Preventing Injury for Manual Wheelchair Users
The Spinal Cord Medicine Clinical Practice Guidelines sponsored by the Paralyzed Veterans of America has outlined how to use a manual wheelchair to avoid repetitive strain and other injuries.
For clients that need a manual chair, experts recommend finding the lightest possible wheelchair for the following reasons:
- Lighter wheelchairs require less force to propel. A lighter wheelchair will reduce the forces needed to popel the chair and thu forces transmitted into the upper limb joints.
- Lighter wheelchairs are adjustable.
- Lighter wheelchairs are made with better components. Ultralight wheelchairs are made out of stronger, higher grade materials and better components, such as bearings that can reduce rolling resistance.
- Lighter wheelchairs cost less to operate.
The following are tips for manual wheelchair clients:
- Encourage long, smooth strokes that limit high impacts on the pushrim.
- Users should allow their hand to drift down naturally, keeping it below the pushrim when not in actual contact with that part of the wheelchair.
- Promote an appropriate seated posture and stabilization relative to balance and stability needs.
- Promote an appropriate seated posture and stabilization relative to balance and stability needs.
The following principles should be observed for stabilization according to the Clinical Practice Guidelines:
- Stabilize the pelvis first, then the lower extremities, and lastly, the trunk.
- Stabilize the pelvis on a cushion that provides postural support as well as pressure distribution. The cushiuon should be mounted on a surafce that maintains its position.
- If the individual has no fixed deformities, promote as neutral and midline a position of the pelvis as possible, and promote a midline trunk with normal lumbar and cervival lordosis.
- Accommodate fixed postures of the pelvis, lower extremities and trunk to allow balance for performance of activities of daily living.
- Place trunk support as high as the client needs to feel stable and comfortable. Apply lateral and anterior trunk supports if the client is unable to maintain a stable posture while performing activities of daily living and other functional skills.
- Make special accommodations for individuals with tetraplegia, who may have a forward head posture that results in rounding of the shoulders and causes anterior instability and reliance on the upper extremities to maintain balance. Address this posture in the following ways: posterior stabilization of the pelvis in its most corrected posture, accommodation of a fixed kyphosis through the shape and angle in space of the back support.
- For those individuals with C4 and higher neurologic levels, provide full support of the forearm and hand to decrease subluxation or dislocation.
Manual Chairs & Accessories
TriPod
The TriPod by Freedom Designs is a manual wheelchair that features mid-wheel drive. Propulsion wheels are located at the center of the side frame instead of rearward or forward. Large wheels located on the center frame allows for a tight turning radius. Conventional front casters with a trailing caster act as a rolling anti-tipper, and a tilting frame allows for maneuvering over small objects and low curbs.
Freedom Designs Inc.; (800) 331-8551; www.freedomdesigns.com
Litestreamz® XF
Quantum Rehab's Litestream® XF, a lightweight, manual wheelchair, is equipped with a double X-frame. Features include flush mount seat rails for lower seat-to-floor heights and easier transfers. The wheelchair also offers bi-directional legrests, drop-in T-arms and tension-adjustable upholstery, with an array of rear wheels. With 56 seat sizes and adjustable back height and seat angles, the Litestream XF offers customized configurations to meet various needs.
Quantum Rehab;(800) 800-8586; www.pridemobility.com
Wheelchair Basket
Skyway Wheels' wheelchair basket is designed for easy swing-away so the user can easily enter or exit wheelchairs. The large 18x13x6" capacity basket can be easily removed and replaced with other attachments, such as a tray. Custom size baskets and trays are available. An adjustable height and universal mount is provided for attachment to most manual chairs. The basket is available in chrome or color powder-coat finishes.
Skyway Machine Inc.;(800) 332-3357; www.skywaywheels.com
AirLite Pro
This ultralight rigid chair is equipped with an aluminum frame, bringing the weigh-in to just 19 lbs. The chair includes a titanium footrest and seat/back module. Equipped with a 267-lb. weight capacity. Aluminum frame reduces weight on this rigid.
Kuschall;(888) 682-2571; www.kuschall.com
Paramount Manual Folding Wheelchair
The new wheelchair from Everest & Jennings offers adjustability with a 22" or 24" seat width; 18" seat depth; removable arms; and industry-compatible swing-away footrests or elevating legrests with aluminum footplates. The chrome steel frame also boasts dual axles, double cross braces, and front and rear slide posts. Heavy-duty components make the chair ideal for users up to 500 lbs.
Graham-Field Health Products;(800) 347-5678; www.grahamfield.com
This article originally appeared in the February 2007 issue of HME Business.