1. Wheelchairs and wheelchair management. Chpt 11,p149 SPINAL CORD INJURIES Ilse Lombard

2. Wheelchair selection  Selecting the most appropriate wheelchair can be a daunting task when faced with the huge variety of cost, type, size and accessories.

3. Wheelchair selection

4.  Use of wheelchair  Mode of transfer  Transport  The user

5. Types of wheelchair Manual  Weight  Backrest  Rear wheels  Front castors  Footplates

6. Types of wheelchair  Power drive  This classification is largely dependent on the power of the motor and the combination of front and rear wheels. 1. The indoor power-drive chair tends to have four solid tires. 2. The indoor/outdoor power-drive chair has pneumatic rear tires with solid front tires. 3. The outdoor/indoor and outdoor power-drive chairs tend to have pneumatic tires on all four wheels to be able to cope with rugged terrain.

7. Power drive

8. Types of wheelchair  Hybrid  Reclining  Stand-up  Sports chair  Pediatric chair

9. Wheelchair accessories  Anti tipping levers  Armrests  Backrests  Brakes  Brake extensions  Push rims  Elevated leg rests

10. Wheelchair maneuvers  BASIC MOVEMENTS WITHIN THE WHEELCHAIR  To manipulate the brakes  To remove the armrest  To pick up objects from the floor. To reach down to the footplates.  To give maximum stability, the small front wheels must point forward, as this prevents the chair tipping onto the footplates, and the brakes must be applied.

11. Wheelchair manoeuvres  To manipulate the brakes  To reach the right brake:  1. Hook the left elbow behind the left chair handle.  2. Lean forward and to the right, allowing the left biceps to lengthen as the trunk movement occurs.  To release the brake, use flexion of the elbow and shoulder to push the lever forward with the palm of the hand or the lower part of the supinated forearm (Fig. 11.6A, B). To apply the brake, pull the lever back using the right biceps and either the extended wrist or the supinated forearm (Fig.11.6C, D).

12. Wheelchair maneuvers  To remove the armrest  Most armrests now tend to flip-up

13. Wheelchair maneuvers  To reach down to the footplates  This position will be necessary to adjust the footplates, to empty the  urinal or for adjustments when dressing:  1. Lean forward on the elbows on the armrests.  2. Change the position of the arms one by one and lean on the forearms on the thighs.  3 Put one hand at a time down to the feet, leaning the chest on the thighs.

14. Wheelchair manoeuvres To regain the upright position, patients without triceps must (1) throw the stronger arm back over the backrest and hook the extended wrist behind the chair handle, and (2) pull the trunk upright by strongly extending the wrist and flexing the elbow.  Patients with good functioning triceps pull the trunk upright by hooking one or both extended wrists underneath the upper, outer edge of the armrest(s).

15. WHEELCHAIR MANOEUVRES  INITIAL AND ADVANCED WHEELCHAIR MANOEUVRES  When putting the wheelchair in motion in any direction, the position of the head and shoulders is important. They are used to reinforce the action of the arms, whether to gain greater momentum or to act as a brake.

16. WHEELCHAIR MANOEUVRES  Patients start moving the chair by pushing on the tires. Paraplegic patients may progress to using the wheel rims, particularly outside, but many patients with tetraplegia continue to use the tires because they find the purchase easier and the push more effective. Pushing gloves (see Fig. 8.2f) are used by tetraplegic patients to protect the skin from callus formation and abrasions due to friction or injury.

17. Advanced manoeuvres: paraplegic patients  To balance on the rear wheels  To mount and descend a curb  To 'jump' the chair sideways  To mount and descend a flight of stairs in a high performance wheelchair  To transfer a wheelchair into a car.

18. To balance on the rear wheels  Balance and movement on the rear wheels are useful to facilitate independent travel over rough ground, e.g. over grass, sand and also in negotiating curbs or a step.  This technique is safe only for patients with a good grip, i.e. for patients with lesions at T1 and below. In a well- adjusted lightweight wheelchair patients with lesions at C6 may also manage it. Anti-tipping levers are used initially.

19. To balance on the rear wheels  There are three maneuvers involved:  To tilt the chair onto the rear wheels  To balance the chair on the rear wheels  To move and turn the chair on the rear wheels.

20. To balance the chair on the rear wheels

21. Practical 1. To reach down to the footplates 2. To manipulate the brakes 3. To remove the armrest 4. To balance on the rear wheels 5. To mount and descend a curb 6. To 'jump' the chair sideways 7. To mount and descend a flight of stairs in a high performance wheelchair 8. Ramp up and down

22. Car readjustments