WHEELCHAIRS w MANUAL WHEELCHAIR COMPONENTS n n n

WHEELCHAIRS w MANUAL WHEELCHAIR COMPONENTS n n n FRAME AND AXLE WHEELS AND TIRES HAND RIMS/ WHEEL LOCKS GRADE AIDS CASTERS/ARMRESTS/LEGRESTS SEAT AND BACK

FRAME AND AXLE w FRAME MATERIAL MAY DETERMINE THE WEIGHT AND DURABILITY OF THE WHEELCHAIR w WEIGHT IS IMPORTANT IN TERMS OF LOADING WC INTO THE CAR

FRAME TYPE w RIGID FRAME IS MORE STABLE FOR ACTIVE USER w MAKE SURE PATIENT CAN LOAD THIS INTO THE CAR

FOLDING FRAME w FOLDING FRAME IS EASIER TO STORE AND TRANSPORT w NEWER LOCKING SYSTEM FOR FOLDING FRAME IMPROVES RIGIDITY AND MAINTAINS BALANCE w SOME FRAMES HAVE FLEXIBILITY IN PLACEMENT OF REAR WHEELS WITH AN ADJUSTABLE AXLE PLATE

WHEEL AND TIRES w WHEEL SIZE AFFECTS n n OVERALL HEIGHT ROLLING EASE TRANSFERRING IN AND OUT OF CHAIR UE MECHANICS OF PUSHING

WHEEL TYPE w SOLID SMOOTH WHEELS w BEST ON n n n SMOOTH HARD INDOOR SURFACES

WHEEL TYPE w THREADED PNEUMATIC TIRES n n GIVES SMOOTHER RIDE EASIER MANUEVERABILITY ON ROUGH TERRAIN, WET OR ICY SURFACES

WHEEL TYPE w FLAT TIRES CAN BE MINIMIZED n WITH THORN RESISTANT TUBES n OR ADDITION OF LATEX GEL

HAND RIMS w VERY SMALL DIAMETER n SMOOTH RIMS FOR HIGH SPEED RACING w LARGE n TO MAXIMIZE MANEUVERABILITY AND POWER

HAND RIMS w MODIFICATIONS n IMPROVE GRIPPING BY ADDING COATING l INCREASE TUBE SIZE l CHANGING SHAPE l ADDING RIM PROJECTIONS l

WHEEL LOCKS w WHEEL LOCKS= BRAKES w POSITION HANDLES TO PROVIDE EASY ACCESS w BUT NOT INTERFERE WITH WC PROPULSION

WHEEL LOCKS w BRAKE EXTENSIONS FOR PATIENTS n WITH U. E. DYSFUNCTION n OR POOR BALANCE

WHEEL LOCKS w FOR ACTIVE USER w WITH LONG PUSHING STROKE n n POSITION BRAKES LOWER DOWN TO PREVENT INJURY TO FINGERS AND THUMBS

GRADE AIDS w SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM ROLLING BACKWARD w CAN BE SELECTIVELY ACTIVATED WHEN GOING UPHILL

GRADE AIDS w FOR PATIENTS WHO HAVE DIFFICULTY GOING UP INCLINES w DON’T USE GRADE AIDS IN STRONG PUSHERS n MAY BE ACTIVATED IN WHEELIES

CASTER w THE SMALL WHEELS FOUND USUALLY IN FRONT OF THE CHAIR

CASTER w HARD SMALL CASTERS ALLOW EASIEST TURNING w SMALLEST 4” CASTORS GOOD FOR SPORTS BUT CAN’T BE USED WELL OUTDOORS

CASTER w LARGE PNEUMATIC CASTERS ARE LESS LIKELY TO GET STUCK ON UNEVEN OR SOFT GROUND w MAKE SURE THEY DON’T HIT FOOT OR FOOT PLATE

