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Eurograduate programme Student and graduates BP: Applications

WHEELCHAIR "ARMS" RACE

Wheelchair “Arms”-Race

The “Arms”-Race is on again but not involving the world’s major powers except in the “wheel-chair” division. This “race” is based upon the many options and choices involved in selecting the kind of arms (non-lethal) that best suit the user; i.e., folding, desk-length, full-length, canti-levered, “flip-up”, “swing-away”, fixed, single-post, dual-post, etc., to name a few.

Learning the basics of wheelchair armrests can improve your comfort, functionality and convenience in addition to improving the satisfaction with your wheelchair-life. Many active users believe that armrests are non-functional and are always in the way, interfering with the user’s ability to sit at tables and desks. In addition, they do not want any additional feature to increase the chair’s weight. Nothing could be further from the truth.

Armrests are not only functional but increase the flexibility and comfort of the chair by at least a hundred percent making their usage invaluable. They allow you to rest your arms at a height that is higher than your lap. When you place your arms on the rests, you take the “pull-of-gravity” off your arms and shoulders. The extra weight of your arms, without the rests might actually pull you forward causing a slouched (sacral) posture. With the weight of your arms resting on these rests, you are able to straighten your spine and sit in a more-upright, vertical position.

Armrests are also used to support desk-and-feeding trays as well as one-sided arm supports. They exist in a great variety of types and styles such as those that can “flip-up”, be removed, “swing-away” as well as remain in a fixed-position. While available in various lengths, the inexpensive chairs do not offer this option and might have only a fixed-height, making it non-removable and that may interfere with transfers, in addition to not being at a height to provide optimal arm-support. For instance, if they are too low, it will encourage your body to lean for-ward. If they are too high, you might have to raise your shoulders just to get your arms on the rests and might “dig” into your armpits.

Some options based on arm-rest choices are:

1)      Fixed: These are bolted or welded to the frame of the wheelchair.

2)      Dual Post: These have two vertical tubes that insert into the side frame of the wheelchair.

3)      Single Post/T-Arm: These have one vertical tube that inserts into the side frame. It offers more clearance for coming up to a table but is slightly less stable than the dual-post arm-rests.

4)      Flip-Down/Cantilever: Rather than attaching to the side frame, the rest attaches to the back, up-right canes and can be flipped upward to allow clearance.

5)      “Swing-Away”: Just as it says, it “swings-away”, out-of-the-way.

6)      Desk-Length, Full-Length: Desk-length – 10 inches. Full-Length – 14 inches. Desk-length arms are easier to pull-up to a table or a desk while full-length arms provide more support while resting your arms on the rests, themselves.

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The styles include:

a)      Full Length, Fixed, Removable Rests: These have a fixed height and provide arm support from the back to the front of the seat.

b)      Full Length, Adjustable, Removable Rests: These are adjustable in height, usually with a push-pin, and provide support from the back to the front of the seat. They e often recommended if a lap tray is being used because of the stability of a long, arm-support and adjustable in height to get the tray in the optimal position.

c)      Desk Length, Fixed, Removable Arm-Rest: These have a fixed height and provide arm support from the back to three-fourths of the seat.

d)      Desk Length, Adjustable Height Removable Arm-Rest: With these, you have the ability to adjust height and have arm support from the back of the chair to three-fourths of the seat. This allows the chair to go under a table or up to a desk.

e)      Space-Saver Arm: These curve inward to bring the front of the armrest closer to the body.

f)        Tubular: These are usually “flip-down” with hardware on the rear uprights or curve downward and attach to a receptacle behind the seat of the chair. These can be ordered with a rolled padding or an upholstered and padded version. Adjustments can be made dependent on the kind of attachment-hardware that has been installed.

g)      “Swing-Away” Arm-Rests: These swing to the side or back behind the wheelchair to allow for transfers or easier clearances.

Pads can be attached of upholstered, hard plastic or a “self-skinned-foam” composite material. The non-padded, upholstered pads might be a better choice if a tray is going to be added so that the tray will not rip or endanger the padding.

Remember: Quoting an old, 1592 proverb, “To be fore-warned is to be fore-armed”, (not four-armed) and not emphasizing the word, “forearm”, that exists between the elbow and the wrist. Thus, the purpose of this article is to be “Fore-Warned”, beforehand.

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WHEELCHAIR ADJUSTABLE FEATURES

A. Problem Specifics

Four accessories on all wheelchairs that are essential for convenience, comfort and safety are the 1) arm-rests (height of), 2) back-rest (tilt of), 3) leg-rests (elevation of), and 4) “tip-angle-knobs” (prevents the chair from tipping-over, backwards). All chairs do not offer all of these features. These items can be aligned, adjusted and installed on any chair, manual or electric.

