure from the front edge of the seat against the popliteal space
- 16 inches
seat depth
- Measure the widest aspect of the user’s buttocks, hips, or thighs, and add approximately 1.5 inches; this will provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel
- 18 inches
seat width
- Measure from the seat of the chair to the floor of the axilla with the user’s shoulder flexed to 90 degrees, and then subtract approximately 4 inches; this will allow the final back height to be below the inferior angles of the scapulae (Note: This measurement will be affected if a seat cushion is to be used; the person should be measured while seated on the cushion, or the thickness of the cushion must be considered by adding that value to the actual measurement)
- 16 to 16.5 inches
back height
- Measure from the seat of the chair to the olecranon process with the user’s elbow flexed to 90 degrees, and then add approximately 1 inch (Note: This measurement will be affected if a seat cushion is to be used; the person should be measured while seated on the cushion, or the thickness of the cushion must be considered by adding that value to the actual measurement)
- 9 inches above the chair seat
armrest height
A proper fit will allow you to place two or three fingers easily under the thigh, with your hand held parallel to the floor, from the front edge of the seat to a depth of approximately 2 inches
seat height/leg length
Proper fit will allow two or three fingers to be placed between the front edge of the seat and the user’s popliteal fold with your palm horizontal to the seat (C) with your hand held parallel to the floor.
seat depth
Proper fit will allow the placement of your hand, held vertically, between the user’s greater trochanter, hip, or thigh and the armrest panels with your hand positioned vertically to the seat.
seat width
A proper fit for a standard seat back will allow you to place four fingers, with your hand held vertically, between the top of the back upholstery and the floor of the user’s axilla.
back height
too high
- insufficient trunk support because the back upholstery will be too low
- difficulty positioning the knees beneath a table or desk
- difficulty propelling the wheelchair because of the difficulty in reaching the hand rims on the drive wheels
- poor posture when the forearms rest on the armrests
seat height
too low
- difficulty performing a standing or lateral swing transfer
- improper weight distribution
seat height
too low
- increased pressure on the distal posterior aspect of the thigh, decreased function of the upper extremities when propelling the chair, and unsafe mobility
leg length
too high
- increased pressure to the ischial tuberosities, difficulty positioning the chair beneath a table or desk, or decreased trunk stability caused by a lack of support by the posterior area of the thighs
leg length
too short
- decreased trunk stability because less support will be provided under the thighs
- increased weight bearing on the ischial tuberosities because the body weight will be shifted posteriorly as a result of the lack of support to the thighs
- poor balance
seat depth
too long
- increased pressure in the popliteal area, leading to skin discomfort or compromise of circulation
seat depth
too wide
- difficulty propelling the chair when using the upper extremities because the distance to the hand rims is increased
- difficulty performing a standing or lateral swing type of transfer
- difficulty moving through narrow hallways or doorways
- postural deviations
seat width
too narrow
- difficulty changing position because insufficient space
- excessive pressure to the greater trochanters
- difficulty wearing bulky outer garments, orthoses, or braces
seat width
too high
- difficulty propelling the chair
back height
too low
- decreased trunk stability or postural deviations
back height
too high
- problems propelling the chair because it will be difficult to reach over the high armrest to grasp the hand rims
- difficulty performing a standing transfer
- postural deviation as a result of elevated shoulders
- limited use of the armrests
armrest height
too low
- poor posture or back discomfort
- increased abdominal discomfort when leaning forward
- inadequate balance
- difficulty rising to a standing position from the chair because the armrests are too low to offer support when pushing to stand.
