19
18
To go down
13
:
•
The user should be facing forward.
•
The rear attendant tilts the wheelchair backwards on to the back wheels and lets the wheelchair roll down the stairs
slowly, one step at a time.
•
The second assistant can help by steadying the wheelchair from the front, holding on to a non-removable part of the
wheelchair.
Note – These actions may require that anti-tippers be flipped up or removed. Make sure the anti-tippers are reattached
or flipped back down before using the wheelchair.
Sitting in your wheelchair
Make sure the user is sitting correctly while in the wheelchair. The user should be positioned well back in the wheelchair
with the seat bones behind any pre-seat bone shelf and the back of the pelvis supported on the backrest. Consult with
your wheelchair service provider on how to properly sit the user in the most upright, balanced, and comfortable position
possible.
Some users may not be used to sitting very much, it may take time for them to become used to sitting in an upright
posture
14
. Consult with your wheelchair service provider on how long the user should sit in the wheelchair. Do not let the
user spend all day sitting in a wheelchair.
If the user has very limited movements, tends to sit in the same posture all the time and cannot change position, consult
your wheelchair service provider about other positions the user can use during the day. For example, lying or standing.
If the user is used to sitting, he/she may spend the same amount of time sitting in their new wheelchair. Gradually
increase the time, if needed.
15
If the user is not used to sitting up, start with no more than 30 minutes followed by a break.
16
Check for pressure areas under the user’s seat bones or any other area at risk every day after the user has sat in
the wheelchair.
Make sure the user cannot slide down the seat. Make sure the pelvis strap is done up firmly and keeps the pelvis positioned.
Transferring in and out of your wheelchair
A transfer requires good balance and stability from the user (if the user can transfer independently) and the person assisting
or lifting. The user and the person assisting should receive training from a qualified wheelchair service professional
before attempting to do a transfer. The wheelchair service provider should teach them a safe and quick transfer method,
according to their needs, that is comfortable and safe for both.
Before transferring the user in or out of the wheelchair, position the wheelchair sideways to the transfer surface. Every
caution should be taken to reduce the gap between the two surfaces.
Always engage the wheel locks to lock the rear wheels before the transfer and rotate the casters forward to increase the
wheelbase of the wheelchair.
Make sure all straps and chest harness are undone before transferring the user out of the wheelchair.
Make sure that no part of the user’s body hits or rubs the wheelchair while transferring. This may contribute to a pressure
sore development. Do not let the user fall abruptly in to the wheelchair. If lift-transferring, always place the user in to the
wheelchair slowly and carefully.
Have someone assisting you unless you are well experienced in transfers.
Make sure the user is seated in a good sitting position after transferring him/her in to the wheelchair.
PRESSURE RELIEF MANAGEMENT AND TECHNIQUES
Pressure sores can develop for many reasons including sitting too long, poor posture, uneven weight distribution, rubbing,
high-pressure points between the user’s body and the position support devices, lack of sensation, bowel and bladder
problems, immobility, weight, etc
17
. The user and his/her attendant should be referred to a medical professional to re-
ceive proper advice on how to prevent and manage these complications. They should also receive proper training from a
qualified wheelchair service professional on pressure relief management and techniques.
Make sure the user is sitting correctly, has good postural support and sits as upright, balanced and comfortably as
possible. Good postural support is important to help improve posture, distribute weight evenly, and reduce shear forces
which, in turn, will reduce the risk of pressure sore development
18
. Adjustment of the wheelchair and its postural support
elements may be needed. Always consult with your wheelchair service provider before making any adjustment to the
wheelchair and its configuration.
If the user has very limited movements, tends to sit with the same posture all the time and cannot change position,
consult your wheelchair service provider about other positions the user can use during the day. Changing position
regularly helps to relieve pressure. For example, change the position from sitting to lying.
Assist the user to perform a weight shift every 15-30 minutes for at least 30 seconds to 2 minutes by bending his/her
upper body forward.
19
Maintaining the weight shift for longer periods of time is recommended (up to 4 minutes.)
Do not let the user spend all day sitting in a wheelchair.
Check the pressure between the wheelchair user’s body part and the postural support devices such as the pelvis/trunk
side pads and the knee separator pad. These should fit closely and comfortably. There should be no high-pressure points.
Consult with your wheelchair service provider if you think the user has grown and adjustments to the wheelchair are
needed.
Check the pressure between the wheelchair user’s body and the pelvis strap/chest harness. Support should feel firm –
but not tight.
Check the skin for signs of pressure under the user’s seat bones and any other area at risk (e.g. under the hip joint or tail
bone) after the user has sat in the wheelchair.
A damp or soiled seat cushion can cause the skin to break down. In addition, bacteria present in feces rapidly leads to
infected pressure sores. The waste products in urine and feces can also infect sores and burn the skin. Make sure the
seat cushion is dry, clean and in good working condition at all times. Stop using the seat cushion if it is wet, let it dry first.
20
Make sure that no parts of the user’s body are being rubbed by the wheelchair, put special attention that his/her arms
and hands are not rubbing against the rear wheels while in motion. This can break the skin.
Handle the user carefully when transferring him/her in and out of the wheelchair. Hitting his/her body against the
wheelchair while transferring can damage the skin.
If you notice a red or dark mark in the user’s seat bones or any other area at risk of pressure sores, take the user out of
the wheelchair immediately. Check the skin again after 30 minutes, if the redness or change in color has not faded, stop
using the wheelchair and contact your wheelchair service provider as soon as possible.
If you notice a wound in the user’s seat bones or any other area at risk of pressure sores, stop using the wheelchair
immediately and contact your wheelchair service provider and a medical professional as soon as possible.
17
WHO (2012), op. cit.
18
WHO (2013), op. cit.
19
Titus L. and Birt J. “Applying Current Evidence to Clinical Practice for Pressure Management in Wheelchairs
and Seating” (2016) http://www.seatingsymposium.com/images/pdf/PS/PS5_Titus.pdf
20
WHO (2012), op. cit.
13
ibid.
14
WHO (2013), op. cit.
15
ibid.
16
ibid.
