Wheelchair Features and Maintenance PDF

TIDEWATER COMMUNITY COLLEGE PTA PROGRAM VA BEACH CAMPUS PTH 105 -- [Unit 5 Lab] -- [HO \#1] -- [Wheelchairs] (Reference: Fairchild- Ch 7) **Learner Objectives**: A1. Describe components of a standard and prescriptive wheelchair and the options available for both. A2. Describe and demonstrate h...

TIDEWATER COMMUNITY COLLEGE PTA PROGRAM VA BEACH CAMPUS PTH 105 -- [Unit 5 Lab] -- [HO \#1] -- [Wheelchairs] (Reference: Fairchild- Ch 7) **Learner Objectives**: A1. Describe components of a standard and prescriptive wheelchair and the options available for both. A2. Describe and demonstrate how to measure a patient for a wheelchair. A3. Demonstrate safe and efficient transport of a patient in a wheelchair on level and uneven surfaces. A4. Educate the patient/caregiver in the safe use of and appropriate care of a wheelchair. A5. Educate the patient/caregiver in recognizing appropriate/inappropriate integumentary changes that occur with the use of a wheelchair. ### ### Wheelchair Features and Maintenance Features -------- 1. **[Types]** -- reference Table 7-1 - [Standard Adult\*] (\300\#); [Ultralight\*] (weighs 12-30\#, carries up to 300\#); [Bariatric] (400-750\#); Narrow adult; Extra-wide; Junior; Growing - Child (up to age 6) - [Hemiplegia] (2" lower to ground); - [Amputee] (rear wheels are offset 2" posterior); [One-arm drive;] [Power wheelchair\*] - [Sports] (back is low profile, drive wheels are cambered (slanted in); [Reclining\*] ; [Tilt in Space\*]; [Companion/"Traveler]" - Child-size stroller - Electric Scooter ;- i-BOT. 2\. **[Drive Mechanisms]** a\. [Manual] -- propel and maneuver using combination of UE, LE, uni-lateral E's or 1 UE b\. [One-arm drive] - Both handrims located on one wheel; designed for patients with use of only 1 UE - **Outer rim (smaller rim) controls wheel on that side** - **Inner rim (larger rim) controls wheel on opposite side** - To go straight, push both rims forward - If push outer rim - W/C turns to that side - If only push inner rim - W/C turns to opposite side - **Problems:** more expensive, heavier, difficult to fold c\. [Power Drive Wheelchairs] - **Basic power chairs:** are sometimes smaller and lighter than customized power chairs but lack the durability of power chairs which can be driven outside, across lawns, dirt, sidewalks, and more. - **Customized** P**ower chairs:** have more features and options specific to the client. - Runs on battery that needs to be re-charged frequently - Heavier chair - typically does not fold, can weigh up to 500lbs. - Very expensive (\$25,000 -\> \$100,000) - Controlled by joystick, head mount, breath (sip and puff), voice control, eye mount, etc. - Advisable only for pts who cannot advance W/C on their own -- need for life (not eligible/appropriate for standard W/C) 3\. **[Arm Rests]** a\. Fixed, removable, or swing-away b\. Full length or desk (cut out) arms c\. Height adjustable 4\. **[Leg Rest]** -- footplate with calf pad or (**[Foot Rest]** -- footplate only) a. Fixed, removable, or swing-away b. Elevating, non-elevating, or telescopic (lengthens as you recline) (for leg rests, with recliner w/c) c. Other accessories include: heel or toe loops to maintain foot position 5\. **[Seat and Seat Back]** a\. [Seat and seat back] 1. [Standard] -- sling back and sling seat- used in temporary situations 2. [Solid (hard)] -- provides postural support for long term WC user 3. [Extended] - higher than standard for pts with poor trunk/head control (p. 148-149) 3\. [Reclining] - for pts who cannot tolerate full vertical position, poor trunk control or lack 90^o^ hip/trunk flex for sitting (p. 148) a\. Fully reclining - reclines horizontal b\. Semi-reclining - reclines to 30^o^ b\. [Other accessories] 1\. Seat cushions (foam, gel, Jay, Roho, etc.) 2\. Head/neck extension - for pts with poor head/neck control (p. 150) 3\. Seat belts (lap belt and chest belt) 4\. Seating systems (seat and seat back -- usually Jay) -- head and trunk support, abductor pommel (placed between thighs to prevent hip adduction) (p. 150) 5. Lap tray 6\. **[Frame]** - - **Cross-brace Frame:** Acts as a shock absorber for a smoother ride; allows for folding. - Accessories to the frame include crutch or Oxygen tank holders and utility bags. - **Rigid Frame:** Usual seen in light weight wheelchairs/ sports wheelchairs - does not fold. - More durable for increased activities/impact. (negotiating curbs, sports) 7\. **[Wheels/Casters]** a\. [Rear wheels] - called the [drive wheels]; generally 24\" in diameter [Front wheels] - called [casters]; generally 5-8\" in diameter b\. Tires for both may be: 1. Solid rubber - esp. seen on casters 2. Semi-pneumatic 3\. Pneumatic (with inner tube; air filled), with or without tread Pneumatics are more prone to flats, but they give a much smoother ride than hard rubber tires and have better traction; require increased energy expenditure 2° friction. c. [Hand rims] -- to propel the W/C; may have vertical, angled or horizontal hand rim pegs to facilitate propulsion in someone with decreased hand function (p. 1300 O'Sullivan) 8\. **[Locks]** -- brakes a. [Toggle lock] -- standard; can be pushed to lock or pulled to lock. Opposite movement disengages lock. b. [Brake Extensions]- added to increase ease of use and or if unable to reach standard brakes. c. ["Z" or scissors lock] -- located under seat so it does not interfere with WC propulsion using drive wheels. 