POWERED SELF-PROPELLED WHEELCHAIRS, MEDICAL REVIEW
By Emmanuel Tristan MD.
There are a few things thing that can bring a smile upon the faces of disabled persons suffering from mobility disability, one of them is providing the disabled person with a device that can comfortably grant him/her access to move about and participate in social activities independently.
A self-Propelled Wheelchair focuses attention on making life easy for those with mobility disability by providing various models of powered wheelchairs, which are also known as motorized wheelchairs; Electric powered wheelchairs etc. to meet the needs of different patients.
A motorized wheelchair, power chair, or electric-powered wheelchair is a wheelchair that is propelled by an electric motor. Powered wheelchairs are useful for those with mobility disability that are unable to propel a manual wheelchair or those who may need to use a wheelchair to cover distances or terrain which would be fatiguing in a manual wheelchair as well as people who desire to move about independent of a helper to push them about. They may also be used by both people with ‘traditional’ mobility impairments, and those with cardiovascular and fatigue-based conditions.
There are Powered wheelchairs for adults as well as children, and of various designs. Such designs include the front wheel driven, four-wheel driven, foldable and portable varieties of Powered Wheelchairs. Some of these Powered wheelchairs are designed in a manner such that they can be used on rough roads.
Powered wheelchairs provide comfort, mobility, and safety to older adults; it helps them (older adults) avoid the danger of incessant falls while moving around. It also enables users to easily perform their day to day activities which would have been quite impossible otherwise. A manual wheelchair can be an overwhelming task for elderly and injured people whereas an electric wheelchair is extremely beneficial.
Powered wheelchairs are designed irrespective of models to be operated with joysticks which control the entire functions of the wheelchairs. These functions may include seat reclining, tilting, and many more features to suit the need of the user according to disability conditions. Depending on the disability of the user, there are various model of wheelchairs with specific functions suited for each need. One of the greatest benefits of many powered wheelchairs is that they can be easily folded.
With the introduction of these powered wheelchairs, traveling by buses, trains and cars have become much easier for handicapped and people with illness that leads to constraint in mobility ability. Self-Propelled wheelchairs are powered electrically by a set of batteries which can be charged. They are modeled to provide comfort to people who find it difficult to perform simple day to day activities. There are different wheelchairs with different functions and uses; therefore, it is quite important to choose the correct one that serves your purpose.
PEDIATRIC USE OF POWERED WHEELCHAIRS
Medical personnel said Independent locomotion is linked to the growth of brain structures, coping, self-awareness, shifts in patterns of attachment and interaction with caregivers, the emergence of a sense of competence and initiative, and the development of cognition.
With a toddler, mobility provides a means of exploring his environment. In the absence of independent mobility, a child may have a decreased ability to learn, decreased socialization, and learned helplessness due to decreased ability to have an impact on the environment.
It is essential not to wait to see if a child will eventually become an independent ambulatory, therefore mobility should be augmented to allow for independence.
Let us look at RESNA position on the application of powered wheelchairs for pediatric users; The Rehabilitation Engineering and Assistive Technology Society of North American (RESNA) published a paper on power mobility in 2009. It describes clinical applications and evidence-based literature supporting the use of power mobility in young children. It is RESNA position that age, limited vision or cognition, behavioral issues, and the ability to walk or propel a manual wheelchair short distances should not be seen and used as discriminatory factors against power wheelchair for children. Also, RESNA recommends early utilization of power mobility for the appropriate candidates as medically necessary to promote psychosocial development, reduce learned helplessness, and facilitate social and educational integration and independence.
ASPECTS OF A POWERED WHEELCHAIR BEFORE PURCHASING
Aspects of powered wheelchairs that require serious attention when deciding to purchase include the base, drive control, and seat functions. There are three (3) basic options for placement of the drive wheels on a power wheelchair: front, rear, and mid-wheel drive.
- In a front wheel drive configuration, the main drive wheel is located in the front, and the majority of the chair is behind the user. When this power wheelchair is driven, there is more of a pulling motion because the front wheels are pulling both the chair and the person sitting on it. This type of chair is good for rough terrain and hills, but it has a slower top speed compared to the other two (rear and mid-wheel drive).
- However, with a mid-wheel drive configuration, the main drive wheel is located typically under the individual operating the chair, this is more centrally. The base has a smaller turning radius to maneuver in tight spaces.
- With a mid-wheel drive chair, there is lesser chair around the driver, resulting in less chair that needs to be judged for maneuvering the chair. While, with a rear wheel drive, the main drive wheel is located in the back and the majority of the chair is in front of the person using it. When driving this power wheelchair, there is more of a pushing motion than a pulling motion. It is known to be a very stable chair for most circumstances and terrain and has a higher top overall speed compared to the other two kinds of wheel drive. Additionally, it is the most stable type of chair for power tilt, which is frequently necessary for individuals with SCI.
It must be noted that; physical limitations should not be a barrier to the use of a correct powered wheelchair. For proper functionality, drive controls can be fabricated to access any body part. It is essential to note this; drive controls require electronic programming to provide control of speed, acceleration, deceleration, braking, and torque. These controls should be adjusted based on the environment. Drive controls include; switches, head array, sip and puff, mouth and tongue pieces, mini proportional joysticks, and standard joysticks, but are not limited to these.
One of the good things about many powered wheelchairs is the fact that, every feature is designed to contribute not only the mobility of the users but their health status as well. For instance, power seat functions can be used to optimize functioning and promote independence, allow for positional changes and pressure relief, assist with environmental access, provide comfort and pain relief, decrease fatigue, and affect physiologic functioning. While the tilt functions, on the other hand, keep the individual in the seated position but provide movement in space. The recline feature will allow tilt and will open the seat-to-back angle which would avail the individual to lie back, this position, for some user may provide easier access for bladder management and hygiene, respiratory care, and management of orthostatic hypotension. The shear potential inherent in a recline system makes mechanical shear reduction available, and with shear reduction, the mechanical component of the backrest and the user interface of the backrest move relative to one another while in the recline position, and this reduces shear on the user.
