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  • Standard wheels tend to come with few options, however there are several things to consider.
    • Every wheelchair should have a cushion.  A very basic cushion should be considered a minimum to provide some comfort and pressure relief. 
    • Seat size. Ensure an appropriate seat size.  There shouldn't be much space between the user's hips and the sides or armrests of the wheelchair.  There should be 1-2" space between the back of their knee and the front of the cushion.
    • Backrest height. The backrest should be sufficiently high to prevent the user leaning backwards over the top of the backrest upholstery.
    • Anti-tips. These are two small wheels that protrude close to the ground from the back of the wheelchair.  They prevent the wheelchair tipping over backwards.  This is especially important if the wheelchair is to be used on slopes or if there is any other reason why the wheelchair should be more unstable than normal, such as leg amputees.
    • Headrests allow the head to be supported, especially when using backrest recline. When reclined, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
    • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
    • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.
  • Active user wheelchairs are manufactured to be efficient to self-propel, therefore the options available on active user wheelchairs are usually aimed at either being lightweight, or enabling an efficient configuration for self-propelling.
  • Reducing the weight of the chair can be achieved either by reducing the amount of material used or by using a lighter material. For example, many active user chairs have a rigid, non-folding design.  Because a folding mechanism uses a lot of additional frame material, rigid chairs will tend to be lighter.  Another example is the use of aluminium, titanium or carbon fibre to construct the frame of the wheelchair, rather than steel.  Minimising the presence or weight of any accessories such as push handles, tool kits and back packs also reduces the weight of the chair as a whole.
  • There are many ways in which an active user wheelchair can be configured to make it efficient, or easier to self-propel. As described above, being lightweight will help with increasing the efficiency of an active user wheelchair, but there are many other considerations:
    • Seat size. Having a seat width that is too wide means that excessive shoulder movement is required when self-propelling.  A narrow seat width means the wheels are as close as possible, allowing the shoulders to move  in their strongest, most efficient position.
    • Centre of gravity. Many active user wheelchairs have forward-backward adjustment of the rear wheel position, or can be built with a specific position.  It is essential for most active user wheelchairs to have more weight distribution over the rear wheels, than the front casters.  The rear wheels are larger, have a larger tyre and therefore roll with less resistance.  By moving the position of the rear wheels forward on the frame of the wheelchair, the wheelchair becomes more efficient to roll and to self-propel.  This forward position of the rear wheels has the added benefit of improving the position of the shoulders.  They can move with greater strength and efficiency.
    • Seat height. Many active user chairs can be adjusted or configured with specific front and rear seat heights.  The rear seat height determines the height of the shoulders above the rear wheels.  If the rear seat height is too great, the user is required to straighten their elbows more to reach the rear wheels, reducing the strength and efficiency of the arm and shoulder when self-propelling.
    • Backrest height. Excessive height of the backrest restricts movement of the back and shoulders when self-propelling.  However, backrest height is important in creating a stable sitting position.  Therefore if the backrest is not high enough, self-propelling efficiency is likely to be compromised.
    • Standard brakes are positioned to be easy to operate and close to the tyre.  During forceful self-propelling, the thumb of the user can contact the brake, resulting in injury.  Many active user wheelchairs are therefore fitted with brakes that fold away from the tyre when not in use.
    • The wheels transfer energy from the user into movement of the wheelchair, therefore they are important in maintaining efficiency of the wheelchair.  A well-built, lightweight but strong wheel will transfer a greater proportion of energy than a poorly made, heavy wheel.  Being the widest part of a wheelchair, they need to be able to deal with knocks.  A strong wheel will be able to deal with those knocks, when they are attached to the wheelchair and when they're not. 
    • The major decision when it comes to tyres is between pneumatic and solid tyres.  Pneumatic (air-filled) tyres tend to be lighter than solid tyres.  They also have significantly less rolling resistance, making self-propelling much less difficult.  The downside with pneumatic tyres is there possibility of puncturing.  This likelihood can be reduced with thicker tyre tread, good maintenance, liquid infills inside the tube and avoiding certain places where puncture might be likely.  Learning to replace a tube or having someone else that can do this can be a very useful skill.
  • Drive Type
    • There are three main drive wheel configurations available on powerchairs. Drive wheels are those which are attached to the motors.  The motors control the movement of the powerchair, as well as steering and braking.  Powerchair motors have brakes integrated into them, meaning that when the drive is not engaged in movement, the brakes will be activated. 
    • Rear wheel drive. This is the most common configuration.  A rear wheel drive has four wheels in contact with the ground, with the drive wheels at the back.  Rear wheel drives have the largest turning circle out of three described here when compared against comparable chairs.  They have good traction when ascending slopes because of the additional weight of the user that transfers to the rear wheels when travelling uphill.  The compromise is on descents, where reduced weight over the rear wheels produces less traction and less braking capacity.
    • Mid wheel drive. Most mid wheel drive powerchairs have six wheels in contact with the ground. The front two and rear two are casters and the middle two are larger drive wheels.  The main benefit with mid wheel drive powerchairs is their turning circle which is significantly smaller than a comparable rear wheel or front wheel drive.  Because the drive wheels are located beneath the user and in the centre of the wheelchair, it can turn within its own length.  This is often very useful in small environments such as bathrooms and kitchens where large turning circles and three-point turns create difficulty.
    • Another benefit of mid wheel drive powerchairs is the weight distribution over the drive wheels. The drive wheels will tend to bear most of the weight irrespective of whether the chair is being driven uphill, downhill or on the flat.  This means the drive wheels are likely to have good traction in all scenarios, maintaining control and braking capacity.  However, there needs to be sufficient up/down movement of the front and rear casters, relative to the drive wheels.  This movement enables the drive wheels to maintain contact with the ground.  If there is insufficient movement, the possibility of the drive wheels losing contact with the ground is increased.
    • Front wheel drive. This is the least common configuration.  Like a rear wheel drive, a front wheel drive tends to have four wheels in contact with the ground.  The motors are connected to the larger front wheels.  The turning circle of a front wheel drive is slightly less than a comparable rear wheel drive but will tend to be larger than a mid-wheel drive.  Front wheel drives have good traction going downhill but are likely to have reduced traction when travelling up hill. 

