June, 1961 P H Y S I O T H E R A P Y Page 7 S pecification s f o r th e c o n stru ctio n o f high ch a ir f o r qu a d rice p s e x ercise : It sh o u ld be m a d e o f s tro n g solid w ood, so th a t it is to o heavy to tip over easily. The legs: s h o u ld b e m a d e 4" lo n g e r t h a n n o r m a l , o f a a r e s h a p e a n d j o i n e d by c r o s s - b a r s 3" a b o v e flo o r level. D o m e s m ay be in s e rte d in t o t h e bases if d e s ire d . The seat: T h is sh o u ld be w ide e n o u g h to a c c o m m o d a te the largest p a tie n t a n d it m a y be b u ilt u p in f r o n t in to a h a lf-d o m e d shape, to p re v en t th e p a tie n t fro m slid in g f o rw a rd s an d a lso to give leverage fo r m uscle w o rk . T he whole surface o f th e se a t m ay b e c overed w ith sp o n g e ru b b e r The b ack: T h e re a re tw o u p rig h t s tru ts fixed to th e re a r corners o f th e seat, ex te n d in g to ju s t a b o v e h e ad h e ig h t o f average p a tie n t; th ey a re jo in e d to g e th e r a t th e to p b y a thick c ro ssb a r, slightly cu rv ed fo r h e ad s u p p o rt. Sling: A b ro a d piece o f c an v a s is p laced ro u n d these uprights a n d stitched to itself. T h is m ak es a n a d ju sta b le back su p p o rt a n d allo w s th e p a tie n t w ith hip o r lu m b a r deform ities to sit in c o m fo rt. ' The arm s: T h ese a re m ad e o f u n p a d d e d w o o d , n a rro w enough to be g ripped easily. T h e y c o m e fo rw a rd fro m the uprig h ts a t elbow level, a lm o st to the level o f th e fro n t o f the seat. T h ere is a s tro n g su p p o rtin g s tru t to th e side o f th e seat. See D iagram IVb Apparatus f o r quadriceps w o rk : F itted to this c h a ir: (1) A t th e m iddle o f th e b a ck o f th e h e ad c ro ssb a r, a stro n g , deeply g rooved p u lley w heel is firm ly screwed in. (2) A t th e m iddle o f th e b a c k o f th e c ro s s b a r betw een the tw o re a r legs o f th e c h air, a swivel p u lle y is fixed so th a t it m oves freely a b o v e th e bar. (3) A ro p e o r m eta l c ab le is inserted betw een th e pulleys w ith a h o o k o n e ach e nd fo r a tta c h m e n t to (a) b a g o r ro d h o ld in g w eights, a n d (b) th e D -lo o p o n th e p a tie n t’s fo o t sling. (4) A “ c u p -h o o k ” is screw ed in to th e b a c k o f th e fro n t c ro ssb a r a n d th is saves th e w eight c ra sh in g to th e floor a n d su b seq u e n t grovelling to p ick u p th e rope. (5) A three-ringed fo o t sling is p u t ro u n d th e p a tie n ts fo o t and a n k le w ith th e D -rin g a t the heel. (6) A sm all b u t s tro n g w o o d e n sto o l, 4 -6 " h igh, 12" long and 8" w ide is p u t u n d e r th e fo o t n o t b e in g exercised. T h is also assists g e tting o n a n d o ff th e c h a ir. T hese stools have m an y o th e r uses in a d e p a rtm e n t. A d ju stm en ts: T h e ra n g e o f m o v em e n t re q u ire d m u st decide th e precise p o in t o f a tta c h m e n t o f the w eights. I f th e ro p e is to o long, th e w eight to uches the g ro u n d ; if it is to o sh o rt it is stopped b y the u p p e r p u lle y wheel b e fo re the p a tie n t h as fully extended h e r knee. A s to p p e r m ay be p u t o n th e ro p e u n d e r the c h a ir to p re v e n t to o m u ch knee flexion. T h ese p ra c tic a l pieces o f a p p a ra tu s have b een evolved as a re su lt o f seven y ears sin g le-h a n d ed w ork, m o stly w ith hem iplegics, b u ild in g u p fro m n o th in g to g e ria tric u n its in E n g la n d . T h o u g h heavy, th e re su lts o f this w o rk w ere very satisfying. N o w these d e p a rtm e n ts a re p ro p e rly e stablished a n d ru n by a c h a rte re d p h y sio th e ra p ist, a re m e d ia l g y m n ast (m ale), tw o a ssista n t n u rse s and a p o r te r in e ac h h o sp ital. DO ES Y O U R W HEEL C H A IR FIT? M ISS M . H U M P H R E Y , B .S c .