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Disabled Village Children

A guide for community health workers, rehabilitation workers, and families

By David Werner


 
 

589

CHAPTER 64

Decisions about Special Seats and Wheelchairs


In this chapter we look at the things you will need to consider when buying or building a special seat or wheelchair, to best meet the needs of a child. Adaptations of seats and wheelchairs for special positioning needs are discussed in Chapter 65. Designs for building 6 basic wheelchairs are in Chapter 66.

Meeting the needs of the individual child, family, and community

Most children who need a wheelchair or special seat have severe weakness in parts of their bodies, or muscles that pull them into awkward or deforming positions. Seating should, as much as possible, keep these children in healthy and useful positions. It must provide support, but also allow them enough freedom to move, explore, and develop greater control of their bodies. For example:

cp

1. A child who is 'floppy' and slow to develop ability to sit, A child who is 'floppy' and slow to develop ability to sit. 2. may at first need a seat with straps and supports to hold her up.

At first need a seat with straps and supports to hold up.

3. As she develops better head control and then body control, the supports can be removed little by little,

The supports can be removed little by little as she develops better control.

4. until finally - if possible - she is able to sit anywhere, with little or no special supports. Now low back support is all she needs.

Finally she is able to sit anywhere with little or no special supports.

CAUTION: If a child needs to be supported as much as the one in the second picture, do not keep her strapped in her seat for long. She also needs periods of free movement and exercise to develop more independent head and body control. Keeping her strapped in for too long, or providing too much support after she has begun to gain more control, may actually slow down her progress. Seating needs to be changed and supports reduced as the child develops.

Also, children who do not feel in their butts need frequent position changes and 'lifting' (see Page 198), and special cushions (see Page 200).


590

Special seats and wheelchairs need to be adapted not only to the individual child, but also to the particular family, local customs, and community situation. For example:

Profits of high chair.

A 'high chair' lets the child join the family that eats at a table.

A 'low chair' lets the child fit in where the family eats at ground level.

Profits of low chair.

Profits of high wheelchair.

Also, a 'high' wheelchair may be helpful where cooking and other activities are done high up.

Profits of low wheelboard or trolley.

But a low 'wheelboard' or 'trolley' may be better where cooking and other activities are done at ground level.


It is also important to consider the type of ground surface on which a wheelchair will be used.

Where land is flat and fairly smooth, and entrance into houses is level, a chair with a small wheel at the rear may work well and be less costly to make.

A chair with a small wheel at the rear.


But where there are curbs, steps, rocks, or other obstacles, a chair with small wheels at the front works better.

A wheelchair with small wheels works better where there are many obstacles.


On rough, sandy surfaces wide back tires and relatively large, wide front casters make moving about much easier.

Wide tires help in sandy places.


Having the right wheelchair for the local situation frees the child to move about more easily in the community.


591

Healthy, comfortable, and functional positions

Whether or not a chair has wheels, the position in which it allows a child to sit is very important. (See Chapter 65.)

For most children, the chair should help them to sit more or less like this:

A child who sits in chair (side). A child who sits in chair (front)
CAUTION: The seat should be wide enough to allow some free movement and narrow enough to give needed support (see Measurements, Page 602).


CP

Common seating problems and possible solutions

Problem: Hips tilt back

A child with spastic cerebral palsy.

In children with spastic cerebral palsy the hips often stiffen backward. This triggers spasms that straighten the legs and cause other muscle tightness with loss of control.

A child with weak hips or back, from spinal cord injury, spina bifida, or severe polio.

Also, children with weak hips or back, from spinal cord injury, spina bifida, or severe polio, often sit slumped with their hips tilted back and the back severely curved. This can lead to permanent deformity.

One of the most common causes of backward tilting hips is a chair like this one that is too big for the child.

Other causes of backward tilt and bad position are:

a chair back that tilts far back

and a cloth back that sags.

These let the child lean back and cause the hips to slip forward.

Cause of backward tilt and bad position.
Also, footrests that are far forward so that knees do not bend enough can increase spasticity that tilts hips back.

A good position can often be gained through:

a fairly stiff, upright back at a right angle to the seat,

a chair that fits the child so that his hips reach the chair back,

A good position.
the knees at right angles, and feet firmly supported.

A better position - the whole chair tilts back a little.

Most children and especially a child who tends to fall forward in his seat, will sit better and more comfortably if the whole chair tilts back a little. But be sure to keep right angles at hips, knees, and ankles.

To tilt the chair back, the rear wheel mount can be moved higher up.

To tilt the chair back, the rear wheel mount can be moved higher up. You may also need to move the wheel mount back rather to keep the chair from falling backward with going uphill. Be sue the front caster barrel is still straight up or making turns will be harder.


592

Keeping cost down and quality up

For many families, a wheelchair can be a great or even impossible expense. There are many ways to keep costs down. But be careful. Some low-cost choices may make the chair too clumsy, weak, or unsafe. Other low-cost choices may actually increase the chair's usefulness and life. For example, a very useful, long-lasting wheelchair can be made of wood-or from a cheap wooden chair. Even wheels made of wood (if made well) may work well and last a long time. But, making the hubs or bearings of wood usually leads to trouble. Standard wheelchair wheel bearings are very expensive. However, you can often get strong, high-quality, used metal bearings free or very cheap at electrical appliance repair shops or auto repair shops.

