Contains everything about wheelchairs...!!

1. SHARMIN SUSIWALA
WHEELCHAIR
 QUESTIONS:
1. Types of wheelchairs-3
2. Prescription and training of a wheelchair-5
3. Measurement of seat of a wheelchair-4
4. Electrically powered wheelchair-3
5. Describe PT management of wheelchair bound patient-4
6. Powered v/s Manual wheelchair-5
7. Discuss principles for wheelchair prescription. What are measurements taken
for wheelchair prescription?-8
8. Describe parts of a wheelchair. Discuss in detail the procedure to prescribe a
wheelchair for a patient-8
9. Key biomechanical components of wheelchair assessment-4
10. Wheelchair management-3
 DEFINITION / INTRODUCTION:
 WHO definition: "A wheelchair is an assistive device which enhances personal
mobility and facilitates participation, for a person with walking limitation".
 A wheelchair is a manually operated or power driven device designed primarily for
use by an individual with a mobility disability for the main purpose of indoor, or of
both indoor and outdoor locomotion.
 Useful device in reintegrating a person with disability into the community.
 A wheelchair is truly a mobility orthosis. It provides appropriate support to allow
maximum functional mobility.
 PARTS:
COMPONENTS OF WHEELCHAIR:
1) Frames
2) Seat
3) Back
4) Pelvic Positioner
5) Wheels
6) Tyres
7) Wheel locks
8) Hand/Push Rim
9) Foot Plate
10) Arm Rest
11) Antitippers
12) Grade-Aids
13) Quick Release Hubs
14) Push Handles/Hand Grip
15) Tilt bars
16) Rear Wheel Camber
17) Specialized Support Components

2. SHARMIN SUSIWALA
1) Frames:
 There are two basic frame types:
Rigid:
 Doesnt centrally fold- it collapses by back folding down and removal of
rear wheels.
 Most common rigid chair is box frame
 Can be very strong and very durable.
 More compact.
 Allows seat back angle adjustment.
 Easier to propel and turn due to frame rigidity.
 DA: More difficult to transport and store.
Folding:
 This type of frame centrally folds via a cross-brace frame.
 Chair is folded by pulling upward on seat upholstery.
 Simple and easy to use.
 Have shock absorbers built into frame to smoothen out the ride for
patients.
 Esier to store and transport.
 DA: Tend to be heavier
No seat-back angle adjustment
Difficulty maintaining correct frame alignment
2) Seat:
Seat Type
 Seat types available from wheelchair manufacturers are sling, or hammock, made of a
flexible material, and solid seats which are generally removable.
Seat Surface
 A fabric or sling seat reinforces a poor pelvic position because the hips tend to slide
forward, creating a posterior pelvic tilt.
 The thighs typically move toward adduction and internal rotation, and the patient
tends to sit asymmetrically.
 A firm sitting surface enhances sitting posture and provides a stable BOS.
 The front of the seat should actually extend into popliteal fossa.
 Front edge should be well padded and contoured to provide relief for hamstring
tendons, calf bulk, and or/bracing.
 This surface may require specialized foam in one or varying firmnesses, or a specific
contour.
 Different types of sitting surface available:
o Firm Sitting surface
o Solid Insert
o Solid Folding Seat
o Solid Hook-on seat
o Standard Hammock Seat
Seat Dimensions
Seat Depth
 The depth of the seat provides support for the thighs.
 A seat that is too shallow causes higher sitting pressures because less of the seat is in
contact with the thighs.
 A seat that is too deep can cause excess pressure behind the knees and calves.
 There can also be a tendency for the pelvis to slide into a posterior tilt so that the
back can be adequately supported by the backrest.
 Measurement: 1- to 2-inch gap between the popliteal area and front edge of the
cushion
Seat Width

3. SHARMIN SUSIWALA
 The wheelchair seat width should be about 1 inch wider than the width of the widest
part of the buttocks.
 Special considerations will be needed for individuals who wear orthoses, require
control blocks at the hip or lateral/knee, wear bulky clothing, or experience weight
fluctuations.
 The goal is to create a chair that fits as close to the user's body as possible. This will
make the chair easy to wheel and maneuver. It also will make the chair seem, visually,
more congruent with the user's body lines.
 If the seat is too narrow, the individual might develop pressure sores on the pelvic
bony prominences.
 A narrower wheelchair allows easier wheel access and propulsion.
 Narrowing a wheelchair by upholstery essentially creates a "growing" chair out of any
size chair.
 The chair is simply folded a bit.
 A limiter strap and/or narrower upholstery is mounted, preventing full width
opening.
 Narrowing devices are useful only for individuals who have sufficient coordination to
rock the chair from side-to-side.
 If the seat is too wide, the individual is forced to abduct their shoulders excessively,
making wheel access and propulsion more difficult for the patient.
 Widening can be accomplished by:
o Use of fixed offset or removable arms
o Use of attachable armrests receivers that space one or both arms out further
o Construction design of a new chair
Seat Height
 The seat should be just high enough to accommodate leg length while leaving enough
space under the foot rests (about 2 inches or so) to clear obstacles
 Optimal seat height:
o Optimal independent functioning in foot-assisted self propulsion
o Transfers
o Ground Clearanceunder footplates on various terrains
o Approaching work surfaces
o Interacting with peers
o Transferring into a van via lift or ramp
 Persons with longer legs often need angled or elevating leg rests that extend the legs
slightly outward instead of straight down(knee angle of 90 degrees).
 The height of the seat should be adjusted so that the person has enough knee
clearance to fit under tables, counters, and sinks at home, at work, at school, and in
the community.
 Seat height can be altered by one or more methods, including:
o Altering the frame construction
o Changing the wheel size
o Altering the rear axle and front caster placement
o Altering the thickness of seat inserts or cushions
SEATING SYSTEM OF WHEELCHAIR
 A seating system should assure a comfortable, healthy, and functional sitting
posture for work, study, and leisure.
 Disability can significantly affect the integrity and stability of the musculoskeletal
system, putting the individual at risk for a number of secondary injuries.
 Failure to provide adequate seating can cause serious secondary injuries, which
can require hospitalization or surgery to correct.

4. SHARMIN SUSIWALA
 Failure to provide adequate seating can cause serious secondary injuries, which
can require hospitalization or surgery to correct.
Seat Cushions
 Different types of seat cushions available are as follows:
o Plain Rectangular Foam
o Contoured foam with skin
o Carve and assemble foam
o Contour molded with gel-filled inserts
o Air cushion with insert padding
o Matrix of air-filled elastic capsules
o Alternating air cell inflation
Custom-Molded Seating Systems
 Used to manage disabilities resulting in complex and fixed orthopedic deformities
and muscle tone.
 A plaster impression of the patient is used to make a positive model that serves as
the foundation for sculpting a seating orthosis constructed of foam and fiberglass.
 The consumer sits on a large rubber “balloon” filled with tiny foam pellets similar
to a “bean bag chair.” The therapist can freely push and shape the pellets or
“beads” to obtain a comfortable, close-fitting contour.
Seat Functions
 Tilt and recline are useful for handling complex seating needs through pressure
distribution management.
 Seat elevators increase independence, productivity, and social interactions by
extending reach capability, enabling and facilitating transfers, and providing peer
height at different ages.
 Tilt
 Tilt is also called “tilt-in-space,” and refers to rotating the person’s entire body,
the seat base, and back and front rigging as a single unit in the sagittal plane.
 Tilt provides weight relief for the sitting surfaces by redistributing the effects of
gravity away from the buttocks and onto the back.
 Tilt can also provide a position of rest and relaxation.
 A wheelchair with tilt is less stressful to the body than a reclining wheelchair
because shear forces to the skin are almost negligible.
 Recline
 Recline refers to a means of increasing the angle between the seat base and back,
typically between 90 and 170 degrees.
 Reclining forces some parts of the body to slide whcih is a risk factor for skin
injury.
 Many power wheelchairs have special linkages or mechanical compensation to
minimize skin shear during recline.
 Elevation
 Seat elevators provide 6 to 9 inches of additional height and can make transfers
easier by placing the wheelchair at the same height as the target surface.
 A seat elevator adds additional weight to the wheelchair and can increase the
seat-to-floor height in some models.
3) Back:
 The backrest of the basic chair is made of a flexible material stretched between the
two side frames which are fixed with respect to the seat .
 BACK HEIGHT:

5. SHARMIN SUSIWALA
 The height of the back is determined by the amount of postural support the person
needs.
 The backrest should be low enough to provide adequate support, but still allow the
upper limbs access to as much of the pushrims as possible.
 Inferior angle of the scapula is used as a basis for determining backrest height.
 The backrest should be high enough to provide support without inhibiting motion,
and not so low that the scapulae can hang over the back of the chair and cause
discomfort.
 Individuals who have a good trunk control usually require only back support to the
mid-scapula.
 BACK SUPPORTS:
 A back support should conform to the normal spinal curvature while allowing
movement as required by the user.
 The typical back support in a folding-frame wheelchair is sling upholstery, not
because it is good back support, but because it bends to allow the chair to fold.
 Also Includes back upholstery with reinforcing straps.
 It increases the overall weight of the wheelchair and does not interfere with
wheelchair.
 In individuals with tetraplegia, the stretching of the sling back can mean that the
wheelchair user adopts a more posterior tilt of the pelvis, and this may contribute to a
kyphotic spine.
 For clients with truncal weakness, the stability from a contoured backrest with or
without modular lateral supports is needed to maintain head and neck position.
 Patients with significant kyphoscoliosis may need a custom-molded backrest to
enable sitting in a more upright posture.
 Types:
o Basic upholstery fabric (vinyl or nylon) sling back found on standard
wheelchairs
o Fabric back with tension ties
o Firm back, minimum contour
o Contour-molded foam over hard back
o Hardback with softer foam or gel central region
 A well-chosen back cushion should meet the following criteria:
o For folding chairs the backrest must be easily removable from the frame with
hand-operated fasteners or be collapsible.
o The backrest must be the proper width and contour to support the back for
extended activities without discomfort.
o For manual wheelchairs the backrest must not impose any unnecessary
weight burden.
o Newer materials (e.g., carbon fiber) are available to keep backrest weight to a
minimum.
 Backrest height is a crucial feature and should be just high enough to maintain trunk
stability. Unneeded extra height adds weight, blocks the ability to look over the
shoulder during backing up, and increases the perception of medical frailty.
 For patients who require comfort and /or postural control , an insert or cushion is
placed in front of the back upholstery.
 These supports add some amount of weight to the chair and must be removed for
folding.
 A back insert is fabricated from a firm base such as very firm foam, wood, plastic, or
metal padded with foam or a layer of air-filled cells.
 The padding can vary in thickness and firmness allowing more or less control at the
pelvis or across the scapular and shoulder areas.
 Solid inserts are available for the backrest when that type of support is required,
usually for people with cerebral palsy .

6. SHARMIN SUSIWALA
 Patients who cannot sit fully erect or otherwise need to be able to adjust the attitude
of the back can be provided with a semi-reclining back that can be adjusted to 30
degrees with the vertical. From this, the patient can be transferred between bed and
wheelchair somewhat easier.
 For patients that have to enter the chair from the rear, backrests with a vertical zipper
or snap fasteners for easy opening are available.
Seat and Back Angle Adjustments
 The angle that the seat makes relative to the horizontal plane can be adjusted, as can
the angle the back makes relative to the vertical plane.
 The adjustments separately or together are done to provide the best postural support
and comfort for the wheelchair user.
 Adjusting the seat so that it slopes downward toward the rear of the wheelchair (also
referred to as seat dump) can assist persons with limited trunk control by stabilizing
their pelvis and spine, making it easier to propel the wheelchair.
 Too much dump, can cause the pelvis to rotate backwards and the lumbar spine to
flatten. This increases pressure on the sacrum, increases the risk of skin breakdown,
and makes it more difficult to transfer into and out of the wheelchair.
 An increased back angle or reclined back might be needed when the person’s hips do
not flex well or gravity is needed to assist with balancing the trunk.
 Using a combination of seat and back angle adjustments increases the number of
possible postural accommodations.
4) Pelvic Positioner:
 A belt or pelvic positioner may be needed for safety and for assistance with postural
control.
 Padding may increase comfort and allow for tighter control thus maintaining pelvic
alignment.
 The direction, angle of pull and number of anchor points of belt is important.
 Angle of Pull to the seating surface should face normanlly be 45 to 60 deg.
 Some patients prefer 90 deg placement which leaves the pelvis free for anterior
tilting, an assist for those patients who can use this mobility for added function.
 Style of closure is by Velcro( most common) but for those who require a great deal of
control D-ring style closure belt, Cinching -style belt or Side-release buckles.
 While mounting the belt to the wheelchair's seat rail, caution should be used with
patients who push into excessive extension.
 The width of the belt and size of the buckle will affect the level of control offered.
 The belt and buckle must be correctly proportioned to the user's body.
o Children-1" wide
o Adults-2" wide
5) Wheels:
Typically, wheelchair have two sets of wheels:
Rear Wheels
Caster Wheels
REAR WHEELS:
 Two types of rear wheels are available: Solid mag wheels and Spoke wheels.
 Spoke Wheels- Spokes generally consist of thin aluminium or stainless steel wires
Lighter
Aid shock absorption
Easier to propel
They require more maintenance secondary to binding and loosening
 Solid Mag Wheels- Consists of 3 or more (commonly 6) large spokes
Heavier

7. SHARMIN SUSIWALA
Less Maintenance
More Durable
Less shock absorption so gives bumpier ride
 Other types of Wheels- Carbon-graphite Mag Wheels
Power Assist Wheels
 Rear Wheel Size: Adults-24" Pediatric-20"
 Too small or too low wheels- Difficult for seated riders to reach
 Too large or too high wheels- Result in shoulder elevation forcing humerus into
acromion.
 Adjusting axle position: Fig
FRONT WHEELS/ CASTERS:
 They are 2 in no.
 Allow steering of wheelchair in all directions
 Allow for greater foot clearance and agility but are more apt to get stuck in cracks
or bumps leading to forward falls.
 Size: 2" to 8" diameter.
PNEUMATIC CASTERS:
 Provide shock absorption.
 Good on uneven terrain.
 Allows least amount of ground clearance.
 High maintenance.
 Larger.
URETHANE CASTERS:
 Good on smooth terrain.
MODIFICATIONS:
 Adding an elastomer shock absorber "frog legs" in series with caster can
produce/provide a means of shock absorption and vibration reduction.
6) Tyres:
 Tires are available in many different sizes, tread designs and widths to accommodate
almost any type of terrain, as well as the individual's mobility needs.
 There are several types of tires available:
 SOLID TYRES:
o Made up of hard polyurethane or rubber.
o Heavier
o Lack "cushioning" on rough terrain.
o Have a decreased rolling resistance on flat or smooth surfaces.
o Designed for indoor use.
o Puncture proof.
 PNEUMATIC TYPES:
o Lightweight
o Provide cushioning against impact and vibration from rolling over surfaces.
o Increased rider comfort
o Improved wheelchair durability
o Recommended for outdoor usage
o They require maintenance as they puncture
o High rolling resistance
o Come with airless(flatfeet)insert that is a soft rubber or a latex gel that
replaces inner tube.
o Greater tread depth and lower tyre pressure provide more traction but require
more effort to propel the chair.
 ALL TERRAIN TYRES:
o Have a wire tread and are wider overall.

8. SHARMIN SUSIWALA
o Used for mobility on soft and sandy terrain.
 KEVLAR TYRES:
o Provide a durable and smooth ride.
7) Wheel Locks:
 Aka Brakes.
 Vary in type of action and position they are mounted.
 The type and position will be influenced by:
o Clients reaching ability, balance and strength.
o Clients hand function.
o Impact of Wheel lock position on transfers.
 Wheel locks act as parking brakes to stabilize the wheelchair when the rider transfers
to other seats or when rider wishes to remain in a particular spot.
 There are a variety of wheel locks used to restrain wheelchairs when transferring or
parking.
 High -Lock Brakes/Toggle:
 Located near front corner of seat, on upper tube of wheelchair's frame.
 Requires least dextrity.
 Pull to Lock or Push to Lock:
 Low Lock B rakes:
 Mounted at lower tube of wheelchair's side frame.
 Require more mobility to operate.
 Retractable Locks:(Scissor or Butterfly)
 Requires more extended reach
More difficult to engage.
8) Push Rims(Hand Rims):
 They are attached to wheel rim to allow propulsion and control safely without
touching the tire directly to avoid soiling the hands.
 Smaller thn the wheel rim to make chair easiert o propel.
 The type of push rims depends on user's grip.
 3 types:
o Standard Metal Rims:
 Circular steel tube
 Used when grip is good.
o Friction Rims:
 Standard Rims covered with a vinyl or foam tubing to provide
additional grip on rim surface.
 Used by patients with low level gripping ability.
 DA: Leads to burns when user attempts to slow down the Wheelchair
o Projection Rims:
 There are vertical, horizontal or oblique projections to improve
propulsion.
 Horizontal or Oblique projections increases the width of the chair.
 Used by people with limited reach and grip, like quadriplegics.
 These are usually knobs which are placed at intervals to give the user better grip and
leverage for propulsion.
 The greater the no. of knobs the greater is the facilitation of movement.
 Variations of Hand Rims:
 For patients with good hand function-a push rim called "Natural-Fit" is an
ergonomically designed hand rim that has been shown to decrease stresses placed on
UE during wheelchair propulsion.