(P hys.) W ITS. H o w o ften h ave y ou given o r received this re q u est “ Please o rd e r a w heel-chair fo r th is p a tie n t” . N o m o re — n o less. D o y o u K N O W w hy so m e c h a irs h a v e th e larg e w heels in fro n t a n d so m e a t th e b a c k ? D o y o u K N O W th a t a w h eel-chair w ith o u t b ra k e s is a d a n g e ro u s vehicle? D o y o u K N O W th a t w heels o f 5 in. o r less c a n b e p o s i­ tively leth a l ? D o y o u K N O W th a t th e re a re m a n y m akes o n the m a rk e t a n d th a t th e m a n u fa c tu re rs o f a g o o d a n d re liab le m ak e are o n ly to o re a d y to m a k e a n y a d ju s tm e n t y ou m ay re q u ire ? A w h eel-chair is like a n y o rth o p a e d ic a p p lia n c e w o rn by a p a tie n t a n d sh o u ld be o rd e re d w ith ju s t as m uch care. T h e p a tie n t’s d isability, w eight, age a n d sex a re a ll im p o rta n t fa c to rs to be ta k e n in to c o n sid e ra tio n w hen it is pre scrib e d . F o r it sta n d s to re aso n t h a t if it is n ecessary to o rd e r a w h eel­ c h a ir fo r a p e tie n t it is going to b e a p re tty p e rm a n e n t e ssential fo r th e re st o f his life. A s he is likely to sp e n d a g re a t d eal o f tim e in th e c h a ir it m u s t m ea su re u p to his specific re q u ire m e n ts. I t m u st be c o m fo rta b le . I t m u st be easily m an o e u v rea b le, it m u st be b u ilt in such a w ay as to fa c ilita te tra n s fe r w ith th e m in im u m o f p h ysical effort a n d a b o v e all it m u st be as safe a n d sta b le as a w h eel-chair c a n p o ssib ly be. W H E E L S A ll m odels sh o u ld h a v e tw o large a n d tw o 's m a ll w heels. W h e th e r th e larg e w heels a re a t th e fro n t o r b a c k d e p en d s largely o n th e p a tie n t’s disability. L arg e w heels sh o u ld h a v e a d ia m e te r o f 23 in .; sm all w heels 8 in .— n ot less, as sm a lle r w heels a re m o re likely to b e co m e e n ta n g led in ru g s, c rac k s a n d sm all objects. H A N D R IM P R O J E C T I O N S H o riz o n ta l, vertical o r diag o n a l p ro je c tio n s m ay be a tta c h e d to th e h a n d rim s. T h e n u m b e r, length, a n d th e desired sp a c in g sh o u ld be specified. T h e p ro je c tio n s a re in d ic a te d fo r p a tie n ts w ho have s h o u ld e r m uscle p o w e r, b u t n o p o w e r in the h a n d s. T Y R E S T h e ty res on th e sta n d a rd m odels a re o f solid ru b b e r b u t p n e u m a tic ty res m a y b e p re scrib e d to m a k e rid in g easier. B R A K ES E very c h a ir sh o u ld h ave b ra k e s to p re v en t ro llin g o n a n incline o r w hen th e p a tie n t desires to get o u t o f th e c h a ir w ith o u t its b e ing held by a n o th e r p e rso n . T h e b ra k e s m u st b e w ith in easy re ac h , a n d if a rm rests a re re m o v a b le , m u st b e low e n o u g h so th e y d o n o t in te rfe re w ith m o ving side­ w a rd s o u t o f th e c h air. R e m o v a b le ex te n sio n a tta c h m e n ts sh o u ld be pre scrib e d w ith th e re m o v a b le a rm rests. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Page 8 P H Y S I O T H E R A P Y June, 1961 S E A T T h e height, d e p th a n d w idth o f th e se a t m u st be c o n ­ sid ered in re la tio n to th e size o f th e p a tie n t, th e a re a in w hich the c h a ir is to b e used a n d the p ro s th e tic a p p liances th a t a re w orn. T h e sta n d a rd specifications o f th e se a t are usually 20 in. fro m th e flo o r, 18 in. betw een th e fro n t u p ­ rig h ts a n d 16 in. in w id th a n d d e p th a t se a t level. B A C K R E S T T h e b a ck re st is m ad e o f fa b ric in o rd e r th a t th e c h a ir m ay be folded. T h e re is a s ta n d a rd h e ight fo r th e b a ck rest (1 6 J in.) b u t it c a n b e o rd e re d slack o r tight. I f it is d esirable to s u p p o rt the h e a d , a h e ad re st e x tension c a n be p rescribed. T h e h e ad re st can easily be rem oved w hen th e c h a ir is placed in a car. By in se rtin g a z ip p e r in th e b a c k re st o r a tta c h in g th e b a c k to th e m eta l b a rs w ith sm all tu rn -b u c k le s th e b a c k can be o p e n ed a n d closed b y th e p a tie n t w ith o u t m uch difficulty. By o p e n in g th e b a ck re st th e p a tie n t can slide in a n d o u t o f th e b a c k o f th e c h a ir to get to a n d fro m th e bed o r to ile t seat. A R M R E S T S T h e sta n d a rd w heel-chairs h a v e ro u n d e d m etal a rm rests b u t w hen p a tie n ts a re confined to th e ir c h a irs fo r long p e rio d s o f tim e it is m o re de sirab le to have flat w o oden o r u p h o lste re d a rm rests. D e ta c h a b le a rm s a re useful fo r th o se w ho m ust e n te r the c h a ir from the side. F O O T B O A R D S T h e re a re m an y v a ria tio n s o f th e fo o t b o a rd s such as sw inging fo o t b o a rd s a n d d e ta c h a b le fo o t b o a rd s. C U S H IO N S E A T S A fo a m ru b b e r c u sh io n seat sh o u ld b e pre scrib e d fo r p a tie n ts w ho h a v e sensory as well as m o to r disabilities. All p a tie n ts w h o a re re q u ire d to sp en d m an y h o u rs in th eir w heel-chairs will b e m ad e m o re c o m fo rta b le th ere b y a n d less liable to d e v elo p p re ssu re sores. C A R E O F W H E E L C H A IR S P ro p e r c are o f th e w heel-chair a fte r it is p u rc h a se d is as im p o rta n t as th e c are o f a n a u to m o b ile . W ith a little re g u la r a tte n tio n , th e life a n d usefulness o f the w h eelch air c an be p ro lo n g e d in g ood c o n d itio n . M o s t new w h eel-chair ow ners a re p ro v id e d , by th e c h a ir m a n u fa c tu re r o r th e d e aler, w ith c irc u la rs giving in stru c tio n s fo r th e p ro p e r c a re a n d lu b ri­ catio n . H I N T S O N G E N E R A L C A R E T o o p e n th e c h a ir it is necessary to p u sh d o w n o n th e seat rails. N e v er try to o p e n th e c h a ir by p u llin g it a p a rt. T o close th e c h a ir, ra ise th e fo o tb o a rd s , th en lift th e se a t u n til it is a lm o st c lo sed , tu ck th e se a t d ow n betw een the seat ra ils a n d close th e re m a in d e r o f th e w ay by p u sh in g the sides to g e th e r. N e v e r pile suitcases o r p a ck a g es on to p o f y o u r c h air. I f the c h a ir d oes n o t fold o r o p e n p ro p e rly , d o n o t force it b u t ta k e it to y o u r d e aler fo r p r o p e r a d ju stm e n t. D O U B L E A M P U T E E T h e m o st useful c h a ir fo r a d o u b le a m p u te e w ould be a light-w eight d u ra b le fo ld in g chair. T h is sh o u ld h a v e b ra k e s a n d th e large w heels in fro n t. H a v in g th e larg e w heels in fro n t will c o m p e n sa te fo r the loss o f w eight o f th e low er extrem ities. T h e d a n g e r o f the c h a ir tip p in g o v e r is e lim in a ted . T H E P A R A P L E G IC A s fo r th e a m p u te e , b u t th e follow ing p o in ts sh o u ld be ta k e n in to c o n sid e ra tio n . 