Factory-made or homemade wheelchairs?

Often you can save money by making your own wheelchair or by asking a local craftsperson to make one. Also, a homemade chair design can be more easily adapted to your child's particular needs.

You can make a fairly effective low-cost wheelchair by attaching bicycle wheels or wooden wheels to an ordinary wooden chair.

On the next pages we give information that may help you decide about different wheelchairs and effective low-cost ways to make them.

You can make a fairly effective low-cost wheelchair by attaching bicycle wheels or wooden wheels to an ordinary wooden chair. Also, it is easier to attach special aids or supports to a wooden chair than to a metal chair. This design is adapted from AHRTAG's booklet, "Personal Transport for Disabled People" (see Page 604).

Look for low-cost alternatives that make a chair better - not worse.

Any wheelchair is better than none-but sometimes not much better. Look for low-cost alternatives that make a chair better-not worse.


REMEMBER: A wheelchair needs to satisfy the rider- not just the maker. Before (and after) buying or making a chair, think carefully about the different features that will help it best meet the needs of the particular child and family.


593

When buying or making a wheelchair (or any other aids), consider:

A person sits in wheelchair.

bulletCost. Keep cost low but quality high enough to meet the child's needs (see Page 592).
bulletHow long will the chair last? The longer the better, unless it is only for temporary use.
bulletHow easy and quick is it to make? The easier and quicker the better, as long as it meets your needs.
bulletAvailability of materials. Make use of local low-cost, good-quality resources (local wood, cheap metal, used bearings, bike parts, etc.).
bulletWhat tools and skills are needed to make it? If welding equipment or skills are not locally available, a wooden chair may be a more practical choice.
bulletHow easy will it be to adjust or repair? Wood chairs that are bolted together are often the easiest to adjust or add special supports to.
bulletWeight. The lighter the better, while making sure it is strong enough.
bulletStrength. Heavier persons need stronger chairs and stronger axles. (A small child's chair may be supported by a bicycle axle attached on one side only. A bigger child needs the axle to be supported on both sides, or a stronger axle. See Page 598 and 615.)
bulletWidth and length. The narrower and shorter the better while meeting the child's needs (but not so short that it tips over easily).
bulletHow easily can it be moved- by the child sitting in it or by someone behind? How easily can it be tilted back to go over rough spots? Lifted up stairs? Transported? (Does it need to fold to take up less space?)
bulletHow well is it adapted to the particular child's wants and needs? Is it comfortable? Does it allow the child to sit in a healthy position?
bulletFit and growth factor. How well does it fit the child now? How long will it continue to fit her? Can it be adjusted to fit her as she grows?
bulletHow well is it adapted to living situations, the home, local customs, width of doorways, surface of floors and roads, curbs and other barriers?
bulletAppearance. Is the chair attractive? Does the child take pride in it? Do other children want to ride it?

In considering choices for the design, building materials, and special features of a wheelchair, be sure to carefully consider the above questions.


594

Design choices for wheelchairs

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
WHEEL SIZE AND POSITION

2 big wheels with 1 or 2 small caster wheels

Wheel size and position (indoor, outdoor)

bulletLarge wheels let rider push herself.
bulletSmall caster wheels allow easy turns (on cement, not sand).
bulletFor leg amputees, rear wheels must be moved back to prevent tipping over backward.

For leg amputees, rear wheels must be moved back to prevent tipping over backward.

bulletChild can move it herself if she has hand and arm control.
bulletLarge wheels go over rough surfaces easier.
bullettakes up more space
bulletharder to get in and out of from the side (because wheels need to be higher than seat so that rider can push herself)
4 small wheels

4 small wheels (Size and Position).

Very simple temporary chairs can be made by putting 4 wheels on an ordinary wood chair.

very simple temporary chairs

bulletgood only on smooth floors for a child who cannot push or help push his own chair
bulletcheaper
bullettakes up less space
bulleteasier to move child in and out of
bulletnot good on rough surfaces
bulletChild cannot move it herself.
bulletcreates dependency
3 big wheels

3 big wheels (Size and Position)

bulletYou can use 3 bicycle wheels.
bulletSome models have removable front wheel so that chair can be easily changed to have small front wheels for use inside the home.
bulletexcellent for long distance and rough road travel
bulletcan be used by a person with strength in one hand only
bullettoo big for use inside home
bulletmore costly
bulletmore difficult to make
Some riders have 2 chairs: one like this for road travel, and a smaller one for home or work.
BUILDING MATERIAL FOR FRAME

Steel tube

Steel tube (Building material for frame)

Whirlwind wheelchair See Page 622.

bulletThin-walled electrical conduit tubing can be used-5/8 inch to 1 inch diameter.

AHRTAG design. see Page 604.

Thin-walled electrical conduit tubing.

