1. WHEELCHAIRS MANUAL WHEELCHAIR COMPONENTS FRAME AND AXLE
WHEELS AND TIRES
HAND RIMS/ WHEEL LOCKS
GRADE AIDS
CASTERS/ARMRESTS/LEGRESTS
SEAT AND BACK

2. FRAME AND AXLE
FRAME MATERIAL MAY DETERMINE THE WEIGHT AND DURABILITY OF THE WHEELCHAIR
WEIGHT IS IMPORTANT IN TERMS OF LOADING WC INTO THE CAR

3. FRAME TYPE RIGID FRAME IS MORE STABLE FOR ACTIVE USER
MAKE SURE PATIENT CAN LOAD THIS INTO THE CAR

4. FOLDING FRAME FOLDING FRAME IS EASIER TO STORE AND TRANSPORT
NEWER LOCKING SYSTEM FOR FOLDING FRAME
IMPROVES RIGIDITY AND MAINTAINS BALANCE
SOME FRAMES HAVE FLEXIBILITY IN PLACEMENT OF REAR WHEELS WITH AN ADJUSTABLE AXLE PLATE

5. WHEEL AND TIRES WHEEL SIZE AFFECTS OVERALL HEIGHT ROLLING EASE
TRANSFERRING IN AND OUT OF CHAIR
UE MECHANICS OF PUSHING

6. WHEEL TYPE
SOLID SMOOTH WHEELS
BEST ON
SMOOTH
HARD
INDOOR SURFACES

7. WHEEL TYPE THREADED PNEUMATIC TIRES GIVES SMOOTHER RIDE
EASIER MANUEVERABILITY ON ROUGH TERRAIN,WET OR ICY SURFACES

8. WHEEL TYPE FLAT TIRES CAN BE MINIMIZED WITH THORN RESISTANT TUBES
OR ADDITION OF LATEX GEL

9. HAND RIMS VERY SMALL DIAMETER LARGE SMOOTH RIMS FOR HIGH SPEED RACING
TO MAXIMIZE MANEUVERABILITY AND POWER

10. HAND RIMS MODIFICATIONS IMPROVE GRIPPING BY ADDING COATING
INCREASE TUBE SIZE
CHANGING SHAPE
ADDING RIM PROJECTIONS

11. WHEEL LOCKS WHEEL LOCKS= BRAKES
POSITION HANDLES TO PROVIDE EASY ACCESS
BUT NOT INTERFERE WITH WC PROPULSION

12. WHEEL LOCKS BRAKE EXTENSIONS FOR PATIENTS WITH U.E. DYSFUNCTION
OR POOR BALANCE

13. WHEEL LOCKS FOR ACTIVE USER WITH LONG PUSHING STROKE
POSITION BRAKES LOWER DOWN
TO PREVENT INJURY TO FINGERS AND THUMBS

14. GRADE AIDS
SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM ROLLING BACKWARD
CAN BE SELECTIVELY ACTIVATED WHEN GOING UPHILL

15. GRADE AIDS FOR PATIENTS WHO HAVE DIFFICULTY GOING UP INCLINES
DON’T USE GRADE AIDS IN STRONG PUSHERS
MAY BE ACTIVATED IN WHEELIES

16. CASTER
THE SMALL WHEELS FOUND USUALLY IN FRONT OF THE CHAIR

17. CASTER HARD SMALL CASTERS ALLOW EASIEST TURNING
SMALLEST 4” CASTORS GOOD FOR SPORTS BUT CAN’T BE USED WELL OUTDOORS

18. CASTER
LARGE PNEUMATIC CASTERS ARE LESS LIKELY TO GET STUCK ON UNEVEN OR SOFT GROUND
MAKE SURE THEY DON’T HIT FOOT OR FOOT PLATE

