Wheelchair Maintenance

Original Editor - Mariam Hashem as part of the Wheelchair Service Provision Content Development Project

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 Wheelchair Inspection

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.

• Check the pressure by pressing down firmly on the tire with your thumb.
• If the tire presses down more than 5mm (roughly the thickness of three pennies stacked together), the tire needs to be inflated.
• 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) 
• Checking the tire pneumatic pressure should be done weekly and more often during winter.
• If you pump your tire and it goes flat right away you may have a hole in the tube. In this case you can either patch it using a patch kit or replace the inner tube for a new one. wheelchair users can be trained on doing this by themselves or contact a maintenance expert.

Cushion Maintenance

Fig. 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. Specifically, for wheelchair users pressure ulcers can develop over the ischial tuberosities.

• Remove the cover so you can inspect both cushion and cover.
• Look for tears or holes in the cover or zipper malfunction, which might expose the cushion surface or create a wrinkled sitting surface.
• If the cover contains a foam liner, look for tears or flaking in the foam.
• The bottom of most covers has a Velcro or a nonskid surface. Inspect this surface for worn or torn Velcro or breakdown of the non-skid material.
• The cover is designed to protect the cushion, so it should be replaced if damaged.
• After inspecting the cover inspect the cushion for shape and contour.
• This should be done weekly.

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.

Nuts and Bolts:

Most maintenance consists of ensuring that nuts and bolts are properly adjusted. Nuts and bolts that are too loose will loosen further or not hold the part properly.

• Visually identify loose bolts.
• Move parts and check that they do not rattle.
• Tighten all loose nuts and bolts until snug.
• Depending on the bolt, you can use a screwdriver, wrench or Allen wrench. Tighten to the point where the parts that the nuts and bolts are holding do not move at all. Do not over tighten!
• Nuts and bolts should be inspected monthly

Tires

Worn out tires can make the wheelchair harder to propel. Rear tires can be pneumatic tires or solid. You can determine what type of tire you have by looking at the rim where the air valve sticks out. If there is no valve your tire is solid. If there is a valve you have a pneumatic tire.

• Visually inspect the rear tires for wear, cracks, bulges, looseness, damage, and flat spots (In solid tires, it can be hard to see a flat spot on the tire. Usually, you will feel it when rolling on a flat and smooth surface).
• Contact a wheelchair maintenance expert to replace tires when the tread becomes worn, cracked, loose or when the side walls begin to bulge out when pumped with air.

Wheel Bearing

The wheel bearings allow for free rotation of the wheel around the wheel axis. Therefore, damaged bearings can increase rolling resistance which will make you spend more energy and stress your shoulders more while propelling.

Bearings will wear out on a wheelchair during normal use. Noise is the first thing that will alert you about a wheel bearing that is failing. Most prominently, a knocking noise, and on some occasions, a squeaky squealing moan is what would be the first indicator of such a problem. Initially, the sound would be heard only at certain speeds, but will become fairly regular and prominent as the condition of the bearings worsen.

• Inspect that the bearings are working properly.
• Lift one side of the wheelchair off the ground, and spin the wheel, letting it rotate to a stop.
• If the wheel slows and stops quickly when spun, the nut and bolt holding the bearing could be too tight.
• If the wheel slows and rotates backwards slightly when spun, the bearing is not being compressed and it could be too loose.
• Repeat the same procedure with the other wheel.
• If problems are identified, contact a wheelchair maintenance expert to get the bearings replaced.
• This inspection should be performed monthly  

Spoke

Through use, spokes can become loosened, damaged, or broken. The spokes should all have equal tension. One loose spoke will cause the others to carry more tension and ultimately the wheel will go out of true (wobble from side to side).

Loose spokes can make the wheelchair harder to propel and/or cause the wheel to collapse. If spoke tension is unequal, you may hear a faint, metallic, snapping sound as you move.

• Inspect the spokes monthly by squeezing two together all the way around the wheel. If a spoke “gives” when you squeeze gently, it may be too loose.
• Inspect that the spokes are not bent.
• Inspect that the nipples are tight, not bent or nicked.
• If problems are identified, contact a wheelchair maintenance expert. It is recommended that you do not do this on your own because spokes must be tensioned to a specific torque range and a special stand is used to do this. Otherwise, spokes or their nipples could break and the wheel could go out of true.
• A bicycle store/shop is useful to get spokes tightened if you have pneumatic tires. If you have solid tires, you need to contact the wheelchair maintenance expert since a new wheel might be the best solution

Wheelchair Alignment

Wheel alignment describes the degree to which the rear wheels are parallel to each other and parallel with the center-line of the wheelchair.

