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Wheelchair seating in a theater.

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.

Contents

History

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[1] in 1933, together with his disabled friend and fellow engineer, Herbert Everest, 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: Everest and Jennings. Their "x-brace" design, albeit with updated materials and other improvements, is still in common use, over 70 years later.

Types of wheelchairs

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 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.

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

Everyday manual wheelchairs come in two major designs -- folding or rigid. The rigid chairs, which are increasingly preferred by active users, have permanently welded joints and many fewer moving parts. This reduces the energy required to push the chair by eliminating many points where the chair would flex as it moves. Welding the joints also reduces the overall weight of the chair. Rigid chairs typically feature instant-release rear wheels and backrests that fold down flat, allowing the user to dismantle the chair quickly for storage in a car.

Many rigid models are now made with ultralight materials such as aircraft alumninum and titanium. One major manufacturer, Tilite, builds only ultralights. Another innovation in rigid chair design is the installation of polymer shock absorbers, such as FrogLegs, which cushion the bumps over which the chair rolls. These polymers may be added to the front wheels or to the rear wheels, or both.

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.

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.

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

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

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.

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Manual wheelchairs

An antique wheelchair

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

An electric-powered wheelchair is a wheelchair that is moved via the means of an electric motor and navigational controls rather than manual power.

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 -- called 'camber' -- 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) [2] 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. Unfortunately, the $25,000 iBot, which was developed as a joint venture between Johnson and Johnson's Independence Technology and Dean Kamen's DEKA Research, was discontinued in January 2009.

The addition of geared, all-mechanical wheels for manual wheelchairs is a new development incorporating a hypocycloidal reduction gear into the wheel design. The 2-gear wheels, such as the MAGICWHEELS http://www.magicwheels.com can be added to a manual wheelchair. The geared wheels provide a user with additional assistance by providing leverage through gearing (like a bicycle, not a motor). The two-gear wheels offer two speed ratios- 1:1 (no help, no extra friction) and 2:1, providing 100% more hill climbing force. The low gear incorporates an automatic "hill hold" function which holds the wheelchair in place on a hill between pushes, but will allow the user to override the hill hold to roll the wheels backwards if needed. The low gear also provides downhill control when descending.

A hand-cranked three-wheeled PET Vehicle is a mobility device especially suitable for outdoor use and is designed to be maintained with improvised resources.

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 [3].

New York City's entire bus system is wheelchair-accessible, and a multi-million-dollar renovation program is underway to provide elevator access to many of the city's 485 subway stations.

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.

The Washington, DC Metro system features complete accessibility on all its subways and buses.

Wheelchair organizations

Several organizations exist that help to give and receive wheelchair equipment. Organizations that accept wheelchair equipment donations typically attempt to identify recipients and match them with the donated equipment they have received. Organizations that accept donations in the form of money for wheelchairs typically have the wheelchairs manufactured and distributed in large numbers, often in developing countries. Organizations focusing on wheelchairs include Direct Relief International, the Free Wheelchair Mission, Hope Haven, Personal Energy Transportation, and the Wheelchair Foundation.

See also

References

  1. ^ Everest, Herbert A., Jennings, Harry C., "Folding wheel chair", US Patent 2095411, 1937
  2. ^ FIPFA Official Website
  3. ^ http://la.streetsblog.org/2008/10/16/metro-making-room-for-bikes-on-their-trains/

Simple English

[[File:|thumb|A manual wheelchair in a theater.]] A wheelchair is a type of chair usually used by disabled people.

A wheelchair is moved either manually (by pushing the wheels with the hands, or pushed from behind with handles by somebody who is not sitting in the wheelchair) or by automated systems such as electric motors which can be controlled by the wheelchair user (the person sitting in the chair) or by somebody walking behind or beside the wheelchair if the wheelchair user needs help to move their wheelchair.

Wheelchairs are used by people for whom walking is difficult or impossible due to illness, injury, or disability. Wheelchairs can have extra cushions and other parts added to improve support if the wheelchair user cannot keep their body in a good sitting position, or to make the wheelchair more comfortable to sit in. The earliest record of the wheelchair in England dates from the 1670s [Oxford English Dictionary, (2nd Ed.), 1989, Vol. XX., p. 203.], and in continental Europe this technology dates back to the German Renaissance.

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