A strong, long-lasting, fairly light chair can be made better and cheaper than most commercial chairs.
bulletrequires welding skills, some design ability, and a fair amount of equipment
bulleta good chair for a well-equipped rehabilitation center workshop to build, but not a family
bulletbuilders need to be trained
Wood

Wood (Building material for frame)

For wood design details, see Page 615 and 620and references on Page 604.

Wood chair model design.

wood chair model design, see Page 615

bulletrelatively cheap and easy to make-mostly wood, few or no welds
bulleteasy to adapt and to add special supports or tray tables

Plywood model design.

plywood model design Page 620

bulletMay not be as stable and long-lasting as other models.

(For tighter joints and more adaptability, use nuts and bolts instead of nails.)

595

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
Re-bar (metal reinforcing rod used to strengthen cement)

Re-bar (metal reinforcing rod used to strengthen cement).

Design can be the same as for metal tube chairs, but it is easier to adapt because the re-bar is easy to bend.
bulletrelatively cheap
bulleteasier to bend and weld than steel tubing
bulletcan have plastic woven seat and back (easy to clean)
bulletespecially good for small chairs
bulletA heavy person or rough treatment may bend it out of shape.
bulletfairly heavy
PVC pipe (plastic water pipe)

PVC pipe (plastic water pipe)

bulletUse 15 mm. PVC pipe.
bulletcomes with joints so that it can be fitted together with a special glue
bulletFor details see reference, Page 606.
bulletlightweight
bulletcan be built mostly by glueing pieces together
bulletcostly materials (around $100 US)
bulletPlastic tubing will in time sag or bend in the direction of stress.

Therefore it may be necessary to fiberglass the frame-which adds to cost, work, and weight.

SEATS AND BACKS

Soft canvas or leather stretched between supports

Soft canvas or leather stretched between supports.

bulletFor child who is likely to pee or shit in the chair, use a cloth that is easy to wash.
bulletPlastic-coated canvas makes cleaning easy but is hot and may irritate child's bottom. Best to use an absorbent washable pad over it.
bulleteasiest seating and back design for folding wheelchairs.
bulletAdjustment to shape of butt gives comfort (but cushion is needed to protect against pressure sores).
bulletCurving back may help keep child from falling sideways.
Soft, curving back lets child bend in an unhealthy position.
bulletSoft, curving back lets child bend in an unhealthy position (see Page 591).
bullethard to attach positioning aids
bulletIn children with spasticity or muscle imbalance, this may increase the risk of developing knock-knee contractures.
Firm (but padded) back and seat

Firm (but padded) back and seat.

bulletUse wood or thin plywood.
bulletSpecial designs allow a wood seat to swing up for folding.
Wood seat and back allow easy addition of supports and adaptations.
bulletWood seat and back allow easy addition of supports and adaptations.
bulletFirm wood back and seat help child sit with back straight and knees apart (especially important for children with spasticity).
bulletmay be less comfortable
bulletwithout cushion may cause pressure sores in child with no feeling in his butt
bulletheavier
bulletdifficult or impossible to fold the chair
Woven seat and back

Woven seat and back.

bulletUse natural basket fibers, reeds, or rattan,
bulletor use plastic webbing,
bulletor use tightly stretched strips of car inner tube.
bulletAn open weave is cooler in hot weather.
bulletPlastic or rubber woven seats can be easily washed. Can be used as a chair to bathe in.
bulletmust be kept stretched tight; not useful on folding chairs
bulletmay not last long if material is not strong
bulletsame sag problems as with canvas or leather


596

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
TIRES

Pump-up with air 'balloon' tires

Pump-up with air 'balloon' tires.

bulletBicycle tires and tubes work well for the large wheels -20 inch (51 cm.), 24 inch (61 cm.), or 26 inch (66cm.), wide or narrow.

Puncture-proof inner liners may be available.

bulletsofter ride
bulleteasy to replace
bulletwide tires good for sand and rough ground
bulletnarrow tires better on smooth, paved roads
bulletPuncture(hole in tire) may occur-especially on rough roads.
bulletmore costly than some other tires
bulletwears out sooner than solid tires
Solid tires (standard wheelchair wheels)

Solid tires.

Buy from wheelchair supply center to fit diameter and width of rim.
bulletno flat tires
bulletgood for speed on very smooth surfaces
bulletcostly
bullethard to replace
bulletvery hard, bumpy ride on rough surfaces
bulletvery narrow-sinks into sand
Rubber hose inside bicycle tire

Rubber hose inside bicycle tire.

bulletOverlap ends and cut at 45° angle.
bulletFit hose into tire.

tire

bulletno flat tires
bulletsofter ride than with solid tire
bulletcheap
bulletFlattening of tire where it touches ground means it moves slower, and is harder to push.
Thin strip of old car tire

Thin strip of old car tire.

bulletCut strip in wedge shape to fit rim.
bulletWire ends together.

wire ends together.

bulletno cost
bulletlong-lasting

Sink bolt head.

bulletbumpy ride
bulletdifficult to fit well on rim and to fasten ends firmly
large machinery fan belt (discarded)

Large machinery fanbelt.