CASTERS w PLACING THE CASTER TO REAR OF CHAIR n n DECREASES TURNING RADIUS INCREASES THE TENDENCY TO TIP FORWARD

CASTER w CASTER LOCKS n NECESSARY FOR ABSOLUTE STABILITY OF CHAIR IN TRANSFERS

ARMRESTS w AID IN TRANSFERS w WEIGHT SHIFTS w REDUCE ISCHIAL PRESSURE n BY CARRYING THE WEIGHT OF THE ARMS AND MAINTAINING TRUNK BALANCE

ARM RESTS w NEED STURDY SUPPORTIVE ARMREST FOR THOSE WITH MARGINAL PRESSURE MANAGEMENT w PATIENTS WITH T 6 OR ABOVE INJURY NEED THEM FOR STABILITY IN SITTING

ARMRESTS w NEEDED IF PATIENT HAS n n n LAPBOARD ARM TROUGH BALANCED FOREARM ARTHOSIS w ATHLETIC WC USERS MAY WANT TO ELIMINATE ARM RESTS

ARM RESTS w TYPES n n FIXED ADJUSTABLE REMOVABLE SWING AWAY

LEG RESTS w TO PROVIDE PROTECTION w PROPER POSITIONING w MAXIMUM BALANCE w WEIGHT BEARING OF LE

LEG RESTS w SUPPORT THE FOOT TO MAINTAIN CIRCULATION w KEEP THE ANKLE IN NEUTRAL POSITION w SHOULD NOT BE SO HIGH IT FORCES WEIGHT BACK ON ISCHIAL TUBEROSITIES OR SACRUM

LEG RESTS w TYPES n n n STANDARD SWING AWAY REMOVABLE

LEG RESTS w ELEVATING n MAY HELP WITH EDEMA n ALTER ACCESSIBILITY n MAKES TURNING MORE DIFFICULT

ELEVATING LEG RESTS n NEED CALFPADS n MORE EXPENSIVE n NEED A SPECIFIC DIAGNOSIS TO JUSTIFY

LEG RESTS w PATIENTS WITH A LOT OF SPASTICITY n MAY NEED A LARGE FOOTPLATE n WITH PROPER FOOT RESTRAINT SYSTEM

SEAT AND BACK w BACK SUPPORT n WC BACK SHOULD BE HIGH ENOUGH TO SUPPORT l LOW ENOUGH TO GIVE AS MUCH FREEDOM AS POSSIBLE l

BACK SUPPORT PATIENTS WITH ABNORMAL TRUNK CONTROL ABOVE T 8 -10 l BUT GOOD HEAD CONTROL l w BACK SHOULD COME UP WITHIN 2” OF THE LOWER EDGE OF THE SCAPULA

BACK SUPPORT w IF BACK TOO LOW n n IT CAN CAUSE INCREASED PRESSURE AT UPPER EDGE OF BACK WHEELING EFFICIENCY IS DECREASED SECONDARY TO POOR STABILIZATION OF THE SHOULDER GIRDLE

SEAT TYPE w IF PATIENT HAS POOR MUSCLE CONTROL w SPASTICITY w DEFORMITY n THEY NEED A SOLID SEAT OR BACK OR BOTH

SEAT TYPE w A STABLE SEAT AND LUMBAR SURFACE n PREVENTS SACRAL SITTING

SACRAL SITTING l LEADS TO SACRAL AND ISCHIAL PRESSURE SORES l INCREASED KYPHOSIS l NECK AND UPPER BACK STRAIN

WHEELCHAIR STABILITY w DEPENDS ON REAR AXLE POSITION n IF REAR WHEELS ARE MOVED FORWARD l CHAIR MOVES EASIER l WEIGHT SHIFT FOR WHEELIES IS EASIER

WC STABILITY w IF REAR WHEELS ARE MOVED FORWARD l CHAIR TIPS BACKWARD MORE EASILY l ESPECIALLY WHEN GOING FAST OR UP RAMPS

