Manual Wheelchairs - World Health Organization

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2.5.2 Cushions desIgn and productIon I 59 An inadequate pressure-relief cushion is the one component of a wheelchair that is most likely to cause pressure sores, serious injury or premature death. Wheelchair cushions are used for three reasons: comfort, pressure relief and postural support. For many users, a cushion that provides some comfort will help them to use the wheelchair for a longer time. Users with limited or no skin sensation are always at risk of developing pressure sores when using a wheelchair without a proper cushion. These users must use a pressure relief cushion to help reduce this risk as shown in Fig. 2.10 and Fig.2.11. Fig. 2.10. Wheelchair cushion Fig. 2.11. Wheelchair cushion Many users require some adaptations or modifications to their cushion to help provide additional postural support or pressure relief. Wheelchair manufacturers need to either keep a good stock of different types and sizes of cushion or have the capacity to produce and modify a cushion as and when needed. Recommendations for cushions are given in Box 2.6. Box 2.6. Guidelines for cushions n The cushion should be removable from the wheelchair. n The cushion should be easy to clean using basic materials such as soap and water. n The cushion should be an appropriate size to fit on the seat base. n Correct cushion use and the way in which it should be placed on the wheelchair seat (which side is up, and which is the front of the seat) should be clearly indicated. n Information on how the cushion should be used and maintained should be available. Pressure relief cushions n A pressure relief cushion should reduce pressures at the high-risk areas for pressure sore development (commonly at ischial tuberosities and sacrum). n A pressure relief cushion should minimize the build-up of moisture between the cushion and the user’s skin. n Information should be available on how to use the cushion, how to maintain it, the expected life of the cushion, when to replace the cushion or parts of it, and any particular risks when using the cushion. n The cushion and cushion cover material should not cause high pressures, thereby reducing the effectiveness of the cushion in distributing pressure over the seat surface. n Pressure relief cushions should maintain their pressure relief properties in the climates where the cushion is expected to be used. 2
60 I guIdelInes on the provIsIon of manual wheelchaIrs In less resourced settIngs 2.5.3 Backrests The backrest provides users the necessary postural support. It needs to be of different heights but usually available in two sizes as shown in Fig. 2.12 and Fig. 2.13. Some users require more support from a backrest than others. For some users, a high backrest can reduce their ability to propel themselves effectively. Backrests may be sling or solid types with foam cushioning and upholstery. Recommendations for backrests are given in Box 2.7. Fig. 2.12. low backrest Fig. 2.13. High backrest 2.5.4 Footrests Box 2.7. Guidelines for backrests n The angle between the seat and the backrest (seat to back angle) should be between 80 and 100 degrees. n Different backrest heights should be available. n The backrest should support the normal curvature of the spine. The middle of the back should be able to rest further back than the back of the pelvis. The footrest provides users with support for their feet and legs. Footrests must be individually adjusted for each user. Correctly adjusted, the footplate reduces pressure on the user’s seat and puts the user in a healthy sitting posture. Footrests may also include a calf strap to keep the foot on the footplate. Sufficient ground clearance needs to be maintained to prevent the footrest hitting obstacles or catching and tipping the wheelchair on uneven ground. The height of the footrest should be adjustable. Footrests need to be long or wide enough to support the foot but, at the same time, should not create difficulty while folding or moving around. For other performance factors related to the footrest see Table 2.10.
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Other resources Cooper RA. Wheelcha
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Manual Wheelchairs - World Health Organization

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