Proper Wheelchair Fitting
The right wheelchair is extremely important to the overall health of a wheelchair user, but often over looked. Information and measurements are essential to a proper fitting wheelchair.
Your first two questions should be: Does the individual use his/her arms to propel, foot propel or a combination? How do they transfer to and from the wheelchair? Both of these questions affect the floor to seat height that the chair would need to be set at. If a wheelchair seat is too high, the user will slide down in the seat in order to touch the floor creating poor posture. This can cause long term damage to the spine. A more immediate problem is shallow breathing as a result of folding your diaphragm in half. If the seat to floor height is too low, it will make transfers difficult or unsafe. Individuals who foot propel will want a seat to floor height that keeps their knee and hip even and still allows the foot to strike the floor heel first.
The type of transfer someone does will also indicate the arm type required on the chair. If you or your client is able to do a standing pivot transfer, full length arms will be required. This will keep your body standing straighter as you gain your balance. Individuals who are unable to stand may perform a sliding transfer. This activity will require removable or swing away arms on the chair. When transferring is not an issue, a shorter arm length will allow for closer access to a desk or table. Wheelchairs also have the option of having adjustable height arms. This is an important feature that assures your shoulders aren’t pushed up too high, nor would you have to lean over to rest your arm. A proper height will leave your shoulders level and arms resting in place.
If you are taller or shorter than average, an adjustable height back may be required depending on your/clients upper body strength. The correct height in most cases in just below the scapula.
Wheelchairs come in a variety of styles and weights. If person using the wheelchair has poor upper body strength, they would need a lighter weight wheelchair. Common sense would indicate the lighter the wheelchair the less effort the user has to exert to push/pull the wheelchair along.
You must keep in mind, when deciding on the weight of the wheelchair, that wheelchairs have maximum weight ratings. Most wheelchairs are rated to handle a client up to 250 pounds. A number of manufacturers specialize in bariatric wheelchairs for patients weighing 300-700 pounds. Wheelchairs can be custom built to meet almost any weight or size requirement.
Wheelchairs are readily available in standard seat sizes. They begin at 14″ wide and increase in two inch increments up to 30″ wide. They also come in a variety of seat depths. This is the measurement from the back of the seat to the front. Most stock chairs are 16″ deep. They also increase in two inch increments up to 20″ deep. Anything wider or deeper would fall into the custom category.
To determine the seat size, you need two measurements. The width of the seat is determined by measuring a straight line from one hip to the other. Do not measure around the mid section, but straight through it, then add 1 inch. Then you measure from the back of the hip to the back of the knee. This must be done with the patient in the seated position. This measurement, minus 1 inch, is the depth of the seat.
Next, you will need to decide which type of footrest will best fill the need. There are two basic types of footrests. The standard footrest is adjustable in length from your foot to the knee. The other type is referred to as elevating leg rests. This type allows you to elevate the foot pad, raising the leg up. It is often required when someone has edema /swelling in the legs. Elevating leg rests add weight to the chair over the front wheels, making it more difficult to propel and steer.
In future articles I will be covering cushions, back supports and other positioning products that promote proper posture and wheelchair health. Be sure the medical store or healthcare provider you choose has the experience to guide you through the process. Education is important, but nothing can replace experience.