 

  • Controls
    • Most powerchairs are controlled with a joystick. This enables the user to control the powerchair in all directions, combining forward or reverse with left or right to create smooth turning.  When the joystick is returned to centre, the chair stops and the brakes are applied automatically.  Speed is controlled by the amount of movement of the joystick in each direction - the further the joystick is moved, the faster the powerchair will go.  This is called proportional control.  Most joysticks are fitted to the armrest of the wheelchair, allowing the user to control it with their hand or fingers.
    • Joysticks can also be fitted to other parts of the wheelchair, enabling control with other parts of the body. Examples could be the chin, lips, head or foot.  Different sizes or joysticks, and the force required to operate them, are available to tailor the joystick to the part of the body being used.
    • For those who find it difficult or impossible to control a proportional control, switched control is also possible. Switched control allows many different combinations of switches or buttons to be used to enable driving.  At a basic level, one switch can control forward movement only with no access to other directions.  Switches can be added to this to enable control of left, right and reverse.  Most powerchairs will have the option of latched or non-latched switch control.  Latched control allows a button to be pressed once and the chair to continue moving in the direction chosen until another button is pressed.  Non-latched control requires a button to be held down to achieve movement in that direction.  Non-latched control is significantly safer and the most common option. 
    • Switches can also be used to operate a scanner control. A scanner is simply a display screen with a direction indicator.  The indicator will highlight or light up each direction, one at a time, in a predictable rotation, enabling the user to select a direction by pressing a single switch.  Used in non-latched mode, when they release the switch, the indicator will start scanning again, giving the user the opportunity to chose a different direction or continue on the same path.

 

  • Leg rests
    • The most common leg rests fitted to powerchairs are swing away. Each leg rest is fitted to the wheelchair on a hinge mechanism.  When unlocked, the hinge enables the leg rest to rotate out to the side, allowing a clear space in front of the wheelchair for transfers or to enable the user to get very close to something in front of them.  A footrest will normally be attached to the end of each leg rests, allowing individual adjustment of the position of each foot.  However a single footplate, spanning the entire width between the leg rests can also be fitted to some powerchairs. 
    • Centre mount footrests can be fitted to mid wheel and front wheel drive powerchairs. A centre mount footrest is fitted to the front, centre of the seat.  It normally enables the user to sit with their knees bent more than with swing away leg rests.  This position reduces the length of the chair as a whole, allowing it to negotiate smaller spaces.  Centre mount legrests can not normally be fitted to rear wheel drive powerchairs because the space between the front casters is not wide enough to fit the footrest. 
    • For below knee amputees, stump supports can be fitted to the legrests as well. This provides a supportive surface for the stump to rest with their knee straight. 

