Wheelchair Maintenance

Original Editor - Mariam Hashem

Top Contributors - Naomi O'Reilly, Mariam Hashem, Kim Jackson, Simisola Ajeyalemi, Shaimaa Eldib, Rucha Gadgil, Amrita Patro, Olajumoke Ogunleye and Robin Tacchetti  

Introduction

Wheelchair and cushion care is important because it saves costs for repairs, extends their lives and prevents injuries and long-term damage to the user’s body. A wheelchair which is cared for will be more comfortable, energy-efficient and easier to use. A cushion which is cared for will continue to provide pressure relief and support.

Between 5 and 18% of wheelchair users experience wheelchair-related injuries each year. Causes of wheelchair-related injuries include tipping over and wheelchair malfunction. In fact, wheelchairs that are poorly maintained increase the risk of their users being injured due to a wheelchair breakdown. Wheelchair users who maintain their wheelchair are 10 times less likely to sustain an injury than those who do not maintain it. repairs and replacement costs account for 30% of the direct wheelchair expenditures annually.

Maintenance

All wheelchairs require periodic maintenance to operate properly. Some wheelchair parts require periodic repair and replacement.

Wheelchair maintenance involve periodic inspection and action. wheelchair service providers must provide training and education for users to detect problems, provide periodic care and should supply them with contact details of repairing professionals.

Periodic maintenance can be classified into inspection and action steps. Inspection means looking for a problem and an action is trying to fix the problem.

Manual chair inspection:

Weekly:

1- Pneumatic Tires:

properly inflated tires are important for wheelchair propulsion. If the tire lacks sufficient pressure, the wheelchair will be difficult to maneuver, propulsion will take more energy and it will stress the shoulders more. The tire and wheel will also wear much more quickly when the tire is not properly inflated. 

Steps:

1-Check the pressure by pressing down firmly on the tire with your thumb.

2-If the tire presses down more than 5mm (roughly the thickness of three pennies stacked together), the tire needs to be inflated.

3-Add air to the tire using a bike pump, compressor, or CO2 cartridge. Don't use a gas station air hose. wheelchair tires have very small volume and it is very easy to explode a tire. (4-There are two types of valves used for pneumatic tires on wheelchairs: presta valves and schrader valves. Make sure your air pump has the correct type of valve for your wheelchair) 

4-Checking the tire pneumatic pressure should be done weekly and more often during winter.

2-Cushion maintenance

Cushions are a very important component of the wheelchair and do not last as long as the frame. The interaction between the cushion and the body determines the user’s comfort, function, and clinical safety. Deterioration in the cushion can increase the risk of developing a pressure ulcer.

Steps:

1-Remove the cover so you can inspect both cushion and cover.

2-Look for tears or holes in the cover or zipper malfunction, which might expose the cushion surface or create a wrinkled sitting surface.

3-If the cover contains a foam liner, look for tears or flaking in the foam.

4- The bottom of most covers has a Velcro or a nonskid surface. Inspect this surface for worn or torn Velcro or breakdown of the nonskid material.

5-The cover is designed to protect the cushion, so it should be replaced if damaged.

6-After inspecting the cover inspect the cushion for shape and contour.

There are many types of cushions. Depending on the type there are signs you should look for:

• Keep air cushions properly inflated and inspect that the valve is in good condition and does not leak. If you suspect that there is a leak, remove the cover and submerge the cushion in water and look for bubbles.
• A rubber air cushion (e.g. ROHO) can be patched using a patch kit.
• When you travel by air pay special attention to the cushion because the pressure will change and always travel with a patch kit.
• If you have a gel cushion, knead the gel daily from the outer perimeter to the middle of the cushion. Inspect that the gel is not hard and that there are no leaks.
• If you have a foam cushion, inspect that the foam is intact and not deteriorated and chipping. When you press it, it should bounce back.
• If the cushion has a solid seat insert, check that it is not broken.

when to call an expert:

-problem identified in wheelchair cushion

1. Clean the wheelchair and cushion: to protect metal and wooden parts from rusting and rotting and stop damage caused by dirt scraping against moving parts.

