Wheeling in the New Millennium: The history of the wheelchair and the driving forces in wheelchair design today

Dr. Bonnita Sawatsky, Department of Orthopaedics, British Columbia's Childrens Hospital, Vancouver, BC, Canada

Slide 1: Overview

  • Historical background
  • Design issues
  • Current research
  • Pilot study
  • Where we should go?

Slide 2: History

  • Man’s two earliest inventions
  • Chair
  • Wheel
  • 4000 B.C.
  • Originated in eastern Mediterranean basin

Slide 3: History

  • First record of combining wheels to furniture
  • Image on Greek vase of wheeled child’s bed
  • 530 B.C.

Slide 4: China

  • Spoked wheels on chariots 1300 B.C.
  • Oldest evidence of wheeled chairs
  • 525 A.D. engraving of one of the earliest representation of a wheeled chair

Slide 5: Wheelbarrow

  • 3rd century invention from China
  • Used for moving the sick or disabled to the “Fountain of Youth”

Slide 6: “Gestations”

  • Greek and Roman physicians prescribed a “gestation” or transportation for the sick or disabled (1553)
  • Get people out into fresh air and help work with whatever they could do in the fields.
  • Carried on a sedan or push on a chair with wheels

Slide 7: Spain

  • King Phillip II (1595) of Spain
  • Had his own rolling chair with foot rests

Graphic Description:

Slide 8: Self-propelled chair

  • Paraplegic watchmaker, Stephen Farfler (1655) built his own chair at 22 yrs of age.

Graphic Description:

Slide 9: “Bath” chair

  • Developed in Bath, England
  • Invented by John Dawson, “Wheel-chair maker” 1783
  • Dominated the market of 19th century
  • Two large wheels, one small wheel

Graphic Description:

Slide 10: “Seating”

  • Comfort for the disabled person became more of an issue
  • Convertible chair (reclining back and adjustable foot rests)
  • 18th century

Graphic Description:

Slide 11: Wheelchair to Bicycle

Notes:
The developments in the wheelchair probably led to the development of the bicycle.

Slide 12: Manual to Motor

  • Self-propelling chair operated by a crank axle connected to a steering rod for the front wheel
  • Inspired the first tricycle

Graphic Description:

Slide 13: Bicycle

  • 1790, de Sirvac (France) invented the celerfere “swiftwalker”
  • Wooden bicycle propelled by user by pushing feet on ground
  • 1865, velocipede, with added cranks and pedals “boneshaker”

Graphic Description:

Slide 14: Bicycle to Wheelchair

Graphics Description:

Slide 15: Bicycle to wheelchair

  • 1867 - changed wooden wheels to iron
  • 1875 - added hollow rubber tires

Graphic Description:

Slide 16: Bicycle to wheelchair

  • 1881 - pushrims were added for propulsion
  • 1900 - wired spoked wheels adopted by wheelchairs
  • 1912 - 1 3/4 horsepower engine was attached to a invalid tricycle
  • 1916 - London produced first motorized wheelchairs

Slide 17: “Lightweight wheelchair”

  • Made from Indian reed
  • Large wheels either front or back
  • 58 lbs. with pushrims
  • 50 lbs. without pushrims

Graphic Description:

Slide 18: The Automobile led to more changes

  • Herbert A. Everest
  • Wanted a wheelchair that could go in an automobile
  • Teamed with engineer, HC Jennings, to manufacture first folding metal WC
  • 1933, Los Angeles

Slide 19: Samuel Duke

  • 1934
  • Independently of E & J responded to demand in Chicago
  • Developed the 2nd manual, lightweight, “folding” wheelchair for the market

Slide 20: Cause of change in WC

  • Introduction of the automobile
  • Need to get wheelchairs into cars
  • Increased # of injuries due to automobiles
  • Development of rehab and re-education programs for injured
  • Improved medical services
  • Demand of independence of disabled people

Slide 21: Wheelchair Sports

  • Introduced as a form of therapy in the rehab program Stoke Mandeville Hospital in Aylesbury, England
  • Annual World Stoke Mandeville Wheelchair Games
  • >70 countries now in International Stoke Mandeville Wheelchair Sports Federation

Slide 22: Wheelchair sports

  • Athletics, rugby, tennis, basketball, etc.
  • Rigid chairs!

Graphic Description:

Slide 23: Wheelchair sports

  • Improved the physical function of disabled people.
  • Created more active individuals who want to do more.
  • Increased the demand for “performance” in their manual wheelchairs.
  • Lightweight, versatility, stability, and endurance.

Slide 24: Materials

  • Steel - most researched and longest used metal for bikes and manual wheelchairs
    • Largest selection and most affordable
  • Aluminum - very light and relatively inexpensive
    • Minimal bending strength, requires largest sized tubing to get enough strength
    • Least flexible, brittle

Graphic Description:

Slide 25: Materials

  • Titanium - best strength to weight ratioT(Titanium - best strength to weight ratio
    • Greatest flexibility
    • Costly 15 x more than steel
  • Carbon fiber - used to mold a frame, boat builders material
    • Less expensive than titanium
    • Strong, yet flexible
  • Chrome alloy - most common
    • ENDURANCE (strength)

Graphic Description:

Slide 26: Issues

  • Lightweight
  • Versatility
  • Stability
  • Endurance

Slide 27: LIGHTWEIGHT!

