Wheelchair Users

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Naomi O'Reilly, Kim Jackson, Jess Bell, Simisola Ajeyalemi, Uchechukwu Chukwuemeka, Rucha Gadgil, Amrita Patro, Lucinda hampton and Olajumoke Ogunleye  

Introduction

Wheelchair users are people who already have a wheelchair or who can benefit from using a wheelchair because their ability to walk is limited. The needs of each wheelchair user will vary. However, they all need an appropriate wheelchair. Every well-fitting wheelchair provides the user some postural support. The backrest, cushion, footrests and armrests all provide postural support when adjusted to suit the wheelchair user’s size. However many children and adults need additional postural support in their wheelchair. Wheelchair users include:

• Children, Adults and the Elderly;
• Men, Women, Girls and Boys;
• People with different mobility impairments, lifestyles, life roles and backgrounds;
• People living and working in different environments including rural, semi-urban and urban.

Epidemiology

Neurological Conditions

Cerebral Palsy

Cerebral Palsy has been defined a group of permanent, but not unchanging, disorders of movement and/or posture, causing activity limitations which are due to a non-progressive interference, lesion, or abnormality of the developing or immature brain , resulting in a wide range of impairments which can affect people very differently..

Personal mobility can range from independent, unaided walking through to totally dependent wheelchair mobility with up to one third of children and adults with Cerebral Palsy being non-ambulant and reliant on some form of wheelchair mobility, either manual or powered.

For a person with cerebral palsy who can sit upright, it is important to remember that they may have difficulty keeping their sitting position because they get tired. This makes doing things harder and more tiring. Good support is very important. People with cerebral palsy may need additional postural support in a wheelchair. To do this safely and effectively, intermediate-level training is needed.

In a recent study by Rodby-Bousquet and Hägglund, they describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in children with Cerebral Palsy, suggesting that environmental factors, influence of parents, personal factors (e.g. choice, motivation, acceptance of disability) and body functions (e.g. spasticity, fatigue) are important when it comes to use of a manual or powered wheelchair, both indoors and outdoors.

Manual wheelchairs for self-mobility were most frequent in children at GMFCS Level III while powered wheelchairs were most frequent at level IV. Children at level III-IV achieved a higher degree of independent mobility using manual and powered wheelchairs, with the largest increase in mobility through use of a wheelchair was seen at GMFCS level IV.

Wheelchair for outdoor mobility was more frequent than indoors and the use of both manual and powered wheelchair outdoors increased with GMFCS levels, as did the number of children requiring adult assistance at all GMFCS Levels with only 14% being able to independently self-propel for outdoor mobility.

Rodby-Bousquet and Hägglund also found a difference in wheelchair use between different subtypes of Cerebral Palsy, with a higher incidence of wheelchair use for indoor mobility among the dyskinetic subtype, although of those children only 11% can self propel. On the other hand those who were utilising Powered Wheelchairs had predominantly spastic bilateral (40%) or Dyskinetic Cerebral Palsy. In the spastic bilateral subtype 40% used wheelchairs, of those 23% self-propelled (manual and powered) and 17% were pushed in manual wheelchairs.

Finally Rodby-Bousquet and Hägglund found that the use of manual wheelchairs for indoor mobility was similar for boys and girls and overall indoor wheelchair mobility increased with age, although this was not evident with powered wheelchairs.

To achieve as high a level of independent mobility as possible, both manual and powered wheelchairs should be considered at an early age for children with impaired walking ability.

Spina Bifida

Spina Bifida in general is defined as "a neural tube defect (NTD) that results when the inferior neuropore does not close.  Developing vertebrae do not close around an incomplete neural tube, resulting in a bony defect at the distal end of the tube." [1]

Spinal Cord Injury

Spinal cord injury is defined as traumatic damage to the spinal cord or nerves at the end of the spinal canal, which can affect conduction of sensory and motor signals across the site of the lesion. Symptoms of a spinal cord injury vary widely dependant on both on the severity of injury and the location on the spinal cord, which are also the key factor in determining the type of wheelchair mobility.

Personal mobility can range from independent, unaided walking through to totally reliant on some form of wheelchair mobility, either manual or powered.

Level of Injury	Type of Wheelchair Mobility
C1 - C4 Tetraplegia	mobilise in a chin-control, sip and puff or head array power wheelchair use attendant operated manual wheelchairs that have been specifically set-up for their needs are unable to self propel a manual wheelchair
C5 Tetraplegia	mobilise in a hand-control power wheelchair can propel a manual wheelchair on flat smooth surfaces with the assistance of adaptive equipment such as plastic push rims and textured gloves, however this is not their main form of mobility are dependent on an attendant for propelling a manual wheelchair on uneven surfaces and slopes
C6 - C8 Tetraplegia	mobilise independently in a manual wheelchair over most surfaces and terrains with varying degrees of skill may find the assistance of adaptive equipment such as plastic push rims and textured gloves useful mobilise in a hand-control power wheelchair as an alternate form of mobility
T1 - T12 Paraplegia	mobilise in a manual wheelchair with varying degrees of skill use power mobility if they are not functional in a manual wheelchair due to impairments such as poor cardiovascular fitness and shoulder pain

People with a spinal cord injury are very likely to be at risk of developing a pressure sore. This is because most people with a spinal cord injury cannot feel below the level of their injury. Always prescribe a pressure relief cushion.

Polio

Multiple Sclerosis

Motor Neuron Disease

Orthopaedic Conditions

Amputations

Catering for Children with a Disability

When providing a child with a wheelchair, it is important to think about how children’s lives are different from adults’. These differences affect the way the wheelchair service personnel work with children and the choices about wheelchairs and additional postural support. Some important differences are;

• the activities children carry out are different to activities of adults (play, school);
• children are often very active and do not stay in one position for very long;
• children are in the care of adults;
• children cannot always speak for themselves;
• children are still developing;
• young children have a different sitting posture to adults;
• children are still growing.

Wheelchairs that meet children’s needs should support them be a part of the activities that children carry out every day. Features in a wheelchair that are important for children include:

If children push themselves, the wheelchair should:

• fit well to allow them to reach the push rims with comfort;
• be light enough for children to control, particularly going up or down hill.
• Try always to make sure the child is more visible than their wheelchair.
• Extended push handles can help family members or caregivers push the wheelchair without having to bend over.
• A wheelchair that can ride over uneven and soft surfaces such as grass and sand will make it easier for children to play with their friends.

A child’s wheelchair should make it easier for them to access education and enable them to both get to school and be mobile within their school environment:

• If most children in the child’s community walk to school, consider whether a wheelchair can travel on these paths?
• Does the child need a wheelchair that is good for rough terrain?
• If the child will go to school in transport (for example car, bus, rickshaw, taxi), think about how the wheelchair will be transported.
• The wheelchair should make it easy for them to be at school. The child should be able to pull up to a desk, or the wheelchair needs a tray as a work surface.

Ideally, children’s wheelchairs should:

• enable children to push themselves (if they are able);
• have push handles to allow adults to assist;
• be able to ride over uneven and soft surfaces such as grass and sand;• make it easier for children to get to school;
• attractive enough in terms of design, size and colour;
• make it easier for children to be at school.

References