9. SHARMIN SUSIWALA
 One-Hand Drive wheelchairs- 2 push rims used in patients with plexus injury, UE
amputee or hemiplegics.
9) Foot Plate:
 Front Rigging=Foot Rest+Leg Rest
 Foot Rest consists of a support bracket with a foot plate
 The footrest and legrest lengths are determined by measuring leg length from
popliteal fossa to heel.
 Footrests are commonly are 1"-2" from ground to ensure sufficient ground clearance
 Footrests are the first part of chair to come in contact with an obstacle, so they must
be durable.
 The footrests must provide sufficient support for lower legs and feet in presence of
postural control problems, limited ROM and/or abnormal tone.
 Types of footrests available:
o Swing Away
o Hook Lift Up
o One Piece Lift Up
o One Piece Lift Off
o Rigid
o Rigid Adjustable Angle
 Legrests consists of an elevating support bracket with swing away mechanism, a
footplate and a calf pad to support the back of leg when elevated.
 They are used for patients with impaired circulation or dependent edema.
 They are longer and heavier.
10) Arm Rests:
 Arm Rest provide a foam of support and are convenient handles to hold on to when
the rider leans to one side or other.
 They are helpful when attempting to reach to higher places.
 Commonly Used to perform a "push up" to assist with seat pressure relief.
 3 basic types:
o Wrap-Around
o Full-Length
o Desk Length
 Wraparound Arm Rest:
o Mount at back of wheelchair onto the frame below backrest.
o Comes up along the back of backrest support and wraps around to the front of
wheelchair
o Doesnt increase the width of wheelchair.
o Popular among active wheelchair users.
o DA: Doesnt serve as a side guard to keep the rider's clothing away from the
wheels.
 Full-Length and Desk-Length:
o Similar in design but length varies.
o Full-Length armrest provide support for nearly entire upperarm.
o They are popular on electric-powered wheelchairs as they provide convenient
and functional location for the joystick.
o They make it difficult to get close to some tables and desks.
o Give more room for UESS to get secured.
o Also afford the user a larger surface to grasp for pushups and transfers.
o Add as much as 5" to the width of wheelchair.
 Armrests can be fixed or height adjustable.

10. SHARMIN SUSIWALA
 Height Adjustable Armrests:
o May move up and down to accommodate the length of rider's trunk and arms.
o Provide clearance for transferring in and out of wheelchair
o Used for chairs ordered with built-in growth allowance.
o Permit placement of UESS without extensive custom modifications.
 Armrests can be tubular v/s standard.
 Tubular Armrests:
o More cosmetic but not suited for heavier individuals.
 Armrests-Too high-Excessive shoulder abduction
 Armrests-Too short-Encourage leaning
 Armrests- Space too far- Interfere with ability to wheel the chair.
11) Antitippers:
 Antitippers are devices that attach to the rear of the wheelchair frame
 Antitippers are often placed on wheelchairs to assure they do not tip over backward.
 These can inhibit the ability to climb curbs, but they do offer a measure of safety.
 These are designed to minimise the risk of the wheelchair tipping fully backwards
when a client loses their balance.
 Can make it difficult for the user to ascend a curb or pop a wheelie.
 The tube length can be adjusted to allow the user to traverse over small obstacles
while still providing some stability.
 They are not designed for a client to rest on in the tipped back position and this
should always be discouraged.
12) Grade-Aids:
 Grade-Aids are devices that attach to the wheel and allow it to roll forward but not
backward.
 In this manner, they make it easier to roll up a hill.
 These should be considered for individuals who have UL weakness and who must
negotiate hills.
13) Quick Release Hubs:
 Push button mechanism which allows the easy removal of rear wheels for
transportation or storage purposes.
 For clients with limited hand function-a form of lever-Quad release axles attached to
quick release button allow easy removal of wheels.
14) Push handles/Hand Grip:
 Push Handles aka Canes are attached to the back of chair with the primary purpose of
making it easier for an assistant to propel the wheelchair.
 Canes can also be used by the wheelchair occupant to help with pressure relief.
 The wheelchair user can hook the arm around the cane and pull to raise the
contralateral hip, even in the absence of triceps.
15) Tilt Bars:
 Tilt bars which project from the back of frame, usually 2"-3" above the floor, are used
by individuals who pushes the wheelchair.
 By placing foot on tilt bar and pushing down with the foot, the personcan tilt lift the
wheelchair back, allowing the casters to rise off the surface, thus enabling them to
clear a doorstep or kerb.

11. SHARMIN SUSIWALA
16) Rear Wheel Camber:
 Camber is the angle of rear wheel tilt.
 Zero degrees of camber implies that the rear wheels line up vertically and with the
side of the wheelchair.
 Most wheelchairs generally have up to 8 degrees of camber.
 Advantages
o Brings wheels inward and closer to the body, which enables the arms to access
more of the pushrim
o Reduces shoulder abduction because the wheels are closer to the body
o Increases lateral stability
 Disadvantages
o Wider wheelchair, which can be problematic in tight areas
o Diminished traction and uneven tire wear on a conventional tire (some tires
have offset treads that accommodate for camber).
17) Specialized Support Components:
 Head/Neck Supports:
o Provides support for patients with fair, poor, or absent head control.
o Posterior, lateral and anterior head or neck controllers available.
o Promotes maintenance of a neutral cervical spine and head position.
o Eliminates Lateral flexion and rotation.
o Supports the head to assist with respiration, visual interaction with
environment, feeding and swallowing.
o Improves safety during transport.
 Lateral Trunk Supports:
o Indicated in presence of weak or spastic trunk muscles.
o Can be straight or contoured for control
o Improves trunk stability and alignment along with pelvic alignment
o Controls lateral trunk flexion
 Anterior Chest Supports:
o Assists with maintenance of upright trunk posture and control of shoulder
position.
o Supports trunk along anterior surface of trunk and shoulders, eliminates
forward lean.
o May influence and discourage shoulder protraction.
o Stabilizes trunk to allow improved UE function and head control.
 Lateral Hip Guides:
o Improves pelvic alignment on seat.
o Assists with maintaining pelvic position on contoured seat
o Improves weight distribution on pelvis
o Improves pelvic positioning
 Lateral Knee Guides:
 Medial Knee Block:
 Anterior Knee Block:

12. SHARMIN SUSIWALA
 GOALS:
 The goals for a wheelchair or seating system are :
1. Maximize Functional Independence With Activities of Daily Living
 The wheelchair or seating system should enable individuals to perform the activities
of daily living (ADLs) that are important to them with minimal to no assistance and
with the least amount of energy expenditure.
 Types of activities can include transfers, personal needs (e.g., bathing, toileting),
working, preparing meals, cleaning, and shopping.
2. Minimize the Risk of Secondary Injuries
 It is imperative that individuals be provided with mobility devices that comply with
internationally recognized wheelchair standards and can be safely operated (as
determined by a skilled therapist or assistive technology professional).
 Seat belts, wheel locks, and a properly adjusted wheelchair can prevent serious
wheelchair-related injuries.
 Pressure ulcers are also a significant risk for those who use wheelchairs.
 Advanced cushion designs and seat functions can provide adequate pressure relief for
person who cannot independently off-load the buttocks.
 Shoulder pathology and nerve compression injuries at the wrist are common among
wheelchair users.
 Using proper wheelchair propulsion biomechanics and an optimal wheelchair setup
can help delay the onset of overuse injuries.
3. Correct or Accommodate for Skeletal Deformities
 When the skeletal deformity is “flexible,” the seating system should correct the
deformity, and when the skeletal deformity is “fixed,” the seating system should
accommodate the deformity.
 The seating system should not create a “new” deformity such as a sacral posture
(posteriorly tilted pelvis), which results from sitting in a seat that is too long or using
footrests that do not account for tight hamstrings.
4. Ensure Comfort
 Along with mobility, comfort has been reported as the most important attribute or
function of a wheelchair.
 Research has shown that most wheelchair users experience regular discomfort. Many
either ignore it or seek relief by getting out of the wheelchair, using pain medications,
or doing weight shifting (either manually or with tilt and recline).
 A wheelchair that allows for “fine-tuning” of the adjustments provides greater options
for achieving comfort, as well as meeting the individual’s postural and pressure
needs.
5. Promote Positive and Unobtrusive Self-Image
 Because a wheelchair is often considered as an extension of one’s body, it should be
as aesthetically appealing as possible.
 Wheelchair designers and manufacturers are using materials that not only have high-strength
mechanical properties, but also have finishes that are smooth, polished,
sleek, and attractive.

