Thursday, January 23, 2014

Wheelchair re-evaluation




Re-evaluating Wheelchair Positioning

After the initial wheelchair fitting the individual is going to be properly positioned within a wheelchair that fits him/her perfectly. As the individual grows, the wheelchair needs to have changes and adjustments made to it in order to guarantee the appropriate fit. Many people do not recognize if the wheelchair is a good fit for the individual. If they do recognize that the wheelchair no longer fits the individual appropriately then they are uncertain of how to make the necessary adjustments.

This headrest position is correct
Prior to today, I was uncertain of how to reassess a wheelchair for an individual and how to make adjustments.  Below is some user friendly information that can help parents, health care providers, direct care workers, teachers etc., to make adjustments to wheelchairs to ensure the appropriate fit.

Headrest: The bottom of the headrest should be placed on the occipital ledge (where the head and the back of the neck meet).

It is important to have the correct headrest placement to give the neck and head proper support allowing for more control.

Footrests: To determine if the footrest height is appropriate look at the space between the thigh (close to the knee) and the seat. The correct height placement of the footrest should show the back of the thighs (particularly close to the knee) touching the seat, the knees at a 90 degree angle and the feet placed flat on the footrests.

It is important to have the accurate footrest height because this gives the individual a good base of support allowing for better trunk and head control. Also, it allows for a better weight distribution which helps to eliminate skin breakdown. If the footrests are too close to the body the back will start to bulge and it can pinch off the intestines. If the footrests are too far from the body the individual cannot evenly distribute weight or shift positions easily.


This footrest height is correct, the back of
the thighs are touching the seat and the
knees are at a 90 degree angle. 
This seat depth is correct, there is a 3 
finger space between the back of the
 knees and the front of the wheelchair.
Seat Depth: To determine if the seat depth is correct, look at the space between the front of the seat and the back of the knee. In order to fit properly, there needs to be three finger space between the front of the seat and the back of the knee.
It is important to have the correct seat depth because this allows the individual to have the proper weight distribution.

Armrests: The appropriate armrest height should show the elbow in a 90 degree angle with the forearm resting on the armrest and the shoulder in a relaxed, level position. The shoulder should not be slumped down or pushed up when the forearm is resting on the armrest.

If the individual has a tray then the tray needs to have the same height considerations as the armrest. This means the elbow needs to be in a 90 degree angle with the forearm resting onto the tray and the shoulder in a relaxed, level position.


This arm rest position is correct, the shoulder is
 level and the elbow is at a 90 degree angle.
Proper armrest (tray) positioning is important because it allows the individual to be relaxed and maintain an appropriate anatomical position. If the armrests (tray) are too low then the individual will have to slump down in their chair to allow their arms to relax. If the armrests are too high then it could overstretch the shoulders causing neck cramps.

Please keep in mind that these wheelchair guidelines might need to be slightly modified for each individual.




References
Batavia, M. (2010). The wheelchair evaluation: A clinician’s guide. Jones & Bartlett Learning.
Fit Form. (N.D). Conditions for ergonomic sitting. Retrieved from http://www.fitform.net/en/about-sitting/conditions-for-ergonomic-sitting/the-correct-armrest-height/
Mobility Basics. (2014). Wheelchair measuring guide. Retrieved from: http://mobilitybasics.ca/
measurelong
Probus. (2011). Wheelchair fitting measurements. Retrieved from: http://blog.rollmobility.com/tag/
wheelchair-measurements/

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