Wheelchairs have evolved immensely, but especially over the past 20 years. The most recent surge in technological advances for manual wheelchairs began in the 1990s and has continued with the implementation of lighter weight material being utilized in manufacturing and the ability to truly customize a wheelchair for each individual.
Part of what has driven these changes has been the data gathered through research studies on the importance of proper wheelchair set-up for not only efficiency, but also for the client's overall health. A fantastic resource on the topic was published by the Rehabilitation Engineering Association of North America (RESNA) in 2012 that detailed research and clinical application of ultra lightweight manual wheelchairs to assist practitioners with selecting the best wheelchair for their clients: "RESNA Position on the Application of Ultralight Manual Wheelchairs".
Initially, the focus on the development and implementation of ultralight weight manual wheelchairs was on adult clients. Yet, in recent years, clinicians, manufactures, and suppliers have broaden the scope of ultralight weight manual wheelchairs to include pediatric clients. There are now options of rigid (Zippie Zone) and folding frame (Zippie X'CAPE) ultralight wheelchairs specifically designed for children.
When it comes to selecting and justifying an ultralight weight manual wheelchair for a pediatric client many of the same principles apply as to when selecting one for an adult. However, there are additional variables brought into the mix when working with a child.
While each child develops at his or her own rate, in general babies without developmental delays or disabilities begin to become mobile (crawling, creeping, and walking) around 6-12 months. It is important to give a child with gross motor delays the opportunity to explore to his environment in order promote learning and growth in all areas of development. The idea of a little one propelling his own manual wheelchair may seem a bit much, but there are alternative mobility options available to promote mobility at a young age, such as the Scooot from Firefly.
Determining what the appropriate age is to allow a child to experiment with an ultralight weight manual wheelchair depends primarily on each individual child’s physical and cognitive abilities. In my career I have worked with children as young as 10-months-old on learning independent propulsion skills. The younger a child is able to explore their environment independently, it increases the opportunity for learning while decreasing the likelihood of the child developing learned helplessness.
Similar to choosing an independent manual wheelchair for an adult the weight of the material, adjustability, modification, configuration, and proper set-up are all important when working with a child.
Depending on the size of the child, some wheelchairs may weigh more than the child. Be sure to not only look at the weight of the frame, but also pay attention to the weight of the seating system and accessories. If it's clinically appropriate consider a lightweight cushion and back that are designed for a child such as the JAY® Zip™ Cushion and Backs. You'd be surprised how fast an ounce here and there can add up.
Proper configuration and set-up are also key pieces of the puzzle. Ensuring that the rear wheels are appropriately positioned and the center of gravity is adjusted to the child's sweet spot (as far forward as possible, but not too tippy) will have a tremendous impact on the child's ability to propel the wheelchair and decrease the impact of propulsion on the child's body.
Understanding the amount of growth and how to grow a wheelchair is also essential when selecting the best option for a pediatric client. Be sure to talk with your manufacturer's representative to fully understand a wheelchair's growth capabilities. Some wheelchairs come with built-in width and depth growth capabilities or offer a growth kit that contains parts needed to adjust the wheelchair to accommodate for changes in the child's size over time. When pondering growth capabilities, it is also important to understand what adjustments can be made to other seating supports such as headrest, armrest, and leg rests.
An example of built-in growth would be the X'CAPE's Z-finity™ System's footplate can be adjusted between .5" above the seat pan to 21" below the seat pan to provide proper support as your child grows. Its rotating hardware allows for infinite adjustment of the footrest angle and placement to achieve optimal positioning of the feet, ankles, and knees.
One of the primary goals of getting a child an ultralight weight wheelchair is to get him or her as active as possible in all areas of life. While we want to encourage the child to propel himself independently as much as possible, the reality is the child may need some assistance from a caregiver at times. The addition of something as simple as push handles to a pediatric ultralight weight wheelchair may make a huge difference in the lives of a child's caregivers.
The ability to transport the wheelchair in the community via a parent's personal vehicle, on public transportation, and/or school bus is vital. When thinking about transporting the wheelchair in a personal vehicle the family should consider how the wheelchair breaks down (quick release wheels, removable seating, fold down back, folding frame, etc.), the number of steps that go into breaking the wheelchair down and reassembling the wheelchair, and the weight of the components. Each wheelchair is different especially when considering a rigid frame wheelchair versus a folding frame.
As mentioned previously, the Zippie Zone is a rigid ultralight weight pediatric manual wheelchair so the frame does not fold; however, a Zippie Zone can be configured with features such as fold down back or removable back, removable seat cushion, quick release rear wheels, and other removable accessories to decrease the weight and make it compact for transporting.
When it comes to a folding frame option, the Zippie X'CAPE has a crossbrace which allows for the wheelchair to be folded. The X'CAPE's convenient one-step push-to-lock and pull-to-fold functions are easy to operate with just one hand. In addition, removable equipment such as the seat cushion, back, rear wheels, etc. can be configured on the X'CAPE to assist with transporting the wheelchair. I always encourage parents to bring the vehicle they are planning to transport the equipment in to the appointment, so they can get experience the process.
If the plan is to transport the child in his wheelchair, it is absolutely essential for the caregivers and school team to understand all of the steps that go into properly securing the wheelchair and restraining the child in the vehicle. The X'CAPE's convenient one-step push-to-lock and pull-to-fold functions are easy to operate with just one hand.
Last, but not least, give the child the opportunity to express himself through the selection of colors. Nowadays clients not only have the ability to choose the color of the wheelchair frame, but on some brands they can also choose the color of a back shell and fabric bands on cushions. It's amazing how a splash of color can impact a user's overall satisfaction with his wheelchair.
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