Bathroom Wheelchairs

• Keeps clothes from rubbing against the rear wheels of the chair.
• Acts as a barrier and protects user from debris tossed up by the wheels.
• Aids in pelvic containment when no arms are being used on a wheelchair.
• Cloth models will fold tight when a folding wheelchair is folded.

• Adds weight to the chair.
• May have to be removed to facilitate transfers.
• May have to be removed when folding a wheelchair.
• Requires mounting hardware to be installed on chair.
• If rigid models are added to a chair whose seat width is small for the user, they may cause pressure against the trochanters (hips).
• May not allow wheelchair to fold tight.
• Will not work with conventional single or dual post arm rests.
  Commonly used with no arm rests or tubular arms.

• Maintains the leg in an extended position. This works well for those users who have limited knee flexion (knee is fixed in a straight position), or for those who require this position post operatively.
• On a chair with a powered recline system, powered elevating legrests are useful in helping a user obtain a supine (laying on back) or reclined position independently.
• The ability to change leg position is sometimes helpful in resolving discomfort or pain issues in the lower extremities.
  
  

• Elevating legrests will add a considerable amount of weight to the wheelchair.
• They have a number of moving parts that may lock up or become difficult to deal with.
• It requires a certain amount of coordination and strength to work this item independently. The user must bend over to one side, depress a lever and lift the leg and device weight all at once.
• The extent of edema (swelling) control is questionable. In the most elevated position the extremity is nowhere near the level of the user's heart.
• Depending on the length of the legrest, elevating the leg may result in flexing the knee.
• When the legrest is elevated it makes the chair longer resulting in the need for increased turning space.
• After a period of time the legrest hanger attachments become warped or worn from the weight of supporting the legs, and the legrests take on an abducted (away from each other) position when loaded. This results in poor positioning of the legs and hips.
• Legrest pads may push against the user's calfs and pull the user forward on the seat resulting in a sacral sitting (slouched) posture.
• The joint at the highest point of the legrest may rub on the outside of the user's leg.
• Elevating legrests increase the cost of the wheelchair.
• This is one item that will make your cool wheelchair look like hell real quick.

• This type of tire is narrower than an everyday tire which decreases contact area with the floor (smaller footprint). The treads are fewer and shallower which decreases rolling resistance. This results in the chair becoming easier to push and rolling further per push.
• High pressure tires are commonly lighter than the standard pneumatics.
• Many users prefer to trade off the softer ride of a conventional pneumatic for the improved push-ability of the high pressure ones.
• Favored by athletes for performance reasons.

• The small volume of air at higher pressure does not afford as much shock absorption, thus it makes for a harder ride than a conventional pneumatic tire.
• The smaller "footprint" of the tire may also result in diminished traction on wet or slippery surfaces.
• Smaller shallower treads tend to wear out quicker than a conventional pneumatic when used for street use.
• May require a valve converter for inflation.

Lateral trunk supports are also known as laterals, lateral supports, lateral thoracic supports, and trunk stabilizers. They are rectangular or square shaped devices that mount to the back posts of the wheelchair and rest against the user's trunk. Most often they are used in pairs, one on each side of the trunk.

Laterals come in a number of different sizes and padding densities. Size and shape will vary depending on manufacturer and style. The most common styles are planar (flat) or contoured (shaped). The amount of contouring may also vary between styles and manufacturers. Many models can be ordered with hardware that allows the lateral to swing away from the user and out of the way. This makes getting in and out of the chair much easier. Laterals are available from the wheelchair manufacturer or can be purchased from a number of aftermarket sources.

These positioning accessories are most often used to increase the user's trunk stability and balance. They can also serve as a tactile reminder. When the user comes in contact with the device they know that they are out of position and can adjust their position or request assistance. Laterals are sometimes used in an effort to control spinal scoliosis ("S" curve of the spine). This tactic may work in those cases were the scoliosis is flexible and can easily be reduced. In cases where the scoliosis is rigid, laterals may cause discomfort and tissue damage (wounds). This is especially true if the lateral is placed on the apex (high point) of the spinal curvature. That brings us nicely to the issue of placement.

If the trunk can be placed in an upright neutral sitting position, but the user can not maintain this position, then the laterals can be placed opposite each other on each side of the trunk. This will add the needed external support to hold the user in position. Many users and professionals think that the laterals have to be placed exactly opposite each other on the trunk. This is not true, and in certain cases may result in poor outcomes and in discomfort to the user. In those cases where you are dealing with a spinal curvature you need to consider uneven or oblique placement of the laterals. One lateral should be placed just under the apex of the spinal curve. The second lateral should be placed on the opposite side of the trunk and above the opposing one. This will set up the proper dynamics for reducing the curve (if flexible) and supporting the trunk.

In order to work well these devices must make contact with the trunk. If they do not make contact with the user there will be no support. If they are too tight, the user may have a problem with breathing. If they are placed too low, support is lost and the trunk may "lean" over the laterals. If placed too high they may impinge on the axilla (armpit) and cause damage to the brachial plexus, irritate the surrounding skin, and restrict shoulder and arm movement.

• Aids in trunk support and stability.
• Improves balance and posture.
• Helps maintain the user in a functional position.
• Prevents further postural decay.
• Diminishes the need for repetitive repositioning of the user during the day.
• Improves appearance.
  
  

• If placed too low they are ineffective.
• If placed too high they may irritate axilla, brachial plexus, surrounding tissue, and limit shoulder and arm movement.
• May be difficult to mount to backrest in proper location.
• When the pad is under pressure the swing-away release may get stubborn.
• Even contact of the entire pad against the body is difficult to realize since there are no adjustments for angling the pad in or out.
• If the user changes position the laterals will most likely no longer be aligned correctly.
• They add another layer of complexity to the entire unit.

