Hesperian Health Guides
Chapter 64: Decisions About Special Seats and Wheelchairs
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In this chapter we look at the things you will need to consider when buying or building a special seat or wheelchair, to best meet the needs of a child. Adaptations of seats and wheelchairs for special positioning needs are discussed in Chapter 65. Designs for building 6 basic wheelchairs are in Chapter 66.
Most children who need a wheelchair or special seat have severe weakness in parts of their bodies, or muscles that pull them into awkward or deforming positions. Seating should, as much as possible, keep these children in healthy and useful positions. It must provide support, but also allow them enough freedom to move, explore, and develop greater control of their bodies. For example:
|1. A child who is ‘floppy’ and slow to develop ability to sit,||2. may at first need a seat with straps and supports to hold her up.||3. As she develops better head control and then body control, the supports can be removed little by little,||4. until finally — if possible — she is able to sit anywhere, with little or no special supports. Now low back support is all she needs.|
|A ‘high chair’ lets the child join the family that eats at a table.||A ‘low chair’ lets the child fit in where the family eats at ground level.|
|Also, a ‘high’ wheelchair may be helpful where cooking and other activities are done high up.||But a low ‘wheelboard’ or ‘trolley’ may be better where cooking and other activities are done at ground level.|
It is also important to consider the type of ground surface on which a wheelchair will be used.
|Where land is flat and fairly smooth, and entrance into houses is level, a chair with a small wheel at the rear may work well and be less costly to make.||But where there are curbs, steps, rocks, or other obstacles, a chair with small wheels at the front works better.||On rough, sandy surfaces wide back tires and relatively large, wide front casters make moving about much easier.|
|Narrow back tires and small front wheels allow for faster travel on hard smooth roads but are useless on rough, sandy roads.|
|To jump over obstacles, the child can learn to do a ‘wheely’ (tilt the chair back with the front wheels in the air).||Wide tires, like the wide feet of a camel, help in sandy places.|
Having the right wheelchair for the local situation frees the child to move about more easily in the community.