A Wheelchair Should Fit The Child

One of the saddest things to me is seeing a child, in a chair, that does not fit them.  Chairs are like a child’s shoes.  The correct fit can mean all the difference in usability, comfort and self-confidence.  A child’s life style, activity level and motor control should drive the selection. 

I plan on it taking 6 month to get a new chair.  This means if you want the chair to be billed in the current year’s insurance, order it in June.   There are so many obstacles; I recommended being an active part in the insurance and vendor’s roles.  One time I had a company send reports to my insurance company.  All types of problems were occurring and I could not figure out why.  Well the wheelchair vendor had sent the wrong person’s information to my insurance company.  Automatic 3 month delay.  I also recommend taking notes when you make phone calls to either place during the processes.  Who did you talk to and when.  People no longer work for one company forever.  Keeping records helps you, help others keep track of the processes.  I recommend making phone contact every 30 days.  If you are sending in written information, include a picture of your child’s face.  This helps the person processing paperwork attach a person to the information. 

The decision to get a wheelchair has been made, what do I do now? 

I recommend you research and know a little about the options that are on the market.  Just like a Ford dealership never recommends a Chevrolet, one wheelchair company representative may not recommend a product they do not carry.  If you think a light weight chair is needed, do not let the wheelchair representative sell you a heavier frame just because they do not carry a certain product.  Know your options.

Speaking of weight, the weight of the chair listed in brochures is the weight of the frame. This does not include the weight of the wheels, breaks, arm rests and such.  Speaking of brochures, if the price is listed, it is often the price of the frame.  The brakes, wheels, cushion and such may cost extra.  Ask!

Do you need a therapist to sell you a chair?  Well, yes and no.  Many insurance companies require an assessment by either an occupational or physical therapist.  Some do not.  I suggest you get one involved if you can.  This being said, if the therapist has no training in wheelchair fitting they are of no use.  The more involved your child is, the more you need extra eyes in the assessment processes.  One year, I had a technician recommend a new cushion for Mel.  The new cushion was thicker and was provided to help decrease the risk of pressure sores.  We were not getting new chair; just a new cushion.  Mel kept reporting she felt off balance.  Lucky I had a connection to a different technician, a person who was a chair user and had helped fit chairs to people for years.  The answer was simple.  The extra 2 inches were throwing Mel’s center of gravity off.  Her foot plate needed to be raised and the weight over the axis of the chair had been changed and may need to be adapted.  Lucky for Mel, raising the foot plate was all it took.  I have no idea how to change the center of gravity over the axis of the chair.  Even friends talk above my head sometimes. 

Cushions  Use a cushion at all times, in every chair no matter what.  Pressure sores can develop in 10 min.  Pressure sores take 3-6 months heal.  After a pressure sore heals, the skin is only 80% recovered. You never get the last 20% back.  The cushion should be a minimum of 3 fingers from chair seat to your child’s legs.  The cushion should not press into your child’s leg at the bend.  Why?  Because; the pressure of the cushion is pressing on veins that allow blood to flow to your child’s feet.  Blood flow is needed to prevent pressure sores and other problems.  A new cushion can be as hard as a rock.  Feel it before you let your child sit in it for an extended time.  I had one child in my class develop a pressure sore because the new cushion was as hard as no cushion.  Her mom told me; they told her after that fact that the new cushion needed breaking in.  After the fact was too late for Trisha.  Her rump was never the same. 

Footrests  The foot rest is an important part of the chair.  Many people with lower level injuries take the foot plate off as it gets in the way.  That is fine, they know their body and the feel of the chair with and without the foot plate.  For young children, first time users and people with move involvement, the foot plate is an essential part of the chair. The basis of all motor skill develop is based on a good supporting surface.  That means the best developmental skills are attained when the body is secure in space i.e. the feet firmly planted on a supporting surface.  Foot rests can be removable or as part of the frame.  The footrest can also be made to allow the feet to be elevated. 

Mel’s foot plates have always been a part of the chair frame.  When she was little, she used the foot plate to sit on as she transferred from the floor to the chair.  As she got older, sometime in middle school, her hips got wider than the foot plate and thus she could now longer sit on the foot plate.  Her body weight also exceeded her strength and she could no longer use her triceps to lift her body upwards.  In Texas we have a saying. “If you lift a calf 20 times every day as it grows, you will eventually be able to lift a cow.”  Well this is not true, Mel lifted her own body into the chair for years and one day, she outweighed her own arm strength.  I think I just called my child a cow.  🙂  By the way, Mel is not overweight in any way, kids naturally get heavier as they grow. 

The feet should sit naturally on the foot plate.  The chair can have straps to hold the feet secure but this is not always needed.  There are good reasons to have and good reasons to not have the feet strapped in.  Mel has always transferred in and out of her chair on her own, thus we have never used feet straps. They were just one more thing for Mel or mom to undo.  They were of no benefit and thus we remove the foot straps if they come with the chair. 