• The molded wheels are said to be more durable and require less maintenance.
  
  

• Molded wheels are heavier than spoked wheels.
• They are not as flexible as spoked wheels so users may experience a rougher or harder ride.
• The lack of flexibility makes them prone to cracking on hard impact.

Wheelchair seat depth is measured from the front to back of the seat. To determine the existing size you need only measure the distance from the front edge of the seat to the back where the seat meets the back upright. This will give you a depth dimension of the existing seat.

Measuring to the back rest upholstery may result in an incorrect measurement. Most back upholstery is stretched and hammocked, so measuring in the center of the seat to the center of the back upholstery will result in a longer and incorrect dimension. Some wheelchairs have add-on backs attached. Many of these mount forward of the back uprights thus making any seat surface located behind the add-on back unusable.

To determine the appropriate seat depth for a user- The user should be placed in the best possible seated position that can be obtained. A measurement is taken from the back of the pelvis (furthest part of the buttocks), forward to the back of the knee. Make sure that each leg is measured separately. There are more leg length discrepancies (differences in leg lengths) than you may think. Deduct 2" from the measured length for clearance.

If you have decided on an add-on back you will need to allow for this. If the decided on back takes up seat space in front of the back uprights, you will have to add that amount back into the formula. If not you will be scratching your head wondering why the seat appears so short on the finished product. How about some formulas about now?

With no add-on back; (measured length) – (2" clearance) = depth. For chairs with an add-on back; (measured length) – (2" clearance) + (overlap of back on seat) = depth.

If there is a leg length discrepancy (differences in leg length), custom upholstery, seat pans, or inserts can be ordered from the wheelchair manufacturer (sometimes) or from aftermarket suppliers. Many cushion manufacturers will also custom make their products to accommodate these differences.

• A proper wheelchair seat depth will afford the user increased pressure reduction.
• It will also enhance comfort and will promote improved sitting posture.
• As shallow a seat as possible will assure a shorter wheelchair frame (in a manual wheelchair) which will result in a lighter chair, decreased turning radius, and easier transporting and storage.
• A longer depth will serve to distribute pressure over a greater area (the surface area of the seat), thus reducing pressure in any given place.
This does not hold true if the user is sitting in the knees up position with only the ischials (sitting bones) making seat contact. The pressure will still remain on the ischials no matter how deep the seat is. If the thighs do not make contact with the seat they will not aid in pressure distribution.

• An excessively long seat will push against the back of the leg or in the area of the popliteal crease (fold on the back of the knee) causing the user to be pushed forward on the seat and into a sacral (slouched) position. If left unresolved in patients with insensate (no sensation or feeling) lower extremities this situation may also result in tissue trauma (sores, wounds) to the back of the leg.
• A overly deep seat will not allow the user to sit all the way back against the wheelchair back.
• An excessively long seat will push against the back of the leg or in the area of the popliteal crease (fold on the back of the knee) causing the user to be pushed forward on the seat and into a sacral (slouched) position.
• If the user is forced foward on the seat most of the weight will be located forward on the wheelchair making the chair harder to push.
• Long seats will also add weight to the chair.
• Excessively short wheelchair seat depths will result in increased pressure to the seating area (less surface area). This may increase the risk of tissue trauma.
• The amount of support offered by the seat will also diminish possibly causing poor posture.

• Originally these were home made and used by athletes to keep other athletes out of their spokes during competition.
• Helps protect the spokes during impact.
• They are also used to protect users who may have a tendency of getting their fingers caught in the spokes while pushing (ouch!).
• Most recently they have been used to make a statement or project a self image. This wide open space lends itself nicely to political statements, decal collections, artwork, and a host of other methods of self expression.
• These are the "feel good about yourself" items of the wheeled world.
  
  

• No way! These are my favorite wheelchair components so it's difficult to think of the down side. But, for those who insist that every coin has a flip side, here it goes.
• If you're cruising around in a strong (very strong) crosswind the guards may not allow wind to pass through the spokes. This results in a sail effect which may blow you off your original or intended course. Sounds good doesn't it?

Wheel camber is applied to the rear wheels of a wheelchair. It can be described as an angling that brings the top of the wheels closer to each other. Athletes who wished to improve wheelchair-handling characteristics and stability first introduced camber into wheelchairs.

The amount of camber introduced into the wheels is measured in degrees. The higher the number the more camber or angling there is. Some wheelchairs have methods of adjusting the camber, while others do not. Camber adjustment is most often accomplished by inserting a different camber bar that alters the angle or by adjusting the axle plate for increased camber. Wheelchairs with fixed camber do not allow for altering the angle. In these cases the camber angle may be specified when the wheelchair is ordered (except in the case of low end cheeseball wheelchairs).

As camber is increased, the width of the wheelchair across the bottom increases. This adds lateral stability to the system by increasing the wheelchairs footprint. If to much camber is added there may be a problem getting through doorways. The amount of camber required for daily use is not commonly the same as that which is required for sports.

• The wider footprint adds lateral stability to the wheelchair.
• Redirects forces to soften the ride.
• Places the push rims in a more ergonomic position for pushing. It is more natural to push down and outward.
• Protects the hands when pushing in tight areas since the bottom of the wheels will make contact first with walls and doorframes.
• Less strain on shoulders since the plane of the wheel is closer to that of the shoulder.
• Makes turning quicker.
• Gives the wheelchair a sportier look.

• Wheelchair will be wider.
• May add cost to the chair.
• Excessive camber may cause the wheels to rub against the armrest side panels or against the user.
• Diminished traction and uneven tire wear on a conventional tire.
  Conventional tread placement is centered on the tire. A cambered tire rides on the inside edges of the tire. Some manufacturers make tires with offset treads to compensate for cambering.