bulletUse old power belts or fan belts from industrial machinery or tractors. Cut to fit and wire ends together.
bulletno cost
bulletlong-lasting
bulletwedged to fit wedge rim
bulletbumpy ride
bulletdifficult to fit
bulletmay be hard to find at the right width
Piece of old bicycle or scooter tire

Piece of old bicycle or scooter tire.

bulletused for middle-sized or small wood wheels
bulletNotch edges, glue, and nail to wheel.
bulletcheap
bulletIf heavy tire is used it may last a long time.
bulletProtects edge of wood wheel.
bullethard, bumpy ride (but softer than on wood wheel alone)
bulletmay tear off
BIG WHEELS

Standard factory-made wheelchair wheels

Standard factory-made wheelchair wheels.

bulletBuy to fit chair.
bulletavailable from wheelchair dealers
bullet24 inch (61 cm.) or 26 inch (66 cm.) rims for adults
bullet20 inch (51 cm.) rims for small children (may be hard to find)
bulletlittle work needed (if they are bought to fit standard hubs)
bulletMay come fitted with hand push rim
bulletcostly
bulletmay be hard to find
bulletwide-wheeled models often not available
bulletmay not hold up on rough ground
bulletpoor quality bearings
Bicycle wheels (rims and spokes)

Bicycle wheels.

bulletFor children, standard thickness spokes may be enough.
bulletFor large persons, heavy-duty spokes may be needed.
bulletless costly than standard wheelchair wheels
bulletavailable in different sizes and widths
bulletPutting on and lining up spokes takes time and skill.
bulletaxles weak (but stronger ones can be adapted)
Bicycle rims with wooden spokes

Bicycle rims with wooden spokes.

bulletnotched wood cross-pieces on a triangular wood base can be greased and used as the hub.
bulletno need to know how to fit spokes
bulletworks with wood hub
bulletRim may easily get bent-especially on rough roads.
bullethard to line up evenly.
bulletHub wears out easily.


597

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
Wood wheels -big or small

Wood wheels-big or small.

bulletUse boards or plywood.
bulletTo avoid splitting, screw and glue 2 layers together with grain running in opposite directions.
bulletCut notch in rim to hold solid tire.

Edge of wheel.

bulletrelatively cheap.
bulletlittle skill required-mostly carpentry.
bulletworks with wood axles.
bulletheavy-duty bearing can be added.
bulletoften heavy
bulletmay not hold up long - especially in wet climate or mud (Keeping wood oil-soaked helps them last. Use old engine oil)
CASTERS AND WHEELS

Standard wheelchair caster wheels.

(Caster means that the wheel can swing in different directions for making turns.)

Standard wheelchair caster wheels

bulletCasters come with hard or balloon tires in many sizes, weights, styles, and prices.

If possible, get (or make) casters with ball bearings.

bulletlittle work to attach - especially if standard mount and bearings are used
bulletusually very costly
bulletmay not be locally available
Casters from other (non-wheelchair) equipment (used or new)

Casters from other equipment.

bulletUse 3 inch to 6 inch wheels.
bulletlarger, wider wheels for rough ground
bulletBe sure bearings are strong enough and in good condition.
bulletDrill holes in rubber wheels to make them weigh less.

3 inch to 6 inch wheels.

bulletless costly (especially if not new)
bulletoften full wheel and caster bearings come with them.
bulletPoor quality casters make wheelchair much harder and more awkward to use.
bulletHard-rubber casters make a bumpy ride.
bulletSome used casters are too weak.
Bent and welded steel caster forks

Bent and welded steel caster forks.

bulletChoose bolt width to fit bearings.
bulletA bent steel tube can be used instead of a metal band.
bulletless costly than factory-made casters
bulletstrong (if well made)
bulletneeds special equipment (bending jig) and welding skills.
HUBS, BEARINGS, AND AXLES

Standard wheelchair bearings

Standard wheelchair bearings.

bulletA standard wheelchair uses 12 bearings: 2 for each wheel axle and 2 for each upright caster bearing.
bulletHow a ball bearing works:

Turning wheel

bulletThese bearings come as part of standard wheelchair hubs and wheels.
bulletMost factory-built wheelchairs have unusual sized axles and therefore must be fit with special wheelchair bearings.
bulletBearings on most factory-built chairs are costly, of poor quality, and wear out quickly.
bulletUnusual hub size makes it hard to replace commercial wheelchair bearings with other standard machine bearings.
Bicycle bearings and axles

Bicycle bearings and axles (front wheel axle)

For mounting alternatives, see wheelchair designs Page 598 and 615. Also, see the AHRTAG Manual (see Page 604).
bulletcheap -especially if old bicycles are used
bulleteasy to get
bulletcan be used with complete bicycle wheels
bulletAxle is too weak to be supported by one end only (except in a small child's wheelchair).


598

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
Rear bicycle wheel axle and bearings

Rear bicycle wheel axle and bearings.

bulletFirst take free-wheel mechanism apart and remove ratchets.

