Wheelchair suppliers suggest that the selection of wheelchairs must be user centered, and occupational therapists should consult with rehabilitation physicians, physical therapists, nurses, patients, family members, etc. to choose wheelchairs based on the type and degree of disability of the user.
1、 General selection requirements for wheelchairs:
Wheelchairs are not only used indoors, but also frequently used outdoors. For some patients, wheelchairs may become their means of mobility between home and workplace. Therefore, choosing a wheelchair should meet the patient's medical needs, with specifications and dimensions that are suitable for the user's body shape, making the ride comfortable and stable; Wheelchairs should also be sturdy, reliable, and durable. When transferring, they should be firmly fixed to the ground to avoid shaking; Easy to fold and transport; Effortless driving and low energy consumption. The price is acceptable to general users, allowing them a certain degree of autonomy in choosing appearance (such as color, style, etc.) and functionality. Easy to purchase parts and repair.
2、 Choose a wheelchair based on different functional impairments:
Different functional impairments have different requirements for wheelchairs. The choice of wheelchair should be based on the user's functions such as upper limb muscle strength, coordination ability, joint mobility, sitting stability, etc.
1. Based on the user's ability to drive the wheelchair:
(1) Those who are completely unable to operate wheelchairs can only choose wheelchairs pushed by others. Such as complete paralysis of both upper and lower limbs and severe intellectual disabilities.
(2) Although both upper limbs do not have the power to drive a wheelchair, those with residual ability to move small handles or press electric switches can choose an electric wheelchair.
(3) Shoulder and elbow muscles have driving force, but if the grip strength of the hand is insufficient, plastic sea shrink can be wrapped on the handwheel, or a handwheel with a push handle can be selected. Patients with C5 spinal cord injury can use the muscle strength of the biceps to manipulate the horizontal push handle; For those with limited shoulder and hand joint movement, a vertical push handle can be used; When finger flexion is limited and it is difficult to make a fist, use a thicker push handle.
(4) For those who can only drive a wheelchair with one hand, they can choose a single-sided drive wheelchair or an electric wheelchair.
(5) Hemiplegic patients can choose a low seated regular wheelchair, use their healthy hands to drive the handwheel, and control the direction when landing on the ground.
(6) Individuals with poor upper limb muscle strength should install extension rods to facilitate the operation of the brake.
2. According to the user's ability to enter and exit the wheelchair, although the weak upper limb muscles can barely drive the wheelchair, they cannot independently enter and exit the wheelchair. Therefore, footrests that can be separated on both sides should be selected to facilitate the wheelchair to be close to the edge of the bed.
3. Based on the user's posture and position
(1) Patients with limited hip joint deformity should choose a tiltable backrest wheelchair.
(2) Patients with limited knee flexion should choose a lifting footrest bracket.
(3) People with complete paralysis of both lower limbs should choose wheelchairs with leg rests, and heel rings should also be placed on the footrests.
(4) People who may develop pressure ulcers should use wheelchair cushions.
(5) Lower limb amputees, especially those with bilateral thigh amputations, need to move the wheelchair axle backwards and install a tilt bar.
(6) Those who cannot maintain a stable sitting position should be secured with seat belts.
(7) Patients with trunk muscle paralysis accompanied by severe paralytic scoliosis are advised to use manual stretchers.
4. According to the usage environment of the wheelchair
(1) Wheelchairs used indoors or on urban streets should be equipped with solid tires and smaller diameter casters; In rural areas and environments with poor road conditions, users should choose pneumatic tires. The casters should be slightly larger.
(2) To prevent finger damage when vigorously pushing the wheelchair, it is possible to consider removing the handrails and brakes of the competitive wheelchair.
5. According to the needs of work and dining, those who need to sit in a wheelchair should choose a stepped short armrest to make the wheelchair close to the writing desk and dining table, or choose a stable wheelchair with an additional wheelchair table.
Different diseases and injuries have special requirements for wheelchairs:
1. Paraplegic patients have similar requirements for wheelchairs, except for those with high thoracic spinal cord injuries who need to consider balance control of the trunk. The specifications of the seats are determined by body measurements. Generally, a stepped short armrest is selected and a wheel lock is installed. If you need to complete the transfer movement from the back, you can place a zipper on the backrest or choose a wheelchair with a tilting backrest; If it is necessary to transfer from the side, a detachable armrest should be selected. For those with ankle spasms or spasms, ankle straps and heel rings should be added. When the road conditions in the living environment are good, solid tires can be used to increase speed, and thick seat cushions can be used for shock absorption.
2. For those with quadriplegia C4 and above injuries, they can choose pneumatic or manual electric wheelchairs or wheel paralysis operated by caregivers. For those with C5 and below injuries, they can use the bending force of their upper limbs to operate the horizontal handle, so they can choose a high back electric wheelchair controlled by their forearms. For those with better functionality, they can choose a lightweight manual wheelchair. Individuals with orthostatic hypotension should choose a tiltable high back wheelchair with a headrest installed; And combined with the use of a knee angle adjustable opening and closing detachable footrest. The axle should be positioned as far back as possible, with a tilt bar installed and a thicker seat cushion chosen.
3. If hemiplegic patients have no cognitive impairment, good comprehension ability, and coordination, they can choose to use a unilateral wheelchair; Those with severe illness choose someone else to push the wheelchair. For those with good balance function, they can choose a standard wheelchair with a lower seat, install detachable footrests and leg rests, so that their feet can fully land on the ground and complete the operation with their healthy upper and lower limbs. If assistance is needed for transferors, it is better to choose detachable handrails.
4. For amputees with both lower limbs, due to significant changes in body center of gravity, it is generally necessary to move the axle backwards to prevent tilting backwards; In the early days, wheelchairs with large wheels in front could be used, and if there were prosthetics, leg and foot supports should be installed.
5. Lower limb disabilities and other lower limb disabilities generally use standard wheelchairs; Elderly, frail, and severely ill individuals generally choose someone else to push their wheelchair. Other obstacles should be considered comprehensively based on the degree of disability or injury, joint activity, muscle strength, weight, trunk balance, living environment, etc.
