Safe Use of Wheelchairs

General Information
Safety Checklist
Precautions
Transfers
Balance and Stability
Obstacles

Tens of thousands of physically challenged Americans depend on the wheelchair, either temporarily or permanently, to add greater mobility and independence to their lifestyle. But regardless of the amount of research and engineering skill that goes into wheelchair design, wheelchairs, by their very nature, harbor a real potential for additional injury.

That's why it is most important that wheelchair users and attendants are fully instructed as to the possible hazards related to wheelchair use. By gaining and applying proper knowledge, optimum safety, as well as well-found confidence in wheelchair use, results.

Before using your wheelchair, we strongly recommend that both user and attendant study the procedures and safety precautions outlined in this pamphlet. Keep it as a reference and use it regularly to refresh yourself on recommended operating techniques.

General Information

Scores of manufactures produce manual wheelchairs resulting in a wide variety of styles and features. Chairs differ greatly in frames, size, arm styles, leg supports, and back styles. The wheelchair you received has been specifically selected to match your physical dimensions and individual needs.

Although the chairs differ, safety precautions as well as procedures for safe operation are similar.

For greater safety, the construction of a wheelchair should match the lifestyle of the user. Very active individuals may require heavy-duty construction even though they themselves are quite light in weight. A heavier, but more passive user may create far less use stress to a chair and can thereby function safely in a less sturdy model.

Like with any new device, safe wheelchair use requires practice not only for the actual user, but for family members or others who may provide assistance to the user. But practice is only valuable when performed correctly!

It is important that you get to know your wheelchair and its individual features. Pay special attention to wheel locks, cross braces, and the type of arm rests used on your chair. Many arms are detachable and must be securely locked in place before using your chair. The initial inspection procedure provided will help your become better acquainted with your chair.

The safety topics discussed in this pamphlet cover those aspects of wheelchair use that results in the more frequently reported accidents. By studying each, you'll be alerted to potential hazards and will gain necessary knowledge to circumvent such problems, thereby enjoying safe and sensible wheelchair operation.

Safety Checklist

Like any vehicle, your wheelchair requires frequent inspections and occasional adjustments to ensure both proper and safe operation. Each item on the following checklist should be examined initially. Those noted with (W) should be checked weekly; those noted (M) require monthly checks. All others should be inspected and adjusted periodically.

1. Wheel locks:
   Engage with ease.
   Do not impede wheels when disengaged (M)
   Pivot points securely attached.
2. Arms:
   Securely attached; release properly.
   Adjustment features function properly and lock securely.
3. Cross braces:
   
   Pivot bolts tight enough to maintain 4-wheel contact on uneven surfaces. No excessive wear or bending.
4. Hand rims:
   Check for rough edges.
5. Wheels:
   Check for looseness or wobbles (M).
   Spin wheel, checking for gradual rather than abrupt stopping (M).
6. Spokes:
   Check for bends or breaks (W).
   Check for uniform tightness (W).
7. Casters:
   Check for wobbles and/or binding
   Spin caster to check axle tension (W).
8. Tires:
   Check for wear and/or flat areas (M).
   Check inflation of pneumatic tires (W).
9. Gen. Op.:
   Check for excessive drag or pulling (W).
   Chair opens/closes easily.

Have your wheelchair inspected and serviced by your home care equipment provider at least annually.

Precautions

• Always make certain wheelchair arms are locked securely before using the wheelchair.
• When folding or unfolding the wheelchair, keep fingers and hands clear of any moving parts.
• Never lift your buttocks (even partially) from the seat to reach forward when your feet are on the foot rests.
• Never attempt to retrieve objects from the floor by reaching down between your knees.
• Never tilt your chair backward without assistance.
• Never use an escalator to transport an individual by wheelchair.
• Only those with upper body strength and adequate mobility should attempt wheelchair-to-seat or to wheelchair-to-bed transfers without assistance.
• Reach backwards with caution. Do not activate the wheel locks when reaching backwards or reach over the backrest.
• Never use the wheel lock as a brake when moving.
• Engage both wheel locks when entering or leaving the chair.


Important: Wheelchairs should not be used as a seating surface in a moving vehicle.

Transfers

As many accidents occur while entering or exiting from a wheelchair, kindly follow these procedures to avoid possible injury. Remember, upper body strength and a degree of mobility are required for this maneuver.

1. Position yourself as close as possible to the seat to which you are transferring.
2. Point casters in the direction of the seat to which you are transferring. Lock both wheels!
3. Remove wheelchair arm on the transfer side and position legs in the direction the transfer.
4. Using the seat and the wheelchair as support, shift body weight into seat.

Note: During an unassisted transfer you have little if any seating beneath you. Use of a transfer board is recommended, especially if upper body strength is questionable.

Balance and Stability

The majority of wheelchair injuries result from falls due to the shifting of body weight away from the chair's center of gravity that creates an imbalance. As shown, the center of gravity with an individual in the chair is approximately at arm rest height (horizontally) and chest level (vertically). Shifting position by bending, reaching, or transferring in an out of the chair, changes both the weight distribution and the center of gravity of the occupied chair.

Pay particular attention to the following precautions:

1. Always point the casters in the forward position before leaning forward. To do this, move the chair forward, then reverse it in a straight line.
2. When leaning forward NEVER extend your shoulders or chest any further than the forward position of the arm rests.
3. Establish safe limits for reaching, bending, and transferring by practicing with a qualified person in attendance.
4. Never tilt a chair without assistance.
5. Use a seat belt when engaged in activities requiring frequent shifts in weight distribution.

Obstacles

Passage of the American Disabilities Act is fortunately removing many of the obstacles previously encountered by manual wheelchair users in public places.

Three of the most frequent accident locations remaining are stairs, curbs, and inclines.

Stairs
1. Never approach within two feet of the head of a stairway without assistance.
2. Two attendants, one in front and one in back, are recommended while ascending or descending stairs.
3. Attendants assisting on stairways should maintain a firm grip on non-detachable chair components only.
4. Attendants should return the chair to its normal position only after negotiating the final stair and moving the chair a safe distance away.

Curbs
The attendant should tilt the chair back far enough to allow the casters to clear the curb, then push the chair forward until the rear wheels completely roll up and are securely over the curb.

Note: Tilting the chair and backing over the curb requires greater upper body strength on the part of the attendant.

Inclines
Ramps can cause injury to the wheelchair user due to inadequate upper body strength to control the chair on an incline. Therefore, inclines greater than 9 percent should not be attempted without assistance.

© HealthCom Services, Denver, Colorado.