Role of the Wheelchair

 The wheelchair is one among the foremost commonly used assistive devices to market mobility and enhance quality of life for people that have difficulties in walking (e.g. an individual with medulla spinalis injuries leading to quadriplegia or paraplegia, dystrophy ,etc).

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Wheelchair mobility exposes opportunities for wheelchair users to review , work, engage in social activities and access services like healthcare.[1] additionally to providing mobility, an appropriate wheelchair benefits the physical health and quality of lifetime of the users by helping in reducing common problems like pressure sores, progression of deformities and improve respiration and digestion.

To ensure effective mobility, wheelchair users need a wheelchair which inserts them correctly and meets their specific needs. However statistics show that about 10% of the worldwide population, i.e. about 650 million people, have disabilities and of those , some 10% require a wheelchair. it's thus estimated that about 1% of a complete population, or 10% of nation with a disability, need a wheelchair, i.e. about 65 million people worldwide.

In addition, it had been estimated that in 2003, 20 million of these requiring a wheelchair for mobility didn't have one. There are indications that only a minority of these in need of wheelchairs have access to them, and of those only a few have access to an appropriate wheelchair.

Appropriate Wheelchair

A wheelchair is acceptable when it meets the individual’s needs and environmental conditions; provides proper fit and postural support supported sound biomechanical principles; is safe and durable; is out there and may be accessed, maintained and sustained within the country at the foremost economical and affordable price. [3] An appropriate wheelchair can assist in opening up a replacement world for the user, from exclusion to inclusion, participation altogether societal activities, and sports and recreation, which all cause independence, better health and improved quality of life.

Physical Needs Intended Use The ability to regulate or customize a wheelchair to satisfy the user’s physical needs will vary, counting on the sort of wheelchair. Wheelchairs should be available in a minimum of alittle range of sizes and permit some basic adjustments. Wheelchairs designed for temporary uses (e.g. to be utilized in a hospital to maneuver patients from one ward to another) aren't designed to supply the user with an in depth fit, postural support or pressure relief, while for long-term users, a wheelchair must fit well and supply good postural support and pressure relief. a variety of seat widths and depths, and therefore the possibility to regulate a minimum of the footrest and backrest height are important in ensuring that the wheelchair are often fitted correctly. Other common adjustments and options include cushion types, postural supports and an adjustable wheel position. Highly adjustable or individually modified wheelchairs are designed for long-term users with special postural needs. Such wheelchairs often have additional components added to assist support the user. Wheelchair designs vary to enable users to securely and effectively use their wheelchair within the environment during which they live and work. A wheelchair that's used primarily in rough outdoor environments must be robust, more stable and easier to propel over rough ground. A three-wheeled wheelchair that might be suited to outdoor use. as compared , a wheelchair that's used indoors on smooth surfaces must be easy to manoeuvre in small indoor spaces. Many users live and add a variety of settings, and a compromise is therefore often necessary like a strong wheelchair with a comparatively short wheelbase but large castor wheels. This wheelchair might be used both indoors and outdoors. Users got to be ready to get in and out of the wheelchair easily, to propel it efficiently and to repair it. Users may have to move their wheelchair, for instance during a bus or car. Different wheelchair designs leave wheelchairs to be made more compact in several ways. Some are cross-folding, while others have quick-release wheels and therefore the backrest folds forwards.

Benefits of an Appropriate Wheelchair

Mobility devices are appropriate for people that experience a good range of mobility difficulties as a results of a broad spectrum of health conditions and impairments, including amputation, arthritis, spastic paralysis , poliomyelitis, dystrophy , spinal-cord injury, rachischisis , stroke and also are relevant for older people that experience mobility difficulties. Assistive technologies like wheelchairs are shown that, when appropriate to the user and therefore the user’s environment, they need a big impact on the extent of independence and participation which individuals with disabilities are ready to achieve. This also reduces the burden of care and has been reported to scale back the general need for formal support services. [6]

