After 25 years of marriage, my husband, the man who vowed to love me forever, dumped me on Fifth Avenue in New York.
I was riding in a manual wheelchair and Jim was pushing me. The light turned green and he shoved my chair into the crosswalk. In an instant, I tumbled headfirst into the intersection and landed in the street.
Before the light changed, several people picked me up and plopped me back into my wheelchair. Luckily, I was uninjured, but Jim was mortified. He slowed his pace and was cautious at the deeply angled curbs.
Being safe in a wheelchair requires anticipating potential problems, using common sense, owning the proper equipment and communicating with assistants.
At home, I use a power wheelchair. However, when we travel, I frequently switch to a manual chair because everywhere we go is not accessible. I’m accustomed to controlling the speed at which I move (full blast) and relinquishing that control is not easy. Frankly, it can be dangerous, especially as I age and my disease progresses and my functionality changes.
My Olympian somersault in New York City could have been avoided. I should have worn a seatbelt. I should have held onto the arms of the chair and not a purse. Jim needed to slow down. He could have exited the curb backward (admittedly, not easy at a pedestrian-packed corner).
For more than a decade, I have been using wheelchairs. Yet, somehow I still manage to get myself in dangerous situations. Most of my wheelchair safety knowledge has come from having accidents and near mishaps. There is a better way.
|Pride mobility safety flag|
“Ideally, the purchase of a wheelchair should be a partnership between the client and his family, a clinician or therapist and a certified supplier,” says Jean Minkel, a spokeswoman for the American Physical Therapy Association.
Wheelchair safety begins before you buy the chair. “A client evaluation will determine what type of postural support is required, the condition of skin to prevent pressure sores and how the individual is able to get around. A manual chair may be ‘optimally configured’ and work well for one client. However, the fatigue factor of people who have neuromuscular diseases might be better served with a power chair,” Minkel says.
“Every person’s needs are individualized,” says Ken Bagot, an assistive technology practitioner (ATP) and certified rehabilitation technology supplier (CRTS) with Mr. Wheelchair in Metairie, La. Simply selecting the type of controls depends upon the client’s physical abilities. Getting clients seated properly is imperative to their comfort and safety. “Posture has an impact on digestion and breathing, which are harder if the person is hunched over. Safety begins with sitting upright, looking forward and being able to clearly see to the left and right.”
Minkel recommends, “Find a team when you’re getting a new wheelchair. Do not just rely on a salesperson dropping it off at your door. Your initial experience with a new wheelchair should be supervised.”
The therapist will be watching to see how much body awareness the client has. It is common for people with neuromuscular diseases to lose trunk strength and stability. For example, I’ve noticed that staying upright as I exit the ramp of my minivan takes more effort. This is “body awareness” and may indicate that I need a chest strap or seatbelt.
A team of experts might include a physical therapist, occupational therapist, physician and ATP. You can locate certified professionals by contacting Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) at (703) 524-6686.
Bagot works with numerous children and adults with neuromuscular diseases. He chuckles as he notes that everyone wants a fast ride. He prefers to start clients at a slower speed until they become comfortable with a new chair. When working with children, he recommends parents buy an emergency lock switch, a device like a car lock that allows a parent or caregiver to remotely turn off a child’s chair. Another option is an attendant control that allows a caregiver to drive a power wheelchair.
“Whether you’re getting your first wheelchair or buying a new one, it is important to receive instructions on how to properly use the chair,” says Mark Sullivan, vice president and category manager for rehab products at Invacare.
|Rascal three-wheel scooter with magnetic stabilizer wheels|
Know how to release the brakes
When Bagot instructs clients on the features of a new power chair, he always explains how to manually release the brake in the event the chair needs to be pushed. If a chair stops while you’re crossing a street, it’s imperative that you can quickly articulate to a stranger how to disengage the brakes. Usually, this requires turning one or two levers on the base of the chair.
Protect your chair
Bad weather and wheelchairs are not a good combination. The joystick on power chairs should be kept dry. I usually carry plastic bags in my wheelchair pocket in the event I’m caught outside without an umbrella. Snow is also an enemy to electronics. Ice and snow can affect the traction of wheelchair tires. If you live in an area with a harsh climate, consider getting knobby tires that grip better. Also, try to keep a small umbrella or rain poncho with you.
Stay in touch
Always carry a cell phone and make sure someone knows where you are going.
Communicate with your helper
Face it, no matter how independent you are, there will be situations when someone else pushes you in a wheelchair. Perhaps it’s at a hospital, boarding a plane or while on vacation. “You need to exercise control and establish communication,” says Minkel.
When Jim is pushing me, I’m always watching for potholes. As we stroll down the sidewalk, I frequently shout, “Hole, hole, hole!”
The little casters on the front of a manual chair can get stuck in a small hole and stop the chair from moving. The passenger will be thrown forward, which is what happened to me in New York City.
The steep angles at curbs and curb cuts can be extremely dangerous. Menkel, who works in Brooklyn, advises that the best way to cross the street while riding in a wheelchair may be to sit through the first “Walk” signal if there are other pedestrians present. After the pedestrians move out into the crosswalk, turn the chair around and move up to the front of the curb. When the light turns green a second time, enter the crosswalk backward and use caution.
Wheelchairs should be inspected periodically to ensure they’re working properly. Ask the vendor what tools you should have on hand to make minor adjustments. Be sure you understand how the charger works. Sullivan suggests wheelchairs be inspected every six months. Some of the most common problems are batteries that need replacing and worn tire tread.
When riding in a car, the ideal is to transfer from the wheelchair, ride in a standard seat and use a seatbelt, says Minkel. But for some, that’s not an option. If you’re traveling in your own vehicle, a lock-down system such as EZ Lock (225-214-4620) can be mounted to your vehicle. Transit tie downs are an accessory sold by most wheelchair manufacturers that permanently attaches four rings to the wheelchair, so tie-down straps can be used to secure the wheelchair in other vehicles.
The varieties of accessories or options that come with a wheelchair are similar to buying a new car. “Standard” features vary from one manufacturer to another. For example, for most manual chairs, anti-tippers are an accessory. However, anti-tippers are usually standard on power chairs.
Additional options may include a positioning belt, flag and a variety of holders for everything from your coffee cup to an oxygen tank.
For more on safety accessories, see “Wheelchair Safety Items Resources” in InfoQuest.
|Auto transit tie-down bracket|
Any time your environment or your wheelchair changes, it can be a potential safety challenge, warns Jerry White, Pride Mobility’s vice president of global power chair products. Even taking a different route home or eating in a new restaurant may present new obstacles.
Even old environments can be “new” when the weather changes. When I wanted a closer look at the flowers blooming in my back yard after a rain, I rolled my wheelchair outside, my tires spun and I was stuck in the mud. No one was home except me. I did not have a cell phone on me. Threatening clouds were moving in and I was being eaten up by mosquitoes. Three houses down, I could see a little boy jumping on his trampoline. I called to him and he got his dad, who came down and rescued me.
Bottom line: You must be constantly observant of the terrain, people around you, and every incline or pothole. I spend a lot of energy looking for potential problems.
Even if you’ve had your chair for a while, dig out the manual and read through it. What you learn might save you from an embarrassing or downright dangerous experience.
You also can learn more about your specific wheelchair by visiting the manufacturer’s website. Pride has a chat room for owners (click on “Owner’s Club”) and Invacare has a blog. Both give wheelchair users the opportunity to ask questions that may make riding safer.
Barbara Twardowski and Jim Twardowski, R.N., of Mandeville, La., are frequent Quest contributors. Barbara has Charcot-Marie-Tooth disease.
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