Abstract
The attendant operated wheelchair is propelled by applying forces to handles at the rear of the chair. There are no published data to justify the design of pushing handles on existing wheelchairs. In Dundee, studies of pushing have been conducted in order to obtain subjective preferences for location and design of handles and an understanding of bio-mechanical factors associated with wheelchair pushing.
Preferred positions for handles have been found to be in the region of 0.75 of shoulder height, 1.14 times shoulder width although deviations of +5% in these values are still rated as acceptable. The preferred positions do not correspond to minimum levels of resultant force or with lowest levels of moment in any of the upper body joints. Moments occurring at the lower back are not substantially affected by handle position. The biomechanical analysis so far has not revealed why some handle positions are more comfortable for pushing than others. Further study, involving calculation of resultant moments (rather than just sagittal plane moments) at these joints and at the lower body joints, is a next step in attempting to find the indicators of discomfort.
Transferring a patient from or to a wheelchair can be a difficult operation with risks of accidents to the patient through falling and risks to the attendant of strain, particularly to the back. Current footrests on wheelchairs are a major source of the problems during transfer. A new approach to footrest design is described which solves these difficulties by using a footrest that lowers onto the floor. This has other attractive features such as providing good stability and restraint of the chair during transfer. The armrests are also discussed since they have a role to play where patients can assist themselves during transfer but have the potential for being an obstruction when patients need to be lifted from wheelchairs.
The ease of pushing and manoeuvring, the difficulties caused by obstacles such as carpet edges and lift entrances, the operation of the brakes, and the position of the pushing handles are all important aspects of chairs used for transporting patients. The wheels, particularly the wheel diameter, tyre compressibility and castor trail, are determinants of the mobility aspects. However, the position of the wheels in relation to the centre of gravity and whether the castors are at the front or rear must also be considered. The brakes, as well as being effective, should be easy to apply and not too affected by wear. A prototype wheelchair is described which incorporates design features suggested by research into the above considerations.