WHEELCHAIR STABLILITY w ANTITIP DEVICES PREVENT BACKWARD TIPPING

WHEELCHAIR STABILITY w FOR LE AMPUTEES n MOVING REAR WHEEL POSTERIOR l KEEPS THE PATIENTS C. OF G. IN FRONT OF THE WHEEL l TO PREVENT TIPPING

WHEELCHAIR STABILITY w RAISING THE SEAT n WILL LESSEN THE OVERALL STABILITY OF THE CHAIR w MOST COMFORTABLE AND STABLE SEATING n WITH SEAT TILTED BACK BY 3 -5’’

WHEELCHAIR STABILITY w CAMBER n THE ANGLE BETWEEN THE VERTICAL AXIS OF WHEELS AND A LINE PERPENDICULAR TO THE FLOOR

CAMBER n n CAN BE ADJUSTED 7” TO MAXIMIZE LATERAL STABILITY WITHOUT MAKING THE CHAIR TOO WIDE CAMBER IS ADJUSTED FOR SPORTS TO ALLOW QUICK TURNS OR LONG LATERAL REACHES

BIOMECHANICS OF SEATING w PELVIS l A KEY GOAL IN WC SEATING IS STABILIZING THE PELVIS l A LEVEL PELVIS IS NEEDED TO OPTIMIZE TRUNK CONTROL AND UE FUNCTION

PELVIS w EVALUATION n LOOK FOR ANTERIOR PELVIC TILT l POSTERIOR PELVIC TILT l LATERAL SYMMETRY l ROTATION l RESTRICTION IN ANY DIRECTION l

ANTERIOR PELVIC TILT w INCLINATION OF THE PELVIS IN THE SAGITTAL PLANE FORWARD OF ITS NEUTRAL POSITION w DUE TO THE HYPOTONICITY OF TRUNK MUSCULATURE

ANTERIOR PELVIC TILT w SHORTENING OF LOW BACK EXTENSORS w TIGHTENING OF ILIOTIBILA BAND w TIGHT HIP FLEXORS

POSTERIOR PELVIC TILT w DUE TO OVERACTIVITY OF HIP EXTENSORS n DUE TO TIGHT HAMSTRINGS n HYPOTONIC LOW BACK EXTENSORS

POSTERIOR PELVIC TILT w LOSS OF LUMBAR LORDOTIC CURVE n n AFFECTS SPINAL ALIGNMENT AFFECTS FUNCTION

POSTERIOR PELVIC TILT w TILTING OF PELVIS n n MOVES C. OF G. POSTERIOR TO ISCHIAL TUBEROSITIES INCREASES WT. BEARING THRU SACRUM

POSTERIOR PELVIC TILT w TILTING OF PELVIS n n INCREASED THE FORCE ON LUMBAR SPINE IN SITTING INCREASES SHEARING AND FORCE OVER SPINE AND PELVIS

PELVIC OBLIQUITY w SLANTING OF PELVIS IN THE FRONTAL PLANE w DUE TO n n IMBALANCED POSTURE MUSCLE TONE SCOLIOSIS HIP DISLOCATION

SCOLIOSIS w EVALUATION OF SEATING IS DIRECTED n n TOWARD TYPE OF SUPPORT OR ACCOMODATION NEEDED NOT A PRIMARY METHOD OF CONNECTION

KYPHOSIS/LORDOSIS w TRUNK SHOULD BE UPRIGHT w TRUNK SHOULD BE CENTERED OVER THE MIDDLE OF THE WHEELCHAIR

HAMSTRINGS w THE MOST IMPORTANT MUSCLE GROUP FOR OPTIONAL n n n POSITIONING COMFORT FUNCTION OF WC USER

HAMSTRINGS w CROSS TWO JOINTS w TIGHTNESS CAN DRAMATICALLY n n CHANGE POSITION OF PELVIS AND KNEES CAN INCREASE POSTERIOR PELVIC TILT l THIS INCREASES SACRAL SITTING