Free-wheel mechanism

bulletThen attach hub to a metal plate as shown and spot weld it.
bulletOther methods for one-end axle support are in the AHRTAG Manual (see Page 604).
bulletAllows axles to be attached by one end only.
bulletNeeds fairly skilled work and welding.
bulletheavy
Used machinery bearings

Used machinery bearings.

bulletFind used high-speed bearings of the size shown (or near the size). Volkswagen alternator bearings and certain power tool bearings work well.
bulletUse 5/8 inch steel bolts for axle. For details, see Page 604, 622, and 623.
bulletno need to adjust, grease, or clean.
bulletusually free or very cheap.
bulletIn wheelchairs they will last a very long time.
bulletIf done well, results are better than with commercial hubs and bearings.
bulletvery careful exact work needed for good results.
Wood bearing

Wood bearing.

bulletUse a hard wood that will not split.
bulletSoak wood in old motor oil.
bulletFor more ideas and details on wood bearings, see AHRTAG Manual Page 604.
bulletcheap and fairly easy to make.
bullettends to wear out, wobble, or crack quickly unless very well made; not as smooth or easy to ride as with ball bearings.
SUPPORT OF AXLES

Axle supported on one side only

Support of Axles (Axle supported on one side only).

This is the standard mount for factory-built chairs.

bulletStrong steel axles are needed for support at one side only. Axle should be at least 5/8 inch thick for a large person.
bulletFor a very small child bicycle axles can be supported by one side only. One way is to weld bicycle axles to a thin metal pipe.

Strong steel axles.

bulletNot as wide or heavy as the chair with 2-side support.
bulleteasier for user to get a full-length push with hands and arms.
bulletnarrow size important for doorways and transporting.

Pass pipe through a wood frame or weld to metal frame.

bulletFor adults and large children, standard bicycle axles are too weak for one-side support.
bulletEven for smaller children, bicycle axles are weak, and rough use can bend them. Put a sign on chair:

FOR SMALL CHILDREN ONLY

Axle supported on both sides

This can be done in several ways:

Axle supported on both sides.

bulletPlace outer bar of axle support so that it allows as much room for hand pushing by the rider as possible.

Outer bar of axle support.

bullet2-sided support allows use of standard bicycle wheels and axles.
bulleteasy to build and replace.

Re-bar loop on re-bar frame.

bulletchair wider, more difficult to get through narrow doors and spaces; more difficult to transport.
bulletWheel supports get in the way of hands when user moves by pushing wheels.
bulletheavy

Wheel supports.


599

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
TO FOLD OR NOT TO FOLD

A typical folding chair

A typical folding chair.

bulletfolding mechanism usually with 2 scissoring flexible cross pieces and cloth or leather seat.
bulletFor details of a make-it-yourself model, see Page 622.
Folding:
bulletnarrow when folded for easier transport or storage.
bulletsmoother ride due to flexibility.

Non-folding:

bulletcheaper and lighter
bulleteasier to make
bulletmore adaptable
bulletoften stronger
Folding:
bulletheavier
bulletharder to make
bulletmore costly
bulletless adaptable

Non-folding:

bulletTransport in cars and buses more difficult. Consider how much this will affect the child's ability to go where she wants.
bulletstiff ride
ARMRESTS

No armrests

No armrests.

Note: Many chairs are built so that armrests are part of the main structure and strength of the chair The armrests cannot be easily removed, even though this might benefit the child. Carefully consider the child's need for armrests before buying or making a chair
bulletMany children with strong arms and trunk control prefer a chair with no armrests and a very low back support.
bulletMoving by pushing the wheels is easier.
bulletless weight
bulletGetting off and on from the side is easier- especially important when legs are completely paralyzed and when arms are also weak.
bulletMany small children need armrests for stability, for positioning, or for comfort.
Fixed armrests

Fixed armrests.

bulletArmrest height and length should be determined for each child and her needs.
bulletFor measurements, see Page 602.
bulletespecially helpful if child cannot use legs to get out of chair
bulletThey can help child to sit in a better position and be more comfortable.
bulletThey can sometimes be used for attaching a removable table.

Attaching a removable table.

bulletThey get in the way for pushing wheels and for getting off chair to the side.
bulletFor many children, fixed armrests get in the way more than they help.
Removable armrests

Removable armrests.

bulletIn folding chairs, armrest attachments must be placed so they do not get in the way of folding.

child transferring from a chair on a board

bulletProvides arm support when needed, yet can easily be removed for travel and transfer.
bulletrequires more work, materials, and exact fittings.
bulletadds slightly to weight.
bulletSeparate armrests may get lost.


600

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
FOOTRESTS

Positions

In adult chairs, footrests often angle legs forward to leave room for casters.

Footrests' positions (for adult)

For a small child, often footrests can position legs straight down. This is important in many cases (see Page 591).

Footrests' positions (for small child),

A larger child may need to sit on cushions so that his feet are above the casters.

Footrest
bulletFootrest should keep the knees and ankles at right angles and the legs slightly separated.

It should usually not twist them or force them together.

bulletIt should usually not twist them or force them together.
bulletGood positioning and support of the feet help the whole body to stay in a better position .