19. CASTERS PLACING THE CASTER TO REAR OF CHAIR DECREASES TURNING RADIUS
INCREASES THE TENDENCY TO TIP FORWARD

20. CASTER
CASTER LOCKS
NECESSARY FOR ABSOLUTE STABILITY OF CHAIR IN TRANSFERS

21. ARMRESTS AID IN TRANSFERS WEIGHT SHIFTS REDUCE ISCHIAL PRESSURE
BY CARRYING THE WEIGHT OF THE ARMS AND MAINTAINING TRUNK BALANCE

22. ARM RESTS
NEED STURDY SUPPORTIVE ARMREST FOR THOSE WITH MARGINAL PRESSURE MANAGEMENT
PATIENTS WITH T6 OR ABOVE INJURY NEED THEM FOR STABILITY IN SITTING

23. ARMRESTS NEEDED IF PATIENT HAS
LAPBOARD
ARM TROUGH
BALANCED FOREARM ARTHOSIS
ATHLETIC WC USERS MAY WANT TO ELIMINATE ARM RESTS

24. ARM RESTS
TYPES
FIXED
ADJUSTABLE
REMOVABLE
SWING AWAY

25. LEG RESTS TO PROVIDE PROTECTION PROPER POSITIONING MAXIMUM BALANCE
WEIGHT BEARING OF LE

26. LEG RESTS SUPPORT THE FOOT TO MAINTAIN CIRCULATION
KEEP THE ANKLE IN NEUTRAL POSITION
SHOULD NOT BE SO HIGH IT FORCES WEIGHT BACK ON ISCHIAL TUBEROSITIES OR SACRUM

27. LEG RESTS
TYPES
STANDARD
SWING AWAY
REMOVABLE

28. LEG RESTS ELEVATING MAY HELP WITH EDEMA ALTER ACCESSIBILITY
MAKES TURNING MORE DIFFICULT

29. ELEVATING LEG RESTS NEED CALFPADS MORE EXPENSIVE
NEED A SPECIFIC DIAGNOSIS TO JUSTIFY

30. LEG RESTS PATIENTS WITH A LOT OF SPASTICITY MAY NEED A LARGE FOOTPLATE
WITH PROPER FOOT RESTRAINT SYSTEM

31. SEAT AND BACK BACK SUPPORT WC BACK SHOULD BE HIGH ENOUGH TO SUPPORT
LOW ENOUGH TO GIVE AS MUCH FREEDOM AS POSSIBLE

32. BACK SUPPORT PATIENTS WITH ABNORMAL TRUNK CONTROL ABOVE T8-10
BUT GOOD HEAD CONTROL
BACK SHOULD COME UP WITHIN 2” OF THE LOWER EDGE OF THE SCAPULA

33. BACK SUPPORT IF BACK TOO LOW
IT CAN CAUSE INCREASED PRESSURE AT UPPER EDGE OF BACK
WHEELING EFFICIENCY IS DECREASED SECONDARY TO POOR STABILIZATION OF THE SHOULDER GIRDLE

34. SEAT TYPE IF PATIENT HAS POOR MUSCLE CONTROL SPASTICITY DEFORMITY
THEY NEED A SOLID SEAT OR BACK OR BOTH

35. SEAT TYPE
A STABLE SEAT AND LUMBAR SURFACE
PREVENTS SACRAL SITTING

36. SACRAL SITTING LEADS TO SACRAL AND ISCHIAL PRESSURE SORES
INCREASED KYPHOSIS
NECK AND UPPER BACK STRAIN

37. WHEELCHAIR STABILITY DEPENDS ON REAR AXLE POSITION
IF REAR WHEELS ARE MOVED FORWARD
CHAIR MOVES EASIER
WEIGHT SHIFT FOR WHEELIES IS EASIER

38. WC STABILITY IF REAR WHEELS ARE MOVED FORWARD
CHAIR TIPS BACKWARD MORE EASILY
ESPECIALLY WHEN GOING FAST OR UP RAMPS

39. WHEELCHAIR STABLILITY
ANTITIP DEVICES PREVENT BACKWARD TIPPING

40. WHEELCHAIR STABILITY FOR LE AMPUTEES MOVING REAR WHEEL POSTERIOR
KEEPS THE PATIENTS C.OF G. IN FRONT OF THE WHEEL
TO PREVENT TIPPING

