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A wheelchair can change the quality of life for someone with mobility issues dramatically. But they aren’t always as safe as you would like to imagine. Wheelchair injuries in the US doubled over a 12-year period, with more than 100,000 people attending ER in 2003 having suffered such an injury.
There are several reasons that a person may fall out of their wheelchair, including improper fit, confusion, and problems with balance, among other things. Understanding what causes these falls can go a long way in helping to prevent them. If you have a family member or friend who uses a wheelchair, this guide will assist in helping to prevent falls.
Inspect the Condition of the Wheelchair to Prevent Falls
One of the most common reasons that a wheelchair fall occurs relates to the lack of maintenance of the chair itself. To avoid problems, it’s important to regularly check the condition of the wheelchair and address any issues as soon as they arise.
Ensure the Wheelchair is the Correct Fit for the Patient
When purchasing a wheelchair, it is vital that the person is fitted so that the chair is as safe and comfortable as possible. Another key factor to think about is the weight of the user. Different wheelchairs are designed with different weight capacities, and exceeding this could put unnecessary strain on the wheelchair, causing it to buckle or tip over.
There are several measurements that will need to be taken when choosing a wheelchair. The most important are the seat width, seat back height, seat depth, and seat-to-floor height. Not only will taking these measurements ensure safety but it will also help to ensure that the user sits in such a way that their posture is not affected. Take the following points into consideration when measuring for a good fit.
- Take the measurement across the widest point of the hips
- Add one inch
- Factor in the size of any side cushions that will be used
Seat Back Height
- Measure from the underside of the extended arm down to the buttocks
- For those with good trunk muscles, subtract four inches but for those with poor trunk muscles, only subtract three inches
- Factor in the thickness of any cushions to be used
- Take the measurement from the back of the knee to the buttocks
- Take away two and a half inches
- Factor in the thickness of any cushions that will be used at the back of the chair
- For users under 5ft5, a hemi sized wheelchair will be necessary
- For users between 5ft5 and 6ft2 a regular adult wheelchair can be used
- For users over 6ft2 opt for a wheelchair designed with taller people in mind
These measurements are important because if the wheelchair seat is too large, this will cause the user to slide around owing to a lack of support. The result of this is a higher risk of falling as well as things like friction injuries. On the flip side, a wheelchair with too small a seat can be incredibly uncomfortable, especially when used for long periods of time.
Check the Condition of the Seat & Backrest
If you notice that the seat or the backrest is sagging, commonly referred to as the hammock effect, then this is something that needs to be addressed as it means that the user will not have the correct level of support. This is a common problem in wheelchairs and occurs after a period of use when the materials become less rigid and begin to sag.
When a user sits in a seat that has suffered from the hammock effect, they will not be centrally aligned in the seat. This can result in accidents as well as discomfort and pressure ulcers. Moreover, the muscles in the back and shoulders could be put under additional pressure.
Some seats have velcro adjustments which is great as they can be easily altered. However, others will need to be fully replaced.
Inspect the Wheelchair’s Brakes
The last thing that you want when using your wheelchair is to find out that the brakes have failed when you’re coming down an incline. This is why it is essential to check them at least once every couple of weeks.
The main thing to look for is that the brake keeps the wheelchair stationary when it is applied. If it doesn’t, there is a chance of the chair tipping. Look at the brakes to ensure that they are tightly fitted to the wheels when applied. However, the brakes should not rub against the tires when they aren’t in use, as this can cause them to wear more quickly.
Wheelchair brakes have locks, and when these are applied, they should hold the tire in place effectively. Moreover, you should ensure that the locks are easy to use.
Check the Back Tires & Casters
With pneumatic tires, there is a risk that they will lose air and become underinflated. When this happens, you also lose performance which means they will wear more quickly. You’ll notice this as the pattern begins to fade, but this is also true of flat-free tires. Underinflated tires do not perform as well when the brakes are applied, making them far less safe.
For caster wheels, you should regularly check them to make sure there is no cracking or other damage. During your inspection, you should also give the wheel a spin to make sure that it moves freely. If there are any problems, you should have them fixed before using the wheelchair again.
General Safety Tips to Prevent Wheelchair Falls
It often only takes a little common sense to avoid serious accidents. But we can all be guilty of failing to follow these general safety tips from time to time when we’re in a rush, for example. So, it’s a good idea to keep this advice in mind to get the safest use out of your wheelchair.
Avoid Manoeuvring a Wheelchair over Steep Inclines or Curbs
You should never attempt to move your wheelchair over a curb without the assistance of another person. The other person will need to take a firm hold of the wheelchair by a non-moving part, such as the handles. They should then tip the wheelchair back at the same time as leaning back themselves.
It’s also imperative not to force your wheelchair up slopes that it is not designed to handle. If you find yourself in a situation where you cannot access a point due to a curb or incline, you should try to find another way around. Using a wheelchair ramp is the safest option.