1. A p a rap leg ic sh o u ld use a special foam c u sh io n which ten d s to ra ise th e level o f th e c h a ir seat. T h e p a tie n t sh o u ld be a b le to re st h is a rm s c o m fo rta b ly o n th e a rm rests. T h e c h a ir b a c k sh o u ld be sufficiently h igh to give a d e q u a te s u p p o rt. 2. Sw inging d e ta c h a b le fo o t rests sh o u ld b e co n sid ere d to fa c ilita te tra n s fe r tec h n iq u es a t th e w he el-c h air a n d a m b u ­ la to ry level. W h e n sw ung o u t o f th e w ay th e y a llow closer a p p ro a c h to th e fu rn itu re . 3. W h e th e r the large w heels a re in fro n t o r a t th e back is a m a tte r o f p e rso n al choice. (a) L a rg e w heels in fro n t. I f th e c h a ir tip s it will tip fo rw a rd a n d th e p a tie n t c a n u su a lly save him self by stre tc h in g o u t his arm s. T h e p a tie n t w ho wishes to b e c o m pletely in d ep e n ­ d e n t u sually c hooses th is ty p e o f c h a ir as he finds it m o re c o m fo rta b le to push. (b) L a rg e w heels a t back. I f th is c h a ir tips the p a tie n t is a p t to hit the b a c k o f his head o n th e floor. T hese p a tie n ts u sually end u p by h a ving so m e o n e else to p u sh them . T H E Q U A D R IP E L E G IC As in th e a b o v e b u t in this case th e large w heels sh ould be a t th e b a c k , a n d o n e d e ta c h a b le a rm sh o u ld b e p ro v id ed to fa cilitate tra n s fe r fro m b ed to chair. A s th e life e x pectancy o f these p a tie n ts has been c o n ­ sid e rab ly ex ten d ed it is often feasable to m o to riz e their c h airs th u s giving th e p a tie n t a fa ir degree o f independence. T h e re a re tw o u n its w hich a re com m e rc ially obtainable^ w hich have been b u ilt to fit a sta n d a rd m odel c h air. A lthough expensive they c a n do m uch to lighten th e load o f the p a tie n t a n d his family. T H E A G E D A N D D E B IL IT A T E D A s fo r th e a p m u te e b u t in this case th e large wheel should be a t th e b a ck a s this type o f c h a ir is m uch easier fo r an a tte n d a n t to m anage. A d e ta c h a b le a rm is a lso a n a d v a n ta g e as a re a d ju s ta b le leg rests. N o w h eel-chair is c h e a p b u t it will be less expensive in th e lo n g ru n to p u rc h a se a s tu rd y w ell-m ade c h a ir th a n one th a t will c o n sta n tly b e in need o f re p a ir w hich is b o th costly a n d inconveniences th e p a tie n t. A. C. MILLER & CO. ORTHOPAEDIC MECHANICIANS M a n ufacturers a n d Suppliers o f: O R T H O P A E D IC A P P L IA N C E S , A R T IF IC IA L L IM B S , T R U S S E S , S U R G IC A L C O R S E T S , U R IN A L S , A R C H S U P P O R T S , C O L O S T O M Y B E L T S , E L A S T IC S T O C K IN G S , A N K L E G U A R D S , W R IS T G U A R D S , E L B O W G U A R D S , K N E E G U A R D S , L I G H T D U R A L C R U T C H E S F O R C H IL D R E N , W O O D E N C R U T C H E S , A N D M E T A L E L B O W C R U T C H E S . Phone 23-2496 P.O. Box 3412 312 Bree Street, Johannesburg R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )