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Uploaded byDr Sanjib Kumar Das
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Wheelchairs - Types and Parts

The document discusses wheelchairs and their components. It describes the basic parts of a wheelchair including the frame, tires, wheels, brakes, casters, push rims, footrests, backrests, armrests, seats, cushions, and anti-tip bars. It explains that wheelchairs come in different sizes for adults, children, and infants. The appropriate wheelchair must be prescribed based on the individual's needs and circumstances to provide maximum comfort.

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WHEELCHAIRS Dr. Sanjib Kumar Das, Fellow Doctoral MPT (Musculoskeletal Disorders) PhD (Ergonomics & Human Factors), NITIE
Introduction • A wheelchair is not just a ‘chair with wheels’. It is a second “home” to the patient, since he spends so much time in it. • The patient’s wheelchair should be designed for comfort and ease of manipulation. Wheelchairs differ in design and construction based on the needs of individuals and their disabilities. • Wheelchairs come in three sizes: adult, child and tiny tot. • Since many of the disabled individuals live out of wheelchairs it is important to prescribe the most comfortable one for a patient in the given circumstances.
BASIC CONCEPTS
PARTS OF A WHEELCHAIR • Frames Wheelchair frames are either rigid or folding. The type of frame affects the maneuverability of the chair. A rigid frame in one solid piece is lighter and used more for sports and other rugged activities. A folding frame is heavier and requires more effort to maneuver but is more convenient for storage in the home and for placing into the car while travelling since it occupies much less space. Figure : The wheelchair and its parts: (1) Handgrip (2) Backrest (3) Armrest (4) Clothes guard (5) Seat (6) Footrest (7) Casters (8) Heel-loop (9) Brake (10) Axle/anti-tip bar (11) Handrim (12) Wheel and tyre
• Tyres The selection of tyres depends on the use of the chair. Tyres made with solid, hard polyurethane and having a smooth tread are designed for indoor use, allowing for easy maneuverability on smooth surfaces. If used outdoors these tyres offer no shock absorption. Pneumatic (air filled) tyres provide for shock absorption and a smooth ride, particularly outdoors on uneven or rough terrain. These tyres require more effort to maneuver and add slightly to the overall width of the chair.
• Wheels Two types of wheels are available: solid magnesium and with spokes. Solid magnesium wheels never lose their shape or need adjustments. Spoked wheels are lighter and therefore easier to manoeuvre. The disadvantage of spoked wheels is that the spokes are easily broken and will cause the wheel to lose its shape. They must therefore be tightened frequently. Wheel sizes may vary depending on the size and weight of the user. There are two sizes- 12'' and 18'' diameter. A smaller wheel size requires more pushing strokes than a larger wheel size to propel the chair over the same distance. A small wheel reduces height to the wheelchair during transfers.
• Brakes There is a separate brake for each wheel of the chair. Brakes must be put on when stopping the chair, whenever the person is being transferred in or out of the chair, or whenever a procedure like standing up in the wheelchair, or eating from a tray placed on it is contemplated. • Casters There are 2 casters in front of the wheels. They are different from wheels in that they can revolve in all directions, and allow for better front end maneuverability on smooth surfaces. Casters are pneumatic, semi pneumatic or solid. The semi pneumatic type is better on uneven terrain. Pneumatic casters provide for greater shock absorption; however, there is an increased drag during propulsion if not filled with air properly. This increases the expenditure of energy. Solid casters are good on smooth terrain. Casters may also have locks.
• Push Rims (Hand Rims) The type of push rim depends on the user’s grip. There are basically three types: • Standard metal rims, • Friction rims, and • Rims with projections. Standard metal rims are used when grip is not a problem. Friction rims are standard rims covered with friction tape or foam tubing to provide additional grip on the rim surface. Projection rims are used by people with limited reach and grip. These are knobs are placed at intervals to give the user better grip and leverage for propulsion. The greater the number of knobs the greater is the facilitation for movement. Projection knobs may be either at an oblique angle or vertical. However, they may hit against the sides of the wall or furniture and add to the overall width. The chair used by a hemiplegic has two hand rims on the same (unaffected) side and the user propels it using the same hand. To negotiate turns he uses either one of the hand rims.
• Footrests Footrests maintain the feet in neutral and prevent deformities like equinus. They are either fixed or movable. Swing away footrests are more convenient but increase the length of the chair, which affects turning and maneuverability. These lack toughness and require frequent repair. Heel loops or leg straps can be added to the footplate. Either or both of these accessories add length to the wheelchair. • Tilt Bars Tilt bars, which project from the back of frame, usually 2 to 3 inches above the floor, are used by the individual who is pushing the wheelchair. By placing the foot on the tilt bar and pushing down with the foot, the person can tilt the wheelchair back, allowing the casters to rise off the surface, thus enabling them to clear a doorstep or kerb. This can also be done by doing what is called a ‘wheelie’, which is the same action as above, done by the wheelchair user himself.
• Backrests High wheelchair backs provide trunk support and are ideal for a high level quadriplegic or a child with cerebral palsy with poor sitting balance. Low chair backs provide a greater freedom for movement and are preferred by individuals with low level spinal cord lesions and by those who participate in sporting activities. The angle of chair backs can be changed and many wheelchairs have their backrests detachable, permitting a back transfer. Chest straps are provided to the back rest when sitting balance is poor. • Armrests Removable armrests are convenient, provide support, and make transferring easier when detached. Armrests can also be fixed or adjustable in height and may be partial length or full length. However, they restrict movement during propulsion. Environment control units, keyboards, books or trays can be placed on these armrests.
• Seats: Patients come in all sizes and it makes sense to take the measurements for the seat, so that he is most comfortable. The dimensions to be taken into consideration are the seat height, depth and width Figure : Wheelchair measurement; Seat width: 1 inch wider than the width of the widest part of the buttocks (A); Seat height: 2 inches higher than the distance from the bottom of the heel to the popliteal area (B); Seat depth: 1 to 2 inches longer than the distance from the popliteal area to the back of the buttocks (C); Backrest height: 2 inches less (may vary) than the distance from the inferior angle of the scapulae to the sitting surface (D); Armrest height: Distance from bottom of buttocks-to-elbow (E)
• Cushions Cushions are used to achieve the most comfortable and supportive position possible and sometimes can make all the difference in the prevention of a secondary disability like pressure sore. Seat cushions may be air-filled, gel- insert/filled, contour foam. Some have individual inflatable air cells, which are available in varying thicknesses and can be customized for posture control and pressure relief. • Head-rest It is prescribed for those who have no head control, and have primitive neck reflexes. It is also detachable. • Clothes Guard This prevents loose fitting clothes from getting entangled in the wheels. • Anti-tip Bars Anti-tip bars keep the chair from tipping too far backward. They are used primarily by new users and by those with a high-level spinal cord injury.
Training to Use the Wheelchair • The patient is taught basic movements within the wheelchair. He learns to use the brakes, remove and replace the arm, back and footrests. • In the maneuvering of the wheelchair, he practices to lift his buttocks in the chair, perform a wheelie, to push on a flat surface or slope and to turn it. • Objects which he can use on the chair like a tray or computer keyboard may also given to him during the practice session.
Thank You Dr. Sanjib Kumar Das, Fellow Doctoral MPT (Musculoskeletal Disorders) PhD (Ergonomics & Human Factors) Mail: sanjib_bpt@yahoo.co.in Contact No: +91 8879485847/ 8169951520 (India)