We have played with the placement of the foot plate as I want Mel’s feet to sit flat on the foot rest.  To me, it just looks better.  Second, if the foot plate was positioned to far forward the foot plate would hit things as she turned the chair around.  Third, do not allow your child’s legs to hang over a foot plate.  This can cause a pressure sore on the back of the leg.  As the child pushes/moves the bare leg rubs on the metal part of the foot plate.  This creates friction and a pressure sore can form.  Forth, shoes or socks are also needed.  The foot plate is metal and rubbing a bare foot on the foot plate is an additional way to get a pressure sore.  Fifth, Mel developed a callous on her heel from rubbing it on the foot plate.  I thought the callous was protecting the heel.  WRONG.  The pressure sore develops under the callous.  Ten minutes of bare feet verses 3-6 months of pressure wound care.  You choose. 

 Wheelchairs Types

Transport Wheelchairs

  1. Designed to be propelled by a caregiver
  2. Ideal for occasional use and are lightweight

Standard Manual Wheelchairs

  1. Designed to be pushed by the user.
  2. May come with detachable or rigid handles when other need to push
  3. When Mel was young we preferred handles that allowed us to stand upright when pushing. We also removed the handles at times to discourage others from pushing her
  4. larger rear wheels and 2 smaller front wheels
  5. Other standard options include removable leg rests, removable arm rests, padded arm rests, cushioned seat and back, rear wheel brakes, anti-tip bars and elevating footrests.
  6. Standard Wheelchair come in with different weight options.
  7. Standard Wheelchair come with different seat dimensions (Standard Seat Size: 17″ – 19″ or Narrow Seat Size: 15″ – 17″)

Ultralight Wheelchairs/Lightweight Wheelchairs

  1. Are constructed from aluminum or titanium
  2. Weigh about 10 pounds less than standard wheelchairs
  3. We lift Mel’s chair all the time so weight of chair was extremely important to us
  4. Mel is getting ready to drive so she has to be able to lift the chair. This makes Ultra light extremely important
  5. Lightweight can be worth the extra 2-3 month delay (when the extra cost was denied by the insurance company)
  6. Come with the same options as standard wheelchairs
  7. The more extras you add the more it will weigh

Bariatic Wheelchair

  1. Have wider seat dimensions, weigh more, and are able to hold a person who weighs more than 300 pounds.

Pediatric Wheelchairs

  1. Designed for children.
  2. Smaller and more comfortable than a standard wheelchair
  3. Can be fitted to kids as young as 2 years of age
  4. The overall dimensions are smaller and kid proportional which makes it easier for a child to propel.
  5. Self-propulsion develop skills such as eye hand coordination, spatial skills (how far away are things) and develops independent thinking
  6. Come with Youth Seat Sizes from 10″ – 16″
  7. Come with most of the options as standard wheelchairs
  8. Can be ultra light

Reclining Wheelchairs

  1. Designed for those who are less mobile and need occasional reclining
  2. A reclining backrest can be adjusted at various angles from the regular sitting position to a full reclined position.
  3. Other options may include padded headrest, detachable arm rests and leg rests, elevated foot rests, and anti-tip rails

Tilt in Space Wheelchair

  1. This chair tilts the whole chair in space.
  2. Is for kids who need to be reclined for extended periods of time
  3. Needs to be considered if you are considering a reclining wheelchair.  Tilt is space allows for proper body position to be maintained.
  4. The correct hip angle is essential for tone management.

Ergonomic Wheelchair

  1. Designed to be shape to the user’s body, to evenly distribute weight and reduce pressure on legs and the back
  2. Backrests are ergonomically designed to curve with the user’s back for improved comfort and fit ie scoliosis
  3. Comes with specially placed padding on seat, backrest, armrests, and leg rests.
  4. You will need more documentation for this type of chair. If it is needed get a therapist involved

Sport Wheelchairs

  1. Designed with the specific sport in mind. I.e. tennis chair are different from basketball chairs.
  2. The chair can be designed for everyday and sport usage.
  3. I recommend you try a sport for at least a year before investing in a sport chair. Kid’s interests naturally change.

Power Wheelchairs

  1. Designed for people who are not able to use a standard wheelchair or have limited control over hands and legs.
  2. Battery-operated
  3. Weigh more than standard wheelchairs
  4. Can be controlled by hand or through assistive devices
  5. I have seen kids as young as three-year of age use an electric wheelchairs.  So cute 🙂
  6. Independent mobility equals learning

Standing Wheelchairs

  1. An option, but you might need a lot of support to get this feature past your insurance provider.
  2. Standing wheelchair that can transition from sitting to standing are heavier and are power-driven
  3. Mel had a standing wheelchair (did not transition from sit to stand) when she was young. It was donated to us. Mel and I both liked the standing chair vs. the rigid stander because it gave her freedom of movement. I got tired of pushing her standing frame from place to place. We only used it in the home. She had a pediatric wheelchair for home, community and school use.

 Wheelchair Components

Frames

  1. The chair could be made of stainless steel, chrome, aluminum, aircraft aluminum, titanium, chrome alloys, or other lightweight composite materials
  2. The materials used in the frame determine the wheelchair’s strength and capacity
  3. Can have folding or rigid frames. Folding frames utilize a crossbrace system that allows the wheelchair to be collapsed for storage or transport. Rigid frame chairs do not fold, but many have quick-release wheels and/or axles to allow the wheels to be removed easily for storage and travel.
  4. Chair come in a variety of color options  including bright neon colors and patterns as well as solid primary colors and the traditional chrome finish.

