Role of the Wheelchair

Original Editor - Priya Gulla Top Contributors - Naomi O'Reilly, Kim Jackson, Lucinda hampton, Jess Bell, Simisola Ajeyalemi, Lauren Lopez, Priya Gulla, Amrita Patro and Samuel Adedigba  

Introduction

Wheelchair

The wheelchair is one of the most commonly used assistive devices to promote mobility and enhance quality of life for people who have difficulties in walking (e.g. a person with spinal cord injuries resulting in quadriplegia or paraplegia, muscular dystrophy,etc). Wheelchair mobility opens up opportunities for wheelchair users to study, work, engage in social activities and access services such as healthcare. In addition to providing mobility, anappropriate wheelchair benefits the physical health and quality of life of the users by helping in reducing common problems such as pressure sores, progression of deformities and improve respiration and digestion.

To ensure effective mobility, wheelchair users need a wheelchair which fits them correctly and meets their specific needs. However statistics show that about 10% of the global population, i.e. about 650 million people, have disabilities and of these, some 10% require a wheelchair. It is thus estimated that about 1% of a total population, or 10% of a people with a disability, need a wheelchair, i.e. about 65 million people worldwide.

In addition, it was estimated that in 2003, 20 million of those requiring a wheelchair for mobility did not have one. There are indications that only a minority of those in need of wheelchairs have access to them, and of these very few have access to an appropriate wheelchair.

Benefits of a Wheelchair

Wheelchair provision is not only about the wheelchair, which is just a product , rather it is about enabling people with disabilities to become mobile, remain healthy and participate fully in community life. A wheelchair is the catalyst to increased independence and social integration, but it is not an end in itself. The benefits for using an appropriate wheelchair are:

Mobility

Wheelchairs help people to get around with the greatest possible independence and do the things they want to do. Wheelchairs provide you freedom to move around as you wish. Most wheelchairs are designed to fit into small, tight spaces. This allows you to move within your home more easily giving you a more comfortable and active lifestyle.

Independence

Difficulty with ambulation, need to frequently lean on someone or hold onto their arm as they walk next to you, decreased balance fear of falling can cause individuals to become isolated from friends and family. A wheelchair that is functional, comfortable and can be propelled efficiently can result in increased levels of activity. Independent mobility and increased physical function can reduce dependence on others. Thus, wheelchair user's can be more independent and more in control of their own life. Individuals who experience the least discomfort when sitting are often more productive. Users who are able to spend more time in their wheelchair will have more opportunities for participating in day-to-day life along with others in the household, greatly improving their quality of life.

Health

A wheelchair can improve the user's health in many ways. A wheelchair that is functional, comfortable and can be propelled efficiently can result in increased levels of physical activity, thus improving both physical and mental health. A well fitting wheelchair with cushion combined with adequate user training can reduce common problems, such as pressure sores, the progression of deformities or contractures, and other secondary conditions associated with poor postures. Other benefits, such as improved respiration and digestion, increased head, trunk and upper extremity control and overall stability, can be achieved with proper postural support. Maintenance of health is an important factor in measuring quality of life. These factors combined serve to increase access to opportunities for education, employment and participation within the family and the community.

Self Esteem & Self Confidence

Wheelchair users may become more confident and have more self esteem when they have a wheelchair that fits them and which they can use well.

Quality of Life

With maintenance of health there is increase access to opportunities for education, employment and participation within the family and the community. These factors also contributes in increasing quality of life of wheelchair user.

Access to Community Life

With a wheelchair, wheelchair users can be more involved in community life. For example, it enables the user to go to the work or school, visit friends , attend places of worship or other community activities.

Economy

A wheelchair often makes all the difference between being a passive receiver and an active contributor. Economic benefits are realized when users are able to access opportunities for education and employment. With a wheelchair, an individual can earn a living and contribute to the family’s income and national revenue, whereas without a wheelchair that person may remain isolated and be a burden to the family and the nation at large. Similarly, a wheelchair that is not durable will be more expensive owing to the need for frequent repairs, absence from work and eventual replacement of the wheelchair. Providing wheelchairs is more cost-effective if they last longer (10). It is also more cost-effective if users are involved in selecting their devices and if their long-term needs are considered (11). For society, the financial benefits associated with the provision of wheelchairs include reduced health care expenses, such as those for treating pressure sores and correcting deformities. A study from a developing country reported that in 1997, 75% of those with spinal cord injuries admitted to hospital died within 18–24 months from secondary complications arising from their injuries. In the same place, the incidence of pressure sores decreased by 71% and repetitive urinary tract infections fell by 61% within two years as a result of improvements in health care training and appropriate equipment, including good wheelchairs with cushions (12).

Challenges for Wheelchair Users

Financial Barriers

Some 80% of the people with disabilities in the world live in low-income countries. The majority of them are poor and do not have access to basic services, including rehabilitation facilities. The International Labour Organisation (ILO) reports that the unemployment rates of people with disabilities reach an estimated 80% or more in many developing countries. Government funding for the provision of a wheelchair is rarely available, leaving the majority of users unable to pay for a wheelchair themselves.

Physical Barriers

Majority of wheelchair users are poor, with inaccessible surroundings. They also live where road systems are poor, there is a lack of pavements, and the climate and physical terrain are often extreme. In many contexts, public and private buildings are difficult to access in a wheelchair. These physical barriers place additional requirements on the strength and durability of wheelchairs. They also require that users exercise a high degree of skill if they are to be mobile.

Access to Services

In many developing countries, only 3% of people with disabilities who require rehabilitation services have access to them. According to a report of the United Nations Special Rapporteur, 62 countries have no national rehabilitation services available to people with disabilities. This means that many wheelchair users are at risk of developing secondary complications and premature death that could be avoided with proper rehabilitation services.

Education and Information

Many users have difficulty in accessing relevant information, such as on their own health conditions, prevention of secondary complications, available rehabilitation services and types of wheelchair available. For many, a wheelchair service may be their first access to any form of rehabilitation service. This places even more emphasis on the importance of user education.

Personal Choice

Users are rarely given the opportunity to choose the most appropriate wheelchair. Often there is only one type of wheelchair available (and often in only one or two sizes), which may not be suited to the user's physical needs, or practical in terms of the user's lifestyle or home or work environment. According to the Convention on the Rights of Persons with Disabilities, “States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities … by facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost”.

References