Appeared in the
Hospital News, Volume 16, No. 6, June 2003
Long term wheelchair use may lead to stress injuries for People with Disabilities according to Mr. Bruce Taylor Seeman's Article in the 2000 Newhouse News Service. America's wheelchair users were encountering a new set of modern maladies due to using their wheelchairs. The population of wheelchair users outside nursing homes in the United States climbed sharply from 720,000 in 1980, to an estimated 2.2 million today; however, more active and independent lives have also led to torn shoulder muscles, pinched wrist nerves, wrenched backs and sores on legs and backsides.
A large group of doctors and engineers dissected the phenomenon, testing new theories about the human body, the wheelchair and the complex physiology of hand to wheel repetitive motions. Rory Cooper, Director of the Human Engineering Research Laboratories at the University of Pittsburgh stated that, "Our society basically said it doesn't matter. If you need a wheelchair, give up"! The wheelchair's plodding evolution tells much about society's awkward relationship with People with Disabilities. In the 1700's, wheelchairs were heavy and cumbersome, more like hospital equipment than mobility aids. A century later, the needs of thousands of Civil War amputees led to lighter wheelchairs, but those veterans were institutionalized. In another 80 years, soldiers injured in the early stages of World War II were issued with those same Civil War wheelchairs. It was interesting to note that Franklin D. Roosevelt, discontented with the clumsy wheelchairs during his presidency, preferred a kitchen chair fitted with wheels. Bob Hall, the first athlete to use a wheelchair to complete the Boston Marathon, recalled pulling apart one of those archaic chairs. "It had stuff I did not need such as armrests, push handles, brakes". Hall eventually became the President of Newhall's Wheels, and with a lighter, simpler frame, plus wheels angled for stability, his wheelchair was coveted by other riders stuck in standard, clunky chairs.
Lightweight wheelchairs weigh between 25 and 40 pounds, and they offer modest adjustments, such as movable armrests. Ultralights may weigh as little as 15 pounds, but approximately 6 in 10 Americans still use the Depot design as they cost a mere $200.00; however, their weight and lack of adjustability created injuries. As a result, further surgery and rehabilitation might cost as much as $100,000.00 which represents a lot of wheelchairs at $200.00 per purchase. At least 50,000 U.S. wheelchair riders required emergency room treatment each year according to Researchers at the University of Pittsburgh. For example, most were hurt in "tip and fall" accidents, but 50 per year would die according to Dr. Lee Kirby, Professor of Physical Medicine and Rehabilitation at Dalhousie University in Halifax, Nova Scotia.
The University of Pittsburgh's Research Laboratory, housed at the Veterans Administration Pittsburgh Health Care Centre, launched groundbreaking tests of machines and bodies. For example, to test how wheelchairs hold up in weather, they were placed in a giant box that became as hot as 160 degrees and as cold as 40 below zero. The chairs were run through an obstacle course to measure maneuverability and perched on rolling drums that simulated bumping over a tree root or sidewalk cracks 800,000 times. One test had a wheelchair with a dummy roll up a ramp to measure the angle at which it would tip over backward. More complex tests investigated developing secondary problems. For example, a patient's seating was evaluated by a device that used sensors to measure the pressure on their thighs and buttocks, which may have led to a change in seating angles or cushions to avoid pressure sores. Another test had patients pushing a stationary wheelchair while computers measured the complicated mix of muscle forces and body geometry. A sensor on the wheel computed how hard a patient worked each joint. To record the body mechanics, special cameras followed 22 dime sized infrared sensors that had been attached to the patient's arms, legs and torso. A monitor depicted the sensors on a blank background; and therefore, the rider looked like a constellation in motion. Researchers were able to pinpoint many problems during such tests. For example, a patient's hand stroke may be too short or too forceful; their torso may lean too far forward, and their hand may twist inward; the wheelchair's push rim may be too narrow, or the wheel position may require a backward reach.
Despite the researcher's attempts to minimize overuse or improper biomechanics, a patient's rotator cuff may become inflamed and tear. Similarly, they may encounter Carpal Tunnel Syndrome due to overuse and strain. Such symptoms exemplified the types of warnings that terrify people who completely rely on their arms; however, while attending the People in Motion Show last year, I discovered even better designs for wheelchairs. These wheelchairs were extremely light weight, pleasing to the eye, and maneuverable; however, they would be limited to use for people with paraplegia. Power wheelchairs have also come a long way; they are more streamlined and functional, and had tilt options to relieve pressure. This is extremely encouraging for people who face a lifetime using a wheelchair, and hopefully in the future, there will be even more options available.