HAMSTRING TIGHTNESS w CORRECTIONS n n INCREASE LENGTH OF HAMSTRINGS WITH STRETCHING TRY TO INCREASE AMOUNT OF KNEE FLEXION ALLOWED IN WC l BY POSITIONING FEET MORE POSTERIORLY THAN USUAL

HAMSTRING TIGHTNESS w DON’T TRY TO STRETCH HAMSTRINGS BY INCREASING THE AMOUNT OF KNEE EXTENSION IN CHAIR w THIS MAY INCREASE POSTERIOR PELVIC TILT

HAMSTRING TIGHTNESS w IF UNABLE TO INCREASE KNEE FLEXION n n USE POSTERIOR WEDGE TO INCREASE HIP FLEXION WITH A PELVIC WELL TO PREVENT SLIDING OUT OF CHAIR

HEAD w POSITION IN SITTING IS CRITICAL w BECAUSE OF INFLUENCE OF HEAD ON n n n PRIMITIVE REFLEXES MUSCLE TONE UE FUNCTION SWALLOWING VISUAL ORIENTATION

UPPER EXTREMITIES w UE FUNCTION AND STRUCTURE n n n AFFECT PROPULSION WEIGHT SHIFT TRANSFERS IN WC

UPPER EXTREMITIES w PROPER ARM SUPPORT w MAY HELP UNWEIGHT THE ISCHIAL TUBEROSITIES w BY 25 -35%

WC MEASUREMENT w SEAT WIDTH 1” WIDER THAN THE WIDTH OF THE WIDEST PART OF BUTTOCK w SEAT HEIGHT n 2” HIGHER THAN THE DISTANCE FROM THE BOTTOM OF THE HEEL TO THE POPLITEAL FOSSA

WC MEASUREMENT w SEAT DEPTH n 1 -2” LONGER THAN THE DISTANCE FROM THE POPLITEAL AREA TO THE BACK OF THE BUTTOCK w BACK HEIGHT n 2” LESS (MAY VARY) THAN THE DISTANCE FROM THE BOTTOM OF THE SCAPULA TO THE SITTING SURFACE

WC MEASUREMENT w ARM HEIGHT l DISTANCE FROM THE BOTTOM OF THE BUTTOCKS TO THE ELBOW

SEAT TYPE w SOLID SEAT, SOLID BACK OR BOTH n IF PATIENT HAS POOR MUSCLE CONTROL l SPASTICITY l DEFORMITY l

SEAT TYPE w STABLE SEAT AND LUMBAR SURFACE n PREVENTS SACRAL SITTING l WHICH w CAUSES SACRAL STRAIN w ISCHIAL PRESSURE SORES w INCREASED KYPHOSIS w NECK AND UPPER BACK STRAIN

WC CUSHIONS w ANOTHER CHAPTER w A CONTOURED CUSHION WITH A FIRM BASE MAY BE THE BEST CHOICE FOR PRESSURE RELIEF AND TO PREVENT A PERSON FROM SLIDING FORWARD

WC WEIGHT w USERS WHO NEED TO LOAD OWN WC INTO CAR n NEED FOLDING OR RIGID ULTRALIGHT FRAMES w LIGHTER, MORE EFFICIENT CHAIRS MAY NOT BE COVERED BY ALL INSURANCE CO. S

WC WEIGHT w HEAVIER CHAIRS n MORE PRACTICAL FOR TEMPORARY USERS l SHORT DISTANCE MOBILITY l OBESE PATIENTS l

WC WEIGHT w CONVENTIONAL Wc- 50 lb. w LIGHTWEIGHT WC- 40 lb. w ULTRA LIGHTWEIGHT WC- 15 -28 lb.

