All clients should be provided with a safe and durable wheelchair that provides proper fit and postural support and suits their local environment [i]. This online factsheet highlights four key considerations when providing wheelchairs for people who have had a single or double lower limb amputation.
A large number of amputations are due to diabetes complications. Diabetes reduces sensation and blood flow, increasing the risk of pressure sores.
For people with diabetes:
- Assess pressure risk carefully
- Provide a pressure relief cushion
- Check the overall wheelchair fit for other possible areas of high pressure, paying particular attention to their residual limb and/or foot.
Wheelchair set up
Clients with high or double amputations do not have the weight of their leg(s) to stop their wheelchair from tipping backwards1. Therefore:
- To improve the user’s balance in the wheelchair and reduce the risk of tipping, position the rear wheel axle in the ‘safe’ position (behind the clients shoulders).
- For some users, as they gain confidence and experience, it may be possible to review the wheelchair set up and move the rear wheel axle position to a more active position.
For users with a below knee amputation, not using a prosthesis;
- Provide a stump board to avoid swelling, pressure and contractures of the residual limb.
Good postural support reduces fatigue and can help to prevent secondary complications. Ensure:
- The backrest, seat, cushion and footrests are all fitted correctly
- The height of the backrest does not interfere with shoulder movement when the user is propelling.
- Tension on canvas seats and backrest is maintained to avoid sagging.
All wheelchair users benefit from learning how to use and look after their wheelchair.
Information and skills of particular importance for people with diabetes are to:
- Wash, dry and inspect their remaining foot everyday;
- Wear an appropriate shoe even when in the wheelchair.
- Check all areas of skin with reduced sensation for signs of pressure.
Provide mobility skills training, ideally with the assistance of a peer trainer. Mobility skills training should include:
- Correct pushing technique (long circular push strokes)
- Propelling over different terrain
- Managing obstacles (steps, kerbs, rough ground)
- Transferring in different situations
When carrying out mobility skills training, remember to:
- Check the wheelchair set up (see Point 2) to ensure the wheelchair is not too ‘tippy’. Adjust if needed.
- Provide a ‘spotter’ to make mobility skills practice safer. Propelling may feel different if the user is wearing a prosthesis – practise with and without.
Users may also use crutches or a walking frame, and will benefit from gait training to use these effectively.
Support services in the Pacific to continue to provide treatment for wheelchair users and those who have had an amputation by donating to Motivation Australia.
[i] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva.