Freedom in a wheelchair: wheelchair options for people with spinal cord injuries

Wheelchairs are one of the most commonly used assistive devices for patients with spinal cord injuries. They provide patients with the opportunity to study, work, participate in cultural activities and access health care services. For patients with spinal cord injuries, an appropriate and well-designed wheelchair is the first step to return to family and society. Unfortunately, however, we find that many patients have 3-4 wheelchairs stored at home, but few actually own a suitable wheelchair. Choosing a suitable wheelchair can not only significantly improve the patient's quality of life, but also reduce the risk of secondary injuries. Therefore, it is crucial for patients and their families to understand how to choose a wheelchair correctly.

PART.1 Common mistakes in wheelchair use: Patients with spinal cord injury should pay attention. In 2019, Mingxia suffered a spinal cord injury after a car accident. In the past five years, she has purchased high-back wheelchairs, electric wheelchairs, elderly wheelchairs, and the semi-sport wheelchair she is using now. For people who don't know about spinal cord injuries, they may not understand why she bought so many wheelchairs, but this is very common among people with spinal cord injuries. Because they don't know which wheelchair is suitable for them, they always find new problems every time and always feel that it is not very suitable.

Mingxia's parents came to us and reported the following problems: 1) Her legs were always close together, which affected her dressing and taking off pants and cleaning her urine and feces. 2) She always hunched her back and could not sit up straight. 3) Her feet were not level on the wheelchair, and she would always fall off the pedals when encountering bumpy roads. 4) She had difficulty maintaining balance in the wheelchair, swaying from side to side and having difficulty sitting still.

After further evaluation, we found that:

PART.2 Evaluating whether your wheelchair is suitable: key points analysis We can't help but ask, what exactly is a suitable wheelchair? It must meet at least the following 5 points:

1. Whether the size matches

According to the primary wheelchair service standards issued by the World Health Organization:

Seat width: equal to hip width.

Seat depth: The straight-line distance from the back of the pelvis to the popliteal fossa minus 30 to 60 mm (whichever is shorter).

Height from the top of the seat to the footrest: equal to the length of the calf.

Backrest height (top of seat cushion to top of backrest): from the lower edge of the rib cage to the seat surface (or measure the distance from the lower angle of the shoulder blade to the top of the seat cushion as needed).

2. Can you maintain a correct sitting posture?

Correct sitting posture depends not only on personal balance ability, but also on factors such as backrest, base, cushion and wheelchair inclination. Generally, harder backrest and base can significantly improve sitting posture, avoid hip internal rotation, and problems such as "always keeping legs close together". This is very important for minors who are still growing and developing!

3. Whether it meets the needs of users

Mingxia wants to be able to carry out long-distance activities, so she needs a wheelchair that can be equipped with a traction head and can be folded and stored. Obviously, her current wheelchair cannot meet these needs.

4. Suitable for the user's usage environment

Mingxia lives in a city with a small house and a narrow bathroom, so she needs a narrower wheelchair to facilitate turning. Some patients may live in rural areas with bumpy roads, in which case they need larger front wheels to cope with complex road conditions.

5. Is it easy to maintain?

Wheelchairs need regular cleaning and maintenance, and some wearing parts need to be replaced in time. Problems such as loose brakes and damaged wheel bearings should be able to be quickly maintained and repaired locally, just like cars, which need good after-sales service.

PART.3 How to choose a wheelchair that suits you: Expert advice (I) Before choosing a wheelchair , you must first accurately measure

1. Seat width

Measure around the hips or the widest part of the thigh. Make sure the wheelchair user's clothing pockets are empty before measuring.

2. Sit Deep

Measure the distance in a straight line from the back of the pelvis to the popliteal fossa. Make sure to measure both legs. If the measurements are different, check that the wheelchair user is sitting upright with a level pelvis. If the measurements are still different, take the value from the shorter leg.

3. Long calves

Measure from the popliteal fossa to the bottom of the heel. Make sure the wheelchair user's ankle is flexed 90 degrees and they are wearing their normal shoes.

4. From the lower edge of the chest to the seat

Measure from the seat of the chair to the bottom of your rib cage. To help locate the bottom of your rib cage, place your hands on either side of your pelvis. Gently squeeze your hands inward and slide them upward so that the bottom of your rib cage is just above your waist.

5. From the lower angle of the shoulder blade to the seat

Measure the vertical distance from the seat of the chair to the inferior angle of the scapula. To help find the inferior angle of the scapula, ask the wheelchair user to shrug their shoulders.

