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Introduction

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For people who have spinal cord injury (SCI) and others who use a manual wheelchair as their primary means of locomotion, the ability to propel and maneuver over and around various obstacles and terrains in their home and community is essential for functional independence, community participation, and quality of life.1,2 To propel a manual wheelchair independently in the home and community environments, riders need to be able to perform basic wheelchair mobility skills such as propulsion, door management, emergency egress, wheelies and be able to ascend and descend steep hills, ramps, and curbs. Optimal wheelchair configuration, which allows for the ideal rider positioning, and appropriate technique while performing these skills is important for energy efficiency, injury prevention, and safety. Physical therapists should also employ appropriate teaching strategies to promote motor learning.

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Wheelchair Configuration

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A wheelchair for a person who will use it for full-time mobility should be custom specified.3 For those who will use it for more than short-duration intermittent transport, the wheelchair should be correctly measured for seat width, seat depth, backrest height, and footrest length. After sizing, configuration should be determined. Configuration establishes the dynamic stability of the wheelchair and the rider. The configuration required depends upon the disability and ability of the rider.

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If the user is a part-time walker, the wheelchair should be configured to make sit-to-stand transfers easiest to accomplish. In this case, the wheelchair is best configured with swing-away or flip-up footrests to allow the feet to be positioned with knee flexion and an anterior tibial inclination. Often, a slightly higher seat height is also advantageous.

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If the user will be propelling the wheelchair with his or her feet, the wheelchair seat needs to be lower to the ground and the seat depth slightly shorter. The footrest should be removable and will need to be set slightly shorter than the user's legs to allow ground clearance when in use. A chair that will be frequently pushed by a caregiver should include push handles and be set up with a slightly longer wheelbase and larger casters. This wheelchair may also have a higher backrest with a posterior bend in the canes (vertical tubular bars supporting the backrest) to create a slight recline at the top to allow better posture and comfort for the rider.

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The wheelchair that will be propelled by the rider independently for community mobility should be set up for optimal push mechanics and dynamic stability. There is a fundamental difference in the configuration needs of a person without innervated trunk muscles compared with someone who has innervated trunk muscles. People who have lower extremity (LE) amputation or lumbar paralysis will be best seated in a wheelchair with a minimal seat angulation (angle above horizontal): generally, approximately 5 degrees or 0.08 slope (Fig. 8.1A). The backrest should support the low back, providing lumbar ...

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