Wheel chair

Definition (Wheel chair):  A wheel chair is a wheeled mobility device in which the user sits. The   device is propelled either manually (By turning the wheels by the hand) or via various automated system.

Parts of wheel chair:

1.      The seat.

2.      The footrest.

3.      The backrest.

4.      Armrest.

5.      Waist strap.

6.      Heel strap.

7.      Toe strap.

8.      Cloth guard.

9.      Breaks.

10.  Small front wheel

11.  Large back wheel.

12.  Wheel rim.

13.  Handle.

14.  Tipping lever

Indication:

Wheel chairs are used by people for whom walking is difficult or impossible due to illness, injury or disability. E.g

1.      Paraplegia.

2.      Hemiplegia.

3.      Quadriplegia.

4.      Diplegia.

5.      Cerebral palsy.

6.      Spinal cord injury.

7.      Muscular dystrophy.

8.      Amputation.

9.      Peripheral nerve injury of lower limb.

10.  Fracture of lower limb.

11.   Soft tissue injury of lower limb.

12.   Extreme age.

13.   Severely ill.

Factors considered in the design of wheelchair:

1)      Cost: Keep cost low but quality high enough to meet the child’s needs.

2)      Longevity: The longer the better, unless it is only for temporary use.

3)      Making easily and swiftly: The easier and quicker the better.

4)      Availability of materials: Make use of local low-cost, good-quality resources.

5)      Tools and skills are needed: A wooden chair may be a more practical choice.

6)      Facilities of adjust or repair: Wood chairs that are the easiest to adjust.

7)      Weight: The lighter the better.

8)      Strength: Heavier persons need stronger chairs and stronger axles.

9)      Width and length: The narrower and shorter the better.

10)  How easily can it be moved?

11)  How easily can it be tilted back, lifted up stairs, Transported.

12)  How will is it adapted to the particular patient’s wants and needs?

13)  Fit and growth factors: How will does it fit the child now?

14)  How well is it adapted to living situations: The home, local customs etc?

15)  Appearance: Attractiveness of the chair.

Wheel chair measurement procedure:

Ø  Seat width: 1 inch wider than the widest part of the buttocks (‘A’ in the figure)

Ø  Seat depth: 1 to 2 inches longer then the distance from the popliteal area to the back of the buttocks (‘B’ in the figure)

Ø  Backrest height: 2 inches less than the distance from the inferior angle of the scapulae to the sitting surface (‘C’ in the figure)

Ø  Seat height: 2 inches higher that the distance from the bottom of the heel to the popliteal area (‘D’ in the figure)

Ø  Armrest height: Distance from bottom of buttocks to elbow (‘E’ in the figure)

Maintenance of a wheel chair:

1)      Manipulate the breaks.

2)      Remove the armrest.

3)      Pick up objects from the floor.

4)      Reach down to the footrests.

5)      Lift the buttocks forwards in the chair.

6)      Use a tray with a cutout.

7)      Perform a wheelie.

8)      Push on the flat surface.

9)      Use the chair on sloping ground.

10)  Turn the chair.

Name some cushions for wheel chair: The main reasons for using a wheelchair cushion are:

1)      Reduce the risk of pressure sore.

·         By prevent friction.

·         Equal weight distribution.

·         Reduce pressure.

·         Decrease temperature.

2)      Provide comfortable.

3)      Improve stability.

4)      Improve sitting posture.

5)      Help in pressure distribution equally.

Role of cushions:

[A] For pressure care: Use thick, soft padding, pillows or other forms of cushion arranged so as to protect bony areas of the body.

For the patient who has lost feeling in his buttock, the type of seat cushion he uses is very important-especially if his paralysis makes it difficult to lift up or change positions.

Materials can use:

·         Special cushions are made with ‘soft spots’ of an almost liquid ‘silicone gel’ in the areas of greatest pressure. However, these cushions are very expensive. Also the gel may get too soft and liquid in hot weather.

·          Good cushions can be made of ‘microcell’ rubber, which is fairly firm. It works best if it is cut and shaped to reduce pressure on bony areas.

·         Air cushions made from bicycle inner tubes are excellent for prevention of pressure sores and for bathing on a hard surface. Use 1, 2 or more tubes, depending on size of tube and size of patient.

Patterns of use:

·         Dip at back keeps hips from slipping forward.

·         Raised ‘Shelf’ here puts more pressure under thighs, less on buttock. It also helps keep the hips from slipping forward.

·         Hollow in back keeps pressure off buttock bones.

·         A ‘thigh’ separator can be included if needed.

·         Bottom curved to fit wheelchair seat.

[B] For maintain proper position:

·         For the patient whose hips tilt back, or whose upper body is ‘floppy’ a padded support across the lower part of the back may help her keep a good position.

·         Block to keep hips from slipping forward.

·         A foot strap or block that keeps knees bent may help keep the child from straightening stiffly.

·         A padded post may also help to keep hips back and legs a part.

·         Pad toe rest to prevent cuts and sores caused by spastic push.

·         Even with a firm board seat, this patients body sags to one side. This can lead to increasing curve of the spine (Scoliosis).

·         Hip guides may help patient sit straighter.

·         Patient may also need carefully placed body guides, to help keep his body in a straighter position.

·         However, a hip strap together with blocks outside his knees gives him a much better position.

·         Patient’s spastic muscles pull his shoulders back and make it hard for him to bring his hands together in front of him. There have an idea. They put ‘wings’ behind his shoulder blades to keep his shoulders forwards.