2 indications Wheelchairs are suitable for:
1. People with decreased or lost walking function? Such as amputation, nonunion of lower limb fracture, paraplegia, paralysis of both lower limbs caused by other neuromuscular diseases, severe arthritis or lower limb diseases, etc.
2. Those people who are not sick in the motor system itself, but walking is bad for their whole body? Such as systemic failure caused by severe heart disease or other diseases.
3. Central nervous system diseases make it dangerous to walk independently? For example, patients with cerebrovascular accident, craniocerebral injury with cognitive and perceptual disorders, patients with severe Parkinson's disease and cerebral palsy with difficulty walking.
4. the elderly? People who have difficulty walking and are prone to accidents.
3 contraindications for severe hip pressure ulcers or pelvic fractures, wheelchairs should not be used.
4 wheelchair selection and training 4. 1 prepare wheelchairs, including standard wheelchairs, electric wheelchairs, prone wheelchairs, wheelchairs for patients with lower limb amputations, wheelchairs for sitting and lying, and wheelchairs with unilateral drive.
It is necessary to explain the purpose, methods and precautions of treatment to patients in order to fully obtain their cooperation.
4.2 Method 1. Rehabilitation doctors evaluate patients? Understand the patient's age, disease diagnosis, dysfunction and rehabilitation needs. For example, unilateral manual wheelchair should be used for hemiplegia; Lower limb amputees should use wheelchairs with adjusted center of gravity; High paraplegia should use electric wheelchair; People with paraplegia and pressure ulcers should use prone wheelchairs; Those who are not suitable for sedentary or standing for a long time should use wheelchairs to sit and lie down; Ordinary patients can use standard wheelchairs.
2. Is the wheelchair opened by a rehabilitation doctor? Take a simple prescription as an example. The contents of the prescription include:
(1) Vehicle types: ordinary type, front-wheel drive type, sports type, one-hand drive type (left and right), amputation type, etc.
(2) Big wheels: specifications are 50.8cm, 55.9cm, 6 1.0cm, 66.0cm(20-inch, 22-inch, 24-inch, 26-inch), and tires (pneumatic and solid).
(3) Manual ring: specification (16,122mm), standard type, with knob (horizontal and vertical).
(4) Casters: specifications are 12.7cm, 15.2cm, 17.8cm, 20.3cm(5 inches, 6 inches, 7 inches, 8 inches), tires (pneumatic and solid), and caster locks (yes or no).
(5) Backrest: standard, detachable, backward-tilting backrest (half-tilting and full-tilting), openable backrest (yes or no) and headrest (yes or no).
(6) Handle: Standard and Folding (Yes or No).
(7) Handrails: standard, desktop and detachable, with padded handrails (Yes or No).
(8) Footrest and pedal: standard, lifting, separating, detachable, left and right (separating and combining), footrest, heel guard and toe guard.
(9) Brake: lever type (tension and compression type), removable type, coupling type and telescopic rod type for sports.
(10) Seat color: blue, light blue, black, red, orange, tea green (other).
(1 1) Accessories: cushion (cushion, backrest), wheelchair table, bag, safety belt.
Electric wheelchairs need special attention.
3. Determination of other conditions in wheelchair prescription
(1) Seat height: The seat height should be based on the patient's ability to maintain the correct posture after sitting for a long time.
(2) seat width: the width of the hip is required, plus about 5cm.
(3) Seat depth: the distance from the front edge of the seat to the back of the chair. When the patient sits down, there should be a gap of about 5 cm between the back of the thigh and the front edge of the cushion.
(4) Arm height: Sit down with hands drooping and elbows bent by 90o. Measure the distance from the surface of the chair to the lower edge of your elbow, plus 2 ~ 3 cm.
(5) Height of backrest: the distance from the seat surface to the central lower part of the two shoulder blades.
(6) Height of the footrest: First lower the footrest so that the patient's heel just leaves them, then raise it to 1.3 ~ 1.5 cm and fix it. It is safe to leave your feet at least 5 cm from the ground.