STEPS:

• Use warm water with a little soap.
• Rinse and dry.
• Pay attention to moving parts, and where upholstery joins the frame.
• Remove cushion from cover and wash separately.
• Always dry the cushion in the shade – not in direct sun.

2. Lubricate moving parts: to stop rust and keep parts moving smoothly.

STEPS:

• Clean and dry the wheelchair first.
• Use a lubricating oil, for example bearing oil.
• Apply to all moving parts.

4- Tighten nuts and bolts (if loose): Loose bolts cause unwanted movement in parts. This can be uncomfortable, and cause parts to wear out or be lost.

STEPS:

• Check wheelchair for loose bolts or nuts. Tighten loose bolts or nuts with a wrench.
• Do not overtighten.

5- Tighten spokes (if loose): Loose spokes can cause wheels to buckle and collapse.

STEPS:

• Squeeze together two spokes all the way around the wheel. If a spoke “gives” when you pull gently, it may be too loose. Tighten with a spoke wrench.
• Spokes can be overtightened. If the spoke feels very rigid, it is probably too tight and should be loosened.

6-Make regular checks:

A-Check for rust and check upholstery: Rust reduces the strength of materials. This can cause parts to break and may cause injury to the user. Upholstery needs to be in good condition to support the wheelchair user and provide good comfort. If upholstery rips suddenly, the wheelchair user may be injured.

STEPS:

• Check painted metal surfaces for rust/corrosion.
• If rust is found, use sandpaper or steel brush to remove the rust.
• Clean with a thinner and cloth and repaint.
• Look for tears, wears, dirt or metal parts sticking out.
• Check the tension of seat and backrest is correct.
• If the upholstery is torn or the tension of a slung seat is too loose, repairs are needed.

B- Check the cushion: Cushions should be clean and dry to help protect skin.

Cushions do not last as long as wheelchairs. A regular check will help wheelchair users to recognize when the cushion needs replacing.

STEPS:

• Remove the cover.
• Check for worn spots, dirt and holes in the cover and foam.
• If the cushion is worn, it should be checked by the wheelchair service personnel. It may need to be replaced.

Common wheelchair and cushion repairs

Wheelchairs and cushions will sometimes need to be repaired. Wheelchair service personnel need to be able to either carry out a repair, or advise wheelchair users where they can get help. Provide patients with available local places where they can repair wheelchairs.Possible places or people are:

• Bicycle repairer;

• Motorcycle or car mechanic;

• Workshops – welder, plumber (metal parts), carpenter, furniture maker

(wooden parts);

• Wheelchair user, wheelchair user’s family member, relative or neighbor;

• Tailor for repairing upholstery;

• Wheelchair service facilities.

Wheelchair Follow up

Follow up happens after the wheelchair user has received their wheelchair and has been using it for a while. Follow up appointments are an opportunity to gather information from the wheelchair user, check that the wheelchair is in good working order and check the fitting of the wheelchair.

Research has shown that approximately 60% of wheelchair users have reported a needing a wheelchair repair in the previous 6 months.**

All users will benefit from a follow up visit, particularly children, users at risk of developing a pressure sore, users who have a progressive condition and those who have had difficulty with any of the training or instruction given to them.

Most intermediate level wheelchair users need additional postural support, and therefore follow up is particularly important.

There is no rule about when follow up should happen though one follow up session within six weeks of the date of delivery is often found to be useful. It will depend on the needs of the user. However, for children, it is ideal if follow up occurs every six months. This is because the needs of children change quickly as they grow.

Follow up can be carried out either at a home visit, at a center or at any other location that suits the user and the wheelchair personnel.

At the follow up the wheelchair service personnel should check that the wheelchair is in good order, provide more tips or training. If needed the service provider may re-adjust the wheelchair, carry out minor repairs or home maintenance, organize major repairs or assist the wheelchair user to arrange for repairs.

Ways to manage follow up appointments

• Give wheelchair users a follow up appointment when they receive their wheelchair.
• Visit wheelchair users at home for follow up, where possible.
• Make follow up visits part of routine visits to communities by community-based rehabilitation (CBR) personnel who have been trained to carry out follow up.
• Arrange a follow up phone call if transport is difficult and the wheelchair user has access to a phone

References