Without these items, the wheelchair becomes uncomfortable, harder to maneuver and control and may even be unsafe. With (1) armrests, many users are sensitive to the height of the arm-rests if you are six-feet tall or taller. If this is the case, the users usually like to have the arm-rests higher than normal.   

The (2) tilt-angle of-the-back of a wheelchair is usually adjustable by as much as fifteen-degrees and is able to be “locked-in” position with a screwdriver when the chair is not occupied.

With (3) elevating leg-rests that allow the leg-rests to be elevated in front of the user, the main purpose is to reduce body-fluid from draining into the ankles, legs or a broken limb. These rests are used to elevate the legs placing them in extended, knee-straight positions with “calf-pads” that are either padded or covered with a hard, plastic material. Foot-plates and calf-pads can be added for improved alignment and foot-placement. Some of these leg-rests have an articulating feature that allows them to be extended and become longer as the leg is elevated. Usually, they are ordered for the control of foot and/or leg-edema (swelling).

Lastly, (4), the adjustable, “anti-tip” protrusions on the back of the wheelchair-frame (keeps the chair from tipping backwards) are essential in preventing just such accidents. Their importance is accentuated by the fact that the user may not have good balance or control of the chair or is a relatively new user of the chair. In addition, they can always be removed, if desired or necessi-tated.

B. Symptoms and Causes

1) Adjustable Height of the Arm-Rests: It is reasonable to assume that if you are six-feet tall or

    taller, the height of the arm-rests are critical for comfort and convenience.

2) Tilt of the Back-Rest: It is reasonable to assume that the angle of tilt be as close to comfort-

    ably-desirable as possible for convenience and ease of smooth operation of the chair, itself.

3) Elevating Leg-Rests: Critical in cases of edema (swelling) of the legs and ankles to elevate

    the legs to minimize the pull of gravity on body fluids towards the lower extremities.

4) Anti-Tip Stability: Stabilizing the wheelchair to prevent tipping backwards by exercising

    body-control and balance, becoming familiar with the wheelchair through hours of training

    and exercise and analyzing the chair and its rear-protrusions, the condition of the terrain over

    which it usually travels and the “up-and-down” surfaces and ramps it usually encounters.

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C. What Is To Be Done About The Problems?

1) Height of the Arm-Rests: Adjust the height upward or downward for comfort, convenience

     and practicality.

2) Tilt of the Back-Rest: Adjust the angle of tilt forward or backward for comfort, convenience

     and practicality.

3) Elevating Leg-Rests: Adjust the height of the legs and ankles in front of the user to extend

     the length of the leg-rests (support) to minimize the pull of gravity towards the lower extremi-

     ties.

4) Anti-Tip Stability: Analyze the stability of the wheelchair and its rear-protrusions. Increase

    the rear-protrusions, if necessary, to prevent rearward tipping. Teach the user to exercise

    better body-control and balance and become more familiar with the wheelchair, itself, through

    additional hours of training and exercise.   Analyzing the condition of the terrain over which it

    usually travels and the “up-and-down” surfaces and ramps it typically encounters.

D. Summary, Conclusions and Cautions

a)      The leg-rests keep the legs extended for those who have limited knee-flexion (knee fixed in a straight-position) or for those who require this position; i.e., after an operation.

b)      On a chair with a powered recline-system, the elevating leg-rests are useful in helping a user into the supine-position (lying on one’s back) or into the reclining position. 

c)      Sometimes, changing the leg-or-arm-position is helpful in resolving discomfort or pain in the upper-or-lower extremities.

d)      The leg-rests increase the weight of the wheelchair as well as the cost.

e)      Some of these accessories may have a number of moving parts that may “lock-or-seize-

up” or become difficult to operate, even though, rarely.

f)        A certain amount of co-ordination and strength is required to operate the elevating leg-rests, without assistance. (Required, simultaneously, the user must be able to bend-over to one-side, depress a lever and lift the leg-rest several inches.)

g)      Elevating the leg may result in a somewhat flexing-of-the-knee depending on the length of the user’s leg.

h)      When the leg is elevated, it makes the chair longer resulting in the need for an increase in “turning-radius” and space and possibly, a re-positioning of the legs and hips.

i)        The elevating rests, after a period of time, may become warped or worn from the weight of supporting the legs and may become “abducted” (away from each other) resulting in poor positioning of the legs and hips.

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j)        The leg-supporting pad, an integral part of the leg-rest, may push against the user's calf, pulling the user forward on the seat. This may result in a slouched position and/or result in some pain with the sciatic (tailbone) nerve.

k)  At the highest-point of the leg-rest is a “mechanical-joint” that has a tendency to rub on

     the outside of the user's leg.

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