Wheelchair provision isn't only about the wheelchair, which is simply a product [7], rather it's about enabling people with disabilities to become mobile, remain healthy and participate fully in community life. we frequently take the power to maneuver in our home and community without any consideration , except for individuals with a disability with mobility impairments even the littlest step can prevent them from accessing all parts of their life. Being mobile enhances a person’s ability to find out , interact with others, earn a living and participate within the community. A wheelchair is that the catalyst to increased independence and social integration, but it's not an end in itself. Studies have shown that assistive technologies including wheelchairs, when appropriate to the user and therefore the user’s environment, have a big impact on the extent of participation which individuals with disabilities are ready to achieve and when provided through a supportive service are reported to scale back the time and physical burden for caregivers. [8][9] the utilization of mobility devices, especially , creates opportunities for education and work, and contributes to improved health and quality of life but can also have an impression on the prevention of falls, injuries, further impairments and premature death. Investment in provision of mobility devices can reduce health-care costs and economic vulnerability, and increase productivity and quality of life.

The benefits of using an appropriate wheelchair are:

MobilityAn active lifestyle has been proven to possess both physical and psychological state benefits with individuals participating in physical activity shown to possess a reduced risk of disorder , type II diabetes mellitus, osteoporosis, osteoarthritis, and a number of other cancers. An appropriate wheelchair provides the user the liberty to maneuver around, allowing the user to access day to day physical activity as they strong-arm conducting activities of daily living increasing overall physical activity levels and day to day mobility.[11] It also provides the best possible opportunity for independence and do the items they need to try to to , allowing indivduals to maneuver within their home more easily, provides increased comfort and a more active lifestyle. 

Independence

Difficulty with ambulation, got to frequently rest on someone or hold onto their arm as they walk next to you, decreased balance fear of falling can cause individuals to become isolated from friends and family. A wheelchair that's functional, comfortable and may be propelled efficiently may result in increased levels of activity. Independent mobility and increased physical function can reduce dependence on others. Thus, wheelchair user's are often more independent and more on top of things of their own life. Individuals who experience the smallest amount discomfort when sitting are often more productive. Users who are ready to spend longer within the ir wheelchair will have more opportunities for participating in day-to-day life along side others in the household, greatly improving their quality of life.

Health

A wheelchair can improve the user's health in some ways . A wheelchair that's functional, comfortable and may be propelled efficiently may result in increased levels of physical activity, thus improving both physical and psychological state . A well fitting wheelchair with cushion combined with adequate user training can reduce common problems, like pressure sores, the progression of deformities or contractures, and other secondary conditions related to poor postures.[10] [12] Other benefits, like improved respiration and digestion, increased head, trunk and upper extremity control and overall stability, are often achieved with proper postural support. Maintenance of health is a crucial think about measuring quality of life. These factors combined serve to extend access to opportunities for education, employment and participation within the family and therefore the community.

Self Esteem & self-worth

Self-esteem is described as a general evaluation of one’s self- concept or sense of private worth and adequacy with high self-esteem linked to several positive health outcomes in persons with a disability including reduced depression and better life satisfaction and well-being. Wheelchairs, are shown to possess a profound influence on quality of life and participation. Wheelchair users may become more confident and have more self-worth once they have a wheelchair, often viewed as an extension of the users body, that matches them and which they will use well, therefore the chair’s weight and dimensions effect the person’s ability to barter through the house and within the community. Research has shown that wheelchair users with higher self-esteem displayed increased participation levels independent of gender, age and disability type.

Quality of Life

With maintenance of health there's increase access to opportunities for education, employment and participation within the family and therefore the community. These factors also contributes in increasing quality of lifetime of wheelchair user. 

