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    Manual chair for c4/5 quad?

    I mentioned in a recent thread that I met a guy at a local specialty care facility that has a c4/5 SCI. He has been injured for 10 years and has never had the opportunity to try using a manual chair, only power. I have an old ZRA that I would like to try to see if I can get setup for him to use, either to push around in when he wants to or for ease of loading/transportation if someone drives him somewhere. As I also said in the previous thread, I don't have much knowledge about the ins and outs of cervical SCI's. For those of you with more experience with this injury level, I have a few questions:

    1. At c4/5 how well can you push a manual chair?
    2. When do you use it vs your power chair?
    3. Do you prefer more grip on a knobby tire to push, but with more rolling resistance, or less grip to push but with a standard high pressure tire with less rolling resistance?
    4. What all do I need to put back on the chair (arm rests, seat belt, etc.)?
    5. Will he need some sort of chest strap?
    6. Should I put the backrest as high as I can get it?

    Any other suggestions would be great. Thanks in advance.

    #2
    A C4/5 should probably not be pushing a manual chair, except perhaps for a very limited time inside one's home. The downsides vastly outweigh any upside.

    If one gets projection (high or low) hand rims one can do damage to the lower thumb joints. With or without projection hand rims one will probably wind up pushing off the tire with the lower palm and wrist area setting yourself up for carpal tunnel and other serious and difficult to treat wrist problems, which I now have.

    There are other reasons I can go into but these are some of the main ones that come to my mind, and I am C7.

    Comment


      #3
      Is the injury complete? If so I'd have to agree with crags. Your dealing with no trunk, triceps, hand grip .... His ability to control a manual would be very limited and his arms, chest, shoulder muscle structure would also be very limited. But a lot of quads are incomplete (like me) and there abilities have to be evaluated on a case to case basis.

      Comment


        #4
        Originally posted by crags View Post
        A C4/5 should probably not be pushing a manual chair, except perhaps for a very limited time inside one's home. The downsides vastly outweigh any upside.
        Believe it or not, many nursing homes will not allow residents to use a power chair; they say they fear that other residents will be injured. I think it is discriminatory. Regardless it is a good idea for any power wheelchair user to have a back-up well-fit manual chair that can be pushed by a caregiver; especially for use when being transferred into a car or to a hospital where there is no way to send a power chair along.

        I hope he is getting help in getting out of institutional living all together, and can get into community living. His local CIL/ILC may have a program to help with that.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          Originally posted by crags View Post
          A C4/5 should probably not be pushing a manual chair, except perhaps for a very limited time inside one's home. The downsides vastly outweigh any upside.

          If one gets projection (high or low) hand rims one can do damage to the lower thumb joints. With or without projection hand rims one will probably wind up pushing off the tire with the lower palm and wrist area setting yourself up for carpal tunnel and other serious and difficult to treat wrist problems, which I now have.

          There are other reasons I can go into but these are some of the main ones that come to my mind, and I am C7.
          So the main benefit at this injury level would be to make transportation easier if someone was going to drive you somewhere and didn't have a van, then they could put the chair in the trunk?

          Comment


            #6
            Be sure you clarify with the nursing home administration that any seatbelts or chest straps are being used as "supportive devices" as they can be interpreted as restraints, which are not allowed in most nursing homes now days. We frequently had this problem with side rails on the beds as well when getting equipment for our SCI Veterans who lived in SNFs.

            Depending on his person C4 injury, arm troughs may be needed as a feature of the armrests. Are his neck muscles strong? Does he use a headrest in his current power chair? If so, he may need a headrest on a manual chair as well.

            Did this young man not have an inpatient acute rehab stay? Is he eligible for a outpatient seating/chair evaluation under his insurance?


            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              Originally posted by SCI-Nurse View Post
              Believe it or not, many nursing homes will not allow residents to use a power chair; they say they fear that other residents will be injured. I think it is discriminatory, but I would imagine that this is why they are looking for a suitable manual chair for this young man.

              I hope he is getting help in getting out of institutional living all together, and can get into community living. His local CIL/ILC may have a program to help with that.

              (KLD)
              Everyone that uses a wheelchair in this facility uses a power chair (mostly cervical SCI, CP, muscular dystrophy, etc.). Since I've seen lots of lower level quads in manual chairs, I asked him if he could use one and he said he has never tried. So that's why I wanted to see if it is even feasible for a c4/5. He seemed very excited about the idea. If anything it would allow someone to be able to get him out of the facility and go somewhere without having to have a wheelchair accessible van. They could just push him in the chair.

              Comment


                #8
                Very difficult if not impossible for someone who is C4 to manually push a wheelchair any distance, especially on carpet. It may also be difficult for someone with C5 function. Goal for a manual chair at this level is generally as a back-up for the power chair (in the shop, etc.) or for transportation in a vehicle with no wheelchair lift/ramp. So looking at fancy push rims probably will just be a waste of time and money.

                See my edits/additions to my post made while you were posting too.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  Brad - it's awesome you have taken an interest in this person! You can/have probably made a big impact in their well-being by being a new friend that believes in them. But you might not want to give them too much false hope as to their future abilities. And I know that is probably why he is living where/how he is living now - because health care professionals are trained to coddle people and not raise their hopes up. But for someone with a complete C4/C5 injury it may be too much to hope they will be able to push a manual chair.
                  Worst case scenario it could lead to a major let-down for this person. All that being said, I don't know this person. Hopefully you're the spark they need to want more from their life. On the other hand you don't want to be one more person that wants the best for them but doesn't allow them to achieve it for themselves. (think of a mother who smothers)
                  I hope I'm getting my point across without being a dick. For a lot of quads I know they feel most independent when they are "forced to" accomplish things on their own. A bit like the old adage "give a man a fish [....] teach a man to fish..."
                  In your other thread I wanted to comment about trying to find a local quad rugby team - he could meet other quads to network with, even if he's not interested/able to play.