A footrest like this,

A footrest

may help feet like these.

A footrest helps feet.

bulletA footrest that keeps the leg at right angles may cause or increase knee contractures in some children. Children should not stay sitting too long and should do daily exercises to stretch their legs, feet, and hips.

To prevent or correct contractures, one or both legs may need to be kept as straight as they will go.

To prevent or correct contractures, one or both legs may need to be kept as straight as they will go.

Fixed position footrests

The height of the rests should be carefully measured to fit the child who will use them. (For measurements, see Page 602.)

fixed position footrests

REMEMBER: Cushions or seating adaptations will change the height needed for the footrests.

bulletIf the footrest is too low, blocks can be placed on it to make it higher. They can be removed as the child grows.

blocks can be placed on it to make it higher

bulletHowever, fixed footrests that are too high are more difficult to correct. So it is better if they are too low.
bulleteasiest to build
bulletFor a small child who can easily be lifted in and out of the chair, they are fine.
bulletif footrests are screwed or bolted onto a wooden wheelchair, their position can easily be changed as the child grows.

On condition that the footrests are screwed or bolted onto a wooden wheelchair.

bulletThey often get in the way when the child gets in or out of the chair, or in the way of the person lifting a larger child. (See other methods below.)
Removable or swing-away footrests

wood chair swing-away footrest

Removable or swing-away footrests (wood chair swing-away footrest)

There are many designs. Here we show one for the wood chair shown above and one designed for a metal chair.

Other designs for sliding or swing-away footrests are on pages 616, and 622.

Metal chair footrest

metal chair footrest See Page 622.

bulletThey make it easier to get in and out of chair.

The best footrests are that can easily move out of the way.

bulletThe best footrests are those the child can easily move out of the way herself.
bulletRemovable footrests may get lost.
bulletmore work to make them.
bulletUnless well-made, they may be less stable than fixed footrests.
Adjustable footrests

Adjustable footrests.

Also serves as storage shelf.

Adjustable footrests' front view

There are many designs. Here is one of the simplest, for a plywood chair.

One of the simplest, for a plywood chair.

bulletvery adaptable.
bulleteasy to make.
bulletcan support a casted leg.

leg board for both legs

bulletA cushion or padding should be placed over the leg board (unless leg is casted).
bulletSide supports may be needed to keep leg from slipping off.

A cushion or padding

No footrests

No footrests

bulletSeat is mounted low so that feet rest flat on floor.
bulletuseful for persons who can pull their chair along with their legs and feet-especially when one or both arms or hands are too weak to push the wheels
bulletFeet may drag when someone else pushes the child in the chair. Swing-away footrests may be the best solution.


601

FEATURE DESIGN DETAILS ADVANTAGES DISADVANTAGES
PARKING BRAKES

lever brakes

Lever brakes

There are many brake designs. This one is from AHRTAG. Two others are on Page 623.

Brakes' side view

bullettakes little space
bulletfairly easy to use if made right (which often they are not)
bulletneeds welding and skill to make.
bulletHomemade brakes often give problems-yet it is important that chairs have them if possible.
Parking block

Parking block.

Brakes on wheelchairs are for keeping the chair from rolling when getting in or out, or stopped on a hill.

Brakes on wheelchairs

bulleteasy to make, requires no welding, and is cheap
bulletIf the child usually only gets in and out of the chair in one or two places in the home, blocks in these places may be all that is needed.
bulleta heavy, awkward object to move from place to place
bulletnot practical outside the house (or in it)
bullethave to tilt child to one side to 'park' chair
HANDRIMS FOR PUSHING

Designs taken from ARHTAG. See Page 604.

Handrims for pushing.

bulletHandrims help keep hands clean. (Otherwise child has to push on tire.)
bulletespecially important where there are very dirty paths and roads.

Handrims help keep hands clean.

bulletAdded width makes it harder to get through narrow doorways.
bulletadds weight
Handrim grip improvers

Cut a piece of rubber hose lengthwise and tape it onto rim.

Handrim grip improvers

bulletFor child with weak or paralyzed hands, a smooth rim can be hard to grip-especially if it is chromed or galvanized.
bulletPutting rough cloth tape, a rubber hose or many small handles on the rim will make pushing easier.
bulletOr you can wrap the rim with a long thin strip of car tire inner tube.

Long thin strip of car tire inner tube.

bulletPegs sticking out from rims increase width of chair.
bulletPegs sometimes cause hand injuries-especially when going fast downhill.


602

Fitting the chair to the child: measurements

These measurements are for wheelchairs and for special seating without wheels.

SEAT WIDTH

Measurements (seat width)

Note: Some specialists recommend wider seats. But the child gets a better arm position for pushing the wheels if only 1 cm. is added on either side. However, you may want to leave a little more room to allow for the child's growth.

SEAT DEPTH

Note: You may want to add 2 cm. or 3cm. to allow for growth - and use a backboard or firm cushion to fill in the extra space.

Measurements (seat depth)

CAUTION: When measuring, be sure to allow for cushions or backboards that will be added.