A standing function will, however, bring the user into standing, which gives room for weight bearing. A seat elevator leads to an increased environmental access and assists with transfers. A seat-to-floor function can grant a child access to lower surfaces, which is important for peer interaction in younger children, and allow the child to crawl into the chair. The power elevating leg rests can increase not only ground clearance but may also provide circulatory benefits and edema control when used in conjunction with tilt or recline.
However, the medical benefit of a powered wheelchair cannot be overemphasized, although, some of the users do not understand that beyond the physical comfort, easy to carry and easy to move benefit of a powered wheelchair, there are countless contributions it has to their health status. This is a reason users are advised to see their doctor for a prescription before choosing a particular wheelchair. Choosing the wrong one can result in a prolonged illness while the right prescription can help the user recover earlier enough. Let’s take a look at few of those conditions that the use of the Ez Lite Cruiser can help;
CONSERVATION OF ENERGY
Introducing a powered wheelchair to persons with a mobility disability can be beneficial for conserving energy. This is important for people with disabilities conditions, such as; multiple sclerosis or post-polio syndrome. A power wheelchair allows people to be mobile within their homes or community without shelling out a lot of muscle work and energy. This can benefit users by allowing them to conserve their energy for other activities important to them.
SITTING, PAIN AND FATIGUE TOLERANCE
The ability to change sitting position increases the comfort levels of users. Sitting for too long in one position is a major cause of pain which is not caused only by pressure, but also an improperly configured wheelchair can increase the discomfort tenfold. Functional activities and sitting stability are greatly increased by tilting the seat at a reclining angle.
Seat elevators also help in the reduction of pain for wheelchair-bound individuals in a number of ways. They allow the users to transfer themselves more easily into their bed or a chair, even onto a toilet, or onto the floor or a lower surface independent of help from someone else without injuring themselves. This ease of independent transfer can as well help to reduce pain and strain on an individual’s knees and hips and as well cause a reduction in the need for extensive strength in their extremities.
Realigning posture incorporating seat functions into the daily activities of people with disabilities of different kinds helps in carrying out daily tasks and in self-management. Gravity assisted positioning is improved by such seats since the different terrains can be balanced with the tilt of the seat. Wheelchair-bound patients with muscular dystrophy and children with spinal cord sits and/or cerebral palsy find this function to be invariably useful in carrying out daily activities.
RANGE OF MOTION:
It is healthy to utilize your full range of motion if possible but very unhealthful to overextend. Overextension resonates with wheelchair use as there is a tendency to stretch to get every last bit out of each push. However, the range of motion is reduced for joints from the shoulders to the wrists when using a powered wheelchair. By reduced range of motion, I mean users’ shoulders, wrists, and hands can operate in their normal range, which leads to the reduction in the likelihood of a shoulder tear, carpal tunnel syndrome, and the other common injuries suffered by wheelchair users.
PHYSIOLOGIC AND ORTHOPEDIC IMPLICATIONS
Improving postural alignment has been found out to help individuals achieve better visual orientation, speech, respiration, arousal and alertness and in carrying out bowel and bladder movements with less stress. It also helps in managing orthostatic hypotension. Risk of injury to the Users’ shoulders, as well as to the caregivers that take time to push patients around in a manual wheelchair, is reduced by a great margin, credit to the seat functions that are available in a power wheelchair.
Elevating leg rests in powered wheelchairs can be used in combination with the tilt feature to raise the legs to about 30cm above the earth. Tilting the chair while the leg rests are fully reclined enhances lower limb hemodynamic states significantly. This can be one valuable way of managing edema. These, among many others, are the bonuses that come with having a high-end power wheelchair with seat functions that help with the ergonomics.
Many users of powered wheelchairs have attained their desires of handling daily duties, gratitude to the multi-seat functions that allow them to take different postures.
An important that has been discovered about persons with mobility disability conditions is that; it is possible that mobility device use, increases participation in both physical and social activities outside the home that users would have been unable to participate in without using such a mobility aid. However, access to these activities, with the help of mobility aid that gives room for readjustment to suit different posture such as the power wheelchair, may increase aspects of quality of life and wellbeing in users.
The society must acknowledge that; assistive technology devices that are completely passive when the user does have some physical function, create the risk of de-conditioning the users’ physical functionality and mobile capabilities at a faster rate than if they had used a more physically active assistive technology
MUSCULAR DYSTROPHY MANAGEMENT
A powered wheelchair is recommended for patients during the rehabilitation of muscular dystrophy to maintain the quality of life, mobility and preserve motor function for other daily life activities.
Difficulty in wheelchair mobility leads to contractures in such patients, but a powered wheelchair is recommended as a solution to such problem. Knee fracture, hip flexion, and abduction contracture are common to patients with muscular dystrophy; hence, joint mobility is highly required. The seat functions, reclining and tilting features in power wheelchair can help to prevent this problem as it gives room for joint mobility.
Power wheelchair provides individuals suffering from mobility disability conditions with an energy-efficient mobility system that increases the ability to work, self-care, and engage in social activities independent of a caregiver. However, the provision of a powered wheelchair should fit into needs based on prescription. It must be noted that; users who receive inappropriate wheelchairs and accessories have a high tendency of experiencing adverse events like low back pain and pressure sores, which may adversely affect physical functioning, safety and quality of life. Injuries associated with wheelchairs use are common and can be serious. Forward-direction tips and falls are most common in powered wheelchairs users which can worsen the health status of users.