A wheelchair is an important rehabilitation tool that enables people with disabilities to take care of themselves. Many people with disabilities, although they have lost the function of walking, can take care of themselves, take care of household chores, and even perform appropriate full-time work with the help of wheelchairs. In addition to being a means of mobility, wheelchairs can also be used to exercise the body in order to enhance the coordination between the cerebral cortex and muscle contraction, improve the function of the cardiovascular system, reduce the occurrence of complications, and improve their enjoyment and confidence in life.
I. Types of wheelchairs
1.Fixed wheelchair
The structure is simple, but it takes up more space when not in use, and it is not convenient to get in and out of the car.
2.Folding wheelchair
The frame can be folded, which is easy to carry and transport. This is currently the most widely used at home and abroad.
This is the most widely used at home and abroad. Depending on the width of the chair and the height of the wheelchair, it can be used by adults, teenagers and children, and some according to the wheelchair can be replaced with a larger seat back and backrest to adapt to the needs of children growing. Folding wheelchair armrests or footrests are removable.
3.Laying wheelchair
The backrest can be tilted backwards from vertical to horizontal position. The footrest can also freely change the angle.
4.Sports wheelchair
A special wheelchair designed for competition. It is light in weight and can run faster in outdoor applications. In order to reduce weight, in addition to the use of high-strength lightweight materials (such as aluminum alloy), some sports wheelchairs can not only remove the armrests and footrests, but also remove the handle part of the backrest.
5.Hand-push wheelchair
This is a wheelchair that is pushed by others. This kind of wheelchair can be used before and after the same diameter of small wheels to reduce the cost and weight, its armrests can be fixed, open or folding type, push wheelchair is mainly used as a nursing chair.
6.Electric wheelchair
There are different specifications for adults or children to use. Its weight is about double the standard wheelchair. To meet the needs of people with different degrees of illness and disability. Electric wheelchairs have a variety of different control methods, hand or forearm function has part of the residual, you can choose the hand or forearm to operate the electric wheelchair. The electric button or rocker of this wheelchair is very sensitive and can be operated with a slight contact of the fingers or forearm. The speed of the vehicle is close to the walking speed of a normal person and can climb a slope of 6-8. For patients with complete loss of hand and forearm function, there are electric wheelchairs that can be operated with the lower jaw. Nowadays, there are electric wheelchairs controlled by breathing and eyes, which further expand the application of wheelchairs and enable many patients with high cervical spine injuries who did not dare to imagine the possibility of getting rid of the lifelong bed-ridden condition to achieve a certain degree of freedom of movement.
7.Other special wheelchairs
For the specific needs of patients with certain disabilities, there are a variety of special wheelchairs. Such as
(1) unilateral passive wheelchair
(2) special wheelchair for going to the toilet
(3) Some wheelchairs with lifting devices
Second, the posture of wheelchair
1.Sit upright, eyes level, both shoulders relaxed, hands holding the armrests, the upper part of the body slightly tilted forward.
2.Hips close to the backrest. When driving movement, the hip and abdominal muscles contract, which is conducive to the stability of the pelvis and reduces abnormal hip activity. If the body forces on the hips indicate that the seat is too deep. If you cannot change to a shallower chair to sit, a small leaning potential can be placed vertically behind the patient.
3.The angle between the large and small legs is within the range of 110-130, with 120 being the most appropriate, and the medulla and knee are at the same height. For those with spasticity of the adductor muscle, an inch pad needs to be placed between the two knees to prevent bed sores.
4.The feet are parallel, the distance between the feet and the pelvis is the same width, which helps to stabilize the pelvis and share the body weight.
5.When driving, it is appropriate to keep the joints around 120, in order to reduce the fatigue of the upper limb muscles.
6.Patients who are unstable in sitting or going down the slope should be girded. Travel slowly and observe the patient’s condition at all times.
III. General techniques for using wheelchairs
Whenever the patient is in the wheelchair for activities or getting in and out of the wheelchair, he or she must master the basic actions such as manipulating the brake (brake), removing the armrests and footrests, lifting the hips to the front in the wheelchair, and being able to pick up things from the ground in the wheelchair and move both hands to the footrest to tighten the toe guard. Patients and family members should learn techniques such as pushing the wheelchair on level ground, pushing the wheelchair on slopes, and going up and down steps.
(I) Self-use
1.Pushing the wheelchair on a flat surface
When pushing the wheelchair on a flat surface, sit firmly on the hips, keep your body balanced, and tilt your head up and forward. With arms back, elbows slightly flexed, hands grasping the rear of the wheel ring, arms forward and elbows extended. At this point, the body leans forward slightly, repeated several times, due to the forward force generated by the upper body to enhance arm strength.
Wheelchair backwards on a flat surface.
(1) arms between the wheel handle around the back of the chair, elbows set hands on the manual circle.
(2) Lean back and depress the shoulders so that the arms can use enough force to push the wheel backwards, or for those who cannot push the wheelchair up the slope, this method can be used to make the wheelchair fall up the slope.
(3) The affected limb of the hemiplegic patient and the healthy measurement coordinate the movement to push the wheelchair forward.
2.Pushing the wheelchair on the slope
(1) Uphill: lean forward. After placing both hands on the top of the manual circle, push the wheel forward with the wrist joint dorsally extended and the shoulder joint flexed and inward. By switching the direction of the wheels to intersect with the slope, the wheelchair can also gain a foothold on the slope.
(2) Downhill: Extend the head and shoulders and apply hand brakes, either by placing both hands in front of the wheel or by placing one metacarpal under the manual ring while maintaining wrist dorsiflexion.
3.Transfer wheelchair direction
Take turning to the left side as an example.
