SMALL Tips That Make a 
       BIG Difference

Wheelchairs can be very important for those with physical disabilities resulting in a decreased mobility. Studies have related significant aspects of wheelchairs and their users. Proper wheelchair use will contribute to a greater level of independence, comfort, and, in the long run, may help minimize repetitive injuries (RI) to the upper extremities. More than 70% of wheelchair users will develop shoulder, elbow and/or wrist pain at some time.  In this article, we will discuss certain measures to be taken by the wheelchair user and therapist that contribute to a more functional wheelchair use. 

Considering the wheelchair user…
Boninger et al (2002) have described four types of wheelchair propulsion patterns: 1. Semi-circular (SC); 2. Single looping over propulsion (SLOP); 3. Douple looping over propulsion (DLOP); 4.Arcing (ARC).

         SC                              SLOP                            DLOP                                   ARC
The SC pattern has been shown to be the most efficient because it results in smoother movement patterns of the upper extremities. As such, the use of this propulsion pattern may help minimize the likelihood of acquiring RIs. On the other hand, the ARC pattern is considered the least efficient because of the abrupt changes in direction of the upper extremities while pushing the wheelchair, thereby increasing the total forces seen by the arms.  . ⇑ frequency of propulsion ⁼ ⇑ pathology

Similarly, other findings have concluded that obese individuals generate higher forces to the upper extremities during wheelchair propulsion and transfers.  ⇑ obesity ⁼ ⇑ pathology

Considering the wheelchair…
A poorly adjusted wheelchair, rather than bringing many benefits, may, instead, bring many detriments!!! Boninger et al (2000) described two essential factors contributing to a more efficient propulsion style: 1) decrease the vertical distance between the shoulders and hub of the wheelchair wheel ;

2) position the wheel more anteriorly.  Only some types of wheelchairs allow this type of adjustment. With this in mind, in choosing a wheelchair, it is very important to consider the adjustability of the equipment.⇓ Vertical distance between the shoulder and wheelchair hub= ⇓ pathology
⇑ forward wheel position= ⇓ pathology.
	
Therefore, it is important to understand that proper wheelchair positioning is not a result of one isolated factor, but instead, a combination of techniques and adjustments that will make the user most functional. 

⇑ research at HERL ⁼ ⇑ happiness  

These research projects were developed at a Center of Excellence in wheelchairs, the Human Engineering Research Laboratories (HERL). This laboratory is a part of the Department of Rehabilitation Science and Technology at the University of Pittsburgh, USA. It is one of the few places in the world where research performed targets assistive technology and its users. The team is led by Dr. Cooper e Dr. Boninger, who work with the objective of understanding the needs of individuals with physical disabilities, keeping always in mind, the ultimate goal of improving their quality of life.
We are having the opportunity to work at this center, which for us is an honor. We believe that there are many special places in the world, and one of them is HERL: special for the work that they do, and for the people who work there. HERL is certainly making a BIG difference in the field of rehabilitation.

                                                                                  -  Eliana Chaves e Fabrisia Ambrosio 

Questions? 
Write to: 

faa7@pitt.edu ou 

7180 Highland Drive 
Building 4, 2nd Floor, East Wing
Pittsburgh, PA  15206
USA