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Issue_H November 2013 13 Dash Life
7. HANDLING & STABILITY ON STEPS & SLOPES
A little forward planning can eliminate difficult
manoeuvres such as steps. Modern public buildings
should provide permanent wheelchair ramps, with a
practical slope angle, built according to regulations, for
safe access.
Technical Test data on stability of wheelchairs should be
seen as a tool for comparison. Data does not convey
actual feel of the wheelchair in the intended
environment. Initial supervised user training and
assessment by a rehabilitation professional, with the
wheelchair in the intended usage environment is
recommended, and users should ensure that they are
confident with regard to this aspect of use.
An important factor in considering accessibility and
slopes is the effort demanded from the occupant or
attendant using the chair (attendant brakes are an
available option). Pushing up a steep slope which
extends over a distance, may create a need to stop and
rest, which in turn demands additional and undesirable
effort to start back upwards again. Stopping a
wheelchair on a steep downward slope also demands
effort and control, and surface conditions need to be
taken into account when deciding what outdoor route to
take. Manoeuvres, which demand over exertion, may
create risk of injury to the user and should be avoided.
However, if in temporary difficulty, wheelchair users
should not hesitate in asking for assistance from people
nearby, someone will usually be happy to help.
Modern buildings should have slopes built to a required
standard angle, but this is not the case with all access
areas. Learning the geography of an area is important.
As an all round guide, a maximum safe slope of 8
degrees is our recommendation for the R Healthcare
range of manually propelled wheelchairs. However this
recommendation may need to be changed if the
wheelchair has attachments added to it, such as an
elevating legrest or carry bag, which adversely affects
stability.
Such changes to the chair specification may
have a critical effect, and they require re-assessment by
rehabilitation professional.
Where possible, the hazard of negotiating steps should
be avoided. Many falls and injuries to both occupant and
helper can occur when inexperienced people are
carrying out this operation, and if users or carers are
concerned about a particular hazard in the usage
environment, which they must regularly overcome, they
should consult their wheelchair rehabilitation service, or
community services department, as appropriate.
DO NOT ATTEMPT SIDE TRANSFER ON
SLIPPERY OR UNEVEN FLOORS
There may still be occasions when steps must be
negotiated. In the event of the chair having detachable
pushing handles, these should be checked for security
in the locked position before attempting this
manoeuvre. Stabilisers may require removal if they
interfere with the chair balance angle on a flight of
steps. This should first be checked out with an
unoccupied chair.
Two attendants at least are required for this operation.
The attendant supporting the main load should grip the
chair at the push handles, and repeat the procedure as
section 2.6 for getting down a kerb at each step, the
second attendant at the front will be required to guiding
the footrest area, and provide reassurance to the
occupant. A third person could act as guide for the
chair team if the steps are high. Reverse this
procedure for going up a flight of steps, with the
attendant supporting the main load at the push handles
pulling, and the second attendant at the front guiding
the chair using the corner of each side frame.
Specialist training for very experienced users to
negotiate a flight of stairs independently is available,
but this is beyond the context of this guide.
8. SEATBELTS (ALSO POSTURE BELTS)
The fitting of these should be considered in all
circumstances where the chair is used outdoors, over a
sloping surface or kerbs. Belts normally secure the
occupant by means of a quick release buckle in the
centre. In cases where the seatbelt is part of the
postural/ clinically assessed needs, provision of a
seatbelt will be covered by a clinical assessment.
A basic security seat belt may become required after a
period of use, if the environment or method of use
changes, or where the occupant feels a need for
greater security in the wheelchair. These can be fitted
retrospectively by a fully trained and competent
technician, but if unable to utilise any of these
instructions, contact either your NHS rehabilitation
engineer
or the manufacturer of the wheelchair.
A correctly fitted posture belt should fit over a user’s
pelvis at approximately 45 degrees from the anchor
without obstruction from any part of the wheelchair (e.g.
skirt guard or armrest). The posture belt should be
adjusted so as to fit snugly around the user’s pelvis to
provide an appropriate sitting position. The adjustment
of the belt must be carried out by a competent person
who is able to assess the client’s needs and frequency
of checking of the belt adjustment.
Future reviews of an individuals needs should include
consideration of the appropriateness of the posture belt
and its method of adjustment, fastening and release
especially where a users’ or carers’ capabilities change
over time.
SAFE SLOPE OF 8 DEGREES FOR MANUAL
WHEELCHAIRS, DYNAMIC STABILITY ON PAGES
23, 24 & 25
