wheelchair

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Wheelchair seating in a theater.

Wooden wheelchair dating to the early part of the 20th century

International Symbol of Access on a door opening button, Hospital Minero-Museo de Medicina Laboral located in Real del Monte, Hidalgo, Mexico.

A wheelchair is a wheeled mobility device in which the user sits. The device is propelled either manually (by turning the wheels by the hand) or via various automated systems. Wheelchairs are used by people for whom walking is difficult or impossible due to illness (physiological or physical), injury, or disability. People with both sitting and walking disability often need to use a wheelbench.

The earliest record of wheelchairs date back to the 6th century, and was found inscribed on a stone slate in China. Later dates relate to Europeans using this technology, dating back to the German Renaissance. Harry Jennings, a mechanical engineer, invented the first lightweight, steel, collapsible wheelchair in 1933 for his disabled friend Ernest who had broken his back in a mining accident. The two saw the business potential of the invention, and went on to become the first mass-manufacturers of wheelchairs: Ernest and Jenning’s international.

Types of wheelchairs

Wheelchair fitted with Mecanum wheels, taken at an exhibition in the early 1980s.

A basic standard manual wheelchair incorporates a seat and back, two small front (caster) wheels and two large wheels, one on each side, and a foot rest.

Wheelchairs are often variations on this basic design, but there are many types of wheelchairs, and they are often highly customized for the individual user's needs. The seat size (width and depth), seat-to-floor height, seat angle (also called seat dump or squeeze) relative to the horizontal plane, footrests/leg rests, front caster outriggers, adjustable backrests, controls, and many other features can be customized on, or added to, many basic models, while some users, often those with specialised needs, may have wheelchairs custom-built.

Transport wheelchairs are usually light, folding chairs with four small wheels designed to be pushed by a caregiver to provide mobility for patients outside the home or more common medical settings.

Various optional accessories are available, such as anti-tip bars or wheels, safety belts, adjustable backrests, tilt and/or recline features, extra support for limbs or neck, mounts or carrying devices for crutches, walkers or oxygen tanks, drink holders, and clothing protectors.

Experiments have also been made with unusual variant wheels, like the omniwheel or the mecanum wheel. These allow more directional movement options.

The electric wheelchair shown on the right is fitted with Mecanum wheels (sometimes known as Ilon wheels) which give it complete freedom of movement. It can be driven forwards, backwards, sideways, and diagonally, and also turned round on the spot or turned around while moving, all operated from a simple joystick.

Manual wheelchairs

Manual wheelchairs are those that require human power to move them. Many manual wheelchairs can be folded for storage or placement into a vehicle, although modern wheelchairs are just as likely to be rigid framed.

Manual or self-propelled wheelchairs are propelled by the occupant, usually by using large rear wheels, from 20-26 inches in average diameter, and resembling bicycle wheels. The user moves the chair by pushing on the handrims, which are made of circular tubing attached to the outside of the large wheels. The handrims have a diameter that is slightly less than that of the rear wheels. Skilled users can control speed and turning and often learn to balance the chair on its rear wheels - do a "wheelie". The wheelie is not just for show - a rider who can control the chair in this manner can climb and descend curbs and move over small obstacles.

One-arm drive enables a user to guide and propel a wheelchair from one side. Two handrims, one smaller than the other, are located on one side of the chair, left or right. On most models the outer, or smaller rim, is connected to the opposite wheel by a folding axle. When both handrims are grasped together, the chair may be propelled forward or backward in a straight line. When either handrim is moved independently, the chair will turn left or right in response to the handrim used. Another alternative is a lever-drive chair that propels the chair forwards by using a lever that is pumped back and forth. Some chairs are also configured to allow the occupant to propel using one or both feet instead of using the rims.

Attendant-propelled chairs are designed to be propelled by an attendant using the handles, and thus the back wheels are rimless and often smaller. These chairs are often used as 'transfer chairs' to move a patient when a better alternative is unavailable, possibly within a hospital, as a temporary option, or in areas where a user's standard chair is unavailable. These chairs are commonly seen in airports. Special airplane transfer chairs are available on most airlines, designed to fit narrow airplane aisles and transfer wheelchair-using passengers to and from their seats on the plane.

Wheelbase chairs are wheeled platforms with specially-molded seating systems interfaced with them for users with a more complicated posture. A molded seating system involves taking a cast of a person's best achievable seated position and the either carving the shape from memory foam or forming a plastic mesh around it. This seat is then covered, framed, and attached to a wheelbase.