 

  • Armrests
    • Most powerchairs are fitted with armrests. They enable the user to rest their arms on a supportive surface, taking away the muscular effort required to maintain the position of their arms.  This also prevents the weight of the arm pulling the upper body of the user forward or sideways.  Most armrests are height adjustable, allowing multiple heights to be achieved. 
    • There are two main types of armrest - single post and flip back. Single post armrests are attached to the side of the seat frame and need to be removed if the user is transferring sideways to or from the wheelchair.  Flip back armrests can be moved without removing them.

 

  • Headrests
    • Headrests allow the head to be supported, especially when using tilt in space or recline. In both positions, the user's head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
    • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
    • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.

 

  • Powered seat movements.
    • Electric actuators (using the same principles as those used to control the shovel on earth moving equipment) can be fitted to many powered wheelchairs. The actuators are powered and controlled through the main control system of the wheelchair and enable the user to move specified parts of the seat frame.  The commonly fitted actuators are described below.
    • Tilt in space. Tilt in space tips the seating of the wheelchair backwards (imagine tipping a dining chair onto its back legs) and allows gravity to ‘push’ the upper body of the user against the backrest of the wheelchair.  This enables the user to maintain a sitting position, but with reduced muscular effort.  Tilt in space also helps with pressure relief by re-distributing weight bearing from the cushion to the backrest.  For users using a hoist to transfer to their wheelchair, tilt in space can make this transfer easier, allowing the angle of the seating to match that of the user in their hoisted position.  For other users, tilt in space enables them to adjust their own position, using gravity to assist them slide back over the cushion.
    • Recline is an adjustment of the seat to back angle only, in the same way a backrest can be reclined on a car seat.  Recline needs to be used with caution because it can often cause the user to slide forward over the cushion.  However it can be useful for some users to manage pain by enabling them to shift their position.  For other users, it can make hoisted transfers easier, by giving carers more space to insert or remove the sling.  When combined with tilt in space, recline can assist with pressure relief, allowing more weight to be re-distributed from the cushion to the backrest.
    • A riser, as the name suggests, simply raises the seating unit of the wheelchair directly upwards.  For some users, this enables them to complete standing transfers by giving them a higher surface to stand from.  For others, it enables them to reach objects that would normally be too high.
    • Both centre mount and swing away leg rests (described above) can have actuators fitted to control their movement.  A centre mount leg rest often has movement in two planes; elevation which moves the footplate forward, straightening the knees, and a direct up and down movement that changes the distance between the seat surface and the footplate.  Sometimes, these movements can be combined.
    • Swing away leg rests can also have elevation. Some are fitted with an additional feature that extends the length of them slightly whilst they elevate, referred to as articulation.  This prevents the knees of the user being lifted off the cushion during elevation. 
    • Elevating leg rests are often fitted to control swelling of the legs, however simply elevating the legs achieves very little improvement - the legs continue to remain the lowest part of the body for fluid to accumulate. Combined with tilt in space and recline however, the legs can be raised high enough to encourage a reduction in swelling.  This can be an uncomfortable position, therefore many users will opt to transfer to their bed, where they can comfortably raise their legs whilst lying down. 

Dear John

I hope that you are well.

I had a call from my client today saying how impressed that he was with you yesterday. He found it really helpful so thanks for that.  He wants to recommend you to a friend of his.

Thanks once again

JC - Anglia Case Management

This is a very quick overview of the different types of chair available.  It doesn't go into great detail, or include every option - we'll save the detail for later posts!  But if you're wondering what is available in the wheelchair market, this post might be a good start.  If you need any specific detail about any of the chairs, please let us know.

 

Standard Wheelchair

Standard wheelchairs are typically used by people for occasional use.  They come in a range of sizes, but their configuration is often limited.  Standard wheelchairs almost always fold for storage.  Most standard wheelchairs will have a transit option with small rear wheels, designed for the wheelchair user to be pushed by someone else.  They will typically have a self-propelling option as well, with large rear wheels, designed for the wheelchair user to propel themselves, using their arms.