  • Finally lightweight chairs that are really light weight 20-25 lbs.
  • Purpose:
    • Decreased energy cost
    • Reduce shoulder and wrist injuries due to repetitive strain
    • Easier to transport

Slide 28: Camber

  • STABILITY
  • Decrease incidence of injuries from falling or tipping
  • Decrease energy cost
  • More ergonomic (positioning)
  • Easier turning ( inertia )
  • Adjustability ( VERSATILITY)
  • “no tools” camber adjustment

Graphic Description:

Slide 29: WE HAVE IT ALL!

  • Lightweight
  • Stability
  • Endurance
  • Versatility
  • What else do we need?

Slide 30: Suspension (bicycles)

  • Decreased the shock sent to body

Pneumatic tires

  • Softer tires rolling resistance

Shocks

  • Coil springs
  • Lever arms
  • Bumpers

Graphic Description:

Slide 31: Suspension manual wheelchairs: “You name it, they got it”

  • Front suspension
  • Rear suspension
  • Increased cushioning?
  • Wheeling cost?
  • Up or down

Graphic Description:

Slide 32: What do we really need?

  • Chairs which require minimal energy to propel
    • Low rolling resistance
    • Lightweight
    • Ergonomically efficient
  • Chairs that provide support and comfort
    • Molded seating (adjust for deformities, minimize potential for pressure sores)
    • Cushioning (padding or shock absorbers)

Slide 33: What are researchers doing?

  • Summary of research 1999
  • Materials strength:
    • “Fatigue life of manual wheelchair cross-brace designs” Cooper et al., 1999.
    • Evaluation of selected ultralight manual wheelchairs using ANSI/RESNA standards. Cooper et al., 1999

Slide 34: What are researchers doing?

  • Summary of research 1999
  • Biomechanics of wheeling:
    • Glenohumeral joint kinematics and kinetics for three coordinate system representations during wheelchair propulsion. Cooper et al, 1999
    • Assessment of geometric and mechanical parameters in wheelchair seating: a variability study. Maltais et al.,1999

Slide 35: What are researchers doing?

  • Summary of research 1999
  • Clinical research of wheeling:
    • Shoulder pain in wheelchair users with tetraplegia. Curtis et al.,1999
    • Wheelchair pushrim kinetics: Body weight and median nerve function. Boninger et al., 1999

Slide 36: What are researchers doing?

  • Summary of research 1999
  • Energy cost of wheeling:
    • Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries. Beekman et al.,1999.
    • Ultralight wheelchairs significantly improved the efficiency of propulsion in paraplegics and tetraplegics

Slide 37: Analysis of the O2 cost of wheeling

  • Measures how much energy a person uses during a given task.
  • Theoretically, the less energy required for wheeling the better the chair
  • Less energy used for wheeling, the more energy available for daily living activities
  • Relates to wheelchair users

Slide 38: Relevant outcome criteria

  • Energy cost: requires minimal energy throughout the day to propel through various environments
  • Comfort: allows for long term use with minimal risk to pressure points
  • Adjustability: ability to adjust chair for good biomechanics for a variety of activity needs (minimize risk to shoulder and wrist injuries)

Slide 39: Pilot study

  • Compare 3 types of chairs:
  1. lightweight rigid chair
  2. lightweight rigid chair w rear suspension #1
  3. lightweight rigid chair w rear suspension #2
  • O2 cost analysis on level smooth surface
  • ml/kg/m (5 min trials)

Slide 40: Energy expenditure

  • Cost of locomotion
    • Wheeling

Graphic Description:

Slide 41: 02 cost of wheeling with suspension

  • Case study:
  • 21 yr. old male, Nemeline myopathy
  • Full time W/C user since birth
  • Three conditions:
    • Rock Shox (spring suspension)
    • Action chair (polymer block suspension)
    • Rigid Titanium (no suspension)

Slide 42: O2 data: Averaged

Graphics Description:

Slide 43: O2 cost of suspension chairs

Graphics Description:

Slide 44: Pilot study: Conclusion

  • Small study
  • Suspension chairs require a significant increase in O2 cost (more work) in wheeling on level surface (dense carpet).
  • Must consider O2cost in trade offs for suspension or not in wheelchair prescriptions
  • Suspension may not be suitable for weak or low endurance clients

Slide 45: Cost / Benefit analysis

  • Knowing the relative cost of adding suspension to a chair one can weigh the benefits of adding suspension to the costs

Slide 46: What are the real issues?

  • Listen to the users and pass on the concerns to the researchers so that relevant research can be implemented.
  • Team up with researchers in the community
    • Users
    • Therapists
    • Wheelchair Providers/manufacturers
    • Researchers

Slide 47: Acknowledgements

  • Motion Specialties
  • Randy (Sunrise Medical)
  • Charles (Invacare)

Return to Slide Series

Updated: June 13, 2002

 

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Please note: This information is provided a archival information from the Rehabilitation Engineering Research Center on Wheeled Mobility from 1993 to 2002.

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