Silver Age Health | Selection and Use of Wheelchairs

Wheelchairs are widely used tools, and are very suitable for elderly people with lower limb disabilities, hemiplegia, paraplegia below the chest, and people with limited mobility. As children or caregivers, understanding the characteristics of wheelchairs, choosing the most suitable wheelchair and the most correct way to use it will make the elderly or people in need feel very comfortable.

| Types of wheelchairs

Wheelchairs include ordinary wheelchairs, single-side drive wheelchairs, standing wheelchairs, electric wheelchairs, reclining wheelchairs, racing wheelchairs, and special amputee wheelchairs (large wheels are positioned backward to maintain balance), etc. Ordinary wheelchairs are also divided into solid tire wheelchairs for indoor use and pneumatic tire wheelchairs for outdoor use.

| Choose a functional wheelchair according to your needs

When choosing a wheelchair, you need to consider various factors, such as the patient's degree of disability and functional impairment, age, hobbies, economic status, living and working environment, etc. Different patients should have different requirements. Only by meeting these different requirements can the wheelchair be used properly and avoid accidents.

1. Patients with spinal cord injury

The height of the injury site in patients with spinal cord injury determines the level of recovery of limb function, so different requirements are placed on wheelchairs. People with cervical spinal cord injury should choose a high-back wheelchair because of trunk muscle weakness. In addition, although these patients have basically lost their upper limb motor function, they may still have some weak movement ability, and they can also use an electric wheelchair that is easy to control. For patients with lower spinal cord injury sites and sound upper limb function, especially young patients, in order to enhance their ability to live independently after rehabilitation, they can use a standard wheelchair and work hard to train wheelchair use skills.

2. People with lower limb disabilities

Whether it is a person with reduced or lost lower limb function or a lower limb amputee, since the rest of their body is generally healthy, wheelchairs are often used for longer distance activities. Due to the different conditions of lower limb diseases and disabilities, some people have ankylosing knee joints, so the wheelchairs they ride should be equipped with lower limb brackets according to specific body position parameters. Some people are only disabled in one leg, and often use one healthy leg as power to walk in a wheelchair. For them, the distance between the seat cushion and the ground is very important, which can be solved by adjusting the fixed position of the large wheel axle on the wheelchair frame and the thickness of the seat cushion.

3. Patients with craniocerebral diseases

Some patients with craniocerebral diseases have ataxia, consciousness and mental disorders, and must be accompanied by a caregiver when driving a wheelchair. The wheelchair should be equipped with a safety belt to prevent the patient from slipping off the wheelchair.

4. The elderly and the infirm

The elderly and the infirm generally only need to use ordinary wheelchairs for indoor and outdoor activities to increase their body activity, improve metabolism, and achieve the goal of delaying aging; at the same time, appropriately expanding the scope of activities can also enrich life and adjust the mentality.

In addition, the appropriateness of the wheelchair size, especially the width and depth of the seat, the height of the backrest, and the distance from the footrest to the seat cushion all affect the rational use of the wheelchair.

| How to choose a comfortable wheelchair

1. Seat width

Refers to the distance between the armrest side panels on both sides of the wheelchair. After sitting properly, the distance between the buttocks and the two inner sides of the wheelchair seat should be 2.5cm each. If the seat is too narrow, it will not only make it inconvenient for the patient to get on and off the wheelchair, but also easily scratch the patient's skin, and even squeeze the femur and cause pressure sores; if the seat is too wide, it will be very difficult for the occupant to drive the wheel ring.

2. Seat length

Measure the horizontal distance between the buttocks and the calf gastrocnemius when sitting, and subtract 6.5cm from the result. If the seat is too short, the body weight will mainly fall on the ischium, which is prone to excessive local pressure; if the seat is too long, it will compress the popliteal area, affect local blood circulation, and easily irritate the skin in this area. For patients with extremely short thighs or hip and knee flexion contractures, it is better to use a short seat.

3. Seat height

The height of the backrest should be determined according to the seat height and trunk function of the occupant. The lower the backrest, the easier it is to move the upper body and arms; the higher the backrest, the more stable the occupant. When placing the footrest, the board should be at least 5 cm off the ground. If the seat is too high, the wheelchair cannot be put next to the table; if the seat is too low, the sitting bones will bear too much weight.

