Common Wheelchair Problems and How To Solve Them

Using a wheelchair everyday comes with its own set of issues, but they are simple to manage with preventive measures and regular maintenance and care. Learn more about common wheelchair issues and how to address them.

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1. Preventing Pressure and Skin Problems
2. Ensuring Proper Wheelchair Fit
3. Reducing Shoulder, Arm, Wrist, and Hand Strain
4. Moving Over Thresholds, Ramps, and Uneven Surfaces
5. Navigating Tight Spaces, Doorways, and Bathrooms
6. Managing Worn Parts, Breakdowns, and Repairs

What Causes Pressure Sores?

Three main causes of pressure sores are:

• Pressure: Prolonged pressure on the skin from sitting in the same position for too long without moving.
• Friction: Constant rubbing/movement against a surface on the same area of skin, like an arm/hand rubbing against a wheel or armrest.
• Shearing: Shearing happens when the skin is pinched or stretched in one place as the muscles or bones move. Poor posture while sitting in your wheelchair can cause this.

You May Be at a Higher Risk of Pressure Sores If:

• You Have Decreased Sensation or Cannot Move Independently:
  For those with little to no physical sensation, especially in the legs or seat areas, it can be difficult to tell whether there is too much pressure on one area of the body. This significantly increases the risk of pressure sores developing.
• You Already Have/Had a Pressure Sore.
• You Are Older:
  As you get older, your skin can become thinner and more easily damaged.
• You Are Underweight or Overweight:
  Those who are overweight may have decreased blood flow and mobility issues, making repositioning more difficult, which increases the risk of skin damage. Those who are underweight may be more at risk, as their bones are not sufficiently protected by soft tissue, including fat, muscle, and skin.
• You Have a Poor Diet or Struggle With Hydration:
  A proper diet and sufficient hydration are essential to maintaining healthy, strong skin.
• You Experience Prolonged Exposure to Moisture:
  If you sweat frequently or experience daily incontinence, moisture can sit on the skin and easily damage it.

Why Is It Important To Prevent Pressure Sores?

Preventing pressure sores is more than just preventing discomfort and pain (though that is certainly important). Pressure sores are wounds that can worsen if not addressed or treated and can even extend to muscle and bone, requiring surgical intervention. For high-risk individuals, pressure sores can develop in just hours, but the consequences can last for a long time if not treated.

If you notice signs of a pressure sore, immediately change position/have a caregiver help you change position to relieve pressure on the affected area. If redness does not fade after pressure is relieved, or if the skin breaks down or shows signs of infection, seek medical care immediately.

How To Prevent Pressure Sores:

• Change Position Regularly:
  Changing position helps relieve pressure on high-risk areas. If you cannot change position independently, you are at higher risk and should have a caregiver help you readjust frequently.
• Check Your Skin Daily:
  Check your body regularly for signs of pressure sores. You can check hard-to-see spots with a mirror or have a family member or caregiver help you check.
• Use a Pressure-Relieving Cushion:
  Pressure-relieving cushions help redistribute pressure to prevent pressure sores when used with regular repositioning.
• Pressure Relief Techniques:
  Common techniques involve exercises as simple as bending forward or leaning side to side. If you have difficulty moving independently, you may need to do these more frequently, around every 15 to 30 minutes.

Ensure your wheelchair fits you: If it does not properly support you, it can cause unnecessary pressure or friction. Read on for more information on how to know whether your wheelchair is the right fit for you.

• Seat Width:
  The seat width should fit you closely. To check the fit, run your fingers along the outside of the thighs and between the sides of the wheelchair. Your fingers should fit comfortably in that gap without being pinched. Make sure the sides of the wheelchair are not pressing in or rubbing against the body.
• Seat Depth:
  There should be a two-finger distance (approximately 60 millimeters) between the back of the knee and the seat cushion.
• Seat Height:
  If foot propelling, the backrest should comfortably support the back, with feet flat on the floor. If the feet cannot rest flat on the floor, the seat height may be too high.
• Footrests:
  The cushion should properly support the thighs with no gaps, and the feet should be fully supported on the footrest without gaps. If there is a gap underneath the thigh, the footrests may be too high. If there are gaps under the foot, the footrests may be too low.

If you use a manual wheelchair and propel it yourself, daily use can cause physical strain, especially on your shoulders. If left unmanaged, you can even become injured. Here are some tips on how to prevent and reduce arm and shoulder strain:

• Opt for a Lightweight Wheelchair:
  For best results, choose a wheelchair made from lightweight materials. These include aluminum, carbon fiber, and titanium.
• Exercise and Stretching:
  Light exercise and daily stretching can increase your range of motion and keep muscles healthy. A physical therapist can help guide you in specific exercises and routines that would best fit you and your lifestyle.
• Keep Good Posture:
  Slumping can decrease your range of motion, which means you have to work harder to push the chair, which in turn causes shoulder strain.
• Ensure You Are Pushing Correctly:
  Pushing incorrectly can make you exert more effort than pushing correctly would. When pushing yourself in a wheelchair, try to push in one intentional, smooth motion, from a 10:00 to 2:00 position.

If you are still experiencing pain, muscle strain, weakness, or numbness while taking the right precautions, talk with your doctor or physical therapist to discuss your options.

Homes have many tight areas, corners, and spaces that can be difficult to navigate in a wheelchair. The following tips can help you more easily get around your home in a wheelchair:

• Using Threshold Ramps: Thresholds are small but can create a major impediment in navigating your home. Threshold ramps solve that problem and create a smooth transition from room to room.
• Use a Wheelchair Designated for Home: If possible, it may be worth it to invest in a second wheelchair that is compact and narrow enough to fit through doorways.
• Use Removable Footrests: If you have removable footrests, try removing them while at home to navigate tight spaces and corners.
• Create Space by Removing Clutter: Organize items and rearrange furniture to make wider paths between rooms. This gives you room to avoid hard edges and obstacles.

Even with regular care, wheelchairs and their parts are still prone to wear and tear. Worn, broken, or loose parts can significantly affect the wheelchair, complicating steering, braking, transfers, and your comfort while sitting in the wheelchair. You can help prevent damage and preserve your wheelchair with regular preventive measures at home:

• Clean Wheelchair:
  Clean the wheelchair and all its parts with warm water and some soap. Pay extra attention to moving parts, as dirt and debris can hide in small spaces. Consistent cleaning helps prevent damage caused by dirt scraping against moving parts.
• Keep Moving Parts Oiled:
  After cleaning and drying your wheelchair, oil moving parts to help prevent rust.
• Tighten Loose Nuts, Bolts, and Spokes:
  Inspect the wheelchair regularly for loose parts, and tighten securely (but not too tightly) with a wrench.
• Keep Tires Inflated:
  Tires tend to last longer when kept properly inflated, which helps reduce shoulder strain from extra effort and allows the brakes to function properly. You should be able to press slightly on the tire when properly inflated.
• Check for Rust:
  Check metal parts regularly for signs of rust, as rust can cause breakdown and damage. You can use sandpaper or a steel brush to remove the rust if you find it.
• Regularly Wash Cushion and Cover:
  Wipe down the cushion with warm water and mild soap. Allow to air dry in the shade or indirect sunlight. Most cushion covers are machine washable; remove and wash the cushion cover frequently. While cleaning, check for any signs of damage in both the cushion and cover, and replace when necessary.

Even with regular preventive care, wheelchairs can still break or wear down due to daily wear and tear. If your wheelchair is damaged, follow the manufacturer’s guidance to replace or repair parts. You can also contact a local wheelchair service technician.