(1) Place the left hand behind the manual ring;
(2) Rotate the left arm slightly to the outside, thus transferring the body weight to the inside of the wheel through the left hand;
(3) Turning the right wheel backward with the left hand while turning the right wheel forward with the right hand in the normal position.
(II) Use of the aider
1. Forward or backward.
(1) Four-wheel landing method: The wheelchair stays horizontal and pushes or four-wheel landing
(2) Two-wheel landing method: the directional wheel is empty, the big wheel is on the ground, and the wheelchair is tilted back 3 mines to push or pull
2.On the steps.
(1) two-wheeled landing method, dragging backward on the steps.
(2) handle to the back of the lower pull, feet on the back tilt lever, the directional wheel on the steps, carry the hand forward and up, the momentum will roll the big wheel on the steps, push.
3.Up and down stairs.
(1) one person type, two wheels on the ground method, dragging backward, step by step. Down the stairs and vice versa.
(2) Two-person style, the same person style, another person placed in front of the wheelchair to assist.
(3) Four people, the same person, two people in front of and behind the wheelchair, coordinated.
IV. Wheelchair transfer technique
Patients using wheelchairs often need to transfer from wheelchairs to beds, buckets, baths and motor cities in the opposite direction, which requires scientific training.
There are two types of transfers: vertical transfer and seated transfer. Vertical transfer is suitable for any patient who can maintain stable standing during hemiplegia and native transfer. There are three main forms of seated transfer: lateral sliding transfer with a skateboard, lateral transfer without a skateboard, and anterior-posterior sliding transfer. Seated transfers are mainly used in patients with paraplegia and other lower limb movement disorders (e.g., bilateral amputees). The vertical transfer is mainly introduced here.
Non-assisted vertical transfer requires good sitting balance; no upright hypotension; relying on contraction of random muscles, long-legged orthosis or extensor muscle straightening to keep the leg in the straight position; having fairly strong shoulder descenders and adductors, and also strong elbow flexors and extensors, and more importantly, good strength of one hand and wrist.
1. Transfer from bed to wheelchair (for example, for hemiplegic patients)
The height of the bed should be close to the wheelchair seat, a short armrest should be installed at the head of the bed, and the wheelchair should have a brake and a folding footrest. The wheelchair is placed on the patient’s healthy side. The wheelchair is positioned at a slight angle (30-45) to the end of the bed.
(1) The patient sits at the bedside and first locks the brake on the wheelchair;
(2) Tilt the torso forward while using the healthy limb, position the measured foot and hand downward while moving to the side of the bed;
(3) Flex the knee of the healthy limb to more than 90, and move the healthy foot to slightly behind the affected foot to facilitate free rotation of both feet;
(4) grasp the bed armrest (if the balance is unstable, grasp the middle of the wheelchair armrest farther away), the patient’s trunk moves forward, using his or her healthy arm to brace forward, so that most of the weight is transferred to the healthy lower leg. The standing position is achieved;
(5) The patient moves his or her hands to the middle of the distal armrest of the wheelchair and moves both feet so that he or she is in a position ready to sit;
(6) After the patient is in the wheelchair, adjust his or her position and release the brake. Back the wheelchair out of the bed;
(7) Finally, the patient places the footrest in its original position, lifts the affected leg with the healthy hand, and places the foot on the footrest.
2.Transfer from the wheelchair to the bed
(1) Face the wheelchair towards the head of the bed;
(2) After braking on the brake, lift the affected chest with the healthy side hand and then move the footplate to the side;
(3) Lean the torso forward and move downward to the front line of the wheelchair until both feet hang down and the healthy foot is behind the affected foot; grasp the wheelchair armrest (or bed armrest), move the patient’s torso forward and use the healthy side to move up and down to support the weight and reach the standing position.
(4) After standing, move the hand to the bed armrest and move to both feet so that they are in a position ready to sit on the bed; sit on the bedside and lie down.
3.Transfer from wheelchair to commode
The patient must be able to dress and undress by himself, the toilet seat should be preferably 50c above the ground and can be lifted, and the wall next to the toilet should preferably be equipped with handrails.
(1) Tilt the wheelchair so that the patient’s body is close to the bucket;
(2) Braking on the brake, then foot off the footrest and move the footrest to the side;
(3) Press the armrest of the wheelchair with the hand on the healthy side, and then the patient leans forward with the trunk. Move forward in the wheelchair;
(4) Use the able-bodied leg to support the majority of one’s weight to rise from the wheelchair. The strength to stand up comes mainly from the able-bodied leg;
(5) After standing, rotate both feet. (5) After standing, turn both feet until standing in front of the toilet.
The patient retracts the pants and sits on the bucket. When transferring from the commode to the wheelchair, the above procedure can be reversed.
4.Transfer from wheelchair to the bath tub
Two sturdy wooden chairs should be used, one next to the bath tub and one inside the bath tub. The patient must have sufficient physical strength to be sure that he or she has the ability to move to the 18Cm or 13Cm high wooden chair or to transfer to the bath tub before using this method. The wooden chair in the tub should be shorter, so that the seat of the two wooden chairs inside and outside the tub and the side of the tub are at the same height, and a rubber pad should be installed on the bottom of the feet of the short wooden chair to prevent the chair from sliding.
(1) the patient’s healthy side of the hand pressed to the chair seat, the healthy limb feet on the floor, the body moved to the side of the wooden chair, and to the side of the bath tub;
(2) The patient lifts the affected leg with the healthy hand and places it in the tub;
(3) The patient slides his body onto the chair in the tub by using the healthy side hand and leg for support and grabbing the handrail on the wall;
(4) Finally, the healthy side is moved into the tub.