                  Comment


                    #10
                    Originally posted by tooley View Post
                    In your other thread I wanted to comment about trying to find a local quad rugby team - he could meet other quads to network with, even if he's not interested/able to play.
                    If he only has C4 function, quad rugby would probably not be realistic. Power soccer though might be a good option, if 1) he is allowed out of the nursing home for non-medical purposes (not allowed by some insurances, including Medicare), and 2) he has a way to get there in his power chair.

                    (KLD)
                    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                    Comment


                      #11
                      Originally posted by SCI-Nurse View Post
                      Believe it or not, many nursing homes will not allow residents to use a power chair; they say they fear that other residents will be injured. I think it is discriminatory. Regardless it is a good idea for any power wheelchair user to have a back-up well-fit manual chair that can be pushed by a caregiver; especially for use when being transferred into a car or to a hospital where there is no way to send a power chair along.

                      I hope he is getting help in getting out of institutional living all together, and can get into community living. His local CIL/ILC may have a program to help with that.

                      (KLD)
                      My understanding of his situation is he has no family that is close enough to help take care of him. All but $30 of his SSDI goes to the facility he is at. If he had his own place, he couldn't afford a care giver to stay overnight. He has no means of transportation and can't work. He's just there... I'll look into the local CIL and see what they suggest.

                      Originally posted by SCI-Nurse View Post
                      Be sure you clarify with the nursing home administration that any seatbelts or chest straps are being used as "supportive devices" as they can be interpreted as restraints, which are not allowed in most nursing homes now days. We frequently had this problem with side rails on the beds as well when getting equipment for our SCI Veterans who lived in SNFs.

                      Depending on his person C4 injury, arm troughs may be needed as a feature of the armrests. Are his neck muscles strong? Does he use a headrest in his current power chair? If so, he may need a headrest on a manual chair as well.

                      Did this young man not have an inpatient acute rehab stay? Is he eligible for a outpatient seating/chair evaluation under his insurance?


                      (KLD)
                      I hadn't thought about neck muscles and I can't remember if he uses a headrest. I'm also not sure about his inpatient rehab, that was 10 years ago. It seems from what has been posted so far that using a manual chair for a c4/5 is not going to work (if he does the pushing). He moves his arms like his injury is lower though. He says he has decent upper body strength (chest/shoulders/biceps) but no triceps or hand function. So I'm not really sure what he is capable of.

                      Originally posted by tooley View Post
                      Brad - it's awesome you have taken an interest in this person! You can/have probably made a big impact in their well-being by being a new friend that believes in them. But you might not want to give them too much false hope as to their future abilities. And I know that is probably why he is living where/how he is living now - because health care professionals are trained to coddle people and not raise their hopes up. But for someone with a complete C4/C5 injury it may be too much to hope they will be able to push a manual chair.
                      Worst case scenario it could lead to a major let-down for this person. All that being said, I don't know this person. Hopefully you're the spark they need to want more from their life. On the other hand you don't want to be one more person that wants the best for them but doesn't allow them to achieve it for themselves. (think of a mother who smothers)
                      I hope I'm getting my point across without being a dick. For a lot of quads I know they feel most independent when they are "forced to" accomplish things on their own. A bit like the old adage "give a man a fish [....] teach a man to fish..."
                      In your other thread I wanted to comment about trying to find a local quad rugby team - he could meet other quads to network with, even if he's not interested/able to play.
                      Thanks for the comments, and I understand what you're saying. I don't want him to get his hopes up either. I'm not sure if we have a local rugby team, I'll have to look into that.

                      Comment


                        #12
                        It would be nice to have a manual chair for times when he is being transported by someone who can't accommodate an electric chair. My main concern would be his stability in the chair. He would need the proper armrests and backrest, maybe even belts. When someone doesn't have any truck muscles or the ability to hold on, then any quick movement or stop can result in them coming out of the chair.

                        Comment


                          #13
                          Just an update, I spoke with the therapist at our local seating clinic who visits this facility twice a month and knows the residents. I asked her if this could at least be an option for transportation, to allow him to be able to leave without someone needing a wheelchair accessible van to pick him up. She did not think a manual chair would provide enough trunk/lateral stability for his injury level and he would have to rely on someone else for pressure reliefs (which I didn't think about). So I guess this isn't going to work out. I wasn't expecting to be told a manual chair can't be setup for someone at that injury level to use safely though. Are there just not lateral supports, high enough backrests, headrests, etc. available for manual chairs? I can imagine it would be difficult to attach things like that to a tilite.

                          Comment


                            #14
                            A reclining back manual wheelchair with chest strap could be used, as long as he has someone with him who could do transfers, dependent weight shifts, and has enough room in their car to break the chair down and get it in/out of the car. There are chairs like this with quick release wheels, and you might be able to find him one on eBay, Craig's List, or other places to get used equipment. It will not be as light weight as a Tilite, but since he wouldn't be able to push it himself anyway, that would not be such an important criteria.

                            Here is an example: https://www.ebay.com/itm/Drive-Medic...kAAOSwGWNUV1DF

                            (KLD)
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                              #15
                              Thanks for the link. Has anyone else used a reclining back manual chair with a chest strap for a C4/5 SCI (even if it's just for transportation)? If so, what kind of backrest did you use that was tall enough to provide enough support? Pics would be great too.

                              Comment

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