An illustration of a man with a stroke, pushing his wheelchair with one hand.

Wheelchair considerations: Stroke

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All clients should be provided with a safe and durable wheelchair that provides proper fit and postural support and suits their local environment [1].

This online factsheet highlights four key considerations for people who have had a stroke.

Pressure risk

Some people who have had a stroke have impaired sensation and are at high risk of developing a pressure sore. Therefore:

  • Assess the pressure risk for each client carefully considering the person’s skin condition, sensation and ability to relieve pressure
  • For those at risk, provide a pressure relief cushion and check pressure under the user’s seat bones and any other possible pressure areas during the wheelchair fitting
  • Provide a spare cushion if incontinence is an issue.

Wheelchair set up

Many people who have had a stroke are able to stand up to get in and out of their wheelchairs. To make standing transfers easier, clients often prefer wheelchairs with armrests to push up on, and footplates that can flip up or away.An illustration of a man with a stroke, pushing his wheelchair with one hand and one foot.

People who have had a stroke may be unable to propel with their affected arm; however may be able to propel using one arm and one leg (foot propelling). To foot propel, set up the wheelchair so the:

  • Seat height (measured from the top of the cushion) allows the user’s foot to sit flat on the ground.
  • Seat depth allows the user’s foot to reach under the seat to increase pushing efficiency [2].
  • Rear wheels are positioned to allow as active a position as possible, in order to make propelling by user or attendant as easy as possible.

Postural Support

People who have had a stroke need good postural support from their wheelchair to reduce fatigue and prevent secondary complications. Ensure:

  • The backrest, seat, cushion and footrests are correctly fitted.
  • Tension on canvas seats and backrests is maintained to avoid sagging.

Also consider:

  • Support for the user’s affected arm with a cushion or armrest.
  • A pelvic belt to keep the pelvis in a good position and prevent the user sliding forward when pushing.

Client Education

All wheelchair users benefit from learning how to use and look after their wheelchair. Many people who have had a stroke will need assistance from family members, so always involve them in training. Information and skills particularly important for people who have had a stroke includeIllustration of a woman completing a standing transfer from her wheelchair to her couch.

Importance of good posture including how to:

  • Maintain good posture.
  • Re-position within the wheelchair with and without assistance.
  • Correctly use any additional postural supports that have been provided.

Mobility skills training: Some specific areas to focus on include:

  • Most effective self-propelling method.
  • Helping the user and their family members to feel confident about assisted propelling in different environments.
  • Transferring safely in different situations, focusing on maximising the user’s independence.

Download a copy of the factsheet.

 


For more information contact:

Motivation Australia

info@motivation.org.au

Website: www.motivation.org.au

References:

[1] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva

[2] Zollars, J.A., 2010. Special Seating: An illustrated guide. Prickly Pear Publications, USA.