9\. **[Anti-tippers]**: attached to Tip Assist bar. Adjustable and able to be flipped into upward position when not needed or when another person propelling and/or assisting up/down a curb. **[Maintenance]:** - W/C should be kept clean to minimize wear and corrosion. - Gliding parts should be regularly cleaned and lubricated. - Tires need replacing/repairing at regular intervals. - Ensure the cross-brace frame remains in proper alignment. **[Wheelchair Measurements]** [Critical Anatomical Landmarks]: 1\. Scapula 2\. Ischial tuberosity 3\. Greater trochanter 4\. Popliteal Crease-fossa [Five Measurements:] 1\. Seat width 2\. Seat depth 3\. Seat height and Leg length 4\. Arm height 5\. Back height **[1. Seat Width]**: (Average adult size = 18") *Measure across the widest part of the hips or thighs with the patient sitting. Add 2\" to this measurement to determine seat width.* - If the seat is too narrow pressure is put on ischium (due to inability to WS) and greater trochanter and it may interfere with transfers. - If seat is too wide patient may be unstable in sitting and may have difficulty reaching handrims on wheels to propel the chair. Wide chair may not fit through narrow doorways. **[2. Seat Depth:]** (Average adult size = 16") *Measure from the posterior edge of the buttocks down the thigh to the popliteal fossa. Subtract 2 inches from this measurement to determine seat depth*. - If seat is too short body weight is distributed over a smaller area which increases pressure, especially over ischial tuberosities. (vs. post thigh) - If seat is too long the skin behind the knee may become irritated and pressure on popliteal artery may interfere with circulation to the lower leg and foot. **[3. Seat Height and Leg Length:]** (Average adult size = 19.5 -- 20.5") *Measure leg length from heel to popliteal crease. The footplate should clear the ground by 2 inches even at the lowest setting. Add 2 inches to the leg length measurement to determine seat height*. *(Use of a cushion will not change the leg length measurement but if patient is seated on a cushion, the footplate may clear the ground by greater than 2")* - If seat is too low there may be improper weight distribution with greater weight over the buttocks. - If seat is too high the patient may not be able to get knees under tables/desks and the patient may have trouble pushing the wheelchair. - If footrests are too low they may drag on uneven surfaces and could tip the patient forward from the chair. **[4. Arm Height:]** (Average adult size = 9" above chair seat) *With the patient\'s arm relaxed by his side and the elbow flexed to 90^o^, measure the distance from the seat to the olecranon process and then add 1 inch for proper height of the armrest. Must take into account the thickness of the seat cushion so measure the patient while on the cushion.* - If the armrests are too high the patient will have difficulty propelling W/C and develop postural problems. - If armrests are too low, poor posture and balance problems may result. **[5. Back Height:]** (Average adult size = 16 -- 16.5") *Determined by measuring from the seat platform to the axilla and then subtracting 4 inches. If a patient is using a cushion the thickness must be taken into account before measuring for back height.* - Some patients with poor trunk control may require a higher seat back. **[Patient and Family Education ]** 1\. Bony areas are prone to skin breakdown; MUST educate regarding skin inspection. These include: - Spinous processes - Inferior angle of scapulae - Ischial tuberosities - Greater trochanters - Lateral femoral condyles - Sacrum - Medial humeral epicondyles 2\. Pressure relieving measures include: (done at least *hourly* or more frequently) " North/South/East/West" - Seated push-ups "North" - Lateral weight shift -- lift one buttocks "East, then the other "West" - Lean forward to unweight the ischial tuberosities "South" - Tilt-in-space wheelchair for those w/limited mobility - If patient is dependent -- remove from W/C every 1-4 hours - Use of a W/C cushion does not prevent the occurrence of pressure sores 3\. Watch for signs of decreased circulation in LEs. These include: - Ankle edema - Color changes in distal legs - Diminished sensation - Loss of hair -- smooth, shiny skin - Skin ulcers (could be a circulation issue or a pressure sore) If the above signs are present, the patient should spend less time in the W/C and/or seek medical attention.