Don’t Hang Shopping Bags on the Wheelchair Handlebars
It can be tempting to hang your shopping or other bags on your wheelchair handles, after all, it’s very convenient. However, this alters the chair’s center of gravity and could cause it to topple over, even when you’re sitting in it. The heavier the load, the more chance there is of this happening.
Use Brakes Lock Extenders
For some wheelchair users, dexterity is a problem, and in this case the use of brake lock extenders can make this feature easier to use. As a direct result, the wheelchair becomes much safer. But it isn’t only wheelchair users that can make use of these add-ons, even caregivers with poor dexterity will find them useful.
Ensure the Foot Rests are Positioned Correctly
Your footplates are far much more than just somewhere to rest your feet while you use your wheelchair. They form the base of a good posture while in a seated position. If they’re not positioned correctly, then this can put pressure on other parts of the body, such as the hips and lower back.
For children’s wheelchairs, the footrests would normally be set at a 90 degree angle. However, for adults, this is usually between 60 and 70 degrees. It is important to adjust the footrests according to the height and leg length of the patient.
While the footrests can be swung to the side to make getting in and out of the chair easier, they should be put back into position when the chair is moving so that the user can rest their feet on them.
With the feet placed flat on a solid surface at the right angle and with good weight distribution, the user achieves a much better posture.
Helping Wheelchair Patients with Positioning Impairments
Poor posture is one of the leading causes of wheelchair falls, so it is imperative to ensure the posture is supported and aligned. However, some patients have natural positioning impairments and may require additional support.
For example, if a wheelchair user has poor trunk strength, they may slide forwards in the chair. Through the use of aids like support cushions, these problems can be easily tackled.
Types of Posture Impairments
Different wheelchair users may face a variety of different postural impairments. Here, we will outline some of the most common.
Anterior Pelvic Tilt
Those with an anterior pelvic tilt have a hyperextended lumbar region due to the top of the pelvis being more forward than usual. This can cause the back to be arched, which can result in your gaze being more upward than forwards.
One of the complications of this postural condition is UTIs and constipation owing to the pressure caused by the spinal curve. Moreover, since the neck is also hyperextended, patients may find that they have difficulty swallowing. This condition is typically caused by muscle weakness and paralysis.
Posterior Pelvic Tilt
On the other hand, some wheelchair users struggle with a pelvis that is tipped backward, known as posterior pelvic tilt. This can be caused by several things, including low tone in the trunk, tight hamstrings and hip flexors, as well as too long a seat depth.
Posterior pelvic tilt can put pressure on the abdomen, causing issues with constipation. It is also known to affect breathing and can make it difficult to speak owing to the inability to lift the head correctly.
In the simplest terms, pelvic obliquity refers to an alignment where one side of the pelvis sits higher than the other. The issue with this is that the person ends up sitting with a tilt, so it looks as though they are leaning to one side. The main problems with this are pain and potential pressure sores.
Pelvic rotation occurs when one anterior superior iliac spine (ASIS) is forward compared to the other. This type of postural problem comes from a variety of issues, including leg length discrepancies, limitations in the range of motion in the hips, as well as tone. It can be difficult for patients to have correct anatomical support of the spine while this condition exists, and the trunk will normally be rotated.
Types of Positioning Support Cushions
While postural issues can be problematic for the wheelchair user, there are ways to provide additional support and improve the posture. One of the most common solutions is to use one of the many types of positioning support cushions. Each one is designed to help with a different problem, so it’s important to choose something that’s right for you.
The anti-thrust support cushion is ideal for people who find that they slouch forward when seated. They are designed with a higher front end and a lower rear end which stops the user from sliding forward in their seat. These cushions also feature a slight tilt between the two areas, which is perfectly placed to prevent sacral sitting and ensure that the pelvis remains upright.
There are several different designs of anti-thrust cushion. You should choose the right material according to your needs. For example a high density foam cushion gives added stability while a low density cushion adds conformity.
A pommel cushion makes transfers a lot easier but is primarily designed for wheelchair users who have a tendency to buckle or cross the knees. These cushions are also ideal for people who find that they slide while sitting in their wheelchair and also reduce internal rotation.
If you have posterior pelvic tilt, then a wedge cushion is the best choice. These cushions offer support so that you can remain back in the seat and keep the posture as it should be. As a direct result of this, patients using a wedge cushion will notice that their pain level is reduced.
Patients that have posterior pelvic tilt will benefit from a contoured cushion, especially if they find that their condition causes them to look downward.
For those that have had a single amputation, an amputee cushion will help to keep the remaining limb in position while seated in the wheelchair.
Other Types of Wheelchair Aids to Help Prevent Falls
Cushions are one way to ensure that wheelchair users can sit safely and comfortably in their chairs. However, there are lots of other options which may come in handy.
Lateral Side Supports
Lateral side supports offer many benefits to wheelchair users, including improvements in support, posture, and comfort as well as aiding in balance. They are fitted on the sides of the backrest and are designed to help patients with poor torso control from falling to the side. For those with more complex needs, it is possible to install two sets of lateral side supports for even greater support.
