Hesperian Health Guides

Chapter 64: Decisions About Special Seats and Wheelchairs

HealthWiki > Disabled Village Children > Chapter 64: Decisions About Special Seats and Wheelchairs

In this chapter:

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.

Meeting the needs of the individual child, family, and community

Most children who need a wheelchair or special seat have severe weakness in parts of their bodies (the 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 with “floppy” muscles who takes longer 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.
Girl sitting, sustained by hands, and body falling over.
Girl strapped into chair with head guards and connected table.
Girl sitting in chair, with one strap and connected table.
Girl sitting on chair with low back support.
CAUTION! If a child needs to be supported as much as the one in the second picture, do not keep her strapped in her seat for long. She also needs periods of free movement and exercise to develop more independent head and body control. Keeping her strapped in for too long, or providing too much support after she has begun to gain more control, may actually slow down her progress. Seating needs to be changed and supports reduced as the child develops.

Also, children who do not feel in their butts need frequent position changes, and special cushions.

Special seats and wheelchairs need to be adapted not only to the individual child, but also to the particular family, local customs, and community situation. For example:
One adult and 2 children eating at table, one child with extra support to back.
2 adults and 1 child eating on floor mat, child sitting on low chair.
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.
Girl in wheelchair cooking at a wood burning stove.
Girl in a wheelboard cooking over a ground-level fire.
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.
Boy in wheelchair wheels himself to house. Boy in wheelchair who wheels himself up steps. Narrow back tires and small front wheels allow for faster travel on hard smooth roads but are useless on rough, sandy roads. woman moving in wheelchair with wide tires on sandy ground.
To jump over obstacles, the child can learn to do a “wheelie” (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.

This page was updated:04 Apr 2024