When to choose electrical functions for tilt, recline and leg support on a wheelchair?
Electrical functions are a great tool to enable independence for wheelchair users that can operate the functions themselves. The electrical functions can also be a relieve for the care givers not having to use their strength to change the seating position of the user.
The purpose of the electrical function is to increase the ADL for the user through:
- A more comfortable seating position
- Frequent change of seating position
- Avoid pain and pressure ulcers
- Being able to spend longer time in the chair – and thus being with friends and family
The tilt, recline and the elevation function of the leg support are designed to create an optimum seating position for the user. These functions can influence the seating position directly, and in that way the impact on the muscle-skeletal system and the skin.
For the user, it is not always easy to operate these functions manually. By making these functions electric, the user can activate these functions more frequent and influence the seating position – and thereby the impact this has on the muscle-skeletal system and the skin. We see it as a very important factor that the user in this way can create control in his/her own life and situation.
Therefore, if the user is using a manual wheelchair as their primary means of mobility, and they are unable to weight shift independently and effectively, then we recommend considering adding electric functions to the manual wheelchair.
Netti III EL
The Netti III EL is the Netti wheelchair with electrical functions and the only wheelchair on the market that offer 3 electrical functions:
- Electrical tilt
- Electrical recline
- Electrical leg supports
Tilt
Tilt allows you to change your seat angle orientation in relation to the ground while maintaining a constant seat to back angle and seat to leg support angle. In this way the angle in the hip and the knee remains unchanged. Changing the tilt can be required when:
- Pressure relief is needed
- There is an anterior tendency of the user (tendency to fall out of the chair)
- There is a need to position the head correctly on the trunk as with e.g., strong kyphosis and reduced hip flexion
- Driving down hills /slopes
An electric tilt function will make it easier to change the pressure to a different area, the wheelchair user can easily operate this by itself. Variation will help to prevent pressure ulcer. Easier access will often mean that it will be used more frequent. The high frequency is important when reducing the chances for pressure ulcer.
Since the Electric tilt can be operated from various positions by the attendant, it also can make the tilting more secure for the user who is more dependent on assistance, since the attendant can be closer to the user, have eye to eye contact, observe the facial expression etc.
Recline
Recline allows you to change the seat to back angle while maintaining a constant seat angle with respect to the ground. Recline can be useful when:
- You want to change the position of the hip, open-up or close the “hip” angle
- There is a need to allow for better respiration, allow the chest/diaphragm to have a larger movement range and helps the lungs expand.
- Transfer in and out of the wheelchair with hoist will be made easier when recline can be used to put the hoist in place before and being removed after the transfer.
Keep in mind that incorrect use of the recline can be the cause of:
- Pressure ulcer. Increased recline without tilt or with the incorrect amount of tilt, will make the user slide out of the wheelchair at worst case. Before that happens, the shear force will increase, and deep tissue deformation will occur, and pressure ulcer development processes will start.
- Incorrect seating position, which loads the muscle-skeletal system in a negative way and pains and ulcers can occur.
- Incorrect position of the head on the trunk which can lead to eating/drinking, speech and breathing problems.
It is essential that the recline angle will be set back to the correct position after having been used, since the recline angle has a very strong influence on the seating position and can easily influence this is a negative way. For most users it will be important to add extra tilt to the wheelchair before adding recline to avoid this negative influence on the seating position
An electric recline function will make it easier to access the function and make the function more secure for the user, since the attendant can be closer to the user, having eye to eye contact, observe the facial expression etc. It will also allow the user to operate the function by itself.
Elevating leg supports
Elevating leg supports allow the user to change the leg angle relative to the seat to flex or extend the knee. The most important functional detail of the leg support is the position of the axis of the leg support, compared to position of the joint of the knee. These 2 need to be aligned or else shear forces start to occur as soon as the angle of the leg support will be changed. Loss of correct seating position and increased risk to develop pressure ulcer is the result.
Having the leg support in elevated position can be recommended for pain, and lower extremity swelling/oedema.
Electric elevating leg supports makes it easy for the user to change the position of the legs. When swelling and or pain is the challenge, frequently elevation can be indicated. It is often difficult, if not impossible for the user to do this when manual leg supports are mounted to the wheelchair.
Electric functions as a total:
Electric functions to the manual wheelchair can give the user the best outcome to meet their individual goals. Fitting and education on how to effectively use these electric functions for positioning, for pressure relief, for comfort and relief should be part of the treatment plan with a focus on post-delivery training and follow-up.