SEAT HEIGHT

CAUTION: Be sure to include cushion when measuring height for chair seat.


Note: Raising the seat of a small child higher lets his feet rest above the casters and therefore directly below the knees. The higher seat also helps for eating at the table with the family. Sideways transfers are also easier. Sometimes seats are placed even higher than shown, but this makes pushing wheels with hands more difficult.

Measurements (seat height - for an ADULT or BIG CHILD) Measurements (seat height - for a SMALL CHILD)


ARMREST HEIGHT

MEASURE FROM BOTTOM OF BUTT TO BEND OF ELBOW.

Before measuring, be sure child is sitting as straight as possible.

Measurements (armrest height)

Put armrest height a little higher than his elbow so that the elbow will be positioned away from the body.

Note: This measurement is standard, but some children need arm support at a higher level. Experiment.

BACK HEIGHT

MEASURE FROM BOTTOM OF BUTT TO ARMPIT.

Measurements (back height)

Note: This measurement is standard, but some children need a higher back, and sometimes head support. Others prefer a back that supports only the hips.

IMPORTANT: Also check how much hips and knees bend, as this may affect position of footrests and casters.

Check how much hips and knees bend.


603

Wheelchair production as a small 'village-industry'

A disabled worker from PROJIMO paints a wheelchair frame.

In several countries small groups of disabled persons have started to produce low-cost, good-quality wheelchairs adapted to local needs. Usually this is in places where standard factory-made wheelchairs are very high-priced and are not suited for use on rough or sandy ground.

Some of these 'little factories' try to be self-sufficient. A few have even succeeded in making a modest profit, while keeping prices low.

Sometimes, a small-scale wheelchair making and repair shop is set up as part of a community rehabilitation program. Self-sufficiency (selling the chairs for a little more than it costs to make them) is often a goal. But because families with the greatest need are often least able to pay, the chairs must often be sold below cost.

WHAT KIND OF WHEELCHAIRS TO MAKE

This depends on many factors: cost, skills or training available, tools and equipment needed, amount of money available to start, building materials available, the possible market, the local economy, and needs of the wheelchair user and family.

wheelchair

For example, folding tube-metal chairs are relatively expensive to make and require more skill, training, and equipment. However, they often work smoother, last longer, and are easier to transport than are many other models. These high-quality, good-looking chairs - painted or even chrome plated - may sell the best, even if expensive, and may compete with factory-made chairs (see Page 622).

If the wheelchair users will be mostly children and poor families, low-cost wooden chairs may be more appropriate. These can be easily built to size and adapted to the needs of the individual child. The chair may not last as long. But the child is growing and her needs may change. Simple wood chairs also require fewer skills to build - mainly carpentry. They are easier for the family to build, repair, or add changes to at home.

Ideally, a village shop would make a variety of chairs out of different materials and at different prices. Chairs of all models, sizes, and adaptations should be kept on hand to give the child and family a chance to know and try different possibilities. Be sure to make child-sized chairs. And make chair inserts so that adult-sized chairs can be adapted for children.

Look for every opportunity to keep costs low. Providing repair services for used and broken chairs are good ways to keep children on wheels. Also use as much 'waste', and used and free materials as you can: old bicycle wheels, old machinery bearings, scrap metal, and bolts from junk yards. For basic building materials, check prices of different sellers. Once you are sure of what you need, try to buy large amounts at lower cost. If you explain to the sellers the purpose of your purchase, they may lower prices or give you useful scraps.

Designs for 6 different wheelchairs are in Chapter 66.

604

How-to-do-it Reference Materials for Wheelchairs, Wheelboards, and Other Seating

It is impossible, in a book such as this, to give detailed building plans for more than a few wheelchairs, scooters, wheelboards (trolleys), and special seats. The following reference materials have more detailed plans. You can send for them at the addresses shown. Some may also be available from TALC, P.O. Box 49, St. Albans, Herts, AL1 4AX, England. With each reference we give one or more drawings of key designs and a few comments about their usefulness and cost.

Personal Transport for Disabled People-Design and Manufacture

AHRTAG Farringdon Point 29-35 Farringdon Road London EC1 M 3JB ENGLAND

Also available through TALC

bulletmany good designs and plans for low-cost aids
bulletdoes not compare strengths and weaknesses or describe limitations of different designs
bulletno design for wheelchairs with casters in front (which are needed for many areas)

wheelchairs (wood, metal, from a chair).

trolleys (metal, wood); Two-hand driven tricycle.

Independence through Mobility: A Guide to the Manufacture of the ATI-Hotchkiss Wheelchair
by Ralf Hotchkiss

c/o Wheeled Mobility Center Dept. of Engineering SFSU San Francisco, CA 94132, USA

bulletdesign for the 'whirlwind', a high-quality middle-cost steel tube wheelchair that can be built by disabled craftspersons as a village industry
bulletshort training usually needed to build it effectively; welding skills and simple math required
bulletcost of materials about US $100

Independence through Mobility.

Local Village-made Wheelchairs and Trolleys
by Don Caston

Available upon request.