Tips ：

1. The user should sit as straight as possible during measurement;

2. Hold the board close to your body to help with accurate measurement.

(II) Accessories selection :

1. Pedal

The pedals are mainly divided into three categories in terms of structure: fixed pedals, split pedals, and detachable pedals. For users who need lower limb support to participate in the transfer, or users with partial standing function, the pedals need to be able to be opened to the sides or back, so that the lower limbs can better participate in the transfer activities.

2. Handrails

The armrests mainly include removable armrests, wheeled armrests, and square fixed armrests. Removable armrests or wheeled armrests make it easier for users to get on and off the wheelchair from the side. For wheelchairs, armrests that are too high will make it difficult for wheelchair users to push the wheelchair comfortably by hand.

3. Braking

Brakes are mainly divided into two types: push rod brakes and scissor brakes. If the push rod of a push rod brake is too long, it will increase the distance between the wheelchair and the bed during transfer. In many high-back wheelchairs, the brake lever of the push rod brake is too high, which may rub against the buttocks during transfer, increasing the risk of skin damage.

4. Backrest

A backrest that is too high will prevent the wheelchair user from moving their arms and shoulders comfortably to push the wheelchair. Common backrests include fabric backrests and hard backrests, and hard backrests should be padded.

5. Backrest handle

When you need someone to help push the wheelchair, such as daily pushing, going up and down stairs, etc., a handle is necessary. In addition to making it easier for others to push the wheelchair, the handle can also provide some protection when the wheelchair falls backwards. However, the handle will also affect the folding and storage of the wheelchair, and increase the volume after folding.

6. Rear wheel

The rear wheels should be positioned so that when the user holds the top of the push ring, the elbow joint is bent 90 degrees. If the rear wheels are positioned relatively far back, it will be more difficult for the wheelchair user to push the wheelchair. When choosing the size of the rear wheels, it is necessary to pay attention to the occupation and environment in which the wheelchair will be used. For example, if a child is short in height, if a smaller rear wheel is used, it will not be possible for the child to maintain a relatively suitable height with others at the dining table or desk.

7. Ferry

The more weight the wheels have to bear, the larger they are. The smaller the wheels, the more flexible they are in steering.

8. Seat

The seat can be either rigid or suspended. Suspension seats are made of fabric that is fastened to the sides of the frame. Poor quality suspension seats can sometimes sag and not provide good support, making it difficult for the user to maintain an upright sitting position.

9. Framework

The frame of the wheelchair not only affects the stability during use, but also the folding and storage. The main difference in the material of the frame is the weight and strength, which is very important for wheelchair users who need to drive a car.

10. Cushion

Seat cushions can be divided into air, fluid or gel cushions based on the filling materials. Different filling materials have their own characteristics. The choice of seat cushions should be based on both ensuring the stability of the sitting position and having a good pressure relief effect.

(III) Steps and precautions for wheelchair customization

Customization steps:

1. Evaluation

Assess the user's physical condition, lifestyle, environment and other needs, and perform accurate measurements.

2. Choose

Choose the appropriate wheelchair type, size and accessories based on user needs and local conditions.

3. Preparation

Adjust and inspect wheelchairs to ensure safety and adaptability.

4. Follow-up

Provide user training to teach users wheelchair operation, transfer, prevention of pressure sores, etc. At the same time, inform users of wheelchair maintenance methods, conduct regular follow-up visits, and adjust or repair wheelchairs as needed.

Note:

1. Meet users’ personalized needs:

Consider the physical condition, age, gender, living environment, etc. of different users to ensure that the wheelchair can provide appropriate support and function.

2. Adapt to the environment and activities:

Wheelchairs need to adapt to different geographical environments and usage scenarios, such as indoors, outdoors, on rough surfaces, etc., while meeting the needs of users in work, study, social activities and other activities.

3. Consider cost and sustainability:

Choose affordable and durable products, ensure local availability, maintenance and repair, and plan funding sources and cost control appropriately.

END
Author: Wang Yue, Gao Dayong, Wei Cuicui (Department of Spinal Cord Injury Rehabilitation, Yangzhi Rehabilitation Hospital, Tongji University, Shanghai)

Reviewer: Liu Xidong, Director of the Assistive Devices Center of Sichuan Bayi Rehabilitation Center (Sichuan Rehabilitation Hospital), Vice Chairman of the Rehabilitation Assistive Devices Application Professional Committee of the Chinese Rehabilitation Medicine Association

Editor: Jia Jing (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)