Wheelchairs Flashcards
History
Age Past medical history, and Current medical diagnosis His or her environment, Family support, and Past use of assistive technology. Physical impairment is changing rapidly or is stable. No ongoing medical problems or complications that can affect the wheelchair prescription and the patient’s health.
Access needs
Access to a range of heights might be important to reach objects in the home and other environments.
To support vocational needs, specific requirements may exist for mobility within a laboratory, operating room, courtroom, or machine shop.
Leisure activities, pursued in such places as community centers, restaurants, movie theaters, and recreational environments, often place the most demands on the wheelchair.
For some users, many of the desired tasks may be accomplished simply and with existing off-the-shelf technology. Others will require custom products
Environment
The wheelchair model chosen should also be compatible with the user’s public and private transportation needs (such as a car, van, bus, train, or airplane) and home/Activities of Daily Living (ADL) environment.
The surface conditions may impose restrictions on the type of wheelchair that is most appropriate.
The regularity of the surface and its firmness and stability are important in determining the tire size, drive wheel location, and wheel diameter.
The performance of the wheelchair is often dictated by the need to negotiate grades, as well as height transitions, such as thresholds and curbs.
The clearance widths in the environment will determine the overall dimensions of the wheelchair.
CVS
For these individuals it is important to document a heart and lung examination. Attention should be paid to dyspnea on exertion and changes in vital signs with activity. These findings can be used to justify a power wheelchair, as the energy cost of wheelchair propulsion is not less than walking. Other common reasons for requiring a wheelchair are musculoskeletal and neurologic deficits. The clinician should document the neurologic and musculoskeletal deficits in a methodical fashion. In a patient with a stroke, for example, an examination to check for neglect or visual field deficit is important because it will impact on the ability to independently drive a chair.
Examination
Ask the patient to perform simple reaching tasks to determine the lateral and forward stability of the trunk, hand and arm strength, and hand fine motor skills. The presence of kyphosis, scoliosis, or other fixed deformities should be determined. Critical point to evaluate is hip and knee range of motion because contractures may need to be accommodated. Poor stability usually indicates the need for special attention to seating and position. Appropriate seating can enhance reach and stability, thus improving the performance of manual activities from the wheelchair. It is well known that various groups of wheelchair users, such as individuals with tetraplegia and cerebral palsy, will develop kyphosis or scoliosis over time
Examination
Symptoms
• Related diagnoses
• History How long the condition has been present Clinical progression Interventions that have been tried and the results. Past use of walker, manual wheelchair, scooter, or power wheelchair and the results
• Physical exam Weight Impairment of strength, range of motion, sensation, or coordination of arms and legs Presence of abnormal tone or deformity of arms, legs, or trunk Neck, trunk, and pelvic posture and flexibility Sitting and standing balance
• Functional assessment
• Any problems with performing activities including the need to use a cane, walker, or the assistance of another person Transferring between a bed, chair, and wheelchair Walking around their home––to bathroom, kitchen, living room, etc.––provide information on distance walked, speed, and balance
Antitippers
Antitippers are often placed on wheelchairs to assure they do not tip over backward. These can inhibit the ability to climb curbs, but they do offer a measure of safety.
Rims
Anodized aluminum rims are the current standard on most K0004 and K0005 chairs. Less expensive chairs may come with plastic push rims. For individuals with difficulty gripping the rim, alternative rims should be considered. These can include vinyl-coated rims, rims with projections (Fig. 78-5), and rims wrapped with surgical tubing. All of these rims have the advantage of increased friction, making it easier to push the chair forward. Unfortunately, this increased friction can lead to burns when the wheelchair user attempts to slow down the chair.
Tyres
The most common type of tire is pneumatic.
- lightweight
- cushioning against impact and vibration from rolling over surfaces.
- increase rider comfort and
- improve wheelchair durability.
Pneumatic tires are recommended for outdoor usage.
The main downside of pneumatic tires is that they require maintenance and they can puncture. Tire pressure needs to be kept at a predetermined level because it is critical to rolling resistance, which can be related to risk of secondary injury associated with manual wheelchair use.
Caster wheels
Caster wheels are available in a variety of shapes and sizes. Pneumatic wheels are larger than solid casters and may interfere with the footrests when turning. Pneumatics offers the advantage of easier propulsion over rough terrain and increased shock absorption. Many wheelchair users are using narrow rollerblade-type wheels which allow quicker turns and reduce rolling resistance. are available in a variety of shapes and sizes. Pneumatic wheels are larger than solid casters and may interfere with the footrests when turning. Pneumatics offers the advantage of easier propulsion over rough terrain and increased shock absorption. Many wheelchair users are using narrow rollerblade-type wheels which allow quicker turns and reduce rolling resistance.
Camber
Camber describes the angle of the wheel with respect to the chair. Increasing camber has several advantages: the footprint of the chair is widened, creating greater side-to-side stability; it allows quicker turning; and positions the push rims more ergonomically for propulsion (it is more natural to push down and out). In addition, by having a wider based, the area where the hands are in contact with the push rims is less likely to come into contact with the wall (24). Finally, adding camber to the rear wheels reduces effective stiffness between the rolling surface and frame, thus reducing the vibration exposure of the user. Between 2 and 4 degrees of camber is appropriate for everyday use.
Advantages of Manual Wheelchairs
Transportation: Easy to transport; can travel with friends without special vehicles
Maintenance: Can be worked on independently Exercise: Theoretical benefit to the user from using own force to propel
Aesthetics: Less appearance of disability
Advantages of Power Wheelchairs
Distance: Can travel long distances without fatigue Speed: Can travel at higher speed without fatigue Terrain: May be able to traverse rougher terrain
Protect the arm: Avoid repetitive strain injuries that are due to manual wheelchair propulsion
Amputee Wheelchair
Wheelchairs for individuals with amputations are typically designed with the rear axle set far behind the user. This is needed because the absence of a leg causes the body’s center of gravity to be shifted posteriorly, thus reducing rearward stability. Unfortunately, all of the negative aspects of a rearward axle are present. An alternative can be to add weight to the front of the wheelchair. Unfortunately, increased weight means increased rolling resistance. There is no simple answer as to what is best, and individual patients should make this decision for themselves.
Hemiplegia
For individuals with hemiparesis or other disability that makes propulsion with a leg or both legs superior to propulsion with the arms, a “hemiheight” chair is an alternative. In this chair, there is typically one footrest or none at all, and the seat is low enough to the ground so that the feet can reach the floor. For an individual with hemiparesis, the use of the uninvolved arm and leg can provide limited, but functional, propulsion.