41. WHEELCHAIR STABILITY RAISING THE SEAT
WILL LESSEN THE OVERALL STABILITY OF THE CHAIR
MOST COMFORTABLE AND STABLE SEATING
WITH SEAT TILTED BACK BY 3-5’’

42. WHEELCHAIR STABILITY CAMBER
THE ANGLE BETWEEN THE VERTICAL AXIS OF WHEELS AND A LINE PERPENDICULAR TO THE FLOOR

43. CAMBER CAN BE ADJUSTED 7” TO MAXIMIZE LATERAL STABILITY
WITHOUT MAKING THE CHAIR TOO WIDE
CAMBER IS ADJUSTED FOR SPORTS TO ALLOW QUICK TURNS
OR LONG LATERAL REACHES

44. BIOMECHANICS OF SEATING
PELVIS
A KEY GOAL IN WC SEATING IS STABILIZING THE PELVIS
A LEVEL PELVIS IS NEEDED TO OPTIMIZE TRUNK CONTROL AND UE FUNCTION

45. PELVIS EVALUATION LOOK FOR ANTERIOR PELVIC TILT POSTERIOR PELVIC TILT
LATERAL SYMMETRY
ROTATION
RESTRICTION IN ANY DIRECTION

46. ANTERIOR PELVIC TILT
INCLINATION OF THE PELVIS IN THE SAGITTAL PLANE FORWARD OF ITS NEUTRAL POSITION
DUE TO THE HYPOTONICITY OF TRUNK MUSCULATURE

47. ANTERIOR PELVIC TILT SHORTENING OF LOW BACK EXTENSORS
TIGHTENING OF ILIOTIBILA BAND
TIGHT HIP FLEXORS

48. POSTERIOR PELVIC TILT DUE TO OVERACTIVITY OF HIP EXTENSORS
DUE TO TIGHT HAMSTRINGS
HYPOTONIC LOW BACK EXTENSORS

49. POSTERIOR PELVIC TILT LOSS OF LUMBAR LORDOTIC CURVE
AFFECTS SPINAL ALIGNMENT
AFFECTS FUNCTION

50. POSTERIOR PELVIC TILT TILTING OF PELVIS
MOVES C.OF G. POSTERIOR TO ISCHIAL TUBEROSITIES
INCREASES WT. BEARING THRU SACRUM

51. POSTERIOR PELVIC TILT TILTING OF PELVIS
INCREASED THE FORCE ON LUMBAR SPINE IN SITTING
INCREASES SHEARING AND FORCE OVER SPINE AND PELVIS

52. PELVIC OBLIQUITY SLANTING OF PELVIS IN THE FRONTAL PLANE DUE TO
IMBALANCED POSTURE
MUSCLE TONE
SCOLIOSIS
HIP DISLOCATION

53. SCOLIOSIS EVALUATION OF SEATING IS DIRECTED
TOWARD TYPE OF SUPPORT OR ACCOMODATION NEEDED
NOT A PRIMARY METHOD OF CONNECTION

54. KYPHOSIS/LORDOSIS TRUNK SHOULD BE UPRIGHT
TRUNK SHOULD BE CENTERED OVER THE MIDDLE OF THE WHEELCHAIR

55. HAMSTRINGS THE MOST IMPORTANT MUSCLE GROUP FOR OPTIONAL POSITIONING
COMFORT
FUNCTION OF WC USER

56. HAMSTRINGS CROSS TWO JOINTS TIGHTNESS CAN DRAMATICALLY
CHANGE POSITION OF PELVIS AND KNEES
CAN INCREASE POSTERIOR PELVIC TILT
THIS INCREASES SACRAL SITTING

57. HAMSTRING TIGHTNESS CORRECTIONS
INCREASE LENGTH OF HAMSTRINGS WITH STRETCHING
TRY TO INCREASE AMOUNT OF KNEE FLEXION ALLOWED IN WC
BY POSITIONING FEET MORE POSTERIORLY THAN USUAL

