Life on Wheels (61 page)

Your doctor or therapist will no doubt recommend such tilting and reclining features if:

Your upper body balance and stability are seriously limited

Your disability involves structural deformities, spinal curvature, or muscle contracture

You are at risk of fainting or developing dysreflexia

You do not have the strength to shift your position on your own

Make sure you have expert assistance when choosing a tilt or recline system, lateral supports, and head support. It’s important to make sure that you have the optimal system for your needs and that the specific models you choose are compatible with the rest of your chair.

“Tilt-in-space” and “recline” systems are distinctly different. With a recline system, only the back of the wheelchair changes its angle, whereas a tilt-in-space system brings the seat and foot rests along for the ride. There are some specific reasons why you would consider one or the other.

Reclining adds “shear forces” to your back and to your bottom. Shear pulls along the surface of your skin, which is stressful to your tissues in the same way that direct, prolonged sitting pressure puts your skin at risk of breaking down. Tilt systems involve no shear forces.

When reclining, your posture is more likely to shift in the chair. Those unable to adjust their posture once back or forward are better candidates for tilt systems. Likewise, reclining opens up the angle of the hips, which requires that you have the range of motion to be able to accommodate the open angle. Hip flexors or the hamstring muscles in the back of the legs can be tightened enough to preclude the use of a reclining system.

A recline system can also elicit spasms. A need to maintain consistent physical relationships to items, such as chair controls or ventilators, could also be compromised with a recline chair.

Tilt-in-space is not ideal for persons who work or spend time at a table, since the full tilting of the seat and legs would be blocked by the table or may even knock it over. This system would also not work if you keep a tray on the chair that must remain flat.

People with circulation issues or edema benefit from tilt, or a recline system combined with elevating leg rests, bringing you closer to a position of laying flat.

Some users find that tilt-in-space is inappropriate for social situations, where extending their legs and feet forward as they lean back is obtrusive or likely to make the user feel self-conscious.

A power chair product unique to the market is the Redman© Chief. It is a rearwheel drive chair that is capable of reclining back to a fully lying down position, reclining only the back, and is also capable of putting the rider into full standing position. Armrests and positioning supports are designed to stay in the same relationship with the body as these changes are made (www.redmanpowerchair.com).

Power chairs always have armrests, but many riders of ultra-lightweight manual chairs find that armrests interfere with their ability to push the chair comfortably and effectively. It’s true that armrests can interfere with wheeling when you want to get your body into the push by leaning forward, and people with shorter arms in particular might find that armrests interfere with a comfortable relationship with the wheels. Armrests can also get in the way of reaching to the side or to the floor or may prevent you from being able to get close enough to a table at work or in a restaurant. In addition, armrests add weight to the chair—a significant amount in some cases. But, before you decide against armrests for your manual chair, consider the following benefits of having them:

Armrests can help prevent spinal problems. When you put the weight of your arms on armrests, you relieve some of the load on your spine.

Armrests may be important for transfers into and out of the chair.

Armrests are helpful for shifting your weight in the chair, a crucial habit for the prevention of pressure sores.

If you have limited upper body balance, your safety may depend on having the added stability that armrests provide.

Generally, armrests are removable, so nothing says that you have to use them all the time. Many chair users purchase armrests and then use them only when it is appropriate. As always, the choice depends on your individual needs and activities.

There are several types of armrests. The typical armrest is wide enough to support the arm, padded, and covered with vinyl upholstery. This type of armrest can be ordered in the desk style—which has a shorter upholstered section allowing you to pull closer to desks and tables—or full-length, which might be important to support a lap tray if you use one.

Some armrests lock down and can be used as a grip to carry a folded chair or by people who might carry you on a stairway. If the armrests on your chair are not fixed, be certain to let people helping you know this before they attempt to lift your chair. Locking the arms of your chair will ensure that the armrests will still be with the chair when you reclaim it after an airline trip.

High-level quadriplegic riders can choose sculpted armrests, possibly with straps, to keep their arms in place. Some riders may have enough dexterity to operate a joystick control on a power chair even though their arms are generally weak. Sculpted armrests can aid them in keeping their arms in place while driving the chair. Sculpted armrests might also include supports for the hands and fingers to keep them from curling into contracture.

Many modern manual chairs have tube-design, swingaway armrests that can easily rotate away from the chair. The horizontal portion is covered with a soft, water-resistant material. These armrests tend not to be comfortable for resting your arms because they are round and not very wide. Tubedesign armrests are more appropriate for doing pushups and correcting yourself if you feel off balance.

There are also flip-up armrests, a good solution for those who need or want armrests only part of the time, but who don’t want the bother of taking the armrests off and putting them back on.