DON CASTON 202 Cheesman Terrace London W 14 9XD ENGLAND

bulletsimple, very low-cost aids, made mostly out of wood, using bicycle or wood wheels
bulletall models are based on one 3-wheel trolley design
bulletInstead of a standard caster, the front slides on its axle and is pushed back to center by a choice of simple methods. (This method is cheap and clever, but unstable and does not turn as well as designs with casters.)

Trolleys (Local village-made) Sales cart (Local village-made)

Piece of inner tube to center wheel after turning. Wheelchairs (Local village-made)


605

Asia-Pacific Disability Aids and Appliances Handbook, Part 1: Mobility Aids, 1982

ICTA Box 510 S-162-15 Vällingby, SWEDEN

bulletbrief descriptions and non-technical drawings and addresses for information on many aids.

Trolleys (Asia-Pacific) Adapted tricycle (Asia-pacific) One-hand powered tricycle (Asia-Pacific)

'Homemade' electric wheelchair using car fan motor and bicycle parts. Wheelchair to be pulled over rough ground. Tilt cart (Asia-Pacific)

An Accent Guide to Wheelchairs and Accessories

ACCENT P.O. Box 700 Bloomington, IL 61702 USA

bulletinformation about different aids, features, and accessories of factory-made chairs
bulletbasic information on cleaning and repairing
bulletdesign and building information limited to a few accessories

Lap trays (An Accent guide to wheelchairs and accessories)

Removable armrests backs (An accent guide to wheelchairs and accessories)

UPKARAN -A Manual of Aids for the Multiply Handicapped

The Spastics Society of India Upper Colaba Road Near Afghan Church Bombay 400 005 India

bulletan excellent resource
bulletmany simple, practical designs for seating, wheelchairs, crawlers, standers, walkers, therapy aids, and toys

Seats (UPKARAN) Wheelchairs (UPKARAN - adjustable, toilet adaptation)

Push-along (UPKARAN) Tricycle with support (UPKARAN) Tire scooter (UPKARAN)

How to Make Basic Hospital Equipment
by Roger England and Will Eaves

Intermediate Technology Publications 103-105 Southampton Row London WC1B 4HH ENGLAND

Also available through TALC and AHRTAG

bulletsimple, attractive designs using tube steel
bulletwelding skill required; fairly costly to make no designs for casters-in-front chairs

Hospital wheelchair

Out-of-hospital wheelchair (2 wheels only)

Bicycle ambulance

Chair made with wheels of rattan.

One-hand driven tricycle

606

Poliomyelitis-A Guide for Developing Countries by R.L. Huckstep

Churchill Livingstone 5 S Fontenac Road Naperville, IL 60563 USA

bulletdetailed designs for 3 models of wheelchairs commonly used in Africa
bulletonly casters-at-rear designs (which often may not be the most appropriate design)

Models of wheelchairs commonly used in Africa.

Basic frame of wheelchair. 2-hand powered tricycle.

Positioning the Client with Central Nervous System Deficits: The Wheelchair and Other Adapted Equipment
by Adrienne Falk Bergen and Cheryl Colangelo

Valhalla Rehabilitation Publications, Ltd. P.O. Box 195 Valhalla, NY 10595 USA

bulletexcellent detailed discussion of specific needs of children with cerebral palsy
bulletmany well-illustrated examples
bulletwritten for developed countries but many aids and designs are simple and can be made anywhere at low cost

This child, whose hips tilt forward, needs a higher belt (wrong, right) This child, whose hips tilt back, needs a low belt (wrong, right)

'Build Yourself' Plastic Wheelchair

Directions for assembly available from:

Spinal Research Unit Royal North Shore Hospital of Sydney St. Leonards, NSW 2065 Australia

'Build yourself' plastic wheelchair.

bulletrelatively expensive (materials about US $ 100)
bulletplastic frame made of 9 m. of 15 mm. PVC pressure pipe; plastic set of 8 mm. soft PVC tubing; 2 rear 24 inch bicycle wheels; 2 front casters (15 mm.)
bulletrelatively expensive (materials about US $100)
bulletPlastic will sag with continued use.
bulletuses standard bicycle axles- which will bend with the weight of an adult or large child
bulletrelatively lightweight
bulletdoes not fold
bulletdesign plan complicated and difficult to follow

Measuring the Patient

Everest and Jennings, Inc. Available through Everest and Jennings wheelchair dealers or:

Everest and Jennings 4203 Earth City Expressway Earth City, MO 63045 USA

bulletgood information on measurements for standard chairs
bulletillustrated discussion of problems with chairs that do not meet a person's specific needs

SEAT HEIGHT

Too low seat height.

Too high seat height.

Functional Aids for the Multiply Handicapped
by Isabel Robinault

Harper and Collins Sales 10 East 53rd Street NYC, NY 10022 USA

bulletmostly factory-built examples but some are simple and well-illustrated enough to serve as design guides
bulletmany good wood special seats
bulletalso support frames, standers, walkers, toys, and eating aids

Small-wheeled adjustable walkers. Child's tricycle with body support bolted to frame.

Scooter that is also a wheeled stander. Support frame.

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