Sunday, January 15, 2006

wheelchair management

As individuals grow older, the likelihood of being confined to a wheelchair increases. The nature of the disability may be temporary, such as post surgery or following a fracture. The disability may be permanent, including such conditions as frailty or arthritis. Regardless of the reason for the disability, it may be necessary at some point to manage a wheelchair.
Transfers Transfers from wheelchair to car, bed, and toilet are made according to the disability.
If the person is a hemiplegic (paralyzed on one side of the body-without use of that arm or leg) he or she should be assisted to a standing position, provided with underarm support and held onto at the waist, by gripping the belt or side. The person should be helped to turn or pivot and assisted with seating. The paralyzed leg should be lifted and placed in a comfortable position. Transferring back to the wheelchair is the reverse of this procedure.
If the person is a paraplegic (paralyzed from the waist down) frequently he or she develops enough upper body strength to transfer from the wheelchair with little or no assistance. If necessary, a transfer board (a plastic board placed between a wheelchair and a car seat or a chair) can be used to make the maneuver easier, as the person can slide his or her body across the board. If the person is a quadriplegic (paralyzed from the neck down) a transfer can be made by one strong person, who places one arm under the knees and the other arm around the back and under the shoulders of the quadriplegic, but usually this maneuver is performed by two people. The transfer board can be utilized in this instance also. Some quadriplegics learn to transfer without assistance. If the person in the wheelchair is disoriented, it may be necessary for the assistant to repeat instructions about when to stand, pivot, etc.
When making transfers into chairs, one should choose stationary chairs with arms if possible. During transfers wheelchair wheels should be locked, so the wheelchair cannot roll away.
Accessibility Once in a wheelchair, the person or the companion will become very aware of architectural barriers. Architectural barriers are structural designs that prevent wheelchair access. Stairs, narrow doorways, curbs, revolving doors, and restrooms are some of the barriers. If there is a low curb or a step, the companion can tilt the wheelchair back to its pivot point and ease the wheelchair up. If the person in the wheelchair is able, he or she can push the wheels at the same time making this an easier maneuver. Planning ahead by calling or writing the establishment one wishes to visit and asking about accessibility is wise. Federal and state governments have made barrier-free access a requirement in government subsidized construction. They have offered certain tax advantages to private owners, who make their businesses accessible. Because of this many newer facilities and businesses are accessible now. This gives the person in a wheelchair the choice of not patronizing establishments that are not barrier-free.
Transportation Airlines are cooperative and helpful with handicapped passengers. An airport attendant will usually assist the disabled person to board early. In major airports the person can usually be wheeled to the door of the plane in his or her own wheelchair. Large airplanes may be able to accommodate boarding into first class in one's own chair; smaller planes may require a transfer to a specially designed airline wheelchair. A person should be sure to make it clear that his or her own chair will be needed immediately upon landing. Many airlines will place the wheelchair into the baggage compartment last for this reason. Many metropolitan bus systems offer special transportation to the disabled. The vehicles are usually specially adapted vans, with raised roofs and hydraulic chair lifts. Fares for these buses will usually be higher than the normal bus fare because the service provided is door to door. These charges are still lower than taxi fares. Most cars, except for the smallest compacts, are large enough to carry a wheelchair. The wheelchair can be carried on the floor in front of the back seat or in the trunk. A foldable, light-weight wheelchair makes loading and unloading more convenient. The light-weight wheelchairs, however, are not as durable. The amount of travel versus durability should be considered before purchasing a wheelchair.
If the person is in an electric or nonfolding wheelchair, a specially equipped van may be necessary for transportation. These vans may have hydraulic or electric lifts that raise the person in the wheelchair from ground level to van floor level and allow the person to remain in his or her wheelchair. They may be equipped with a folding ramp. With either the lift or the ramp, extra space is required for parking. Designated handicapped parking spaces offer this extra space. It is also important to remember that when parking it is necessary to leave enough space between cars for the car door to open fully so the person can transfer or be transferred into and out of the wheelchair.
Gillies, J. A Guide to Caring for and Coping with Aging Parents. Nashville: Thomas Nelson Publishers, 1981.

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