Light weight and high cost are related in the manual wheelchairs market. At the low-cost end, heavy, tubular steel chairs with sling seats and little adaptability dominate. Users may be temporarily disabled, or using such a chair as a loaner, or simply unable to afford better. Heavy unmodified manual chairs are common as "loaners" at large facilities such as airports, amusement parks and shopping centers. In a higher price range, and more commonly used by persons with long-term disabilities, are major manufacturer lightweight chairs with more options. The high end of the market contains ultra-light models, extensive seating options and accessories, all-terrain features, and so forth. Reclining wheelchairs have handbrake-like controls attached to the canes which when pressed by the caregiver allow the backrest to recline from is normal upright position (at 90 degrees) to varying angles up to 180 degrees.

Electric-powered wheelchairs

The electric-powered wheelchair was invented by George Klein who worked for the National Research Council of Canada, to assist injured veterans during World War II.[1]

Woman in motorized wheelchair.

Four general styles of electric powered chairs (EPWs) exist: rear, center, front wheel driven or four wheel driven. Each style has particular handling characteristics. EPWs are also divided by seat type; some models resemble manual chairs, with a sling-style seat and frame, whereas others have 'captain's chair' seating like that of an automobile. EPWs run the gamut from small and portable models, which can be folded or disassembled, to very large and heavy full-featured chairs (these are often called 'rehab' chairs).

EPWs may be designed specifically for indoor use, outdoor use, or both. They are generally prescribed for persons who have difficulty using a manual chair due to arm, hand, shoulder or more general disabling conditions, and do not have the leg strength to propel a manual chair with their feet, a practice not generally recommended by most Allied Health Professionals (AHPs). They may also be issued to those with cardiovascular conditions. A person with full function of the arms and upper torso will generally be prescribed a manual chair, or find that their insurance will not cover an electric power wheelchair.

The user typically controls speed and direction by operating a joystick on a controller. Many other input devices can be used if the user lacks coordination or the use of the hands or fingers, such as chin controls and puff/sip scanners for those with C2-3 spinal cord lesions or head injuries (the user blows into a tube located near the mouth, which controls the movement of the chair). This controller is the most delicate and usually the most expensive part of the chair. EPWs can offer various powered functions such as tilt, recline, leg elevation, seat elevation, and others useful or necessary to health and function.

EPWs use electric motors to move the wheels. They are usually powered by 4 or 5 amp deep-cycle rechargeable batteries, similar to those used to power outboard boat engines. These are available in wet or dry options; currently dry cell batteries are more popular^{[citation needed]}. Many EPWs carry an on-board charger which can be plugged into a standard wall outlet; older or more portable models may have a separate charger unit.

Other wheelchair variants

A Standing wheelchair is one that supports the user in a nearly standing position. They can be used as both a wheelchair and a standing frame, allowing the user to sit or stand in the wheelchair as they wish. They often go from sitting to standing with a hydraulic pump or electric-powered assist.

A mobility scooter (see full article) is a motorized assist device similar to an EPW, but with a steering 'tiller' or bar instead of the joystick, and fewer medical support options. Mobility scooters are available without a prescription in some markets, and range from large, powerful models to lightweight folding ones intended for travel.

A bariatric wheelchair is one designed to support larger weights; most standard chairs are designed to support no more than 250 lbs. on average.

Pediatric wheelchairs are another available subset of wheelchairs. Hemi wheelchairs have lower seats which are designed for easy foot propulsion. The decreased seat height also allows them to be used by children and shorter individuals.

A knee scooter is a related device which may be substituted for a wheelchair when an injury has occurred to only one leg, below the knee. The patient rests the injured leg on the scooter, grasps the handlebars, and pushes with the uninjured leg.

A Power-Assisted wheelchair is a recent development that uses the frame & seating of a typical manual chair while replacing the standard rear wheels with wheels that have small battery-powered motors in the hubs. A floating rim design senses the pressure applied by the users push & activates the motors proportionately. This results in the convenience, small size & light-weight of a manual chair while providing motorised assistance for rough/uneven terrain & steep slopes that would otherwise be difficult or impossible to navigate, especially by those with limited upper-body function.

Sport wheelchairs

A modern racing wheelchair

Disabled athletes use streamlined sport wheelchairs for disabled sports that require speed and agility, such as basketball, rugby, tennis and racing. Each wheelchair sport tends to use specific types of wheelchairs, and these no longer look like their everyday cousins. They are usually non-folding (in order to increase rigidity), with a pronounced angle for the wheels (which provides stability during a sharp turn) and made of composite, lightweight materials. Sport wheelchairs are not generally for everyday use, and are often a 'second' chair specifically for sport use, although some users prefer the sport options for everyday.

Powerchair Football/Power Soccer

US versus France, FIPFA World Cup, Tokyo, Japan, October 2007.

A new sport has been developed for powerchair users called powerchair football or power soccer. It is the only competitive team sport for powerchair users. The Federation Internationale de Powerchair Football Associations (FIPFA) ^[1] governs the sport and is located in Paris, France with country affiliates around the world.

