40 Fisioterapie, Ju n ie 1982. deeI 38, n r 2 THE VERTICAL WHEELER P. C. W A K E F I E L D . Dip. Physio. (U.C.T.)* SU M M A R Y Tile vertical wheeler provides the m eans fo r independent m obi/it v in the standing position, thus contributing towards the p h y sica l a nd psy c h o lo g ica l requirem ents o f the paraplegic child. I N T R O D U C T I O N I nd e p en d e nt mob ili ty a n d upri ght po st u re are m aj o r r e qu ir e m e n ts in the m a n a g e m e n t o f the pa raplegic child d u r i n g his g r o w in g years. T h e qu ali ty o f life lo r the physically di sab led child is e n h a n c e d by p r o v i d i n g t h e mea ns for the fr eedom o f m o ve m e n t he longs for a n d needs in o r d e r to e x p e r i e n c e a n d e x p l o r e his e n v i r o n m e n t . T he psychological benefits de rived from the upri ght pos tu re include an imp ro ve d self-image, potential lor n or m al eve- level c o m m u n i c a ti o n a n d i n ter act ion with his peers and the c o m m u n i t y . T h e p h y s i o l o g ic a l a d v a n t a g e s of we ig htb ear in g in the s t a n d in g po sition co m p ri se the pre ven tion o f lower limb c o n tr a c t u r e s anti spinal de formity , decreas ed o ste o p o ro si s, s t i m ul a tio n o f bon e growth, re d u ct io n o f spa sticit y a nd i m pr ov e d urinary drainage. In the tr ea tm e n t o f the parapl egic child, a great deal of em ph a si s is placed o n ach iev in g the maximal degree of a m b u l a t i o n a n d mini mal use o f the wheelchair. However, unless the level o f the ne ur ological lesion is sufficiently low. a m b u l a t i o n with the aid o f calipers a n d cr utches is frustratingly slow, requires a high level o f energy ex pe nd it ure a n d the ha nd s a r e not free for func tio nal a n d play activities. These limita tio ns hav e led to the de v elo p m en t o f the swivel walker but this ap pl ia n ce docs not provide for speed of mo v em e nt a n d c ru tc he s are r e qui re d for o u t d o o r use. The vertical w a lk er has been de vel ope d in o r d e r to meet bo t h the physical a n d psychological req u ire m e nt s o f the paraplegic child. Th is a p p li a n ce p rov id es fast, precise, indepe nde nt mo bility in the s t a n d i n g position. The d e v el op m en t o f the vertical w he cl e r at the Spinal C o r d Injuries C e n tr e . C o n r a d i e Hosp ita l, was un d e r ta k e n as a joint project by the P h y s io th e r ap y D e p a r t m e n t of the C o n r a d ie Ho sp ita l a n d the D e p a r t m e n t o f Bio-Medical Engineering. U.C .T . a n d G r o o t e Sch ut ir H o s p ita l, in 1979. D E S C R I P T I O N O F A P P L I A N C E The vertical wheeler con si st s o f a frame which holds the child erect bv m ea n s o f foot, knee, p c lv i s a n d t r u n k s u pp o rt s. Thes e su p p o r t s, which are well p a d d e d to prevent pressure sores, arc fully a d ju s ta b l e to allow for initial fitting as well as for sub se qu e nt gr ow th . The frame is m o u n t e d on rear wheels a n d front cas tors a nd is pr opelled m an u a lly by pu sh in g rims a n d a chai n drive, which are also ad ju sta bl e to the height of the user Alternatively, pow er-d rive wheels a n d joystick control may be fitted to the fra m e for the m or e severely disa bled child wh o is una ble to pr op el the a pp lia n ce with his han ds. Pa rk in g br a ke s a r c pro v id ed to e n su r e that the appli an ce rem ain s sta ti o n a r y d u r i n g trans fer activities. T he provision “C h ie f P h ys io th e r ap is t. C o n r a d i e Hos pital. Pinelands. Received 8 April 1982. O P S O M M I N G D ie vertika le w ielstoel voorsien o n q fh a n k lik e m ob ilite ii in die si aan tie posisie. wat bvdra tot die fisiese en psigiese behoeftes van die parap/cgie-.e kind. o f a lipp in g b a r a n d h a n d - h o ld en su re easy h a n d li n g for the a t t e n d a n t , especially o f the \ c r y voting child. The a p p e a r a n c e o f the vertical wheeler is a tt r ac t iv e to the child by virtue o f its design