(7) Overall height: The distance from the upper edge of the push handle behind the backrest to the ground is generally 93cm, and if the extension of the head is added, it will be 25 ~ 30 cm.
4. Rehabilitation engineers and technicians prepare wheelchairs for patients according to the wheelchair prescription.
5. The rehabilitation therapist is responsible for the wheelchair operation training of patients.
(1) transfer training: transfer training of exercise bed wheelchair, wheelchair toilet, wheelchair bathtub, wheelchair floor, etc. For example, when training the transfer from wheelchair to the ground, first lock the wheelchair with the brake, slowly move the buttocks to the front edge of the seat cushion, hold the armrest on the same side with the affected hand, then touch the ground with the healthy hand, then move the center of gravity to the healthy side, and gradually leave the seat with the buttocks. The healthy upper limb bends elbow slowly, and at the same time supports the body, making the patient sit on the ground. When the patient sits back in the wheelchair from the ground, first fix the wheelchair, keep his body as close as possible to the wheelchair seat, hold his chest out and bend his elbows, so that his upper limbs are supported on the front edge of the seat cushion, and his head is tilted back. Then he uses his arms to support his hips to move towards the seat, and then slowly adjust his sitting posture.
(2) Decompression training: Patients sit in wheelchairs, support their bodies with upper limbs every 15 ~ 20min, and lift their hips to decompress. If the muscle strength of triceps brachii is too weak to support your body with your hands, you can tilt your trunk so that one hip leaves the seat cushion, and then lift the other hip after a while, and decompress the left and right hips alternately.
(3) Advance and retreat training: The patient sits firmly on his hips, keeps his body balanced, looks forward with his eyes, then stretches his arms backward, slightly bends his elbow, holds the wheel ring in his hand (slightly backward), leans forward slightly, and pushes the wheel ring forward with his arms at the same time to make the wheelchair move forward, and repeats the above actions. When retreating, the arm moves in the opposite direction, the body leans forward slightly, and slowly retreats.
(4) Training along the stone or steps: First, under the protection of the therapist, practice the balance on the rear wheel. The patient's hands push the wheel rings on both sides with equal force, so that the small wheel is suspended and the wheelchair leans back. Both hands constantly adjust the wheel ring forward or backward, and under the coordination of the body, the rear wheel of the wheelchair touches the ground to keep balance. After mastering this skill, practice the steps. When crossing the steps, the wheelchair faces the steps with a distance of about 20cm, leans forward slightly, holds the back of the rim with both hands and pushes forward quickly with the same force. At this time, the small wheel lifted and landed on the steps, and then pushed the big wheel forward until the whole wheelchair crossed the steps.
(5) Up-and-down training: Patients should practice pushing or pulling with both hands synchronously, and learn to use the brakes flexibly, so as to stop the car as soon as possible when it is out of control.
(6) wheelchair door opening and closing training: for ordinary doors, you need to take a step back to open them; You need to step back after entering the door to close it.
(7) Other training: including standing up or sitting down from a chair, special exercises for special control (such as electric, pneumatic, jaw control, voice control, tongue control wheelchair), upper limb muscle strength, overall physical strength and endurance training, etc.
4.3 Precautions 1. When choosing a wheelchair, we should pay attention to the safety of use, the patient's operating ability, the weight of the wheelchair, the place of use, comfort, price and appearance. Special attention should be paid to the selection of appropriate wheelchair cushions to prevent pressure sores. Patients with poor trunk balance and head and neck control can use headrest or neck support.
2. Pay attention when others push the wheelchair? Before pushing the wheelchair, pay attention to whether the patient is correct, whether he leans forward or askew; Help the patient to put his hands on the armrest and his feet on the pedal, and tie them with a fixing belt if necessary; It is difficult for patients with severe balance dysfunction to maintain their balance, so they should be fixed with belts, especially when going down the slope. Travel slowly, always pay attention to the surrounding environment and observe the patient's condition to avoid accidents. When getting down the curb or steps, let the wheelchair get off first. When climbing a curb, step or threshold, let the front wheel of the wheelchair get on first.