For those who need extra support for upper body alignment, a lap cushion is a great solution. These cushions fit across the front of the wheelchair and act as a support from the front without the need for buckles or seatbelt. There are cutouts so that the cushion can fit comfortably around the armrests.
There has been some concerning research that shows there are a large number of deaths by asphyxiation due to the improper use of belts on wheelchairs. Before you allow this to concern you too much, we should point out that when used correctly, these belts can help to improve posture, secure the user and provide additional support.
To get the safest use out of a positioning belt, it should be prescribed by a doctor who will give instructions and when and how the belt should be used. It is also a good idea to consider how the use of a belt will affect the mental health of the patient. There have been reports of people trying to fight their way out, which has resulted in strangulation. Positioning belts should only ever be used as a short-term solution and when they will benefit the patient and not make them feel trapped.
More often than not, it is recommended only to use a positioning belt to keep the wheelchair user still for things like feeding or medical procedures.
Again, it is absolutely essential to keep in mind the research that has been completed surrounding the use of belts and harnesses with wheelchairs. While they are designed as a safety measure, they can often be to blame for injuries or even death.
Chest harnesses are designed to support the trunk, keeping the user upright in the wheelchair. When used correctly, they will offer this support, but it’s also important to think about comfort. For this reason, you will find that some chest harnesses come with padding.
There are different types of chest harness. Some are a simple one-strap design while others wrap around the chest and shoulders. Which you choose will depend on the level of support needed by the patient.
Non-Slip Wheelchair Seat Cover
If the wheelchair user lacks stability or finds that they slide around while seated, then a non-slip wheelchair seat cover could be a solution. These covers not only ensure that the user is more stable but can also help to improve posture, which in turn can reduce slouching.
Preventing Falls During Wheelchair Transfers
It probably won’t come as a surprise that a lot of wheelchair falls come as a result of improper transfers. When moving the patient in and out of the wheelchair, there are many things that can be done to improve safety and reduce the risk of falls.
Apply the Brakes during Wheelchair Transfers
It’s incredibly important to make sure that the wheelchair brakes are applied during a transfer. If they are not, the wheelchair may move around and stability will be lost.
Lift Footrests and Armrests Up
On most wheelchairs, the footrests and armrests will swing away or lift so that transfers can be more easily made. It’s vital that you make use of this feature as if you do not, the footplates can serve as a tripping hazard. Moreover, if the armrests are not in the way, the patient can be more easily moved in and out without obstruction.
Position the Wheelchair Close to the Transfer Surface
You want to make the transfer distance as short as possible. This means placing the wheelchair as close as you can to the bed, toilet, chair, or any other place you are transferring the user. If there are caster wheels, these should point in a direction that does not hinder the transfer.
Use Transfer Aids to Make Transfers Easier & Safer
Sometimes we require more than just the physical strength and ability of the caregiver to make a safe and successful transfer. The good news is that there are several transfer aids out there that can help with this.
A wheelchair transfer board is ideal for patients whose caregivers may not have the strength to lift them out of the chair. These boards have a smooth surface across which the user can slide and are great for moving from one place to another that is of the same height.
A transfer belt, sometimes called a gait belt, features four webbed handles and can be used to move the patient from a standing position to the wheelchair, for example.
Preventing Falls When the Wheelchair is Stationary
Wheelchair falls aren’t only a problem when making a transfer, it is also possible for the user to fall when the wheelchair is stationary. Again, this involves taking certain measures to ensure maximum safety.
Avoid the User from Overreaching
If you are sitting in a wheelchair and are attempting to reach and grab something that’s just a little too far away, this could result in you toppling out of the chair. It simply isn’t worth the risk but using a tool like a grabber can extend your reach and allow you to access the things you need. However, it can also be a good idea to make sure that your room is arranged in such a way that you won’t ever have to overextend yourself.
Even when trying to grab something within your reach, make sure that the caster wheels are positioned away from the drive wheels and that the brake locks are on.
Use a Wheelchair Alarm
In home settings, being alerted to a potential problem is essential for caregivers. A wheelchair alarm will alert a caregiver if the patient attempts to get out of the wheelchair. This could be dangerous owing to many conditions such as balance or stability issues and dementia.
Normally, these alarms rely on a chair pad and sensor which, when activated, will set off the alarm to let the nearest caregiver know what’s going on. There are also products that act as something of a lap belt but without restraining the user, and these are great for serving as a reminder to the wheelchair user.
Fit an Anti-Rollback Device
If a person tries to sit in the wheelchair or stand up from it, it can sometimes roll back if correct support isn’t in place. But with the simple addition of an anti-rollback device such as the Safe-T mate, the wheelchair remains in place and allows for safer independent transfers. There’s no need to worry about locking the brakes, which can sometimes be fiddly.