Tracking is important as the user pushes on the hand-rims very frequent about once a second. If the wheelchair does not track well, it will drift from its course between pushes and forces the wheelchair user to push more often with one arm than the other to travel straight. This will increase strain on one arm, waste energy, and reduce control over the wheelchair.

Wheelchair users learn how the wheelchair “feels” so they can identify misalignment. The wheelchair should roll straight with no excess drag, pull or side motion. It should not be difficult to push and you should not hear wheel rubbing. When turning, there should be no squeaking, binding, or excessive side motion.

• Tracking can be checked by rolling through a puddle of water and allowing the wheelchair to coast.
• The wheelchair should maintain its direction.
• If problems are identified, contact a wheelchair maintenance expert.
• This task should be performed monthly

Brakes

Brakes act to stabilise the wheelchair when transferring to other surfaces, or when user wishes to remain in a particular spot. They allow the user to be more stable when desired, such as when lifting or pushing things or even simply sitting still.

• First inspect that the brakes are secured tightly to the frame.
• Apply the lock and check that it holds the tires firmly in place. Note that they are easily activated and that the brakes do not interfere with the tire while rolling. Brakes that interfere with normal propulsion cause wear to the tire and brake.
• This task should be performed monthly  

 If you find any problem while inspecting the brakes:

1. Adjust brakes if they are loose or not working properly.
2. Use an open-box wrench and/or Allen wrench to adjust as necessary.
3. If the locks still do not work properly, contact the wheelchair maintenance expert. 

Hand-Rim

Hand-rims are metal or plastic rings that are attached to the rear wheels and used to propel a manual wheelchair.

• Inspect the hand-rims for wear, dents, or bends. Cracks can cut or harm the user, if found, contact a wheelchair maintenance expert to have the hand-rim replaced.
• Inspect if they are loose. You can feel that they are loose while you propel. A loose hand-rim can make it more difficult to grasp and may fall off.
• You can tighten the hand-rim using an open-end wrench or a screwdriver. If unable to do so contact the wheelchair maintenance expert.
• This inspection should be performed monthly

Wheelchair Caster

The caster wheels have an important effect on the performance of the wheelchair. Worn out caster wheels can make the wheelchair harder to propel.

• Inspect casters wheels for wear, cracks, looseness, bulges, and tears.
• Inspect that the casters wheels are evenly touching the floor when on a flat surface.
• When one of the casters wheels does not touch the floor while on level ground, the wheelchair has caster float. This decreases the stability and performance of the wheelchair.
• Inspect that the caster stem housing is aligned vertically.
• If you find problems contact the wheelchair maintenance expert.
• Inspect the front caster caps; these caps protect the caster assembly from moisture and water. If they come off, contact the wheelchair maintenance expert.
• This task should be performed monthly  

****Studies show an inverse relationship of increased percentage of weight on the rear wheels, there will be a decrease in propulsion efforts

Foot Rests

Often the foot rests are the first part of the wheelchair to come in contact with an obstacle. They are used to open doors, act as bumpers, and are often scraped along the ground when the wheelchair is loaded into a motor vehicle or during mobility techniques such as wheelies, curb cuts, and sharp inclination changes such as the end of ramps.

Cross-brace-frame wheelchairs typically have foot rests that can flip up or down, swivel, are angle-adjustable, or can be removed, whereas rigid-frame wheelchairs have the foot support built into the frame.

Rigid foot rests are normally are not removable, but the height often can be slightly adjusted to accommodate various leg lengths. Swing-away foot rests are not as durable as rigid foot rest.

• Inspect that the foot rests are intact, tightened and can be released (if originally designed to do so), put back into place with ease and that they latch properly.
• Inspect the swing away foot rest, look for wear in the pin, bolt and bushing in this mechanism.
• You can use a screwdriver, wrench or Allen wrench to tighten loose bolts.
• If problems are identified, contact the wheelchair maintenance expert.
• This task should be performed monthly  

Armrest

The primary purpose of the arm support is to provide good resting posture for the arms. In addition, arm supports provide a form of support and are convenient handles when the rider leans to one side or the other. They are also helpful when attempting to reach higher places, and they also assist some people with transfers.

Arm supports can be fixed or adjustable. Most can be removed or flipped out of the way in order to provide clearance for transferring in and out of the wheelchair.

Removable arm supports usually fit into one or two sockets. Commonly, if there are two attachment points, the front socket contains a latch to lock the armrest in place.

