An ‘appropriate wheelchair’ as defined by WHO is a wheelchair that:
WHO emphasizes that inappropriate wheelchairs can lead to poor outcomes for wheelchair users, including decreased health and mobility participation barriers, wheelchair breakdown resulting in disruption in use, and/or development of secondary complications – which in cases of people with spinal cord injuries and similar conditions can cause premature death.
WHO guidance on manual wheelchairs design for low-resourced settings154 emphasizes the following:
Table 50: WHO assistive product specification for manual active-use wheelchair
Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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User |
Child or adult with basic, intermediate or advanced posture support needs Primarily for people who self-propel, but also for people who need assistance |
Child or adult with basic, intermediate or advanced posture support needs Primarily for users who self-propel, but also for users who need assistance |
Child or adult with basic, intermediate and advanced posture support needs to self-propel in rough outdoor terrain |
Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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User (continued) |
For use in urban, indoor and outdoor environments People with advanced mobility skills may also use this wheelchair for short distances on uneven terrain |
For use in indoor and outdoor uneven urban, peri- urban and rural environments Offers better outdoor mobility for users who do not have advanced wheelchair mobility skills |
Also users who need assistance (excluding lever-propelled wheelchairs) |
Specific Characteristic |
Wheelchair with folding or rigid frame, three or four wheels with large rear wheels, seat and backrest, armrests and footrests Overall length and wheelbase are similar to or shorter than transport wheelchair with large rear wheels Rear wheels and front castors appropriate for urban indoor and outdoor use |
Wheelchair with folding or rigid frame, three or four wheels with large rear wheels, seat and backrest, armrests and footrests Footrests positioned in line or behind front castors Longer wheelbase and shorter or similar overall length than transport wheelchair with large rear wheels Rear wheels and front castors appropriate for indoor and outdoor mixed terrain |
Wheelchair with folding or rigid frame; three, four or more wheels, with two larger drive wheels; seat and backrest; and footrests behind front castors May be lever- propelled Similar or longer wheelbase than dual- terrain wheelchair; larger overall length than transport wheelchair with large rear wheels Low centre of gravity to ensure stability Rear wheels and castors appropriate for outdoor rough terrain |
Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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Requirements for standard configuration | |||
Frame |
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Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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Frame (continued) |
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Frame Size Range |
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Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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Rear Wheels |
Quick-release or removable without tools Optional camber with maximum 3 ° (off from vertical) • diameter e.g. 508–660 mm Width e.g. 25–35 mm Puncture-proof or pneumatic rear tyres |
Quick-release or removable without tools for rigid frames Quick-release or removable without tools for folding frames is optional Camber ranges from 0° (rear wheel perpendicular to ground) to 1−3 ° (off from vertical) Diameter, appropriate for size of wheelchair, e.g. 508–660 mm Width e.g. 35−44 mm Puncture-proof or pneumatic rear tyres |
With push-rims or lever-propelled Quick-release or removable without tools for rigid frames for transport; optional for wheelchairs with folding frame Camber minimum 3° (off from vertical) for stability Diameter, appropriate for size and design of wheelchair, e.g. 610–711 mm Width e.g. 35−44 mm Wider or larger- tread tyres Puncture-proof or pneumatic rear tyres |
Front Castors |
Diameter e.g. 127– 203 mm Width e.g. 13–50 mm Puncture-proof or pneumatic front castors |
Diameter and width variable: e.g. 203 x 50 mm, 102 x 76 mm Puncture-proof or pneumatic front castors |
Diameter e.g. Over 203 mm Width e.g. Over 50 mm Puncture-proof or pneumatic front castors |
Active Urban Wheelchair | Active Dual-Terrain Wheelchair | Active Rough Terrain Wheelchair | |
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Frame and Wheel Adjustments |
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Rear and front wheels (lever propelling) | Information not available | Information not available |
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Postural Support for intermediate- and advanced- level services |
Wheel or frame adjustments using tools to change seat angle; minimum adjustment range 10–15 degrees; if seat angle is independently adjustable, seat-to- backrest angle must also be adjustable Backrest to seat angle (recline) adjustments with or without use of tools; minimum adjustment range 10–15 degrees Mechanism or adjustment options are available to maintain backwards stability with maximum combined seat and backrest configuration adjustments Additional requirements on adjustability for postural support for intermediate- and advanced-level services: Removable backrest upholstery with back-post capabilities to accept third- party backrests Armrests with adjustable height, and short and full-length arm pads; design and function of armrests should not restrict fitting of third-party backrests |
Source: WHO Assistive Product Specification https://www.who.int/publications-detail-redirect/9789240020283
124Table 51: WHO general seating and postural support guidelines
WHO general seating and postural support guidelines | |
