Wheelchair Preparation

Introduction

The wheelchair service provision process is not simply assessment followed by prescription; but providing a client with an appropriate wheelchair. [1] Wheelchair preparation is the Step number five, as per the eight steps of wheelchair service delivery, described in the WHO guidelines on the provision of manual wheelchairs in less resourced settings. [2]

The objective of good practice in product preparation is to prepare the wheelchair for the fitting, including modifications or custom postural support component. [3]

Once the equipment is received, the wheelchair base/frame, accessories, and seating and positioning components should be assembled and set-up according to the preliminary specifications detailed in the recommendation and selection process. [1] This includes fabrication and installation of custom items and assessment of the function and operation of all mechanical components.

Wheelchair Preparation Includes

  • Preparing the wheelchair to match the wheelchair user’s prescription (selection);
  • Checking the wheelchair to make sure that it is safe and ready to be used and all parts are working properly. [4]

Good Practice in Product Preparation

  • Each wheelchair being prepared is labeled with the user’s name and a serial number or barcode.
  • Modifications to wheelchairs (permanently altering the frame or a component of the wheelchair) are carried out only by personnel with the appropriate knowledge and skills, since any such modification may have structural and functional implications.
  • The production and installation of custom seating systems or individual postural support components should be carried out by personnel with the appropriate knowledge and skills. This work should also be done in close collaboration with the assessment personnel.
  • All mobility equipments should be checked for quality and safety before the user tries it. [3]

Steps in Preparing the Wheelchair

Prepare the wheelchair in the following order: [4]

  1. Check that the wheelchair seat width and depth measurements are correct for the prescription   (selection).
  2. Check that the cushion width and depth match the seat.
  3. Adjust (where possible)
    • Backrest height and angle;
    • Armrests height;
    • Rear wheels position;
    • Brakes position;
    • Footrests height;
    • Push handles height;
    • Any other adjustments.

4. Carry out a “Wheelchair Safe and Ready” check.

Wheelchair Safe and Ready Checklist:

Use the checklist below to make sure that the wheelchair is safe to use and all parts are working. Always do this before the wheelchair user tries the wheelchair[4]
For the Whole Wheelchair How to Check
There are no sharp edges Check all over the wheelchair with eyes and hands
No parts are damaged or scratched.
The wheelchair travels in a straight line Push the wheelchair away from you, making sure the castor wheels are in the “trail” position.
Front Castor Wheels
Spin freely. Tip the wheelchair on to the back wheels. Spin the castor wheels.
Spin without touching the fork.
Bolts are tight. Check. They should feel firm. Do not over tighten.
Front Castor Barrels
Castor fork spins freely. Tip the wheelchair on to the back wheels. Spin the castor fork around.
Rear Wheels
Spin freely. Tip the wheelchair sideways on to one rear wheel. Spin the other wheel. Check the other side.
Axle bolts are tight. Check. They should feel firm. Do not over tighten.
Tyres (if those are pneumatic) are inflated correctly. Press on the tyres with your thumb. The wheel should depress a little, but no more than 5 mm.
Push rims are secure Check
Brakes
Function properly Apply brakes. Check the wheelchair cannot be moved.
Footrests
Footrests are securely attached. Check.
Frame
Cross-folding wheelchair folds and unfolds easily. Fold the wheelchair to check that the folding mechanisms are working correctly.
Fold-down backrest – the backrest folds and unfolds easily.
Cushion
The cushion is in the cover correctly. Usually the cushion cover is done up at the back of the cushion, underneath.
The cushion is sitting on the wheelchair correctly. If the cushion is contoured, the “well” for the seat bones should be at the back of the seat.
The cushion cover fabric is tight but not too tight. The cushion cover should not stretch tightly over any contours of the cushion.
The cushion fully covers the seat Check that no part of the seat is visible from under the cushion. This is particularly important for solid seats.

Good Practice

References

  1. 1.0 1.1 Stan Arledge, William Armstrong, Mike Babinec,Brad E. Dicianno; Rehabilitation Engineering and Assistive Technology Society of North America,RESNA Wheelchair Service Provision Guide-2011..https://www.resna.org/sites/default/files/legacy/resources/position-papers/RESNAWheelchairServiceProvisionGuide.pdf
  2. William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon; Guidelines on the provision of Manual Wheelchairs in less resourced settings, WHO 2008 publication; Chapter No.3; Service Delivery; Page no.76 :Steps in service delivery.http://www.who.int/disabilities/publications/technology/English%20Wheelchair%20Guidelines%20(EN%20for%20the%20web).pdf
  3. 3.0 3.1 William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon, Guidelines on the provision of Manual Wheelchairs in less resourced settings - 2008 publication, Chapter No.3;Service delivery;Page No.82:Product preparation.http://www.who.int/disabilities/publications/technology/English%20Wheelchair%20Guidelines%20(EN%20for%20the%20web).pdf
  4. 4.0 4.1 4.2 Sarah Frost, Kylie Mines, Jamie Noon, Elsje Scheffler, and Rebecca Jackson Stoeckle,World Health Organisation; Wheelchairervicetraining package; Reference Manual For Participants; Basic Level; - 2012 publication;Step 5 Product Wheelchair preparation; Page No.55,56http://apps.who.int/iris/bitstream/handle/10665/78236/9789241503471_reference_manual_eng.pdf?sequence=1 .
  5. William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. World Health Organization; Geneva: 2008.