Module 9 - Manual Wheelchair

1. There should be at least 2in/50mm footplate clearance from the ground.

2. The front seat to floor height impacts on access to transport, kitchen, work station and social environments such as restaurants. For a client with a 90 degree thigh to lower leg angle, the front seat to floor height is calculated by adding the lower leg length, the shoe/heel height and the ground to footplate clearance, and subtracting the estimated cushion height. Subtract from this calculation for smaller front frame angle or a tighter thigh to lower leg angle ("tuck under") as the feet are at a further distance from floor (around 1in/25mm for a 70 degree front frame angle). This is often a strategy that tall clients use to keep the chair low and accessible.

3. A swingaway footplate system can increase the overall wheelchair length and can change the thigh to knee angle depending on foot support style. Access and transfer to tight turning areas such as cars and toilet should be assessed.

4. The front castor size can influence the front seat to floor height, front frame angle and foot support style. The selection of the castor design and material is determined by the ease of manoeuvrability, roll resistance and ride quality preferred by the user.

5. Select the type and profile of rear wheels that meet terrain requirements without compromising the desired rake and rear seat to floor height.

6. Wheel lock type and position are determined by the client's hand function and reach, and available and accessible mounting positions on the wheelchair frame to provide an effective wheel lock.

7. Determine the seat to back angle and back height using the outcome of MAT evaluation. Remember that cushions add sitting height.

8. The narrowest seat width provides optimal wheel propulsion and environmental access. Add-on seating systems may change the dimensions of seat width and seat depth.

9. Follow the manufacturer's prescription form to select appropriate accessories and custom options. Read the instruction carefully as they vary between manufacturers and wheelchair frame style.

• Explore options and "trade-offs" with the client
• Refer to a spinal physiotherapist when wheelchair skill training is required
• Provide the suppliers with detailed seat frame specifications for trials. Suppliers have the most up to date product options and applications.

• The trial wheelchair should be set to the correct size and shape for the client. It should have comparable stability and manoeuvrability adjustment to match the balance and wheelchair skill of the client
• The trial should cover time duration and all aspects of daily activities around the home, work and community outings. Pay particular attention to the performance of the wheelchair during transfers and personal care activities when stability and environmental access are important
• Set an obstacle course for indoor and outdoor environment if trials cannot be conducted in the home environment. This may include a specific route around the hospital that involves ramps, pedestrian crossings, kerb ramps, gutters, uneven terrain, carpet, tight circulation space and doorways. Consistency is the key
• Therapist should list the trial conditions and ask for feedback in a systematic way using a table format. It is particularly useful when documenting clinical rationale and funding applications.