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All wheelchairs provide seating and postural support as well as mobility. Good postural support is critical especially for users who have an unstable spine or are likely to develop secondary deformities. A wheelchair and cushion should meet the seating and postural support requirements of the user(s). This includes the size of the wheelchair, the type of cushion, and the adjustability and ergonomic factors of the wheelchair All wheelchairs should be provided with a cushion that is appropriate to manage the user’s risk of developing pressure sores. A wheelchair should be evaluated based on the seating and postural support measures, and the results should be available to the users and purchasers. Cushions should be evaluated and rated based on their ability to provide comfort, pressure relief and postural support, and the results should be available to the users and purchasers. A higher level of adjustability or custom adaptations may be needed for users who require more complex postural support. Overall, WHO recommends that wheelchairs and cushions be evaluated based on the seating and postural support performance measures, and the results be available to the users and purchasers. The areas in which a wheelchair and cushion should be evaluated or reported on are 1. seating dimensions and adjustability, and 2. cushion types and characteristics. Seating dimensions and cushion characteristics tests and reporting techniques are covered in ISO standards 7176-7 and 16840-2. |
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Seating and Postural Support Elements | |
Seat bases |
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WHO general seating and postural support guidelines | |
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Cushions |
The cushion should be removable from the wheelchair. The cushion should be easy to clean using basic materials such as soap and water. The cushion should be an appropriate size to fit on the seat base. Correct cushion use and the way in which it should be placed on the wheelchair seat (which side is up, and which is the front of the seat) should be clearly indicated. Information on how the cushion should be used and maintained should be available. Pressure relief cushions: A pressure relief cushion should reduce pressures at the high- risk areas for pressure sore development (commonly at ischial tuberosities and sacrum) A pressure relief cushion should minimize the build-up of moisture between the cushion and the user’s skin Information should be available on how to use the cushion, how to maintain it, the expected life of the cushion, when to replace the cushion or parts of it, and any particular risks when using the cushion The cushion and cushion cover material should not cause high pressures, thereby reducing the effectiveness of the cushion in distributing pressure over the seat surface Pressure relief cushions should maintain their pressure relief properties in the climates where the cushion is expected to be used |
Backrests |
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Footrests |
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Armrests |
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WHO general seating and postural support guidelines | |
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Rear Wheels |
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Source: WHO Guidelines on the provision of manual wheelchairs in less resourced settings (2008) https://iris.who. int/bitstream/handle/10665/43960/9789241547482_eng.pdf?sequence=1
Many international organizations such as the International Society of Wheelchair Professionals (ISWP) 155, a global, multidisciplinary, nongovernmental organization aiming to improve the quality of life for people who may benefit from mobility devices, serve as global resources to coordinate and improve wheelchair service standards and provision. ISWP has published design considerations for wheelchairs used in adverse conditions.
Per ISWP guidance, “a wheelchair interacts with and is affected by both the environment and the user.” Hence a wheelchair design needs to consider both the user and its environment. Design considerations should consider the user: A wheelchair design needs to account for who they are designing the wheelchair for. Wheelchairs for permanent use are not generic devices that can be utilized by anyone needing a wheelchair. Wheelchair users vary by:
Design choices should also consider users’ environment and transportation.
Implications on reliability related to the environment:
How will the wheelchair be transported:
In the rehabilitation of individuals with walking limitations, it is crucial to provide a wheelchair that not only fits correctly but also aligns with the user’s physical, functional, and environmental needs. This requires an approach that responds to individual’s unique requirements and promotes the provision of wheelchairs through service provision that assesses individual user needs, assist in selecting an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services where appropriate.
In terms of service delivery, WHO recommends wheelchair provision through a service model, which provides, at a minimum: individual assessment and selection; preparation and fitting of the wheelchair for the wheelchair user; information and training for wheelchair users to maximize their safe and efficient use and care of the product; and follow-up to ensure the wheelchair continues to meet the user’s needs.
Figure V: Summary of wheelchair service steps recommended by WHO
1. Select | 2. Fit | 3. Train | 4. Follow up |
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The wheelchair user’s specific needs and preferences are defined through an individual assessment, to select the most appropriate wheelchair(s) for them. | The wheelchair, wheelchair cushion, postural support devices and any other accessories are prepared and fitted for the wheelchair user. | The wheelchair user, along with those who will assist them, takes part in task- specific training in how to use and care for their wheelchair. | Follow up is offered to all users, for as long as they require a wheelchair, with the frequency based on their individual needs. |