This month I have been asked by a clinician how can we determine what is the optimal manual wheelchair set up for an upper limb propeller. To answer this question we must first consult a few important resources:

• Position on the Application of Ultralight Manual Wheelchairs: www.resna.org 
• Preservation of Upper Limb Function Following Spinal Cord Injury: www.pva.org

What is it?

• 35 clinical guidelines to help optimise chair set up to prevent upper limb injury
• Focuses on
  • // Education 
  •  // Propulsion technique 
  • // Equipment selection 
  • // Wheel position 
  • // Recommendations are transferable to other user groups

Optimal set up

Rear wheel:

• Tip of middle finger at centre of hub (another method to support CPG 9)

• Why? So Centre of Mass (for maximum manoeuvrability) is positioned over hub of wheel
• 70-80% of user weight over rear wheels (CPG 8 - Adjust the rear wheel as far forward without compromising stability)

• 120° of elbow flexion at top of push cycle (CPG 9 - hand top dead centre – elbow angle should be 100-120°)
• Optimal wheel access – 10 to 2 (CPG 5 - avoid extreme positions of the wrist)

• Use wheel camber – increases lateral stability and brings top of wheel closer to user – more efficient push phase (RESNA 2012)

Front castors:

• 20-30% user weight over castors
• Use smallest castor fork – reduces turning circle and obstruction with feet or footplates

Why?

// Minimise resistance to turning & more efficient propulsion

// Provides compromise between indoor manoeuvrability and outdoor terrain navigation

Quickie wheelchairs are designed to be easily configurable to meet end user needs and also set up according to these guidelines:

// Folding frame wheelchairs – Q2, Q2 Lite, Xenon2, Xcape

// Rigid Framed wheelchairs – 7R, 5R

RESNA (2012) emphasise the importance of achieving an optimal set up for all manual wheelchair users to maximise function and independence and reduce potential injury advising that: “The person cannot conform to the wheelchair, but the wheelchair must conform to the individual.”