4. Armrest height

When sitting, keep your upper arms vertical and your forearms flat on the armrests. Measure the height from the seat to the lower edge of your forearms and add 2.5cm. The proper armrest height helps maintain a correct body posture and balance, and allows the upper limbs to be placed in a comfortable position. If the armrests are too high, the upper arms are forced to rise, which can easily lead to fatigue. If the armrests are too low, the upper body needs to bend forward to maintain balance, which can not only lead to fatigue, but also affect breathing.

5. Distance between seat and pedal

After the passenger sits down, put both feet on the pedals, and the bottom of the front thigh at the popliteal fossa is about 4cm away from the seat cushion. If the distance between the seat cushion and the pedals is too small, the distance between the front thigh and the seat cushion will be too long, causing the ischial tuberosity to bear too much weight; if the distance between the seat cushion and the pedals is too large, the passenger's feet cannot step on the pedals, and the feet will lose support and swing freely, which can easily cause injuries.

6. Seat cushion

For comfort and to prevent pressure sores, a cushion should be placed on the seat. Foam rubber (5-10 cm thick) or gel pads can be used. To prevent the seat from sinking, a sturdy wooden board can be placed under the cushion.

▏The correct way to use a wheelchair

1. Pushing a wheelchair up and down a slope

When going uphill, the caregiver should stand behind the wheelchair, lean forward, and push the wheelchair forward to prevent the wheelchair from tipping over due to the shift of the center of gravity. When going downhill, turn the wheelchair upside down, and the caregiver should also lean forward and walk backwards. The caregiver should go downhill backwards to prevent the wheelchair from sliding down due to inertia.

2. Go up and down stairs and cross thresholds

When going up the stairs, the caregiver presses the power-assisting frame with one foot to raise the front wheel of the wheelchair (using the two rear wheels as fulcrums to allow the front wheels to move up the stairs smoothly) and gently puts it on the stairs. After the rear wheels are close to the stairs, use both hands to lift the handrails at the same time to lift the rear wheels of the wheelchair off the ground. Be careful not to lift it too high so that the elderly's center of gravity leans forward. When lifting the handrails, get close to the wheelchair and drive it closely to facilitate force. The same method can be used when crossing the threshold.

When going down the stairs, step on the power-assist frame with one foot to lift the front wheel of the wheelchair off the ground. The caregiver should put the center of gravity on the back of the body. When pushing the wheelchair to the edge of the stairs, pull the wheelchair backward with both arms to slowly move it down. Do not release the force after the rear wheel lands. Do not relax the body until the front wheel also touches the ground. During the process, instruct the elderly to hold the handrails tightly, lean back against the wheelchair, and keep stable. Note: It is not recommended to push the wheelchair down the stairs when caring for the elderly alone. If necessary, try to seek help from people next to you to lift the wheelchair down.

▏Care methods for elderly people in wheelchairs

1. Before helping an elderly person sit in a wheelchair, you must first understand the elderly person's physical condition and mobility, communicate with the elderly person, and tell them that you will turn their body so that they will actively cooperate.

2. After unfolding the wheelchair, press the seat cushion with your hand to see if it is soft, comfortable, dry and fresh.

3. Before the elderly sit on the wheelchair, be sure to lift the footrest first, and wait until the elderly sit firmly before placing the footrest under the elderly.

4. Family members and caregivers should keep the elderly person's body steady, with their back against the back of the wheelchair, their hands placed steadily, and their seat belts fastened to prevent them from slipping.

5. The time that the elderly sit in a wheelchair should not be too long each time. Every 30 minutes or so, relatives or caregivers should help the elderly stand up, or change their sitting position appropriately to avoid prolonged pressure on the buttocks causing pressure sores.

6. Pay attention to the placement of the seat belt. After unbuckling the seat belt for the elderly, do not place it in front of the seat or on the cushion at will. This will easily cause the safety buckle to break or the safety buckle to get caught in the wheel. Every time you unbuckl the seat belt, place it behind the back of the seat.

7. When the weather turns cold, when pushing a wheelchair outside, you should always pay attention to the elderly person's health and put a thin blanket on the elderly person's legs to keep them warm.

8. If the elderly have edema, ulcers or joint pain in the lower limbs, they can lift the footrest and place a soft pillow under it.

(Picture from the Internet)

Author | Li Aiping

Born in Qiqihar, Heilongjiang Province, graduated from Fuzhou Medical University, has 20 years of nursing experience, and is a national second-level nurse. An expert in food hygiene and nutrition, with national nutritionist qualifications, and a science enthusiast.