Adapting (Wheel) Chairs Henk Wilemsen Handicap International Sri Lanka

The right chair for local situation Special seats and wheelchairs need to be adapted to the individual child, but also to the particular family, local customs, and community situation. A 'high chair' lets the child join the family that eats and does most activities at a table. A 'low chair' lets the child fitin where the family eats at ground level. Henk Wilemsen Handicap International Sri Lanka

The right wheelchair for local situation Narrow backtyres and small front wheels allow fast travel on hard and smooth surface but are useless on rough and sandy roads. Wide backtyres and a single wide caster wheel in front making moving easier. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Tips; Look for the best solution for the problem a pwd has with sitting in a (wheel) chair Assistive devices can help but always discuss with the pwd or parent of a cwd, what could help, why and how to make it. How can it help the pwd and what is the goal you want to reach? Make a plan how to start using it Follow up; does the pwd use it, does it fit, does he like it, does he think it is useful In a lot of projects with CBR special seats are provided for children with CP. A chair is made but often copied from a book. Maybe the size is adapted to the child`s size, but the chair is often not adapted for thespecifiic child`s needs.As a result the child often does not want to use the chair and it disppairs in the garden or the chickens use it. Then the parents get blamed because they do not stimulate the chold enough to use it. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Tips; Do not let the pwd or the family feel guilty if they do not use a wheelchair or adapted chair. Usually they have a good reason. Find out and adapt it If the person finds it helpful and likes it, he / she will use it! Most people who need a wheelchair or special seat have severe weakness in parts of their bodies, or muscles that pull them into awkward or deforming positions. It must provide support, but also allow them enough freedom to move, explore, and develop greater control of their bodies. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Tips Never put straps around the heck or head If the head keeps tilting forwards, try tilting the chair backwards If the head keeps falling sideward, always make head support The seat should be wide enough to allow some free movement and narrow enough to give needed support Henk Wilemsen Handicap International Sri Lanka

Seating should keep people in healthy and useful positions. Henk Wilemsen Handicap International Sri Lanka

Seating should keep people in healthy and useful positions. Most children sit best with their hips, knees, and ankles at right angles. A slight backward tilt helps most children sit in a better, more relaxed position. Henk Wilemsen Handicap International Sri Lanka

Common seating problems and possible solutions; Hip straps A low hip strap helps keep the hips at a good angle. Supporting the hips in a better position helps the whole body take a more normal position. Henk Wilemsen Handicap International Sri Lanka

Common seating problems and possible solutions Spastic children often stiffen the Hips backwards. This triggers spasms that straighten the legs. Children with weak hips or back often sit slumped with their hips tilted back and the back severely curved. Most common causes of backward Tilting hips; chair is too big for the child. chair back tilts far back cloth back that sags. footrests that are far forward Henk Wilemsen Handicap International Sri Lanka

Common seating problems and possible solutions A good position can often be gained through: a fairly stiff, upright back at a right angle to the seat, a chair that fits the child so that his hips reach the chair back, the knees at right angles, and feet firmly supported. Children who tends to fall forward in their seat, will sit better and more comfortably if the whole chair tilts back a little. But be sure to keep right angles at hips, knees, and ankles. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Armrests No Armrests A person with strong arms and trunk control prefers a chair with no armrests and a very low back support. Moving by pushing the wheels is easier. Getting off and on from the side is easier- especially important when legs are completely paralyzed. Armrests They can help child to sit in a better position and be more comfortable. They can sometimes be used for attaching a removable table Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Footrests Footrest should keep the knees and ankles at right angles and the legs slightly separated If the footrest is too low, blocks can be placed on it to make it higher. They can be removed as the child grows. However, fixed footrests that are too high are more difficult to correct. So it is better if they are too low. Some children need straps across their hips or ankles to keep a good position. Henk Wilemsen Handicap International Sri Lanka

Keeping the body straight from side to side Even with a firm board seat, this boy's body sags to one side. This can lead to increasing curve of the spine (scoliosis). Hip guides (cushions, pillows, foam, etc) may help him sit straighter. Sometimes, hip guides alone are not enough. He may also need carefully placed body guides, to help keep his body in a straighter position. Henk Wilemsen Handicap International Sri Lanka

Deciding where to place body guides Look carefully at how the child sits. Draw a sketch of how he sits. Then draw arrows where you would need to push to help him sit straighter. 3. While someone holds the child in his best position, mark where you think the guides should be placed. Henk Wilemsen Handicap International Sri Lanka

Deciding where to place body guides 4. First, build in the guides in a temporary way. 5. See how well the child sits in the adapted seat. When you cannot improve it more, fasten the guides firmly and pad them so they do not hurt him. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Kneeposts A knee post (block/cushion between the knees), might help to improve a whole body position- without straps! Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka LAP BOARDS Can be made from thin wood Should be easy to take off, but grip firmly when in place. A lap board can help keep shoulders, arms, and body in a better position, especially if it has a part cut out measured to fit around the child. 'Velcro' (stick-to- itself tape) can be used to fix the board to the chair for easy removal - and to adjust it forward or backward. Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Task 1 Makes a drawing of a chair that can be made in the field. Draw a chair for a child that is spastic, very stiff, Has crossed legs and almost no head control. Chair should have; Head support Log between the legs Straps to keep the hips in a good position Footrest and straps Chair maybe tilted backwards Henk Wilemsen Handicap International Sri Lanka

Henk Wilemsen Handicap International Sri Lanka Task 2 Draw a chair for a floppy child who sits with a round back and a short neck, but who can sit by himself. Chair should maybe tilted a bit forward which forces the child to sit with the trunk straight and the keep the head in a good position. Foot on the floor or on a footrest. Henk Wilemsen Handicap International Sri Lanka