wheelchair ambulation transfers

Question 1

First wheelchair model

Answer 1

• 1300 B.C in China spoked wheels
• 16th century first dedicated wheelchair
• Used by King Philip II
• Featured: reclining back and moveable armrest and footrest + 4 small wheels

Question 2

Second wheelchair model

Answer 2

• 1655
• by Steven Farffler who is believed to be paraplegic
• Featured: 3-wheeled chassis with handled in the front + independently propelled

Question 3

First real wheelchair model features

Answer 3

• 2 big wheels in the front

- 2 small wheels in the back

Question 4

Folding Chair (same model as today)

Answer 4

• in 1932 by Everest & Jennings
• Everest broke his back in a mining accident and become confined to a wheelchaire.
• They wanted a wheelchair that is easily transportable in an automobile.
• 2 big wheels in the back, 2 small wheels in the front

Question 5

Types of Wheelchair Users - Amputation

Answer 5

• Absence or loss of lower extremity (due to trauma or surgery)
  Note: the higher the amputation the greater chance that a chair is needed
• can use a mix of prosthetics and wheelchairs

Question 6

Types of Wheelchair Users - Arthritis

Answer 6

pain in joints, usually reducing ROM and causing weakness

Question 7

Types of Wheelchair Users - Multiple Sclerosis

Answer 7

Disease causing:

• progressive muscular weakness
• loss of muscular control
• difficulty walking

Question 8

Types of Wheelchair Users - Paraplegia

Answer 8

Impairment in motor and sensory function of the lower limbs

Question 9

Types of Wheelchair Users - Stroke

Answer 9

• Cerebral Vascular Accident
• Lesion to the brain causing paralysis on one side of the body
• usually use a cane and will walk with a circumducting limb on the affected side

Question 10

Types of Wheelchair Users - Quadriplegia

Answer 10

• Also known as tetraplegia

- Impairment in motor and sensory function of the upper and lower limbs

Question 11

Types of Wheelchair Users - Diabetes

Answer 11

-Metabolic disease in which a person has high blood glucose; often results in neuropath and limb loss

Question 12

Types of Wheelchair Users - Cerebral Palsy

Answer 12

• Damage to the motor area of the brain prior to brain maturity

Question 13

Characteristics of the Manual Wheelchair - Footrests

Answer 13

• Support feet and lower legs

- Can be fixed or folding

Question 14

Characteristics of the Manual Wheelchair - Armrests

Answer 14

• Support arms when the person is not moving

- Fitting is important because armrest position can alter the way the wheelchair is propelled

Question 15

Characteristics of the Manual Wheelchair - Weight

Answer 15

• Manual 15-60 lbs

- Motorized - 50-250 lbs

Question 16

Characteristics of the Manual Wheelchair - Tires

Answer 16

• Most commonly air filled (pneumatic) and therefore lightweight
• Require maintenance and can be punctured

Question 17

Characteristics of the Manual Wheelchair - Wheel locks

Answer 17

• Act as parking break (not use during ambulation)
• Important for transfer (immobilizes bike)
• Can get in the way during propulsion

Question 18

Characteristics of the Manual Wheelchair - Push Rims

Answer 18

• Variety of push rims with different friction coating and shapes for various functional adaptions
• Gloves are popular among wheelchair users
• Use to slow down while descending a ramp

Question 19

Characteristics of the Manual Wheelchair - Backrests

Answer 19

• Height depends on strength of trunk muscles
• Back height: support vs freedom of mvmt
  
  • Shoulder height if needs harness (poor control)
  • Within 2” of lower scapula: moderate support
  • Lower OK for active users (good trunk control)
• Sling backrests are most common
  
  • provide little postural support

Question 20

Characteristics of the Manual Wheelchair - Additional Features

Answer 20

• Anti-tippers (help prevent tipping backwards)
• Grade aids (keep chair from rolling backwards)
• Chaster wheels (front wheels)

Question 21

If the seat is too tight

Answer 21

can cause pressure sores

Question 22

If the seat is too wide

Answer 22

• can be difficult to reach hand rims and propel the wheelchair
• Prevent manoeuvring through small spaces

Question 23

How to adjust the seat height

Answer 23

• Let your hands dangle at your side when sitting in the chair
• Fingertips should extend just past the chair’s axle

Question 24

Characteristics of the Manual Wheelchair - Rear Axle Position

Answer 24

• Allows the center of gravity to be adjusted for each individual and reduces the effort required to propel the wheelchair
• Have an effect on shoulder joint forces and push frequency

Question 25

Characteristics of the Manual Wheelchair - Camber

Answer 25

- Angle of the wheel with respect to the chair - Increase base of support = more stable - Help protect hands - Too much camber can make it hard to fit through doorways * Less friction, more stable, easier to turn*

Question 26

Best method to propel a wheelchair in a Safe and Efficient manner

Answer 26

A longer stroke means fewer strokes & less likely to get injured - Use of lower force = smooth - Approach the handrail from below which maximizes smoothness - Apply force gradually and consistently

Question 27

Wheelchair Transfer - Chair to Floor (4)

Answer 27

SHOES AND BRAKES ON 1. Sit on the edge of the seat with feet on the floor 2. Lean your trunk forward 3. Place your non-dominant fist on the floor and your dominant hand on the front frame of the chair 4. Slowly ease yourself to the floor and swing your rear away from the chair

Question 28

Wheelchair Transfer - Floor to Chair (two methods)

Answer 28

1. Forward Facing Method 2. Rear Facing Method FFM is generally more difficult and less practical - chair tends to tip forward

Question 29

Wheelchair Transfer - Forward Facing Method (4)

Answer 29

1. In kneeling position facing your chair 2. Use your arms (ND fist on floor and D hand on the seat) to bring your knees up to the foot plate 3. Bring your dominant hand to the front of the chair frame and use both arms to push your body up while rotating trunk & pelvis 4. Finish having your rear in your chair

Question 30

Wheelchair Transfer - Rear Facing Method (6)

Answer 30

1. Feet positioned at 45 degrees from the chair 2. Feet placed as close to your bottom as possible, use your chin to hold knees in place. Place ND fist on the floor and dominant hand on the front of the chair frame 3/4. Use both arms to push your legs and body up while rotating your trunk and pelvis to be aligned with the chair 5/6. For weak trunk muscles, use your hand and arm muscles to extend your trunk and reach a vertical position

Question 31

Elements to think about when aiding in wheelchair transfers (4)

Answer 31

- Which side of their body would you support - Transfer towards their stronger side - Communication with individual - Be attentive to your back

Question 32

Wheelchair Transfer - Wheelchair to Chair (6)

Answer 32

1. Explain procedure 2. Lock the wheels of the chair 3. Stand as close to the person as you can (maintain straight back) 4. Grip the persons belt 5. Lift as the person pushes up 6. Pivot the person around and onto the chair * Keep the person's weaker knee between your legs for added stability*