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Optimal manual wheelchair set up for an upper limb propeller

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This month I have been asked by a clinician how can we determine what is the optimal manual wheelchair set up for an upper limb propeller. To answer this question we must first consult a few important resources:

  • Position on the Application of Ultralight Manual Wheelchairs: www.resna.org 
  • Preservation of Upper Limb Function Following Spinal Cord Injury: www.pva.org

What is it?

  • 35 clinical guidelines to help optimise chair set up to prevent upper limb injury
  • Focuses on
    • // Education 
    •  // Propulsion technique 
    • // Equipment selection 
    • // Wheel position 
    • // Recommendations are transferable to other user groups

Optimal set up

Rear wheel:

  • Tip of middle finger at centre of hub (another method to support CPG 9)

  • Why? So Centre of Mass (for maximum manoeuvrability) is positioned over hub of wheel
  • 70-80% of user weight over rear wheels (CPG 8 - Adjust the rear wheel as far forward without compromising stability)

  • 120° of elbow flexion at top of push cycle (CPG 9 - hand top dead centre – elbow angle should be 100-120°)
  • Optimal wheel access – 10 to 2 (CPG 5 - avoid extreme positions of the wrist)

  • Use wheel camber – increases lateral stability and brings top of wheel closer to user – more efficient push phase (RESNA 2012)

Front castors:

  • 20-30% user weight over castors
  • Use smallest castor fork – reduces turning circle and obstruction with feet or footplates

Why?

// Minimise resistance to turning & more efficient propulsion

// Provides compromise between indoor manoeuvrability and outdoor terrain navigation

Quickie wheelchairs are designed to be easily configurable to meet end user needs and also set up according to these guidelines:

// Folding frame wheelchairs – Quickie Life, Youngster 3, Neon2, Xenon2

// Rigid Framed wheelchairs – Quickie Life R, Simba, Argon2, Helium

RESNA (2012) emphasise the importance of achieving an optimal set up for all manual wheelchair users to maximise function and independence and reduce potential injury advising that: “The person cannot conform to the wheelchair, but the wheelchair must conform to the individual.”

 

Matt Eveleigh - Sunrise Medical EU

Matt Eveleigh - Sunrise Medical EU

Clinical Specialist Occupational Therapist (OT) - Clinical Education Specialist

Matt Eveleigh has worked for Sunrise Medical since 2013 and his current role is as a European Power Product, Market and Training Manager within the European Product Management Team. Prior to this he was the Clinical Specialist, STEPS Clinical Educator and JAY Product Specialist for the UK and Eire. He is a Clinical Specialist Occupational Therapist by background and has specialised in wheelchair and Seating for over 15 years.

SÓLO PARA USO PROFESIONAL. ESTE BLOG Y LA INFORMACIÓN MOSTRADA EN ÉL NO PRESUPONEN ASESORAMIENTO CLÍNICO. Sunrise Medical no puede proporcionar servicios médicos. Toda la información que aquí se muestra (y los documentos a los que se hace referencia), incluyendo, pero no limitando a, textos, gráficos, imágenes y descripciones, son meramente informativos y deben usarse exclusivamente por profesionales de la salud, como un recurso general de información y apoyo a su labor de valoración y asesoramiento a personas en sillas de ruedas, en materia de sedestación y adaptación de equipos de movilidad. La información aquí mostrada (o los documentos a los que se hace referencia) no pretende ser ni sustituir a una valoración clínica, diagnóstico o tratamiento médico. Nunca ignores los tratamientos médicos y consejos de un profesional de la salud por la información y documentos referenciados que puedas hallar en esta web. Es labor de los especialistas clínicos revisar y contrarrestar la información aquí recogida con otras fuentes.