58. HAMSTRING TIGHTNESS
DON’T TRY TO STRETCH HAMSTRINGS BY INCREASING THE AMOUNT OF KNEE EXTENSION IN CHAIR
THIS MAY INCREASE POSTERIOR PELVIC TILT

59. HAMSTRING TIGHTNESS IF UNABLE TO INCREASE KNEE FLEXION
USE POSTERIOR WEDGE TO INCREASE HIP FLEXION
WITH A PELVIC WELL TO PREVENT SLIDING OUT OF CHAIR

60. HEAD POSITION IN SITTING IS CRITICAL BECAUSE OF INFLUENCE OF HEAD ON
PRIMITIVE REFLEXES
MUSCLE TONE
UE FUNCTION
SWALLOWING
VISUAL ORIENTATION

61. UPPER EXTREMITIES UE FUNCTION AND STRUCTURE AFFECT PROPULSION
WEIGHT SHIFT
TRANSFERS IN WC

62. UPPER EXTREMITIES PROPER ARM SUPPORT
MAY HELP UNWEIGHT THE ISCHIAL TUBEROSITIES
BY 25-35%

63. WC MEASUREMENT SEAT WIDTH SEAT HEIGHT
1” WIDER THAN THE WIDTH OF THE WIDEST PART OF BUTTOCK
SEAT HEIGHT
2” HIGHER THAN THE DISTANCE FROM THE BOTTOM OF THE HEEL TO THE POPLITEAL FOSSA

64. WC MEASUREMENT SEAT DEPTH BACK HEIGHT
1-2” LONGER THAN THE DISTANCE FROM THE POPLITEAL AREA TO THE BACK OF THE BUTTOCK
BACK HEIGHT
2” LESS (MAY VARY) THAN THE DISTANCE FROM THE BOTTOM OF THE SCAPULA TO THE SITTING SURFACE

65. WC MEASUREMENT ARM HEIGHT
DISTANCE FROM THE BOTTOM OF THE BUTTOCKS TO THE ELBOW

66. SEAT TYPE SOLID SEAT, SOLID BACK OR BOTH IF PATIENT HAS
POOR MUSCLE CONTROL
SPASTICITY
DEFORMITY

67. SEAT TYPE STABLE SEAT AND LUMBAR SURFACE PREVENTS SACRAL SITTING WHICH
CAUSES SACRAL STRAIN
ISCHIAL PRESSURE SORES
INCREASED KYPHOSIS
NECK AND UPPER BACK STRAIN

68. WC CUSHIONS ANOTHER CHAPTER
A CONTOURED CUSHION WITH A FIRM BASE MAY BE THE BEST CHOICE FOR PRESSURE RELIEF AND TO PREVENT A PERSON FROM SLIDING FORWARD

69. WC WEIGHT USERS WHO NEED TO LOAD OWN WC INTO CAR
NEED FOLDING OR RIGID ULTRALIGHT FRAMES
LIGHTER, MORE EFFICIENT CHAIRS MAY NOT BE COVERED BY ALL INSURANCE CO.S

70. WC WEIGHT HEAVIER CHAIRS MORE PRACTICAL FOR TEMPORARY USERS
SHORT DISTANCE MOBILITY
OBESE PATIENTS

71. WC WEIGHT CONVENTIONAL Wc- 50 lb. LIGHTWEIGHT WC- 40 lb.
ULTRA LIGHTWEIGHT WC lb.

72. WC PRESCRIPTION DONE IN A MULTIDISCIPLINARY WC CLINIC WITH P.T.
WC VENDOR
PHYSIATRIST

73. WC PRESCRIPTION OBTAIN MEDICAL HISTORY SURGICAL HISTORY
SEATING HISTORY
WHAT HAS WORKED OR NOT WORKED IN THE PAST

74. WC PRESCRIPTION CHECK PATIENT’S ABILITY TO DO WT. SHIFTS
IF UNABLE TO DO WT. SHIFTS PT. MAY NEED POWER RECLINE OR TILT IN SPACE SYSTEM

