DISABILITY EQUIPMENT -
THE WHEELCHAIR



Introduction

The wheel chair - well known disability equipment - is the primary mobility equipment for the movement-impaired. Students using wheelchairs report that this equipment contributes significantly to success in completing tertiary studies. This article will consider a brief history of wheelchairs, types of wheelchair available, important considerations when choosing a wheelchair, regulatory authorities in Malaysia and in the world that provides standards to reference on this topic.

Brief History

It’s been suggested that wheelchairs probably dates as far back as 3500 B.C.E. Observed samples of this disability equipment were usually heavy and cumbersome to operate and transport. However, it was in the eighteenth century that wheelchairs were seen as medical vehicles for the impaired. This equipment was not always viewed favorably. In the first half of the twentieth century, it was viewed as a failure of medical science and this slowed its development. Notably, the polio epidemics of the 1940’s and 1950’s, the two world wars and the Vietnam war contributed to increased numbers of disabled people needing assistance and means of maintaining a livelihood. This sparked government research and involvements in the provision of rehabilitative medicine or disability equipment development. Manual wheelchairs were used during the twentieth century and were gradually made to be light weight. At the end of the twentieth century, powered wheelchairs started emerging. A notable design was the George Kline’s design that had an attachable friction motor to the wheelchair with a joystick for control. Various aspects of the wheelchair developed such as its design, seating materials and design and research. Today, wheelchair research continues with studies relating to psychological and emotional effects on its users (Woods and Watson, 2004).


Types of Wheelchairs

There are four main types of wheelchairs namely:

  1. Manual wheelchairs,
  2. Electric-powered wheelchairs,
  3. Scooters and
  4. Pushrim-activated power-assisted wheelchairs.

Some scholars have suggested that electric-powered and scooters have a higher durability when compared to manual and Pushrim-powered power-assisted wheelchairs (Wang et al, 2010).


Important selection considerations for students

When selecting a wheelchair, it is important to consider factors such as measurement, tires and kind of cushion, flexibility of the adjusting mechanisms, weight, safety standards that governed its manufacture and battery choice (Adelson, 2006).

First, measurement is probably the first consideration for you to get a good wheelchair or any other disability equipment. Measurements must be carried out by a licensed physical or occupational therapist. This ensures that your equipment meets your physical needs, lifting needs, security needs (e.g. securing the equipment in your car) and house needs (movement within the home) (Adelson, 2006).

Second, tire consideration is important since rolling resistance must be reduced to ensure the wheelchair is operated efficiently. Rolling resistance is the force that opposes the movement of the wheelchair. If the rolling resistance is high, the wheelchair will require of a lot of effort (manual wheelchairs) or power (motorized or electric wheelchairs). Although many wheelchair manufacturers prefer solid tires, research indicates that pneumatic tires offer the least rolling resistance requiring less effort and power to operate it efficiently. This is because as load increases the solid tire deforms in a non-uniform manner increasing the rolling resistance of the wheelchair (Kwarciak et al, 2009). Therefore, when choosing a wheelchair, it is advisable to consider pneumatic tires as it will make it easier for you to operate a manual wheelchair.

Third, cushioning and flexibility of adjusting mechanism are important considerations as these affect the user's comfort when using the equipment. Cushioning provides a stable base of support for the wheelchair user and the design and material used for its manufacture must be considered. Cushions must provide pressure relief or reduction and ensure proper sitting postures and this applies when used in any other disability equipment. The two main types of cushions available include static and dynamic cushions. Static cushions include linear cushions (this flat sitting cushion is suitable for those with low to medium pressure ulcer development), visco-elastic cushions (suitable in preventing pressure ulcer development and managing sitting stability), molded cushions (provides excellent stability and overall pressure-reduction since it is constructed to conform to the body shape) and air cushions (provides excellent pressure-reduction and stability since the body is cushioned by the air sacs used in its construction). Dynamic cushions apply to those with high risk or existing pressure damage. It reduces mobility and maximizes positioning as such users are moved infrequently. Experts usually use a pressure-mapping instrument to determine the type of cushioning that is appropriate for you (Collins, 2007). Hence, ensure that the appropriate cushion is provided for you by ensuring your therapist discusses this aspect of the wheelchair.

Fourth, weight is another important consideration for any disability equipment especially with manual wheelchairs. Heavy wheelchairs are difficult to move and sap a lot of energy from the user. The present and future needs of the user, functional ability and size and sitting abilities of the user must be analyzed (Collins, 2003). Weighty wheelchairs can also contribute to shoulder pains and other propulsion discomforts (Sarrai and Massarelli, 2011). It is advisable to seek a lightweight framed wheelchair even if you want a motorized (electric-powered) wheelchair. This is especially critical in an emergency situation where speedy movement is vital.

Fifth, safety is important to the manufacture of any disability equipment as it provides reassurance that the equipment can be referenced to a known standard. Always ensure that the wheelchair is produced to an accredited standards organization. RESNA (Rehabilitation Engineering and Assistive Technology Association of North America) is one such organization. Always insist on the standard of manufacture of the wheelchair as this can also be a factor with insurance and reimbursement agencies.

Six, battery selection is important wherever it is incorporated into any disability equipment. Typical economical recommendation for a wheelchair includes the tubular positive plate battery. However, where this is not available a ‘lead-acid wet cell (deep discharge, golf cart or boat) battery be selected since it is also economical and recommended by wheelchair manufactures. Generally, the chosen battery rating should be up at least 37 ampere-hours at the 20-hour rate (Kauzlarich, 1990).


Regulatory authorities in Malaysia

Government agencies in Malaysia providing for disabled persons include;

1. Ministry of Women, Family and Community Development (operates through its social department and act of law to cater for the disabled women.).

2. Department of Social Welfare (Empowered through the Social workers Act to standardize social work in Malaysia and provide a platform for qualified social workers to work with the disabled).

3. Ministry of Human resources (provides industrial training for various manpower sectors of the country).


Regulatory authorities worldwide

1. International Standards Organization (ISO 7176-21:2009)

2. Rehabilitation Engineering and Assistive Technology Association of North America (RESNA)

3. American National Standards Institute (ANSI).


Conclusion

This article set out to discuss the history of wheel chairs, types of wheel chair available, important considerations when choosing a wheel chair, regulatory authorities in Malaysia and in the world that provides standards to reference on this topic. It was determined among other points that in considering a wheelchair the measurement, tires, weight and safety standards governing its manufacture were critical. It was advised that disability equipments such as the wheelchair should be purchased from licensed agencies that are accredited to internationally recognized standards organizations. Finally, some regulatory organizations in Malaysia and in the world were highlighted.


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References

Adelson, R (2006), ‘Buying that big-ticket item part II: stair lifts, ramps and wheelchairs’, InsideMS, Vol. 23, Issue 6, p. 52-59.

Collins, F (2007), ‘A practical guide to wheelchair cushions’, International Journal of Therapy & Rehabilitation, Vol. 14, Issue 12, p. 557-561.

Collins, F (2003), ‘An assessment of the quickie classic range of lightweight wheelchairs’, International Journal of Therapy & Rehabilitation, Vol. 10, Issue 9, pp. 422-427.

Kauzlarich, J., J (1990), ‘Wheelchair batteries II: capacity, sizing and life’, Journal of Rehabilitation & Development, Vol. 27, Issue 2, p. 163.

Kwarciak, A ., M, Yarossi, M, Ramanujam, A, Dyson-Hudson, T., A and Sisto, S., A (2009), ‘Evaluation of wheelchair tire rolling resistance using dynamometer-based coast-down tests’, Journal of Rehabilitation Research & Development, Vol. 46, Issue 7, p. 931-938.

Sarrai, A., R and Massarelli, R (2011), ‘Design history and advantages of a new lever-propelled wheelchair prototype’, International Journal of Advanced Robotic Systems, Vol. 8, Issue 3, p. 12-21.

Wang, H, Liu, H, Pearlman, J, Cooper, R, Jefferds, A, Connor, S and Rory, A (2010), ‘Relationship between wheelchair durability and wheelchair type and years of test’, Disability and Rehabilitation: Assistive technology, Vol. 5, Issue: number 5, p. 318-322.

Woods, B and Watson, N (2004), ‘The social and technological history of wheelchairs’, International Journal of Therapy & Rehabilitation, Vol. 11, Issue 9, p. 407-410.


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