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WHEELCHAIRS
MANUAL WHEELCHAIR COMPONENTS
•FRAME AND AXLE
•WHEELS AND TIRES
•HAND RIMS
•BRAKES AND GRADE AIDS
•CASTERS/ARMRESTS/LEGRESTS
•SEAT AND BACK
CASTERS
ORTHO-FINALS
•Usually in front, great turning but less stability if behind, used for first chair such as Quickie
Kidz
•Smallest (4”) and hard good turning, poor for outdoor use.
•Large pneumatic for uneven or soft ground
•beach chairs with four of them
•may contact foot plate if footrests long and not angled
HAND RIMS
•Small diameter and smooth rims for high speed racing
•Push 360 degrees instead of just top
•Large rims maximize maneuverability and power
•Modification for better grip (e.g. C5-6 quadriplegia)
•Coating
•Increase tube size
•Add projections (“quad knobs”) or bumps
ARMRESTS
•Aid in transfers and weight shifts, remove weight of arms from seat pressure
•Recommended for T6 or above SCI for stability
•BUT not a true trunk support, active users may omit
•Needed to support tray, arm trough, balanced forearm orthosis
•Types:
•fixed (cheap, but bad for lateral transfer)
ORTHO-FINALS
SEATING TYPES
ORTHO-FINALS
•Movement disorder (e.g. athetosis) or ataxia may “move up” a notch (e.g. custom mold for
functional stability even if not severe deformity) ASK PATIENT PREFERENCE!
•Don’t take away ability to self-adjust or fidget for comfort and optimal pressure relief if you
don’t have to; custom fit is good, but movement is better.
CONFIGURATION ISSUES
•TILT VS RECLINE
•Fixed tilt back 3-5 degrees with 90 degree seat to back angle stable and comfortable for
anyone
•Recline (open seat to back) increases extensor tone effects and shear forces, may be needed
for some post-op casting as temporary measure or with hip extension contracture
•Open seat to back may accommodate kyphus
•Closed seat to back has antithrust effect
•Reverse wedge seat is posture aid if tolerable and motor control potential is there (e.g.
hypotonia but good strength)
Tilt-In-Space chairs
•Passive pressure relief
•Challenge and rest/support periods
•Heavier, foldability and transportability question
•Respiratory care, feedings
ORTHO-FINALS
TROUBLESHOOTING 101
•CORRECT SIZE!!!!!
•Too wide = poor support, can’t reach wheels
•Too deep = forces slouch due to popliteal impingement
•Too short footrest = knee to nose, high ischial pressure
•PELVIC POSITION AND STABILITY FIRST
•Legs can point off to one side, pelvis should not
•Then look at trunk, then look at head and neck.
WC MEASUREMENT
•Seat 1" wider than widest part of buttock, 2” for growing child, want adjustable frame width
•Seat height 2" higher than heel to popliteal fossa unless planning foot propulsion, make sure
footrest can be angled to clear casters; child may be at 90 degrees and a little higher
•Seat depth 1-2" shorter than back of buttock to popliteal fossa in child, OK for a little more in
adult
PELVIC POSITION
•ANTERIOR PELVIC TILT
•Top forward in sagittal plane
•Lordosis, tight or short back extensors
•Some cases with hypotonia
•Hip flexor or ITB contracture
•POSTERIOR PELVIC TILT
•Top back in sagittal plane
•Slump, sacral sit, kyphosis
•Hamstrings
•Extensor tone
•LATERAL TILT OR ROTATION (“OBLIQUITY”)
•Scoliosis, hip dislocation, asymmetric tone
SPINAL DEFORMITY
•Try to get upright, centered trunk position
•May use trunk supports, accommodate some pelvic tilt or obliquity
ORTHO-FINALS
•“Ya can’t do orthopedic surgery with a wheelchair” – even custom mold may not stop
progression, TLSO may be better
•Lumbar supports, manipulate tilt and recline
HEAD POSITION
•CRITICAL INFLUENCE ON
•PRIMITIVE REFLEXES
•MUSCLE TONE
•UE FUNCTION
•SWALLOWING
•VISUAL ORIENTATION
•Anterior or posterior supports available
•Allow as much mobility as possible
POWER CHAIRS
•FOR INDIVIDUALS WHO CANNOT PROPEL A MANUAL WC
•DUE TO:
•WEAKNESS
•POOR ENDURANCE
•CARDIAC OR RESPIRATORY LIMITATIONS
•LIMB ABSENCE
•PARALYSIS
•DEFORMITY
•EXCESSIVE DISTANCE OR TERRAIN
•TOO SLOW FOR DISTANCE OR SITUATION
POWER PREREQUISITES
•Reasonable cognitive function, behavior and judgement. (VERBAL SKILL, DRIVING PERMIT
OR LICENSE NOT NEEDED; some discipline needs / doing donuts OK.)
•Reasonable visual function usable for mobility (PILOT’S LICENSE NOT NEEDED EITHER)
ORTHO-FINALS
WC CHECKOUT
•DO NOT HAVE WC DELIVERED DIRECTLY TO PATIENT
•HAVE IT DELIVERED TO CLINIC
•P.T. CAN CHECK IT TO MAKE SURE IT FITS THE PRESCRIPTION
•CHAIR CAN BE RETURNED IF SOMETHING IS WRONG OR MISSING
•HAVE P.T. CHECK OUT PATIENT IN WC TO MAKE SURE IT FITS AND THEY CAN
USE IT CORRECTLY
MEDICAL NECESSITY
•Medicare more strict if you are honest (NO walking ability, NO recreational use, NO bath
equipment, 100% home use only
•Theory is item not desirable in absence of disability
•Medicaid more based on need for item due to medical diagnosis. “Payor of last resort” principle
also.
•“Convenience” item never approved
•Social and educational reasons may not be medical enough
•Time limits (2 years for child, 5 for adult on ANY wheelchair or stroller, no chair until 2)
absolutely rigid
•Police reports needed if lost in burglary or fire
ORTHO-FINALS