Lab Guide 11

Wheelchair Propulsion

• Hand Placement: To optimize efficiency, position the hand at the bottom of the pushrim for the start and top of the pushrim for the finish.
• Elbow Angle: An elbow angle of 90 degrees is most efficient for propulsion.

Wheelchair Types

• Reclining Back: Adjusts the angle of the back to increase comfort.
• Tilt-in-Space: Allows the user to recline without changing their position relative to the floor.

Wheelchair Capacity

• Standard Capacity: Typically handles 250 pounds.

Wheelchair Maneuvering

• Curb Ascent: Position the wheelchair facing the curb.
• Right Turn: Push the left wheel forward and the right wheel back.
• Wheelchair Wheelie: The center of mass (CoM) should be positioned forward when attempting a wheelie.

Wheelie Usage

• Purpose: Used in situations where a ramp is unavailable or to navigate over small obstacles.

Ramp Accessibility

• Slope: Maximum slope should be 1:12 for the most efficient accessibility.
• Rise: Maximum rise should be 30 inches.
• Width: Minimum width should be 36 inches.

Ramp Ascend and Descend

• Ascent: Teach patients to ascend a ramp facing forward. For steep ramps, instruct them to use a zigzag pattern.
• Descend: Assist the patient down the ramp facing backward with the wheelchair’s back wheels in contact with the ramp.

Assisting Patients

• Descend Incline Facing Forward: Assist the patient facing backward to prevent the wheelchair from tilting forward.
• Elevator Assistance: Assist the patient facing forward into the elevator.

Curb Maneuvering

• Dependent Patients: The most typical method is to lift the wheelchair over the curb.
• Independent Assistance: Patients can assist the caregiver by leaning back on the wheelchair, reducing the effort needed to lift the wheelchair.

Wheelchair Stair Navigation

• Upstairs/Downstairs: Position 3 individuals: two at the bottom and one at the top. The individuals at the bottom should grip the wheels. The individual at the top grips the backrest.
• Action: The three individuals slightly lift the wheelchair in a synchronized manner.

Fall Protection

• Forward: Protect the head, face, and neck.
• Backward: Protect the back and head.
• Lateral: Protect the hip and shoulder.

Two-Finger Confirmation

• Purpose: To check the proper positioning of the wheelchair's wheels.
• How: Place two fingers between the wheelchair's rear wheels and ensure they fit snugly.

Wheelchair Wheel Tilting

• Benefit: Tilting wheels minimizes the force required to propel.

Wheelchair Ordering

• Trade-offs: Consider factors such as weight, adjustability, cost, and functionality when ordering a wheelchair.

Wheelchair Propulsion

• Start pushing from the top of the wheel (12 o'clock position) for optimal leverage.
• Finish the push at the back of the wheel (2-3 o’clock position) to maximize efficiency.
• Maintain an elbow angle of 100-120 degrees for effective force and to minimize strain.

Wheelchair Types

• Reclining Back Wheelchair: Only the backrest reclines, keeping the seat stationary.
• Tilt-in-Space Wheelchair: Both the seat and backrest tilt together, maintaining hip angles and redistributing weight for comfort and pressure relief.

General Wheelchair Information

• Standard wheelchairs typically handle up to 250-300 pounds.
• Approach a curb backward to make it easier to ascend, allowing the larger back wheels to make contact first.
• Tilt the wheels to widen the base of support, enhancing stability and making turning easier.

Wheelchair Maneuvers

• To turn right, pull back on the right wheel while pushing forward on the left wheel.
• To perform a wheelie, position the center of mass just behind the axle. This is useful for negotiating small obstacles and curbs.
• Teach wheelies to patients who need to be independent in difficult terrains to prevent tipping.

Ramp Accessibility

• The maximum recommended slope for a ramp is 1:12 (1 inch of rise for every 12 inches of ramp length).
• A single ramp should not have a rise greater than 30 inches without a landing for rest.
• Ramps should be at least 36 inches wide to accommodate standard wheelchair dimensions.

Ascending Ramps

• Lean forward to counterbalance while ascending a ramp.
• Use smooth, steady pushes, and consider zig-zagging or taking short breaks if the ramp is steep.

Descending Ramps

• Position the wheelchair backward to prevent runaway speed, and keep hands ready for control.
• Avoid assisting a patient down an incline facing forward as this can cause the wheelchair to gain too much speed and make it difficult to control.

Wheelchair Transfers

• Assist patients into an elevator by backing the wheelchair in so they face the door when exiting.
• For dependent patients, back the chair up the curb for ascending and lower it forward onto the larger wheels for descending.
• Patients can help by leaning forward when ascending and backward when descending to adjust their center of mass for stability.