a n d bright, cheerful c o lo u r Fig. I. Independent mobility — Shaun age 9 years, T4 complete paraplegia. D I S C U S S I O N Th e vertical wheeler has been fo u n d to be o f c on si der ab le value in the r e hab ili tat io n o f par apl egi c children. It is clear that the a p pl ia nc e prov ides a degree o f i nd ep e n d en t free do m o f m o ve m e n t which these children a r e o th erw is e un a b le to attain , whilst, sim u lta n eo u sly , g a in in g the benefits ol stand ing . It is st ri kin g to obse rv e the p lea su re a n d fun the children derive from using the vertical wheeler. H o m e a n d school re p o rt s indicate that the child ren a r e m o r e active, m o r e alert a n d that social fu nc ti o n i n g is greatly impr ove d. 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. ) P hysiotherap y, Ju n e 1982. vol 38. no 2 41 Fig. 2. Han ds-fre e standing. The wheeler is p r ov in g to be especially effective m the pr evention o f joint c o n tr a c t u r e s a n d a b n o i m a l . i n c o r r e a post nres as well as in hibiting spasticity Fu nc tio na l ability is e n h an c ed by secure h a n ds - lr ee sta n d in g, a n d up p er limb strength as well a s c a r d i o p u l i n o n a r v Inness is increased The children are able to to lerate use of the ap pliance for the full period o f a no rm al clay a n d no evidence o f lower limb oe d em a has been e n co un te re d. T h e u heeler is inherently stable and is safe to use up a n d dovwi slopes. Ap ar t from a few sessions l ea rn ing how to get in a n d ou t o f the appl ia nce user t r ai ni ng has been l o un d t o be un necessary. The ap pliance is b r a k e d a n d tipped b a c k w a r d s to the horizo nt al position for the child to tr an s f er in a n d ou t o f it. The s up p or ts arc then fastened in sequence c o m m c n c i n g w i th the feet, a n d by mea ns o f a m o n k e v ch ain, o r similar device, the child can pull hi ms elf u p to the vertical position. T h e ease an d simplicity with which a d ju s tm e n t for gro wt h ii acc omplished, o bv iat es a m i n te r r up t io ns in the use o f the wheeler a n d is a saving in cost. T h e wheeler initially issued willl see a child th r o u g h his g r o w i n g years until he reaches a d u lt h o o d , at which stage the pa raplegic usually beco mes a “ sit ter " in a wheelchair. Provi sion has been m ade in the design, for the fra m e to be ex ten de d if need be. a nd . in lacl. the ap p lia nc e has been succesfullv tested by a few adult paraplegics. Finally, a lt h o u g h iniliallv de ve lo p ed lor the tr aum ati c paraplegic, the vertical whcclei has been fo u n d useful in the m an a g em e n t o f the physically h a n d ic a p p e d child o f various o t h e r disabilities. Fig. 3. Social functioning. Early model of the Vertical Wheeler. Annie, age 3 years. T1 complete paraplegia. Bibliography Be d br o o k. G M ( 1977 78). C o l l e c t i o n o f scoliosis due to p a ra p le a ia sus tai ned in paediati ic a a e - c r o u p P a ia /’lequi 15. 90-96 Bromley. 1. f 1976) T et ra p le g ia a n d Paraplegia Ch uichill Livingston. E d in bu rg h K a p l an . P E . Rode n. W , Gilbert. E. Richards. I. . G o l d s c h m id t , R D a n d J o h n W (1981) Red uct io n ot hy pe rc a lc m ria in t c u a p l c g i a altei w ei g h t- b e ai m g a n d s tr e n gt h e n in g exercises. P aia/i/eyia 19. 289-293. Rocca, L a n d H o p k i n s. P (1978) S v m c l Walkers. P h w to - lh eiap\ 64, 14-18 A M E N D M E N T T O E T H I C A L R U L E 2 1 ( 1 ) T he So ut h Al ri can Medical a n d Dental Co un c il has a cc ept ed the a m e n d m e n t o f Ethical Rule 21 ( I ) to that ol ■‘Pa tients will be tr eat ed on referral from a Registered Medical o r Dental p r a ct iti o ne r o r in close c o -o p e r a ti o n with such registered p r a c t it i o n e r s " T h e a m e n d m e n t of this rule still has to be passed bv the M in ist er o f H e al t h a n d then gaze tted befo re it will apply in ptactice. 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. )