13. SHARMIN SUSIWALA
 PRESCRIPTION PROCESS:
 A prescriptive wheelchair is a combination of a postural support system and a
mobility base that are joined to create a dynamic seated environment.
 Postural support system is made up of surfaces that contact the user's body directly.
This includes seat, back and foot supports as well as any additional components
needed to maintain postural alignment.
 Mobility Base consists of tubular frame, armrests, foot supports and wheels.
 Selecting the most appropriate wheelchair and seating system requires that
information be obtained about type of disability, prognosis, physical capacity and
limitations, involvement in work or related activities, physical and social
environment, and means of transportation.
Criteria to be considered while selecting a Wheelchair
Include selecting a chair that:
 Has the lightest weight possible.
 Has a stable frame for most efficient movement.
 Is well-manufactured, with high-quality bearings for less roll resistance when push
forces are applied, and secure non-moving parts.
 Has optimal wheel size and type for individual patient function.
 Provides the best possible combination of ease of propulsion and stability.
Team Approach
 It is important to involve an interdisciplinary team in the decision-making process.
 The most important team member is the patient.
 The family and caregiver should also provide input, as they will be the next most
affected by the choice of wheelchair.
 To ensure that the most suitable device is obtained, the team must have a clear idea
of:
- Who will be using it
- What functional level is expected
- Where the chair will be used
 The assessment team can consist of :t Team
o Patient
o Rehabilitation engineer
o Occupational therapist
o Physical therapist
o Rehabilitation technology supplier
o Speech and language pathologist
o Rehabilitation physician
Assessment
 To complete a thorough assessment of a wheelchair for a client many different factors
need to be considered.
 These are described below and are guidelines for the assessment process :
CLIENT

14. SHARMIN SUSIWALA
1) Client goals - includes intended use of equipment, preferences, importance of
cosmesis, likes/ dislikes of current chair.
2) Client profile – this includes client attributes such as physical strength and functional
abilities, balance, pain, contractures or deformities, postural issues, experience of the
client with the equipment
3) Seating requirements – for example this will include the type of cushion or back
support that will be used
4) Environment – includes the home, community and the workplace/study facility etc.
Consider the clients life style with respect to leisure and recreation
5) Portability and transport – ability for the client to collapse the wheelchair into the
car, ability for storage in the vehicle with the rest of the family etc
6) Geographical location of client– access to repair centres, rural and remote issues
CARER
1) Carer goals and comments
2) Manual handling issues
3) Issues with any current equipment
4) Maintenance issues and abilities
WHEELCHAIR
1) Reliability and durability
2) Level of maintenance required
3) Options and accessories available
4) Supplier service and follow-up
5) Availability for the wheelchair to be trialled from supplier
6) Cost
 Medical Variables:
 Age, past medical history and present medical history.
 The underlying medical conditions that require prescription of a wheelchair should
be assessed.
 The prognoses for certain conditions need to be considered in the prescription
decision, especially if a condition is progressive.
 Equipment should ideally address current and future needs based on the anticipated
natural progression of a disease or condition.
 In addition, other factors that need to be taken into account include pain, obesity,
cardiopulmonary or musculoskeletal problems, and risk for falls.
 Potential risks and secondary injuries such as pressure ulcers, postural deformities,
or upper limb repetitive strain injuries associated with the use of equipment need to
be assessed and considered.
 To assure that there are no ongoing medical problems or complications that can
affect the wheelchair prescription and the patient’s health.
 Physical and Functional Variables/ Physical Examination:
 A physical examination should focus on aspects of the patient that will help:
(a) justify the wheelchair and seating system,
(b) determine the most appropriate wheelchair and seating system, and
(c) assure that medical issues are appropriately addressed.
 Often individuals require a wheelchair because of cardiopulmonary disease,
musculoskeletal or neurologic deficits.
 It is essential to determine if the individual’s physical impairment is changing rapidly
or is stable.
 It is important to understand both the intentions and the abilities of the user.
 Obvious examination items include physical-motor assessment of strength, range of
motion, coordination, tone, and proprioception, balance, posture, contractures,
endurance, sitting posture, cognition, perception, and use of external orthoses.

15. SHARMIN SUSIWALA
 The physician should be thinking about how the individual will control the
wheelchair. If there is poor hand coordination, head control or switch control, foot
joystick may be needed.
 It is important to establish how long the individual will be using the chair.
 Physical assessments should be followed by observation of performance in ADLs that
are reported by the person or the family or caregiver as being essential. These include
self-care, reaching, accessing surfaces at various heights, transferring to various
surfaces, and functional mobility.
 Functional mobility should be assessed in the user’s home and community.
 Ambulation should be assessed from the perspective of the surfaces and distances
encountered in a routine day.
 Access to a range of heights might be important to reach objects in the home and
other environments.
 Stability can be assessed by observing the individual in the current wheelchair or by
asking him or her to sit unsupported on a mat table. Ask the patient to perform
simple reaching tasks to determine the lateral and forward stability of the trunk,
,hand and arm strength, and hand fine motor skills.
 Poor stability usually indicates the need for special attention to seating and position.
 Appropriate seating can enhance reach and stability, thus improving the performance
of manual activities from the wheelchair.
 Likewise, spinal deformities like the presence of kyphosis, scoliosis, or other fixed
deformities need to be accommodated in the design of the backrest, to allow the user
to tolerate sitting.
 Assessment of pelvic alignment is critical because the pelvis becomes the base of
seating support. An obliquity of the pelvis to one side needs to be accommodated or
corrected (if possible) to prevent leaning or development of spinal deformities.
 ROM measurements: Hip Flex, Abd, Add, IR and ER; their effect on pelvic position
and general body alignment should be noted as well.
 Determine what seat-to-back angle can be tolerated.
 Tight hamstrings significantly affect the positioning of foot supports.
 It is important that excessive tension not be placed on the hamstrings because this
can be painful and pull the pelvis into a posterior tilt.
 It is also necessary to respect a person’s preference for different seated postures, even
if these postures do not appear appropriate.
 Examination of upper and lower extremities
 Evaluation in upper extremities include:
-ROM and strength
-grasp patterns
-eye-hand coordination
-joint stability
-movement patterns
-functional use of hands
 Evaluation in lower extremities include:
-ROM
-joint stability
-movement patterns and function
-foot propulsion
-weight bearing and transfers
 Skin Examination:
 This may not be needed for individuals with cardiopulmonary disease, but it is
essential for individuals with neurologic deficits or those with previous history of
pressure sores.

16. SHARMIN SUSIWALA
 The examination should include not only the buttocks but also the feet and calves,
which can be affected by pressure against a leg rest.
 Attention should be paid to bony prominences and previous scars.
 This examination will help with cushion selection and wheelchair setup.
 Environmental Variables:
 It is important to assess both the physical and social environments.
 The assessment process involves obtaining critical information about the user and his
or her environment, family support, and past use of assistive technology.
 A home assessment is often needed to ensure that the device will be compatible,
especially when there are stairs, narrow doorways and hallways, or other tight spaces
to be negotiated.
 The assessment involves taking devices to the home, surveying the environment for
accessibility, and having the user get into the device and maneuver it in the spaces
used in a typical day.
 The wheelchair model chosen should also be compatible with the user’s public and
private transportation needs (such as a bus, train, car, van, or airplane) and
home/Activities of Daily Living (ADL) environment.
 The social environmental assessment includes the roles, interests, responsibilities,
and occupation important to the user. The roles include being a parent, spouse,
worker, homemaker, or community volunteer. The level of available assistance from
others needs to be assessed from the perspective of the ability to maintain and
troubleshoot complex equipment.
 The physical capacity and health of caregivers need to be assessed.
 Family, social, and cultural values can be barriers or can facilitate a person’s
inclusion in the community.
 Also, if the patient has been using a chair, historical information about his or her
current chair should be addressed, including problems he or she may be having.
 Aesthetics:
 Aesthetics is an increasingly extremely important factor in wheelchair prescription.
 This is because a wheelchair is such a personal and intimate product.
 The appearance of the wheelchair is mainly a function of the frame design and
materials.
 It is important that wheelchairs have as attractive an appearance as possible so that
the user is pleased with using it and gains the most positive attention possible from
peers and from the community.
 Transportation Variables:
 The feasibility of assembling and disassembling equipment by the user or caregiver,
however, needs to be carefully assessed.
 The portable design can compromise durability as well as the capabilities of the
device to negotiate uneven and soft surfaces.
 If transporting the wheelchair and seating system is an essential goal, the person
should get an opportunity to try it before the final prescription is written.
Documentation
Medicare Recommended Documentation Items
• Symptoms
• Related diagnoses
• History
a) How long the condition has been present
b) Clinical progression

17. SHARMIN SUSIWALA
c) Interventions that have been tried and the results
d) Past use of walker, manual wheelchair, scooter, or power wheelchair and the results
• Physical exam
a) Weight
b) Impairment of strength, range of motion, sensation, or coordination of arms and
legs
c) Presence of abnormal tone or deformity of arms, legs, or trunk
d) Neck, trunk, and pelvic posture and flexibility
e) Sitting and standing balance
• Functional assessment
a) Any problems with performing activities including the need to use a cane, walker,
or the assistance of another person
b) Transferring between a bed, chair, and wheelchair
c) Walking around their home––to bathroom, kitchen, living room, etc.––provide
information on distance walked, speed, and balance
Measurements
PATIENT MEASUREMENT:
Supine postion: Fig 33.3 Sullivan
 SEAT DEPTH- Examiner supports the LEs in an optimal position and
neutralize pelvis. Measurement is done from the undersurface of the thigh
from the popliteal fossa directly down to the support surface and obtain a
right and left measurement.
 FOOTREST LENGTH MEASUREMENT: Measure the leg length from the
popliteal fossa to the heel.
Sitting position: Fig 33.5 Sullivan
A. SEAT DEPTH- Behind the buttock to the popliteal fossa.
B. FOOTREST LENGTH- Popliteal fossa to heel.
C. KNEE FLEXION ANGLE-BACK
HEIGHT
D. Sitting surface to PSIS.
E. Sitting surface to lower scapula
F. Sitting surface to top of shoulder
G. Sitting surface to occiput
H. Sitting surface to Crown of head.
ARMREST HEIGHT:
I. Hanging Elbow from sitting surface to the elbow or forearm
SEAT WIDTH:
J. Between lateral aspects of trunk
L. Between the lateral aspects of greater trochanters in sitting
K. SEAT DEPTH:
M. MEASUREMENT OF FOOT LENGTH
WHEELCHAIR MEASUREMENT:
 SEAT WIDTH: measurement is generally from outside of frame to outside of frame.
 SEAT DEPTH: measurement is from the front of the upholstery to the back upright
(where the upholstery is attached).
 BACK HEIGHT: measured from the top of the seat rail to the top of the upholstery (at
the side).

18. SHARMIN SUSIWALA
 SEAT TO FOOTPLATE DISTANCE: measurement is from the top of the seat rail at
the front of the chair to the rear of the footplate below.
 REAR SEAT TO FLOOR HEIGHT: measurement is from the top of the seat rail (at
the rear) to the floor.
 FRONT SEAT TO FLOOR HEIGHT: measurement is from the top of the seat rail (at
the front) to the floor.
 FRONT FRAME ANGLE: This is an angle measurement from the seat to the footplate
hangers from the floor.
Goals of Prescription
 A well-planned seating system may be able to:
 Normalize tone
 Decrease pathological reflex activity
 Improve postural symmetry
 Enhance ROM
 Maintain or improve skin condition
 Increase comfort and sitting tolerance
 Decrease fatigue
 Improve function of ANS
 Effective in accomplishing all recreational and vocational activities
 Assist caregiver with patient management
Postural Goal: To achieve thr optimal trunk position because all function, both central and
distal is based on position and control of trunk and limb girdles.
Mobility Goal: To provide efficient ease of movement from the users and caregivers
perspectives.
System Outcome: To provide comfort and maximal functional independence.
Considerations for Selected Populations
Pediatric:
 Children have special mobility needs.
 Those must have following features:
o Wheeled mobility that can be adjusted to accommodate growth
o Mobility that can be managed by parents (i.e., wheelchairs that can be readily
disassembled for car transport).
o Special technology to complete school assignments, such as augmentative
communication aids, alternative computer access, and sensory aids. These
devices are often mounted on the wheelchair so they can travel with the child
to and from school.
o Wheelchairs that facilitate interaction with other children. One example is a
power wheelchair that lowers the seating surface to the floor so that the child
is at eye level with peers and can participate in exploratory activities that
unimpaired children carry out while seated on the floor.
o Early utilization of powered mobility as medically necessary, to promote
psychosocial development, reduce learned helplessness, and facilitate social
and educational integration and independence
Progressive Disorders
 Progressive disorders such as amyotrophic lateral sclerosis, multiple sclerosis, or
Parkinson’s disease require special consideration when prescribing a wheelchair and
seating system.
 They might have trouble at times because of fatigue, tremors, and weakness.
 Power wheelchairs with programmable functions are good choices because they can
be tailored to the individual’s driving abilities as the disease progresses, and can
accept multiple inputs (e.g., joystick, head array, sip and puff).

19. SHARMIN SUSIWALA
 From a seating perspective, these patients will need periodic seating updates as the
disease progresses.
 Indoor-outdoor power wheelchairs allow for interchanging seating and positioning
hardware, or adding a tilt or recline system, or both.
Vision Impairments
 Individuals with low vision have an additional challenge when using wheeled
mobility.
 When using wheeled mobility, the arms can no longer explore ahead of the body and
are partly occupied either with propulsion or using a joystick to drive.
 Driving safety with wheeled mobility has to be assessed in individual cases.
Weight Disparity
 Individuals with chronic disabilities who use wheeled mobility are at risk for weight
problems.
 Reduced tissue thickness across bony prominences increases the risk of pressure
sores.
 On the other end of the weight disparity spectrum, the sedentary lifestyle of wheeled
mobility can result in poor fitness and obesity.
 In addition to the regular health risks, obesity has an impact on wheeled mobility in
the following
ways:
o A wider, heavier wheelchair is required. This can impose navigation limits on
access through narrow doorways and small rooms.
o Propulsion of manual wheelchairs is interfered with, and more force is
required to overcome the increased rolling resistance.
o Transfers, pressure relief, and personal care are substantially more difficult,
leading to an increased risk for skin breakdown and pressure ulcers.
o Third-party funding is sometimes delayed because some funding sources
believe obesity is a preventable complication.
Older Adults
 Aging can be thought of as a collection of progressive disorders that can complicate
wheelchair prescription and seating.
 The older patient is frailer and requires extra diligence by the clinician.
 The partner should be included in the clinical decision-making, and it often necessary
to have a home assessment made to determine additional hazards or
accommodations required.
 Effects of aging vary widely, but pertinent problems include the following:
o Osteoporosis, stress fractures and arthritis. These can increase pain, limit
range of motion, and reduce sitting tolerance.
o Impaired circulation resulting from coronary artery disease and diabetes,
which can increase the risk of pressure ulcers
o Sedentary lifestyle, with weight gain and reduced muscular strength
o Cognitive impairments and depression
o If an older patient relies on a partner for personal care, aging of the partner
can limit this assistance and result in a caregiver injury during a strenuous
procedure such as a transfer.
o Older patients are often on fixed incomes and might be unable to absorb the
cost of chair accessories.
Wheelchair Modifications
 There are five justifications for modifying specific wheelchair parts and presenting new
models:
o To facilitate transfers

20. SHARMIN SUSIWALA
o To facilitate proper positioning
o To allow its own transportation
o To allow self-propulsion
o To permit transportation of objects, in the wheelchair
o To overcome architectural barriers
 TYPES OF WHEELCHAIR:
1) Manual Wheelchair
2) Pediatric Wheelchair
3) Sports and recreation Wheelchair
4) Power Wheelchair
5) Scooter
6) Stand Up Wheelchair
7) Recliners
 Manual Wheelchairs
Persons with good upper body function and stamina might well be able to use a manual
wheelchair for mobility.
Advantages of Manual Wheelchairs
o Easy Transportation
o Maintenance: Can be worked on independently
o Exercise: Theoretical benefit to the user from using own force to propel leading to
promotion or maintenance of physical fitness
o Aesthetics: Less appearance of disability
o Lighter weight
o Lower cost
o Greater portability
o Greater efficiency
o Increased maneuverability
o Easier to handle/operate
o More easily covered by insurance and payment providers.
Disadvantages of Manual Wheelchairs
o The single greatest disadvantage of manual wheelchair use is the possibility of
contracting an upper body repetitive strain injury.
o Less stability
o Less comfort
o Require inflation of tires
o Cannot be travelled to longer distances and at high speed without the user getting
fatigued.
Types of Manual Wheelchairs:
1. Standard/Depot and Attendant-Propelled Wheelchairs
2. Lightweight
3. High strength Lightweight
4. Ultralight Weight
5. Heavy Duty
6. Extra Heavy Duty
Depot and Attendant-Propelled Wheelchairs

21. SHARMIN SUSIWALA
o The depot or institutional wheelchair is the default chair intended for institutional
use.
o These wheelchairs are typically used in airports, hospitals, and nursing care facilities.
o They are inappropriate for active people who use wheelchairs for personal mobility,
including older persons in nursing homes.
o Depot wheelchairs are designed to be inexpensive, to accommodate large variations
in body size, to be low maintenance, and to be attendant propelled.
o Depot chairs are designed neither for the comfort of the person being transported nor
for the person pushing the chair. A typical depot wheelchair will have swing-away
footrests, often removable armrests, a single cross-brace frame, and solid tires.
o Depot wheelchairs have sling seats and back supports, which are uncomfortable and
provide little support.
o Swing-away footrests add weight to the wheelchair; however, they make transferring
into and out of the wheelchair easier.
o Armrests provide some comfort and stability to the depot wheelchair user and can aid
in keeping clothing off the wheels.
o Depot chairs typically fold to reduce the area for storage and transportation.
o Solid tires are commonly used to reduce maintenance.
o Solid tires typically dramatically reduce ride comfort, increase rolling resistance, and
add weight.
o Leg-rest length is adjustable.
o Depot chairs are available in various seat widths, seat depths, and backrest heights.
Lightweight Wheelchairs
o These chairs do not offer features suchas adjustable axle plates, quick-release wheels,
or a method to change the seat to back angle of the wheelchair.
o Generally have sling-type upholstery. Sling upholstery has no capacity to provide
pressure relief, and the hammock effect that occurs from wear causes uncomfortable
and unstable inward rotation of the hips.
High Strength Lightweight Wheelchairs
o They are designed for long-term use by individuals who spend more than a couple of
hours each day in a wheelchair.
Ultralight Wheelchairs
o The ultralight wheelchair is the highest-quality chair that is designed specifically as
an active mobility device.
o These chairs are usually highly adjustable and incorporate numerous design features
made to enhance the ease of propulsion and increase the comfort of the wheelchair
user.
o Made of titanium or high strength aluminium and can easily weight less than 20 lb.
Heavy Duty and Extra Heavy Duty Wheelchairs
o Pertain to persons who weigh more than 250 lb.
o These wheelchairs are heavier than the wheelchairs in the other classes, to support
more body weight.
o Extra–heavy-duty” wheelchairs also referred to as bariatric wheelchairs are built to
support individuals who weigh between 300 and 1000 lb.
o These chairs are built for transport and not self-propulsion.
Alternative Manual Wheelchairs
o Two alternatives worth mentioning are chairs for amputees and chairs for individuals
with hemiparesis.

22. SHARMIN SUSIWALA
o Wheelchairs for individuals with amputations are typically designed with the rear
axle set far behind the user.
o This is needed because the absence of a leg causes the body’s center of gravity to be
shifted posteriorly, thus reducing rearward stability.
o Unfortunately, all of the negative aspects of a rearward axle are present.
o An alternative can be to add weight to the front of the wheelchair.
o For individuals with hemiparesis or other disability that makes propulsion with a leg
or both legs superior to propulsion with the arms, a “hemiheight” chair is an
alternative.
o In this chair, there is typically one footrest or none at all, and the seat is low enough
to the ground so that the feet can reach the floor.
o For an individual with hemiparesis, the use of the uninvolved arm and leg can
provide limited, but functional, propulsion.
o Another alternative for an individual with hemiparesis is a one-arm drive chair.
o This chair has two push rims on one side that control separate wheels.
o One-arm drives are heavier than standard chairs and can be difficult to control.
o These limitations make them less than ideal for an elderly stroke patient.
 Pediatric Wheelchairs
o Pediatric manual wheelchairs are similar to the adult wheelchairs but are smaller
(seat width or depth <14 inches).
o Several variables in system design need to be considered with children, including
developmental status, mobility, growth, age-appropriate activities, school, therapies,
the environment, and family issues.
o Children not only change in size but their disability also often changes as they grow,
even in nonprogressive disorders such as cerebral palsy.
o Mobility is the precursor to all childhood development. Children need to explore their
environment to know where things are and how to get them. The need for specific
types of mobility bases, such as strollers, self-propelled systems, and powered
systems, will depend on the age and the physical, developmental, and functional
capabilities of the child, as well as the environmental and transportation resources of
the family.
o If the child is unable to self-propel the chair, a powered mobility device might provide
independent mobility
 Power Wheelchairs
 People who do not have the strength or stamina to propel manual wheelchairs
typically need power wheelchairs for mobility independence.
 Power wheelchairs can be grouped into four broad categories based on wheelchair
features and their intended use:
(1) conventional power wheelchairs;
(2) folding and transport power wheelchairs;
(3)combination indoor-outdoor power wheelchairs;
(4)heavy-duty indoor-outdoor power wheelchairs.
 Use of powered mobility facilitates independence, improves occupational
performance, and is correlated with a higher sense of quality of life for people who
cannot ambulate or propel a manual wheelchair effectively.
1. Conventional Power Wheelchairs
 Conventional power wheelchairs are not programmable (e.g., no adjustments in
acceleration or deceleration, turning speed, joystick sensitivity) and have very basic
seating with limited sizes available

23. SHARMIN SUSIWALA
 They are low cost and low quality
 They are appropriate for limited indoor use for individuals with good trunk control
who do not need specialized seating.
2. Folding and Transport Power Wheelchairs
 Folding and transport power wheelchairs are designed for easy disassembling to
facilitate transport
 They are usually compact for indoor use and have a small footprint (i.e., area
connecting the wheels) for greater maneuverability in confined spaces.
 They might not, however, have the stability or power to negotiate obstacles outdoors.
 The batteries are often housed in separate boxes having easy-to-separate electrical
connectors.
 These wheelchairs are typically used by individuals with reasonably good trunk and
upper body control.
3. Combination Indoor-Outdoor Power Wheelchairs
 Combination indoor-outdoor power wheelchairs are often purchased by people who
wish to have mobility indoors (home, school, work) and in the community, but who
stay on finished surfaces (e.g., sidewalks,driveways, flooring).
 These wheelchairs are equipped with standard proportional joysticks and standard
programmable electronics (e.g., speed adjustment, tremor dampening, and
acceleration control).
 They come with either standard seating or rehabilitation seating .
 Rehabilitation seating allows for the attachment of modular seating hardware (e.g.,
backrests, cushions, laterals, hip guides, and headrests).
4. Heavy-Duty Indoor-Outdoor Power Wheelchairs
 Heavy-duty indoor-outdoor power wheelchairs are for use by people who live in
communities without finished surfaces.
 These wheelchairs usually have large-diameter drive wheels with heavily treaded tires
or four-drive wheels for climbing obstacles and traversing rough terrains.
 Wheelchairs that can support persons who weigh more than 250 lb also fall under
this category.
 These wheelchairs usually weigh 300 to 500 lb.
 Power seating options, such as tilt-in-space, power recline, and seat elevation, can be
integrated with wheelchairs to adapt for progressive medical conditions or severe
disability.
 Another advantage is that the position of the wheels with respect to the seat can often
be changed.
 Power wheelchairs typically use two deep-cycle lead acid batteries in series, each
producing 12 V, for a total of 24 V.
 There are two types of lead-acid batteries: wet-cell batteries and gel-cell batteries.
Power Bases
 The power base is the lower portion of a power wheelchair that houses the motors,
batteries, drive wheels, casters, and electronics to which a seating system is attached.
 The base allows for the mounting of any variety or combination of different seating
systems and seat functions, including tilt-in space, reclining back, elevating leg rests,
and seat elevator.
Drive Classification:
 Power wheelchair bases can be classified as:
Rear wheel drive (RWD)
Mid-wheel drive (MWD)
Front wheel drive (FWD).

24. SHARMIN SUSIWALA
 The classification of these three drive systems is based on the drive wheel location
relative to the system’s center of gravity.
 The drive wheel position defines the basic handling characteristic of any power
wheelchair.
 Each system has unique driving and handling characteristics.
RWD:
 In RWD power bases the drive wheels are behind the user’s center of gravity, and the
casters are in the front.
 The rear-wheel drive power wheelchair steers and handles predictably, and naturally
tracks straight, making it is the most appropriate drive configuration for high-speed.
applications
 RWD systems are the traditional design and it is preferred by people who drive with
special input devices (chin joystick, head array, etc.) or have reduced fine motor
coordination.
 A major advantage of an RWD system is its predictable drive characteristic and
stability.
 A potential drawback to an RWD system is its maneuverability in tight areas because
of a larger turning radius.
MWD:
 Has been one of the fastest growing power bases in the wheelchair industry
 In MWD power bases the drive wheels are directly below the user’s center of gravity
and generally have a set of casters or antitippers in the front and rear of the drive
wheels.
 The midwheel drive can be among the most effective at both ascending and
descending obstacles for skilled and practiced users.
 The advantage of the MWD system is a smaller turning radius to maneuver in tight
spaces.
 A disadvantage is a tendency to rock or pitch forward, especially with sudden stops or
fast turns. When transitioning from a steep slope to a level surface (like coming off a
curb cut), the front and rear casters can hang up, leaving less traction on the drive
wheels in the middle.
 These wheels are equipped with suspension and shock absorbance systems that
enhance forward stability and small obstacle climbing capability.
FWD:
 A FWD power base has the drive wheels in front of the user’s center of gravity, and
the rear wheels are casters.
 The advantage of an FWD system is that it tends to be quite stable and provides a
tight turning radius.
 It is a very stable setup for uneven terrain and hills. It has the best capability to climb
forward over small obstacles.
 FWD systems may climb obstacles or curbs more easily as the large front wheels hit
the obstacle first.
 A disadvantage is that an FWD system has more rearward center of gravity;
therefore, the system may tend to fishtail and be difficult to drive in a straight line,
especially on uneven surfaces.
 The overall turning radius is smaller than that of rear-wheel drive, but larger than
that of the midwheel drive power base.
 The front-wheel drive power wheelchair has a tendency for the back of the chair to
wander side to side (“fishtailing”), especially with increased speeds.
 This directional instability requires steering corrections, which could make the
wheelchair difficult for some users to steer.

25. SHARMIN SUSIWALA
Adavantages of Power Wheelchair
 Energy conservation
 Greater comfort
 Increased stability
 More accessories and extra options.
 Distance: Can travel long distances without fatigue
 Speed: Can travel at higher speed without fatigue
 Terrain: May be able to traverse rougher terrain
 Protect the arm: Avoid repetitive strain injuries that are due to manual wheelchair
propulsion
Disadvantages of Power Wheelchair
 Less portability
 Weigh considerably more
 Require additional maintenance
 Decreased maneuverability (especially on certain terrains)
 Require more effort in terms of insurance coverage
 Expensive
Controls
 The majority of input controls are programmable, allowing changes in speed and the
amount of movement to determine the direction of the wheelchair.
 Includes: Joysticks, Mini Joysticks, Sip and Puff, Switches and Buttons, Head array,
Voice control.
Integrated Controls
 Wheelchair input devices are used for controlling both wheelchairs and electronic
aids to daily living or computers.
 When a single control interface (e.g., joystick, head switches, voice recognition
system, or keypad) is used to operate two or more assistive devices, the system is
called an integrated control system.
Programmability
 Performance of a power wheelchair also depends on how the wheelchair control
module has been adjusted.
 Not all power wheelchairs are programmable, but programming or fine-tuning the
wheelchair to meet the needs of the individual user can improve control, safety, and
maneuverability.
 Fast and simple adjustments can be made for directional control (forward, reverse,
and turning), speeds (acceleration and deceleration), and sensitivity of the joystick.
 These adjustments affect how the wheelchair responds to different commands.
Power-Assisted Wheelchairs
 A developing class of wheelchairs provides a power assist when desired, but allows
the user to push the wheelchair as one would with a manual wheelchair.
 Power-assisted wheelchairs have force/moment-sensing push rims that provide an
additional torque to the rear axle proportional to the applied moment.
 Such devices have potentially important benefits, such as allowing individuals to
perform tasks faster and easier.
 In addition, people who normally would need to use a power wheelchair are able to
self-propel a power-assisted wheelchair despite obstacles such as steep ramps.
 Finally, when using a power-assisted wheelchair, oxygen consumption and heart rate
are significantly lower.

26. SHARMIN SUSIWALA
 For individuals with upper-limb pain or tetraplegia, the power-assisted wheelchair
may prove to be a good compromise between a manual wheelchair and a power
wheelchair.
 These devices are particularly likely to help those with muscle paralysis or weakness,
overuse, and fatigue.
 They are also ideal for individuals who are apprehensive about transitioning to a fully
powered wheelchair. This can be due to not wanting to be viewed by peers as being
“more disabled,” having homes that do not accommodate the increased size, lacking
the financial resources, or having difficulties with transportation.
 Sports and recreation Wheelchair
 Sports and recreation wheelchairs are designed specifically for participating in such
athletic endeavours as racing, rugby, tennis, dancing and basketball.
 Features:
Lightweight frame
Wide wheel Camber
 Some of the sport wheelchairs have only one wheel in the front, which allows quick
turns and enhanced maneuverability
 Individuals who compete in road racing will need competition chairs that have taken
many of their design features from racing bicycles: narrow hard tires, lightweight
frame, low seats, small pushrims for higher gearing.
 For tennis and dance, the chair is slimmed down to its sleekest configuration with all
its accessories, even wheel locks removed.
 The backs are as low as possible to leave the user's upper body free for movement.
 Scooters
 Provide intermittent mobility support for individuals with good arm strength, trunk
balance, and ability to transfer in and out of the device.
 These devices typically have a single front wheel for steering and two drive wheels in
the back.
 Steering is accomplished via hand bars that are intuitive to users who have previously
used a bicycle.
 Seating is provided in a chair having foam padding typical of a car seat.
 The backrest height ends at the level of the shoulder blades, which allows for
unencumbered rotation of the trunk.
 Have a greater degree of social acceptability than wheelchairs.
 Three-wheeled scooter are more common than four-wheeled scooters, which can
traverse more rugged terrain but are large for most indoor settings.
 Compared with power wheelchairs, many scooters are relatively easy to disassemble
for storage in a car or trunk.
 Scooters also cost lesser than a typical power chair.
 They lack the capacity to allow modification of seating to accommodate postural
deformities and have limited control options.
 They cannot accommodate for changes as the user’s needs change, and are not
recommended for persons with progressive medical conditions such as multiple
sclerosis and amyotrophic lateral
 sclerosis.
 In general, scooters are a reasonable option for individuals who retain some ability
to ambulate, such as those with cardiopulmonary disease limiting the ability to walk.
 Advantages
Lower Cost
Easier to assemble and disassemble for transportation

27. SHARMIN SUSIWALA
Better than some chairs at rough terrain
Less perceived stigma of disability
 Disadvantages
Less stability
Require greater arm strength and control to drive
Fewer seating options
Poor turning radius
 Stand-Up Wheelchairs
 Stand-up wheelchairs offer a variety of advantages over standard wheelchairs.
 The ability of a person to achieve an almost vertical position has several advantages,
including physiologic (i.e., pressure relief, improved circulation and digestion, and
improved bone density), practical (i.e., improved reach to higher surfaces, which
increases functional independence), and psychological (i.e., interacting with
colleagues face to face)
 Stand-up wheelchairs are more complex than most manual or power wheelchairs.
 All power wheelchairs with a stand-up feature use a separate electric drive system for
the stand-up mechanism.
 This type wheelchair has a very high center of gravity and can easily topple over.
 User of a stand-up wheelchair should never transition into a standup position when
outdoors or when on a cracked, rough, or broken floor indoors.
 Stand-up wheelchairs are safe only on perfectly flat and smooth flooring, and only if
the user is properly strapped and secured to the seat and seat back.
 People who have not stood for a long time might not have the hip, knee, or ankle
range of motion to accommodate standing, and can experience orthostatic
hypotension.
 The stand-up mechanism also adds weight to the wheelchair, making it more difficult
to lift and transport.
 Recliners
 Patients with poor postural control, abnormal tone, muscular shortening, or skeletal
deformities often require wheelchairs that offer varied positioning possibilities.
 A frame which offers fixed or adjustable posterior tilt-in space orientation is needed.
 These frames are combined with reclinable back or angle-adjustable seating surface.
 Wheelchairs that tilt-in space with all their angles preset are called Tilt-in space
Wheelchairs
 They also offer components for positioning, such as head and torso supports.
Manual V/S Powered Wheelchair
Manual Wheelchair Power Wheelchair
Transportation: Easy to transport; can travel
with friends without special vehicles.
Transportation: Difficult to transport
because of heavyweight; needs special
vehicle to transport.
Maintenance: Doesnt require high
maintenance; Can be worked
on independently.
Maintenance: High maintenance concerns
related to batteries or controllers.
Exercise: Theoretical benefit
to the user from using own force to propel
leading to promotion or maintenance of
physical fitness
Exercise: Not much physical benefit to the
user.

28. SHARMIN SUSIWALA
Chances of more RSI to UE due to
wheelchair propulsion.
Protect the arm: Avoid repetitive strain
injuries that are due to manual wheelchair
propulsion
Aesthetics: Less appearance of
Disability
No Aestherics.
Distance: Cannot be travelled at longer
distances; User gets fatigued.
Distance: Can travel long distances without
fatigue
Speed: Cannot travel at higher speeds. Speed: Can travel at higher speed without
fatigue
Terrain: Not much suitable for rougher
terrain.
Terrain: May be able to traverse
rougher terrain.
 WHEELCHAIR TRAINING:
 New wheelchair users should go through a wheelchair-training program.
 During this time the patient will learn:
- Basic movements within the chair
- How to propel the chair in all directions.
- How to operate the wheel locks, foot supports, and armrests.
- Use the mechanisms safely without tipping forward or sideways out of the chair
seat.
- How to transfer in and out of the chair with maximum to least possible assistance.
- To perform a Wheelie.
- How to maintain Wheelchair
 Wheelchair users can first practice basic maneuvers like wheelchair to bed,
wheelchair to chair, or toilet(sideways and backwards).
 Then in controlled environments like transition to uneven surfaces and slope
transitions (i.e., level to sloped surfaces) in both the uphill and downhill directions
and maneuvering through tight environments.
 Once these skills are mastered, they should gradually tackle more challenging
environments, such as steep grades and step transitions.
 The rider should always practice with an appropriate lap belt and chest support in
place, and a spotter (therapist) to assist if needed.
PROPULSION BIOMECHANICS
 The ability of an individual to propel their own wheelchair efficiently is influenced by
many inter-related factors which can be summarised into three main categories:
 Individual characteristics:
Type and degree of disability, body dimensions, weight, co-morbidities, age,
method of propulsion chosen by client, confidence and motivation
 Properties of the wheelchair:
Size and weight of wheelchair, size and type of wheels and tyres, adjustability of chair
in relation to axle position, backrest height, footplate height and position, use of
armrests
 Wheelchair / client interface:
The individual fit and set up of the wheelchair for an individual
Below are considerations when preparing a client for optimal propulsion efficiency in a
manual wheelchair:
o Shoulder to axle alignment – the shoulder should be positioned over the rear wheel
axle or slightly in front of the axle. This allows for the body’s centre of gravity to be

