Page 287 - Handbook of Electronic Assistive Technology

276 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

iii� Manoeuvring inside the confines of a vehicle can be difficult, particularly
for an attendant who will often be stooped where the available height is
restricted.
iv� Some chairs can be hoisted into the empty boot; this may mean that the back-
rest must detach.
v� The testing standard for a tilting wheelchair in transportation states that the
chair must not be positioned with the seat rails inclined at more than 30 degrees
to the horizontal (ISO, 2008), but many manufacturers choose to test in the
upright position (seat rails horizontal), presumably because this reduces the
chance of mechanical/test failure. Technically, this means that the chair should
not be used in a tilted position when in transport. However, if someone has
need of tilt for postural reasons (of all the places that they are likely to require it,
travel is surely one of the top priorities), a risk assessment may be completed to
assess whether the risk of injury from failure of the chair in the tilted position is
outweighed by the risks of the chair being in the upright position and the effect
of this on the person’s posture and of their consequent inability to be aligned
with the vehicle occupant restraint. A guide to transportation has been written
by an international panel and is published on the Posture and Mobility Group
website. 1
Powered Elevating Leg Rest/s

Many wheelchair users find that being able to independently elevate their legs throughout
the day is a real benefit and they can stay in their chair much longer as a result. Giving their
legs a stretch can help manage pain in the knee and ankle joints, and in some cases can
help reduce oedema in the lower legs and ankles.
Use of elevating leg rests may reduce the risk of the development of contractures in the
knees, but a postural assessment must first be completed to establish whether the person
has sufficient joint range. In particular, the amount of knee extension available with the
hips flexed must be clearly understood, because if there is insufficient range the pelvis
1
will be pulled into posterior tilt, the person may start to slide forward and the trunk will
tend to adopt a slumped position (Pope, 2007). As such, it is not advisable to use elevating
leg rests to place these muscles on stretch.
Elevating the lower legs may change the pressure distribution through the feet, which
might be helpful for users with a history of pressure issues in that area.
Some chairs will offer manual elevating leg supports that are less expensive and do not
use one of the powered options on the control actuator (note that some control systems
will only be capable of offering two powered functions, so if the person has already chosen
powered tilt and powered recline, then it would not be possible to select a third power
function without also changing the control system, which might be costly).

1 www.pmguk.co.uk/resources/best-practice-guidelines.