Standard wheelchairs can be fitted with parts and accessories to make them useful for more complex users who use their wheelchairs frequently.  The addition of a contoured cushion, backrest, lateral supports and headrest can enable a standard wheelchair to be used for a more complex, full time user.

 

Active User Wheelchair

Active user wheelchairs are used by people who often use their wheelchairs for all their mobility.  Active user wheelchairs are configured to be efficient to propel by the wheelchair user themselves.  They are typically lighter weight than standard wheelchairs and have more weight distributed over the rear wheels.  The front wheels (casters) of an active user chair are often smaller than standard wheelchairs.  This helps to reduce rolling resistance and make the chair easier to turn.  Active user wheelchairs are configured very precisely for each person.  They therefore have many size and configuration options to tailor the wheelchair to each person and the way that they use the wheelchair.

 

Powered Wheelchair (Powerchairs)

Powerchairs are typically used by people who lack sufficient arm movement or strength to propel a manual wheelchair or are limited by distance or terrain.  Powerchairs have electric motors powered by batteries.  Control of the motors is usually via a joystick on the armrest, however other parts of the body can be used as well.  Powerchairs enable people to mobilise with very minimal effort.  Basic powerchairs are used indoors only and will have a small turning circle to cope with doorways and small spaces.  Larger powerchairs enable outdoor use as well and will cope with hills, rougher terrain and have larger battery capacity.  Some powerchairs are designed for outdoor use only and will cope with off-road terrain.

 

Tilt in space Wheelchair

Tilt in space tips the seating of the wheelchair backwards (imagine tipping a dining chair onto its back legs) and allows gravity to ‘push’ the upper body of the wheelchair user against the backrest of the wheelchair.  This enables the user to maintain a sitting position, but with reduced muscle control.  Tilt in space also helps with pressure relief by re-distributing weight bearing from the cushion to the backrest.  For users using a hoist to transfer to their wheelchair, tilt in space can make this transfer easier, allowing the angle of the seating to match that of the user in their hoisted position.  For other users, tilt in space enables them to adjust their own position, using gravity to assist them slide back over the cushion.

 

Bariatric Wheelchair

Obesity is defined by Body Mass Index (BMI) above 30.  Those with a BMI above 40 are considered morbidly obese or bariatric.  Specific wheelchairs, both manual and powered, are available for this weight range.  They will often look like other wheelchairs but have different construction materials or design that provides greater strength.  They will have a size range that is larger than other wheelchairs.

Link below to our second product review.  We take the Quickie Q700M (mid wheel drive) with Sedeo seating from Sunrise Medical and plough through some deep mud!  

We'd love to hear your feedback, so get in touch.  Don't be shy!

If there's a product you'd like to know more about, let us know:  info@silverferntherapy.co.uk

https://www.youtube.com/watch?v=O9vTxvj0Uw0

John

Link below to our first product review.  We take the Quickie Q700F with Sedeo seating and plough through some deep mud!  

We'd love to hear your feedback, so get in touch.  Don't be shy!

If there's a product you'd like to know more about, let us know:  info@silverferntherapy.co.uk

https://www.youtube.com/watch?v=o8Qwj7R1KbY&t

John

Here's a link the first video on our new YouTube channel!

https://www.youtube.com/watch?v=O9vTxvj0Uw0

We know its a bit rough around the edges, but its the content that counts right?

We want to review a wheelchair every few weeks and give our subscribers some real world information on how the chair performs.  We'd even love to get wheelchair users involved, so if you're up for appearing in our videos, please get in contact:  info@silverferntherapy.co.uk

Our first two videos will review the Quickie Q700 from Sunrise Medical.  We'll look at the outdoor driving performance of the front wheel drive and mid wheel drive versions of this wheelchair.  

Hope you like them.  As always, we'd love to hear your feedback.  Don't be shy!

John

We now have a YouTube channel! 

We're not 100% sure how the channel is going to develop in the future, however to start with we're going to use it for product reviews.

We have two reviews lined up already for two wheelchairs from Sunrise Medical: Quickie Q700F and Quickie Q700M.

Here's a link to our channel.  Please subscribe and we're really keen on your feedback.  If there's something you'd like us to review, please tell us!

https://www.youtube.com/channel/UC3qOVEd2t-hQ0UueUDIGLkw

John

What affects the manoeuvrability and self-propelling efficiency of a manual wheelchair? There are a whole host of variables that have influence, and we’ll cover some of them in this article.  We’ll go into more detail in future articles.