Flip back arm supports are hinged at the back near the intersection of the seat and backrest. Some flip back supports use the latch in the front to help secure them in place.

• Inspect that the arm supports are intact, tightened and can be released (if originally designed to do so), put back into place with ease, and latch easily.
• Inspect for sharp edges that could cause harm.
• Loose arm supports can make the user fall when using them for support during transfers.
• Tighten as necessary.
• If a problem is identified, contact the wheelchair maintenance expert.
• This inspection should be performed monthly  

Back Support

Back supports provide comfort and postural support while sitting. Back supports can be sling upholstery or rigid.

For Upholstery Back Supports:

• Inspect it for wear, tears, stretched upholstery, or metal parts that may be sticking out.
• Inspect all upholstery rivets or screws and check that the upholstery is not tearing in those spots.
• Loose upholstery may provide less postural support and can lead to skeletal deformities.
• Contact a wheelchair maintenance expert to replace the upholstery when these problems are identified.
• When the upholstery is replaced, it is best to replace the bolts or screws that hold it in place. This will ensure that they are properly maintained as well.

For Rigid Back Supports;

• Inspect the surface is intact.
• Inspect that the back support hardware is properly attached to the back support posts and does not rattle.
• Tighten loose bolts with a screw driver, Allen wrench, or wrench.
• If the fabric is worn out and/or the foam is rigid, contact the wheelchair maintenance expert to get a replacement.
• The back support should be inspected monthly. 

Most rigid-frame wheelchairs have a foldable back support for transport and storage. If you have a folding back support, check that the mechanism lock is in place. Loose back supports can be dangerous during transfers because they could move or come out. Always make sure that the back support is locked before using it after unfolding the back. If problems are identified contact your wheelchair maintenance expert to get it fixed or replaced .

Folding Frame

Cross-brace frames allow for the wheelchair to collapse towards the middle for storage.

• Inspect that the cross brace mechanism is working properly every time you use it. It should open and fold easily, If it is difficult to close or if the wheelchair is unsteady during transfers.
• Problems with the cross-brace mechanism may cause the wheelchair to collapse and injury to the user.
• If problems are identified, contact a wheelchair maintenance expert.
• If you do not fold the wheelchair frequently, this task should be performed monthly
• Some frames have built in or “add-on” suspension elements to decrease shock and vibration and make for a smoother ride.
• Inspect that the paint in the spring is intact and it has no cracks.
• Inspect that the damper is not leaking lubricant.
• Contact the wheelchair maintenance expert if you find any problems.
• Get your suspension professionally inspected if you lose or gain weight significantly.
• Inspect the suspension elements monthly

Anti-Tips

Anti-tip casters may be used on the front and rear of a wheelchair. When rear anti-tip casters are in use and properly adjusted, if the wheelchair begins to tip over the rear anti-tip casters resist the tipping. Therefore, they can help to prevent some tipping accidents.

• Inspect that the pins work, that they can be put on and off, and that the rollers are not broken.
• If problems are identified, contact the wheelchair maintenance expert to have the anti-tip casters replaced.
• If anti-tippers are present, inspect them monthly  

Manual Wheelchair Action Maintenance

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.

• 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.
• Remove dirt, lint, and hair from the caster axles bearings with scissors, tweezers, toothbrush, or plyers. Dirt, lint, or hair buildup on the axles and casters can eventually cause premature wear. Hair especially can twist around the bearings and cause breakage. 
• This task should be performed monthly   

Lubricate Moving Parts

To stop rust and keep parts moving smoothly. Increased friction between moving parts can accelerate wear of the moving parts.

• Clean, dry, and apply lubricating oil or Teflon-based spray to all moving parts, including the folding mechanism, where the front casters turn, and exposed hinges.
• Use a lubricating oil, for example bearing oil.
• DO NOT lubricate sealed bearings!
• DO NOT use penetrating oil!
• Use a rag to remove excess lubricant.
• Apply to all moving parts.
• This task should be performed four times a year

Professional Wheelchair Service

Have wheelchair professional serviced at least once a year. In places with inclement weather condition, wheelchairs should be professionally serviced twice a year.

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 neighbour;
• Tailor for repairing upholstery;

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

Resources

NSW State Spinal Cord Injury Service Wheelchair Maintenance Guidelines

• This document provides an outline for general maintenance that can be applied to most wheelchairs and includes a 4-Week Cycle Sample Maintenance Calendar for a Manual Wheelchair.

References