armrest height
It is important to routinely inspect the skin that overlies bony prominences such as the
vertebral spinous processes, inferior angles of the scapulae, ischial tuberosities, greater trochanters, lateral femoral condyles, sacrum, and medial humeral epicondyles
The patient and his or her family should be instructed to watch for the following signs or symptoms of decreased circulation in the lower extremities
- Ankle edema
- Color changes in the toes, feet, or legs
- Decreased sensory response to surface stimuli
- Loss of hair follicles
- permanently attached to the chair frame
- recommended for users who will be performing standing transfers
fixed armrests
recommended for users who will perform a lateral swinging or sliding transfer in a sitting posture
removable or reversible armrests
position the wheelchair close to a permanent surface such as a desk, table, or countertop
desk or cutout armrests
need to adjust the armrest height for different activities or when cushions with different thickness or bulky outer garments are used
adjustable armrests
- located at the front of the chair to permit changes of direction and turns
- 5 or 8 inches
caster wheels
provide a smoother, more comfortable ride and function better on rough and soft surfaces such as sand, gravel, and grass, but they may require greater energy expenditure by the user to propel the chair
pneumatic or semipneumatic tires
used to propel the chair
Drive or Rear Wheels
used for independent propulsion when the user has only one functional upper extremity and no functional lower extremities
one arm drive chair
engaged either by pushing it forward or backward
toggle lock
lock the caster wheels to prevent them from turning
caster locks
- attached permanently to the chair frame
- can be elevated or raised from a horizontal to a vertical position when the user rises, sits, or desires to place his or her feet on the floor
- prevents the chair from being positioned close to and directly in front of most objects
fixed footrests
release of a locking mechanism allows the front rigging to be pivoted outward, and lifting the leg rest removes the front rigging from the chair frame
swing-away or removable leg rests
the entire front rigging can be elevated and maintained at different heights
elevating leg rest
- located beneath the chair seat toward the front of the seat rail
- wheelchair user must be able to reach under the seat to operate the lock
z or scissors lock
necessary to release the back and to increase the wheelbase when the back is reclined
auxiliary lock for a reclining back chair
lock the caster wheels to prevent them from turning
caster locks
- footplate
- It may have a toe or heel loop to help maintain the foot on the footrest
footrest
prevents the foot from sliding backward
heel loop
prevents the foot from moving forward
toe loop
- attached to the frame of the chair, is designed to prevent the patient from falling out of the chair or sliding forward in the chair
- crosses the wheelchair user’s lower abdomen or pelvis, similar to an airplane or automobile lap belt
lap belt (waist)
- attached to the frame of the chair at the mid-chest level to increase trunk stability, prevent the wheelchair user from falling out of the chair and maintain the body upright
- provided to protect patients who have inadequate balance or trunk stability while seated
- not appropriate for use as a method to restrain a patient in the chair for a prolonged period
chest belt
- allow the back of the chair to be adjusted to various positions from fully upright to 30 degrees of extension
- The chair back usually is higher than that on a standard chair, and a removable head component is necessary to support the wheelchair user’s head when he or she is in a reclined position
semireclining
- allow the back to be adjusted to various positions from vertical to fully horizontal
- Adjustment knobs or levers located on either side of the back frame are used to adjust the position of the back
- rear wheels will be located more posteriorly than on a standard chair
- used for persons who must recline periodically while seated in the chair. Persons with lower extremity circulatory problems who cannot tolerate an upright position because of decreased circulation or who need to relieve skin pressure but cannot perform pressure relief independently
fully reclining
- powered by one or more deep-cycle batteries that provide stored electrical energy to one or more belts that drive or propel the chair
- available for persons with insufficient strength or motor control of the extremities to propel a standard chair
externally powered wheelchair
cheapest battery, use a chemical reaction between lead and sulfur to create a charge
wet batteries
contain a mixture of phosphoric acid, sulphuric acid, fumed silica, and pure water and tend to be heavier and more expensive
gel batteries
costly, feature an absorbent glass mat between plates soaked with an acid electrolyte
AGM batteries
- low backrests, solid, lightweight frames, canted (angled) rear wheels, low and narrow seats, and an overall low profile to make the chair more functional for the user
- be tough, highly maneuverable, responsive, and stable
- built to withstand the impact and jarring that occurs with different types of competitive and recreational sports
- adjustable back and/or seat height
sport or recreational wheelchair
- lighter than folding wheelchairs because they don’t feature the additional hardware and mechanisms that folding wheel- chairs require
rigid wheelchair
made of aluminum, but titanium is the material of choice for lightweight mobility aids
lightweight wheel chairs
- not only a lighter metal, but it is more durable and features built-in shock absorption
- very durable, has higher quality wheel bearings, and has several adjustment features. It weighs from 12 to 30 lb
titanium
Each wheelchair user should be taught to perform the following maneuvers
- operate the wheel locks and tighten them when necessary
- remove and replace the armrests
- swing away, remove, and replace the front rigging
- elevate and lower the footplates before performing other activities