The main objective of a wheelchair is for the user to have maximum functionality, comfort and mobility. An inadequate wheelchair, as well as being uncomfortable, can cause sliding, leaning to the side, or generally uncomfortable postures, which can cause problems in the long run. It may also put certain muscle groups at risk of injury or result in a position that is not strong or efficient for self-propelling.   The shoulder is not a particularly stable or strong joint of the body, yet self-propelling a wheelchair is asking the shoulders to provide the engine behind the wheelchair’s motion.  Think how many times those shoulders are going to be used.  Soft tissue injury around the shoulder is a real risk, therefore anything that can be done to increase the efficiency of the push, or reduce the strength required to push, will reduce the risk of injury. That is why it should always be the chair that should fit your needs and not the other way around.

When assessing the suitability of a wheelchair, four factors need to be considered. How the weight is distributed between the wheels, what the centre of gravity is, the ground on which it is to be used, and the technical aspects (size, material, wheel type etc…). 

 

  1. The weight distribution between the front and rear wheels

The weight distribution of a wheelchair user refers to the proportion by which the weight is divided between the front and rear wheels. Generally, the greater the amount of weight on the front wheels, the greater friction will be, so it will require more effort to move it, although you will have greater stability.

A traditional 50% rear-wheel and front-wheel distribution (typical of standard wheelchairs) will guarantee stability, but will also require more effort to move - more appropriate if you are not going to self-propel yourself. An 80% distribution on the rear wheel and 20% on the front, will give you great efficiency, and will be more active.

 

  1. Centre of gravity adjustment

This can be the difference between a chair that can be self-propelled, and one that can’t.  It is important that the centre of gravity (COG) be set appropriately so that maximum efficiency can be gained, whilst maintaining some kind of stability.

Most active wheelchairs will have centre of gravity adjustment.  This could be achieved by moving the rear wheels forward/backward on the frame, or by moving the weight of the user forward/backward on the frame.  Both have the same effect.

Being able to move the centre of gravity of your wheelchair will allow the maximum adjustment of weight distribution. Generally, light aluminium chairs allow you to adjust it by moving the rear wheel position forwards, backwards, upwards and downwards. The further back and upwards you position the centre of gravity, the more weight you will give to the rear wheels achieving more mobility but less stability. It is advisable to adjust the centre of gravity of your wheelchair to meet your needs.

  1. Wheels

The rear wheels and tyres play a key role in the mobility of your wheelchair. Wheels provide the interface between your pushing force and the wheelchair therefore they need considerable attention when prescribing your wheelchair.  A strong wheel will flex less than a less strong wheel, therefore transferring more of your pushing force into forward movement.  You’ll get a slightly harder ride from a stiff wheel but this is unlikely to be noticeable.  Cheaper wheels will flex slightly during every push, absorbing some of your pushing energy resulting in a less efficient push.  They’re also more likely to suffer broken spokes or buckled rims.

Tyres cause a lot of debate, especially in NHS wheelchair services who are trying to save costs on repairs.  When choosing a tyre material, pneumatic ones are more comfortable and allow shock absorption, and provide less rolling resistance. The big benefit of solid tyres is the guarantee of never getting a puncture! The size of the wheel needs to be considered in combination with the height of the user, and the rear seat height of the wheelchair.  Taller users are more likely to gain benefit from a larger wheel (25 or 26”), especially if their rear seat to floor height is quite high. 

The distance between the casters and the rear wheels will greatly influence mobility and stability. The smaller the wheelbase, the better the wheelchair will turn and the more manoeuvrable it will be, however, as in all previous cases, greater mobility is usually synonymous with less stability. 

  1. Casters

Smaller casters will provide quicker, more efficient turning particularly on flat, hard surfaces.  This is why sports wheelchairs will always have very small casters. Outside, or on rough terrain, it is better that the front wheels are bigger because the contact surface with the ground is bigger and so the imperfections of the terrain can be absorbed.  Most active user wheelchairs will have 4 or 5” casters, a compromise between the very small and the very large.

Affiliations

Affiliations

HCPC
RCOT
Institute of Ergonomics & Human Factors
NHS Wales
Posture & Mobility Group
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