Transfer, stretcher, or mechanical chairs

Stretcher (or transfer) chairs are mobile chairs that can be adjusted to lay flat like a stretcher to help in the lateral (or supine) transfer of a patient from a bed to the chair. Once transferred, the stretcher can be adjusted to allow the patient to assume a sitting position. Transfer chairs often use sliding sheets or inflatable sliding mats with air bearings to facilitate the movement of the patient from the bed to the chair. The patient in bed is rolled onto the transfer sheet or mat, and the sheet slides between the bed and the chair (configured as a flat stretcher), carrying the patient with it. Transfer chairs sometimes have separate manual cranks or electric winches which attach to the sliding sheet and pull (or drag) the patient off the bed and onto the chair. Such devices can also be used to transfer patients to standard gurneys. Alternately nurses can lift or slide the transfer sheet and patient manually. Transfer chairs are usually much more expensive than common wheelchairs. This is because of the complex engineering required to be able of change the chair's configuration from a stretcher to a mobile chair. This kind of lateral patient transfer requires a stable platform to prevent injury (i.e., avoid patient falls). This stability requirement makes transfer chairs larger, heavier, and less mobile than standard wheelchairs.

Beach wheelchairs

This wheelchair allow users to enter the water and provide a better mobility in the sand. There are lots of different models available. In many countries in Europe where the Accessible Tourism is well set, many beaches are wheelchair accessible and provide this kind of wheelchairs to clients free of charge.

Recent developments

Recent technological advances are slowly improving wheelchair and EPW technology. Some wheelchairs, such as the iBOT, incorporate gyroscopic technology and other advances, enabling the chair to balance and run on only two of its four wheels on some surfaces, thus raising the user to a height comparable to a standing person. They can also incorporate stair-climbing and four-wheel-drive feature motorized assists for hand-powered chairs are becoming more available and advanced. The popular Segway Personal Transporter is a mobility device that was a direct outgrowth of the development of the iBOT wheelchair. The Segway, which is basically an iBOT with two wheels removed, was developed explicitly to increase the number of units produced and take advantage of the economies of scale to make the iBOT affordable to wheelchair users.

Three-wheeled wheelchairs are wheelchairs with the least wheels and are found in EPW technology.

Assessments for wheelchairs

When a professional assessment is required, the team may comprise of an occupational therapist, physical therapist/physiotherapist and a rehabilitation engineer or clinical scientist.

Building access

Wheelchair ramp and disabled parking space

A gate for wheelchairs in Hiroshima

Wheelchair elevator located outdoors

Adapting the built environment to make it more accessible to wheelchair users is one of the key campaigns of disability rights movements and the Americans with Disabilities Act of 1990 (ADA). The most important principle is Universal design - that all people regardless of disability are entitled to equal access to all parts of society like public transportation and buildings. A wheelchair user is less disabled in an environment without stairs.

Sometimes it is necessary to add structures like ramps or elevators in order to permit people in wheelchairs (and those using crutches, canes, walkers and so forth, or those with unsupported walking disabilities) to use a particular building. Other important adaptations are powered doors; lowered fixtures such as sinks and water fountains; and toilets with adequate space and grab bars to allow the person to maneuver himself or herself out of the wheelchair onto the fixture. In the United States, most new construction for public use must be built to ADA standards of accessibility.

The construction of low floor trams and buses is being encouraged, whereas the use of paternosters in public buildings without any alternative method of transportation has been criticized due to the lack of access for wheelchair users. Modern urban architecture now incorporates better accessibility for people with disabilities.

In many countries such as UK the owners of inaccessible buildings are advised to keep a lightweight portable wheelchair or scooter access ramp on hand to make premises disabled friendly.

Public transit

In Los Angeles there is a program to remove a small amount of seating on some trains to make more room for bicycles and wheel chairs ^[2].

In Adelaide, Australia, all public transport has provision for at least two wheelchairs per bus, tram or train. In addition all trains have space available for bicycles.

See also

• Cart
• Hobcart
• List of wheelchair organizations
• List of wheelchair users
• Rayleigh bath chair murder
• Stairlift
• Wagon
• Wheelchair (hydrogen)

References

1. ^ FIPFA Official Website
2. ^ http://la.streetsblog.org/2008/10/16/metro-making-room-for-bikes-on-their-trains/

External links

Wikimedia Commons has media related to: Wheelchairs

Look up wheelchair in Wiktionary, the free dictionary.

• Rehabilitation Engineering Research Center on Wheeled Mobility
• Dept of Transportation Information for air travelers with disabilities and their rights in the US
• Etiquette: Wheelchair users Suggestions for better communication with people who use wheelchairs
• Honda's Prototype Walking Assist Devices Demonstrated in U.S.