1. Adapting (Wheel) Chairs
Henk Wilemsen Handicap International Sri Lanka

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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