Page 289 - Handbook of Electronic Assistive Technology

278 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

3� Standing during the day can be beneficial for bowel and bladder function (Dunn et al.,
1998); it can help manage constipation (Shields and Dudley-Javoroski, 2005) and
urinary tract infections (RESNA, 2013) that are associated with long periods of sitting.
4� Standing might be able to help maintain range of movement and reduce stiffness and
pain in hips, knees and ankles, although the evidence for this is sparse.
5� At school, college and in the workplace, an individual who can stand independently
throughout the day can lead a far more inclusive and independent life. In some cases,
organisations such as Access to Work will look to find a chair with a standing function
to enable the individual to be able to continue working. Education services will also
consider contributing funds toward this type of chair to maximise the student’s
potential within the school or college.
6� The need for other pieces of therapeutic equipment, such as standing frames, may be
reduced, as might the amount of care/support needed to look after an individual.
7� The shape of the anatomy changes in the transition from sitting to standing,
particularly around the buttocks; this can result in the seating supports needing to be
reduced in size to facilitate a stand, but in so doing may pose too great a compromise
for supported sitting.
8� Standing can only take place if there is sufficient hip and knee extension, range in the
ankles, feet having a shape able to bear weight and if the pelvis, trunk, shoulders and
head can be positioned in reasonable alignment. As such, it is critical that a postural
assessment be undertaken prior to provision of a standing chair.
9� Finally, standing should only be pursued if the person is comfortable, functional
and motivated to stand. Therapists and parents/carers should take care that in
encouraging use of a standing position, they are not promoting it to the detriment
of the person. If standing is not appropriate, it might be possible to achieve physical
management and the enabling of functional tasks by other means.

Drive Wheel Options

There are broadly three drive wheel options, or wheel layouts, to consider when obtaining
a powered wheelchair. Which is the most appropriate for an individual’s needs? Here we
discuss the pros and cons of each.

Rear Wheel Drive
Historically, rear wheel drive (Fig. 9-2) was the most commonly selected option. It tends to
provide a directionally stable drive outdoors, which can make the user feel more in control
of the chair and more secure in their own abilities. It is also the closest match to the wheel
layout of a car, which might be helpful where the person is/was a car driver.
Rear wheel drive chairs are sometimes less suited to very small home environments because
many (but certainly not all) take up more space to turn than other wheel configurations.
When driving up ramps into a vehicle, this configuration tends to be the easiest to
operate, partly because of the directional stability mentioned earlier, but particularly if the
ramp is steep because there is less tendency for the drive wheels to become ‘beached’, as