75. POWER RECLINE SYSTEMS RECLINING MAY PRODUCE SHEAR DURING RECLINING
SYSTEM ADDS 1-2” TO SEAT HEIGHT
TILT IN SPACE PRODUCES BETTER REPOSITIONING WHEN UPRIGHT POSITION RESUMED

76. WC PRESCRIPTION
TO JUSTIFY POWER RECLINING SYSTEM OR TILT-IN-SPACE SYSTEM
HAVE TO SHOW PATIENT UNABLE TO SHIFT WEIGHT
OR TRANSFER INDEPENDENTLY
AND DOESN’T HAVE SOMEONE TO ASSIST WITH THIS

77. WC PRESCRIPTION
EXAMINE PATIENT IN SITTYING AND LYING SUPINE ON A FLAT SURFACE
CHECK
SPASTICITY
JOINT R.O.M.
HIP FLEXION
HAMSTRING TIGHTNESS
POPLITEAL ANGLES

78. WC PRESCRIPTION CHECK PELVIS
LOOK AT HOW THIGHS AND FEET WILL BE POSITIONED
EVALUATE THE NEED FOR HEAD AND BACK SUPPORTS

79. WC PRESCRIPTION LOOK AT SEAT CONFIGURATION
EVALUATE HOW WEIGHT SHIFTS WILL BE DONE

80. WC PRESCRIPTION BASED ON CLINIC EVALUATION DEVELOP A PRECRIPTION
DEVELOP A LETTER OF MEDICAL NECESSITY FOR INSURANCE CO.
DISCUSS PRESCRIPTION WITH PATIENT
HAVE HIM SIGN IT AFTER DISCUSSION

81. POWER CHAIRS FOR INDIVIDUALS WHO CANNOT PROPEL A MANUAL WC DUE TO
WEAKNESS
POOR ENDURANCE
CARDIAC OR RESPIRATORY LIMITATIONS
LIMB ABSENCE
PARALYSIS
DEFORMITY

82. POWER CHAIRS INDIVIDUALS MUST HAVE NECESSARY
COGNITIVE FUNCTION
JUDGEMENT
VISION
TO SAFELY DIRECT POWER CHAIR

83. POWER CHAIR
SELECT CHAIR ON SAME PRESCRIPTION PRINCIPLES AS MANUAL

84. POWER CHAIR CONSIDER WHERE THE CHAIR WILL BE USED MAY NOT BE PRACTICAL
IF PATIENT LIVES IN A TRAILER
OR DOESN’T HAVE A VAN TO TRANSPORT IT

85. WC POWER BASES TYPE I DIRECT DRIVE MOTORS SMALL BALLOON TIRES
MORE DURABLE
BETTER ABLE TO TRAVERSE ROUGH TERRAINE
SHORT BASED
INCREASED EASE OF TURNING IN SMALL SPACES

86. WC POWER BASES TYPE II DRIVE POWER LINKAGES
LARGE REAR HARD RUBBER TIRES
SMALL FRONT PNEUMATIC TIRES
ATTAIN HIGHER SPEEDS
PROVIDE MORE STABILITY

87. WC CHECKOUT DO NOT HAVE WC DELIVERED DIRECTLY TO PATIENT
HAVE IT DELIVERED TO CLINIC
P.T. CAN CHECK IT TO MAKE SURE IT FITS THE PRESCRIPTION
CHAIR CAN BE RETURNED IF SOMETHING IS WRONG OR MISSING
HAVE P.T. CHECK OUT PATIENT IN WC TO MAKE SURE IT FITS AND THEY CAN USE IT CORRECTLY

88. WHEELCHAIRS COSTLY OFTEN COMPLICATED
EVALUATE PATIENT IN WC CLINIC OR BY SKILLED P.T.
IF PATIENT IS HARD TO FIT
TO MAKE SURE THEY GET APPROPRIATE WC