Stair Transfer Basics

• For stair transfers, two helpers should be at the back, holding the frame or handles, and one helper at the front gripping the footrest or lower frame.
• Each helper should guide and stabilize the chair, not fully lift it.

Safety Precautions

• When falling forward, use arms to protect the face, tucking elbows in.
• When falling backward, tuck chin to protect the head and neck, and avoid reaching back.
• When falling laterally, extend one arm to break the fall, protecting the shoulder and head.
• Perform a two-finger confirmation check by placing two fingers between the patient’s body and the WC at pressure points (e.g., hips, knees) to ensure adequate spacing.

Wheelchair Ordering Considerations

• Weight vs. Durability: Lighter chairs are easier to transport, but heavier ones are more durable.
• Adjustability vs. Stability: Adjustable chairs offer customization but can sometimes sacrifice stability.
• Cost vs. Features: Advanced features increase costs, so prioritizes essential features.

Wheelchair Ramp Safety & Dimensions

• Maximum slope of ramp should not exceed 1:12 inch rise:run
• Maximum rise of a ramp should not exceed 30 inches
• Minimum width of a ramp should be 36 inches
• Handrails are required if the rise is greater than 6 inches or run greater than 72 inches

Wheelchair Safety Considerations

• Going up a curb with help: Tip the casters up onto the curb and push on the rims to help the wheelchair roll onto the curb.
• Going down a curb with help: Reverse the process by tipping the casters down onto the curb and guide the wheelchair backward down the curb.
• Going down a steep ramp with help: Use a zigzagging motion to control descent down a steep ramp, remember to guard the chair and keep your leg in contact with the back of the chair.
• Going up a steep ramp unassisted: Use a pushing motion to ascend the ramp while keeping your leg in contact with the back of the chair, be mindful of your strength and limitations.
• Going up a curb unassisted: The patient should be able to do this by pushing on the pushrim to go up

Proper Wheelchair Fit

• Ensure proper seating position supports the normal curves of the spine.
• Hips should be flexed to at least 90 degrees.
• Forearms should be supported with relaxed shoulder alignment.
• Position the pelvis back and central in the seat.
• Always use proper guarding and blocking when transferring a patient.
• Key measurements for wheelchair fit: seat depth, seat width, seat-to-floor height, and seat back height.
• Confirming fit: symmetrical posture, 90/90/90 position, hips flexed at or above the height of the hips, and normal spinal curves maintained.
• Remember the 2" rule for proper fit, ensuring there's a 2-inch space between the patient's body and the wheelchair's seat.

Wheelchair Propulsion on Even Surfaces

• Skills needed: proper propulsion technique, tight turns, entering and exiting doors independently (as a caregiver pushing the wheelchair).
• Propulsion Technique: Use the 10 and 2 or 3 o'clock position on the wheel for long, smooth strokes to optimize efficiency.
• Turning: Hold one rim while pushing with the other.
• Tight Turns: Move the wheels in opposite directions simultaneously.
• Door Navigation: Be aware of the path of the door and ensure fingers do not get caught between the door and the wheel.

Wheelchair Management on Uneven Surfaces

• Curb Navigation: Easiest ascending forward and descending backward.
• Ramp Navigation: Easiest ascending forward and descending backward, use a zigzagging motion for steep slopes.
• Guarding and Safety: Maintain your leg in contact with the wheelchair.

Advanced Wheelchair Management

• Assisting someone in a wheelchair up and down stairs: Multiple helpers should guard and stabilize the chair, with two at the back and one at the front.

Key Safety Considerations

• Falling Forward: Protect face with arms, tucking elbows.
• Falling Backward: Tuck chin to protect the head and neck, avoid reaching back.
• Lateral Fall: Extend one arm to break the fall, protecting the shoulder and head.
• Two-Finger Confirmation Check: Place two fingers between the patient's body and the wheelchair at key pressure points (hips, knees) to ensure adequate spacing for comfort and circulation.
• Tilted WC Wheels: Provide wider base of support, enhancing stability and easier turning.
• Weight vs Durability: Lightweight chairs are easier to transport but less durable.
• Adjustability vs Stability: More adjustable chairs allow customization but can compromise stability.
• Cost vs Features: Advanced features (powered chairs, tilt functions) increase costs.

Review Questions

• Where should the patient position their hand to start the push and finish it?
• What elbow angle optimizes propulsion efficiency?
• What are the differences between a reclining back and a tilt-in-space wheelchair?
• What is the typical weight capacity of a standard wheelchair?