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.
Today I will focus on the subject of tilt in space. I was recently asked what is the recommended degree of tilt for an individual for maximal pressure relief? To answer this we must first ask a few questions.
When the rear axle is set correctly for a self-propelling manual wheelchair user the wheelchair feels better and opens up the most independent performance. Set poorly and the wheelchair can become unstable, painful and even more immovable than the current parliamentary Brexit debate.
One of the first concepts most high-end manual wheelchair prescribers learn is that, generally, moving the rear axle forward makes propulsion easier but reduces the rear stability. This isn’t inherently a bad thing, as a little rearward ‘tippiness’ is needed to clear small everyday obstacles.
Have you ever sat in a chair and tried balancing yourself by tilt backwards onto the back two legs of the chair? (I am not recommending anyone try this while sitting in a chair - it can be dangerous and you can fall backwards and get hurt! I just realize that it is something I have done in my youth and I have seen my own children do it, too - and, of course, I cautioned them against it.) Perhaps you held onto the table in front of you and used your arms to push yourself backwards to find the balance point? You may remember doing this when you were a child in either grade school or high school. Some of you may have experienced going past the tipping point and having the chair fall behind you or if you were lucky enough, you quickly recovered by moving your weight forward to prevent falling backwards.
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