Access to Community Life

Access to community life including community participation, involving both being active in family and community life with engagement in typical roles and responsibilities in society plays a key role within the health and wellbeing of wheelchair users and has been shown to be a key think about preventing health deterioration in individuals with medulla spinalis injury. having the ability to access the community, move outside the house is vital for social participation and engagement and lots of positive health indicators also . Having an appropriate wheelchair improves access to the community and enables wheelchair users to be more involved in community life i.e. it enables the user to travel to the work or school, visit friends, attend places of worship or other community activities. Additionally, appropriate wheelchairs influence individual autonomy because they facilitate both mobility and activities of daily living both within the home and within the community.

Economy

A wheelchair often makes all the difference between being a passive receiver and a lively contributor. Economic benefits are realized when users are ready to access opportunities for education and employment. With a wheelchair, a private can earn a living and contribute to the family’s income and national revenue, whereas without a wheelchair that person may remain isolated and be a burden to the family and therefore the nation at large. Similarly, a wheelchair that's not durable are going to be costlier due to the necessity for frequent repairs, absence from work and eventual replacement of the wheelchair. Providing wheelchairs is less expensive if they last longer. it's also less expensive if users are involved in selecting their devices and if their long-term needs are considered. 

For society, the financial benefits related to the supply of wheelchairs include reduced health care expenses, like those for treating pressure sores and correcting deformities. A study from a developing country reported that in 1997, 75% of these with medulla spinalis injuries admitted to hospital died within 18–24 months from secondary complications arising from their injuries. within the same place, the incidence of pressure sores decreased by 71% and repetitive tract infections fell by 61% within two years as a results of improvements in health care training and appropriate equipment, including good wheelchairs with cushions. 

Challenges for Wheelchair Users

Financial Barriers

Some 80% of the people with disabilities within the world sleep in low-income countries. the bulk of them are poor and don't have access to basic services, including rehabilitation facilities. The International Labour Organisation reports that the unemployment rates of individuals with disabilities reach an estimated 80% or more in many developing countries. Government funding for the supply of a wheelchair is never available, leaving the bulk of users unable to buy a wheelchair themselves. 

Physical Barriers

Majority of wheelchair users are poor, with inaccessible surroundings. They also live where road systems are poor, there's a scarcity of pavements, and therefore the climate and physical terrain are often extreme. In many contexts, public and personal buildings are difficult to access during a wheelchair. These physical barriers place additional requirements on the strength and sturdiness of wheelchairs. They also require that users exercise a high degree of skill if they're to be mobile. 

Access to Services

In many developing countries, only 3% of individuals with disabilities who require rehabilitation services have access to them. consistent with a report of the United Nations Special Rapporteur, 62 countries haven't any national rehabilitation services available to people with disabilities. this suggests that a lot of wheelchair users are in danger of developing secondary complications and premature death that would be avoided with proper rehabilitation services.

Education and knowledge

Many users have difficulty in accessing relevant information, like on their own health conditions, prevention of secondary complications, available rehabilitation services and kinds of wheelchair available. For many, a wheelchair service could also be their first access to any sort of rehabilitation service. This places even more emphasis on the importance of user education. 

Personal Choice

Users are rarely given the chance to settle on the foremost appropriate wheelchair. Often there's just one sort of wheelchair available (and often in just one or two sizes), which can not be suited to the user's physical needs, or practical in terms of the user's lifestyle or home or work environment. consistent with the Convention on the Rights of Persons with Disabilities, “States Parties shall take effective measures to make sure personal mobility with the best possible independence for persons with disabilities … by facilitating the private mobility of persons with disabilities within the manner and at the time of their choice, and at affordable cost”. 

Stigma

Community, Government, and Non-Government ignorance and stigma in reference to people with a disability and wheelchair use including poor understanding of the principles of a top quality wheelchair, and reduced rights of the users to access their environment / community which include:

Poor road designs that don't consider the requirements of wheelchair users
Drivers not sensitive to the road needs of wheelchair users;
Inaccessible buildings;
Lack of easily accessible skilled service providers for wheelchair maintenance;
Innaccessible and dear conveyance with limited space available for wheelchair users

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