29. SHARMIN SUSIWALA
slightly anterior to the axle resulting in minimal shoulder extension at the beginning
of the push phase.
o If the wheel axle is placed too far back the individual must reach into the extremes of
shoulder extension and wrist deviation to initiate an effective push.
o Rolling resistance increases as the axle is set further back, thus increasing the energy
required to push the chair.
o A more forward axle has a detrimental effect on stability - in this situation anti-tip
bars may be useful for client confidence
o Width of wheelchair compared to body - it is easiest to push a wheelchair if the
wheels are close to the body, thus minimising shoulder abduction throughout the
movement. Camber in the wheelchair is an advantage in propulsion.
o Distance of shoulder to axle of wheel – in the resting position with hands resting on
the apex of wheel, shoulders should not be elevated and elbows should be flexed to
approximately 60-70 degrees (from extended position)
o Stability of trunk in the wheelchair – this is especially important in high thoracic and
cervical lesions
o Controlled slight forward trunk movement occurs in propulsion and aids in the
application of force to the push rim.
Propulsion Technique
o Propulsive strokes are generally described in two phases: when the hand is in contact
with the pushrim applying forces (push phase), and when the hand is off the rim and
preparing for the next stroke (recovery phase).
o Four distinct propulsion patterns have been identified, which are defined by the path
the hand takes during the recovery phase: arc, semicircular, single- looping over, and
double-looping over.
PUSH PHASE:
o The push rim is gripped between the thumb and index finger. The remaining fingers
should be curled in to the palm to prevent getting caught in the spokes.
o With the hand positioned just behind the apex of the curve of the wheel, the user
flexes at the shoulder and brings the hand (& wheel) forwards.
o The last segment of the push incorporates elbow extension and shoulder external
rotation.
o The wrist moves from radial to ulnar deviation.
o This combination of muscle activity enables maximum force to be exerted.
o Force is to be applied tangentially rather than vertically downwards.
RECOVERY PHASE:
o Recovery of the arm involves release of grip from the wheelchair rim, extension and
internal rotation of the shoulder, flexion of the elbows and replacement of the hand
behind the apex of the wheel ready for the next push.
TRANSFERS
o The physical act of moving a patient from one surface to another is described as a
Transfer.
o Wheelchair users generally need to transfer to the toilet, another chair or to the bed.
o When perfoorming transfers attention must be given to the use of body biomechanics
and forces needed by the patient and the assistant.
Independent Transfers:
o For patients who perform standing transfers (independent or assisted), special
attention should be given to the user's ability to get out of or back into the chair.
o Most chairs with cushioning allow a user to slide forward and come to standing.
o Some patients may benefit from adjustable height armrests.
o The armrests are raised during sit-to-stand transfers.

30. SHARMIN SUSIWALA
o Patients who are capable of independent community mobility benefit from learning
to do WHEELIES to negotiate existing curbs. The chair is balanced on the rear
wheels while the front casters are elevated and then propelled forward to mount the
curb.
Dependent Transfers:
o Involve use of contraptions that help to tranfer.
o This is done by:
 Hydraulic Lifts or Hoists
 Manual Pivot
 Transfer Board
 Manual Lift
 Wheelchair Lifts
 Hydraulic Lifts or Hoists:
 These are devices that are used for safer transfer of patients by raising them with
minimal effort from the helper.
 Hoists must have the capacity to lift weights of 100-150 kg, be stable enough and
have a braking system.
 Mobile hoists are used for severe disability like Quadriplegia, while static hoists are
used where transfers are more, like bathrooms.
 They work with hydraulic devices or electric motors and consists of a metal
framewith a canvas swinging from it.
 The patient is suspended from it, and hoists generate enough power to lift him and
transfer him.
 The caregiver must ensure good body alignment and positioning.
 One must assess patient's weight and check if it is within the capacity of the
particular lift.
 Then the hoist is moved to the bedside, and then brought to a level where the
leverage is minimal.
 Using the canvas sling, the patient is positioned and gently transferred to the sling,
and later to the location where he or she needs to be transferred.
 Care should be taken to prevent the head and LL from damage.
 Manual Pivot:
 Helps swivel patient when getting out of a car or wheelchair.
 Transfer Board:
 These are simple boards that come in many designs, but essentially enable a patient
to slide from wheelchair to bed, commode or carseat.
 They often come equipped with discs to enable pivoting and turning.
 Manual Lifts:
 This is virtually the same as hydraulic lift except that manual power is used instead of
motors.
 Wheelchair Lifts:
 This is a device that lifts the Wheelchair as a whole onto an area hitherto inaccessible
to it, like the first floor of building or a bus.
 Wheelchair lifts may be electrically or hydraulically operated.
POWER WHEELCHAIR TRAINING
 Power wheelchair training is slightly different and usually concentrates on driving
skill and safety.

31. SHARMIN SUSIWALA
 The initial challenge is to locate a reliable access control site and method(e.g, hand
control with a joystick, head control with individual switches).
 Training then involves working with the user on consistent responses( especially to
"stop" commands, or the recognized needs to stop based on the user's awareness) and
accurate maneuverability.
 Ensure the driver knows how to respond to a variety of situations, distractions and
obstacles.
WHEELCHAIR MAINTENANCE
 A regular maintenance program for a manual wheelchair is important to ensure it is
functioning properly and to maximise durability.
 Below are some general guidelines for wheelchair maintenance and troubleshooting
problems.
 The wheelchair should be cleaned regularly.
 UPHOLSTERY
 Cloth upholstery fabrics and vinyl upholstery should be cleaned weekly by
wiping with a damp cloth and a mild detergent.
 Upholstery should be checked regularly for wear and tear.
 Sagging or torn upholstery in the backrest or seat sling can cause
significant deterioration in posture, and impact on pressure relief.
 FRAME
 Chrome or painted surfaces should be wiped over weekly with a cloth to
remove dirt and maintain the finish
 The frame should be checked monthly for early signs of rust and any
evidence of metal fatigue or cracks in the welds.
 In folding frame wheelchairs, the folding mechanism should be checked
for ease of use.
 Any stiffness may be alleviated by using a small amount of silicone spray.
 WHEEL TOE-IN/TOE-OUT
 The terms toe-in and toe-out refer to the alignment of the rear wheels.
 Incorrect alignment may cause the wheelchair to veer in one direction or
affect how the wheelchair rolls.
 Adjustments to correct this are usually achieved by using washers to space
the axle block, either at the front or the back, whichever is appropriate.
 It may be possible for one wheel alone to be toe-in or toe-out in relation to
the other. This situation may cause the wheelchair to veer in one direction.
 REAR WHEELS
 The wheels should be checked monthly to see if they spin freely and stop
smoothly.
 Check whether the wheels run parallel in a straight line.
 There should be little sideways movement present.
 Excessive sideways movement of the wheel may also be caused by
loosening of the nuts holding the axle or axle block in place.
 The tension of the nuts and bolts should be checked and tightened if
necessary.
 Spoke tension should be checked every few months, more frequently if the
client is an active user.
 Loose, broken or bent spokes may cause the wheel to buckle or warp,
leading to deterioration in performance.
 CASTERS
 Lint and hair can build up quickly around the inside and outside of
casters.

32. SHARMIN SUSIWALA
 This may restrict free movement, making it harder to push and turn the
wheelchair.
 This should be removed by removing the caster from the caster fork
assembly. Care should be taken not to over tighten the nuts when
replacing the caster.
 Grinding noises or excessive sideways movement may be due to worn
bearings. Replacement may be necessary by a qualified person.
 Excessive caster wobble may also be due to the loosening of the nuts on
the caster fork or stem bolt. Check these nuts for tension, but take care not
to over tighten them, as this may restrict free movement of the caster.
 TYRES
 Tyre pressure should be checked weekly and kept inflated to the
manufacturer’s recommended levels.
 Tyres should be replaced if worn. If fabric or canvas is showing through,
they should be replaced immediately.
 Worn tread may result in poor traction, particularly in the wet, and may
affect the efficiency of brakes. The tyre will also be more susceptible to
puncture.
 BRAKES
 Brakes should be checked weekly to ensure that they are operating at their
best.
 As brakes are a safety feature of the wheelchair, malfunction may result in
injury.
 The mechanism should not be excessively loose, but should not be so tight
that it makes them difficult to operate.
 Once every 6 months, the wheelchair should have a complete overhaul by the
manufacturer, particularly if used outdoors.