Optimal manual wheelchair set up for an upper limb propeller

This month I have been asked by a clinician how can we determine what is the optimal manual wheelchair set up for an upper limb propeller. To answer this question we must first consult a few important resources:

• Position on the Application of Ultralight Manual Wheelchairs: www.resna.org 
• Preservation of Upper Limb Function Following Spinal Cord Injury: www.pva.org

What is it?

• 35 clinical guidelines to help optimise chair set up to prevent upper limb injury
• Focuses on
  • // Education 
  •  // Propulsion technique 
  • // Equipment selection 
  • // Wheel position 
  • // Recommendations are transferable to other user groups

Optimal set up

Rear wheel:

• Tip of middle finger at centre of hub (another method to support CPG 9)

• Why? So Centre of Mass (for maximum manoeuvrability) is positioned over hub of wheel
• 70-80% of user weight over rear wheels (CPG 8 - Adjust the rear wheel as far forward without compromising stability)

• 120° of elbow flexion at top of push cycle (CPG 9 - hand top dead centre – elbow angle should be 100-120°)
• Optimal wheel access – 10 to 2 (CPG 5 - avoid extreme positions of the wrist)

• Use wheel camber – increases lateral stability and brings top of wheel closer to user – more efficient push phase (RESNA 2012)

Front castors:

• 20-30% user weight over castors
• Use smallest castor fork – reduces turning circle and obstruction with feet or footplates

Why?

// Minimise resistance to turning & more efficient propulsion

// Provides compromise between indoor manoeuvrability and outdoor terrain navigation

Quickie wheelchairs are designed to be easily configurable to meet end user needs and also set up according to these guidelines:

// Folding frame wheelchairs – Quickie Life, Youngster 3, Neon2, Xenon2

// Rigid Framed wheelchairs – Quickie Life R, Simba, Argon2, Helium

RESNA (2012) emphasise the importance of achieving an optimal set up for all manual wheelchair users to maximise function and independence and reduce potential injury advising that: “The person cannot conform to the wheelchair, but the wheelchair must conform to the individual.”