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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