WC PRESCRIPTION w DONE IN A MULTIDISCIPLINARY WC CLINIC w WITH P. T. w WC VENDOR w PHYSIATRIST

WC PRESCRIPTION w OBTAIN n n n MEDICAL HISTORY SURGICAL HISTORY SEATING HISTORY l WHAT HAS WORKED OR NOT WORKED IN THE PAST

WC PRESCRIPTION w CHECK PATIENT’S ABILITY TO DO WT. SHIFTS w IF UNABLE TO DO WT. SHIFTS PT. MAY NEED POWER RECLINE OR TILT IN SPACE SYSTEM

POWER RECLINE SYSTEMS w RECLINING MAY PRODUCE SHEAR DURING RECLINING w SYSTEM ADDS 1 -2” TO SEAT HEIGHT w TILT IN SPACE PRODUCES BETTER REPOSITIONING WHEN UPRIGHT POSITION RESUMED

WC PRESCRIPTION w TO JUSTIFY POWER RECLINING SYSTEM OR TILT-IN-SPACE SYSTEM n n n HAVE TO SHOW PATIENT UNABLE TO SHIFT WEIGHT OR TRANSFER INDEPENDENTLY AND DOESN’T HAVE SOMEONE TO ASSIST WITH THIS

WC PRESCRIPTION w EXAMINE PATIENT IN SITTYING AND LYING SUPINE ON A FLAT SURFACE w CHECK n n SPASTICITY JOINT R. O. M. HIP FLEXION l HAMSTRING TIGHTNESS l POPLITEAL ANGLES l

WC PRESCRIPTION w CHECK PELVIS w LOOK AT HOW THIGHS AND FEET WILL BE POSITIONED w EVALUATE THE NEED FOR HEAD AND BACK SUPPORTS

WC PRESCRIPTION w LOOK AT SEAT CONFIGURATION w EVALUATE HOW WEIGHT SHIFTS WILL BE DONE

WC PRESCRIPTION w BASED ON CLINIC EVALUATION w DEVELOP A PRECRIPTION w DEVELOP A LETTER OF MEDICAL NECESSITY FOR INSURANCE CO. w DISCUSS PRESCRIPTION WITH PATIENT w HAVE HIM SIGN IT AFTER DISCUSSION

POWER CHAIRS w FOR INDIVIDUALS WHO CANNOT PROPEL A MANUAL WC n DUE TO w WEAKNESS w POOR ENDURANCE w CARDIAC OR RESPIRATORY LIMITATIONS w LIMB ABSENCE w PARALYSIS w DEFORMITY

POWER CHAIRS w INDIVIDUALS MUST HAVE NECESSARY n n n COGNITIVE FUNCTION JUDGEMENT VISION w TO SAFELY DIRECT POWER CHAIR

POWER CHAIR w SELECT CHAIR ON SAME PRESCRIPTION PRINCIPLES AS MANUAL

POWER CHAIR w CONSIDER WHERE THE CHAIR WILL BE USED w MAY NOT BE PRACTICAL n n IF PATIENT LIVES IN A TRAILER OR DOESN’T HAVE A VAN TO TRANSPORT IT

WC POWER BASES w TYPE I DIRECT DRIVE MOTORS l SMALL BALLOON TIRES l MORE DURABLE l BETTER ABLE TO TRAVERSE ROUGH TERRAINE l SHORT BASED l INCREASED EASE OF TURNING IN SMALL SPACES l

WC POWER BASES w TYPE II n n n DRIVE POWER LINKAGES LARGE REAR HARD RUBBER TIRES SMALL FRONT PNEUMATIC TIRES ATTAIN HIGHER SPEEDS PROVIDE MORE STABILITY

WC CHECKOUT w DO NOT HAVE WC DELIVERED DIRECTLY TO PATIENT w HAVE IT DELIVERED TO CLINIC n n n 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

WHEELCHAIRS w COSTLY w OFTEN COMPLICATED w EVALUATE PATIENT IN WC CLINIC OR BY SKILLED P. T. n n IF PATIENT IS HARD TO FIT TO MAKE SURE THEY GET APPROPRIATE WC