Seating Systems

  1. Seating systems are selected separately from the wheelchair itself.   This is the size of the cushion, the backrest, headrest and such.  What does the child need to sit comfortable in the chair?  If the seating system is ordered separately from the chair, it is essential to make sure the frame is compatible with the seating system being considered.  Seating systems can be custom for those with back problems such as scoliosis, can have pressure control features for those with a history of pressure sores or the chair may offer growth capability, enabling the chair seat to be adjusted within a specified width and/or depth range to accommodate growth.

Upholstery

  1. Upholstery must be rugged enough to withstand daily use and a variety of weather conditions.
  2. The upholstery may be made of  nylon, velour, polyester, vinyl, and leather.
  3. Upholstery can be found in a variety of colors and styles

Brakes

  1. Most brakes are applied by using a pushing or a pulling motion.
  2. Brakes can be mounted at different heights depending on the user’s needs
  3. Brakes can be mounted in different places.  Originally Mel’s brakes were mounted on the outside of the frame.  Now they are mounted under the frame and she has to reach under the frame to lock and unlock
  4. Mel does not always lock her brakes. She knows her skill and her chair.  Sometime in middle school, I stopped harping on her to lock her brakes.  She had a brain and need to learn to use it. At first, I just stood by the chair so it could move and she had to respond to the chair.  She now does what she feels is correct.  She always locks on inclines.  Do not get a chair with no locks.  At some point your child will need to transfer on a hill and need locks. 
  5. Brake lever extensions and other modifications are available. If your child can not lock and unlock the brakes, ask you wheelchair representative for options
  6. Powered chairs usually feature electromechanical and/or dynamic brakes.

 Wheels and Tires

  1. The most common rear wheel is 24 inches in diameter, but other wheel sizes are available.
  2. Most chairs are equipped with pneumatic tires, but several other types are also available.  We prefer the solid tires.  Flats are no fun
  3. Tire options include mag (oversized width) tires, off-road tires, steel-reinforced radial tires, semi-pneumatic tires (a combination of solid rubber and air-filled tubing), and solid tires (tires without air space or tubes).
  4. Tires are extra-cost options on most chairs but a chair with the incorrect tires is of little use. 
  5. A typical castor or front tire is 8 inches in diameter with solid or pneumatic tires. Casters are important and the kind can vary depending on where the chair is used. Using a chair on a gravel road is easier if the front casters are larger. 

Armrests

  1. Armrests are available in full- and desk-length styles, and may be detachable, height-adjustable, flip-up, have a combination of features, or be fixed.
  2. Lightweight and sport models are designed to be used without armrests.
  3. We have always removed Mel’s arm rests.  They interfered with her pushing and we always ordered a chair to fit under desk height. When she was 3, the desks was toddler size so the chair was toddler size. 

 Anti-tip bars

  1. Anti-tipping bars are the small bars or wheels on the back of chairs that help prevent the child or adult from tipping over backwards.  I recommend you get anti-tip bars for any child’s first chair.
  2. At some point, long-term wheelchair users (with good wheelchair skills) remove the anti-tip wheels. This allows increased independence with going up and down curves
  3. We started with the standard anti-tipping wheels on Mel’s chair.
  4.  By kindergarten, we put anti-tipping wheels on her chair that could be removed or turned up when needed.  We quickly found out we had to remember to put the anti-tip wheels back on as Mel would assume they were on and they would not be.  Falling backwards was not Mel’s favorite thing to do.
  5. For kids with good wheelchair balance and skill, you might consider removing the anti-tip wheels sometime in high school.  Mel was in 9th grade when we removed hers.  She could hold a wheelie by that time.  Removing the anti-tip wheels allowed her greater independence with curbs.  The world has curbs and she needed to learn how to go up and down them.  To teach this skill, we enrolled her in 6weeks (1xweek) of physical therapy.
  6. Mel’s friends, who get in the chair for fun are not at greater risk for tipping backwards than she is.  It’s nice to warn them of this possibility.  It’s amazing how they assume wheelies are easy

Additional Thoughts

When possible the child should help in the selection process.  Under all circumstances the parents needs to actively participate in the selection process. Parents and caregivers  are aware of the environment and circumstances in which the wheelchair will be used. Think and discuss with the vendor and therapist topics such as where the chair will be used, what will the child want to do in the chair, how will the chair be transported, what is the process for repairing the chair and how long will it be before my child can get the new chair. 

One mistake we made was getting Mel a chair she could grow into.  The chair was so big, it engulfed Mel.   When you saw Mel, you saw the chair.  She has less control; fell more often and just never looked right in that chair.  Once a chair is built, it is yours.  Make good decisions from the start and do not let anyone convince you the child needs 2 extra inches on both sides for growth.  Take the time for a second opinion. 

A chair is not simply something a child needs to use; it is an extension of his or her personality.

A place to review chairs   http://usatechguide.org/reviews.php

I got my information primarily  from the following sites.

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