Are Carers Pushing Safe Wheelchair Loads?

 Ailsa Reston, OT, highlights the benefits of motorised power packs to protect carers from excessive back strain, when propelling manual attendant-controlled wheelchairs


1. About the Author: Ailsa Reston, Occupational Therapist

Ailsa Reston qualified as an OT in 1986 from St. Andrews School of Occupational Therapy. She initially worked in the NHS in the field of adult physical medicine and then specialised in the field of neurology and the treatment of Stroke. In 1999, alongside fellow OT and COTSSIP member Bev Kelly, she set up the independent OT Practice, RKS Occupational Therapist Services based in Cheshire.


RKS provides assessments and reports for various organisations and individuals including the NHS, Social Services, case managers, housing associations and charities. It has specialist knowledge regarding wheelchair and seating provision – both of which the NHS and Social Services depend upon. In addition to these frontline activities, the Practice provides an independent living showroom where end users can discuss individual mobility needs and trial products before purchase.


2. As average wheelchair occupant weight increases, a wheelchair power pack can be a proven solution 

A power pack is a battery operated, powered unit that can be fitted to the underside of a manual attendant-controlled wheelchair. It can include one or two drive wheels that are powered by an onboard battery connected to controls mounted on a wheelchair handle. If a reliable, ergonomic model is selected it will provide reliable and controlled, powered propulsion of a wheelchair and occupant with a common speed of 3-4mph. This is particularly important when carers need to negotiate slopes, ramps, kerbs or uneven surfaces and will eliminate potential overexertion. Products available will fit a wide variety of wheelchairs including many tilt-in-space models and TGA, as an example, has just introduced a bariatric power pack that can drive an occupant and wheelchair weighing up to 32st. Models can also provide forward and reverse motion to assist with manoeuvring in space limited places. 

 3. The evidence for change

As independent OTs, we receive countless visits and enquiries from people with disabilities, and carers who are looking for powered assistance with propelling an attendant-controlled wheelchair. It is critical that wheelchair attendants in the community can manoeuvre immobile people in a strain-free manner and without affecting posture.


Fitting a motorised power pack to an attendant-controlled wheelchair can provide sufficient assistance for carers, so that the effort needed to exert is nominal, ie. steering the wheelchair rather than pushing it. This gives carers protection against back and shoulder injuries, as well as providing a safeguard for those with heart or respiratory conditions

Loads that are safe for carers to push are based on guidelines issued by the HSE. These clearly state that the exertion of force in excess of the guidelines, increases the likelihood of injury. It should be noted that HSE guidance assumes that the wheelchair being pushed is well maintained and being operated on a smooth surface. Unfortunately this may well not reflect most real life situations for carers and wheelchair users, who will be negotiating uneven paving, carpet and kerbs.

The excessive stresses and strains being commonly placed on carers today can also be illustrated clearly by the following data:

A six-year-old child weighing 20kg will, in conjunction with a standard wheelchair (12kg), have a combined weight of approximately 32kg. This is just over the safe limit for a female to push in order to maintain a chair’s momentum, on a gradient of 1:12, without risk of injury. In the same scenario, an 80kg adult in conjunction with a standard wheelchair (15kg) will weigh 95kg, well beyond the safe limit for males and females to push.

Significant evidence continues to mount regarding the moving and handling risks associated with carers pushing manual wheelchairs. As an example, the ‘Keeping the Wheels Turning’ white paper produced by the University of Dundee in association with NHS Fife, states why power packs significantly reduce pain and health-related difficulties for attendant carers:

‘….shoulder pain for example is over four times as common for carers propelling attendant-controlled manual chairs as for those where the user has a power assisted chair. It is also noticeable that carers propelling manual wheelchairs are very much more likely to report heart, breathing or balance problems than those supporting powered wheelchair users….’


4. Making a real difference at community level

We have recently provided a TGA Powerpack to a customer who came to us with a voucher from NHS wheelchair services. He approached us for a lightweight wheelchair and a power pack to enable him to access the shops and local amenities with his wife. The gentleman had a severe visual impairment, Arthritis and was unable to walk more than 20 yards. He was given a choice of transit wheelchair that fulfilled his prescription and chose one that was lightweight for his wife to lift in and out of the car. They decided on the TGA Powerpack as this was the lighter option and was easier for his wife to fit to the wheelchair. She found the controls much simpler to use too. When demonstrating the chosen wheelchair and power pack, the gentleman stated that the provision of this power pack would ‘change his life’. Previously if he went out with his wife he had to sit in the car or alternatively was housebound.


At RKS we also carry out work for local military veteran charities such as SSAFA and the Royal British Legion. I recently recommended a lightweight wheelchair with a TGA Powerpack to a 90-year-old ex-serviceman who suffered from Angina and a severe back problem. As he was unable to walk any distance due to his medical condition, his daughter wanted to take him out to the local shops, amenities and on day trips. His daughter also had trapped nerves in her back and struggled to push their existing NHS wheelchair, especially on inclines. The provision of this equipment will make pushing the wheelchair and her father around hilly Cumbria strain-free. Both wheelchair and power pack did not require excessive lifting to place in a car boot, which also helped to improve the quality of life for the client and his daughter.


Another recent example involved provision of a unit to a gentleman who had suffered a Stroke, resulting in a left sided weakness. He was able to propel himself around his home in a wheelchair but outside accessibility was not possible as he lived on a steep hill. The provision of a power pack enabled his wife to take him into the local village with far greater ease, especially when coming back up the hill to their home.


5. Benefits to carers and wheelchair occupants of specifying a reliable, proven power pack

The TGA Powerpack is light-in-weight and therefore makes lifting easier for carers when placing in a car. This is especially important as many may themselves be elderly or have medical problems such as back issues or Arthritis. The ergonomic controls make handling of the power pack straightforward and the battery can be removed quickly for off-board charging. The extended, padded handles provide better grip, which is of benefit if reduced dexterity is a problem for carers.


The ease of connecting the TGA Powerpack drive unit to the controller is also a feature enables easy use. This power pack it is not as fiddly as some other models on the market. Being able to put the power pack on the majority of wheelchairs makes, with the multitude of bracket options available, gives the customer choice over the type of wheelchair that fulfills their needs. The power pack can also be fitted to wheelchairs with a tilt-in space-feature. As some of these specialist wheelchairs are quite big and bulky to push, it is a significant advantage to be able to use a power pack with these chairs.


The TGA Powerpack can be positioned further under the wheelchair and therefore does not pose a tripping hazard for the attendant. The ability to change speed also allows the individual pushing the wheelchair to walk at a pace that is comfortable for them. The use of a power pack enables the wheelchair and occupant to be more easily propelled across grass or gravel and up or down slopes and ramps. 


6. Conclusion

Working in independent practice for many years now, I have seen the negative impact of excess strain on carers pushing attendant controlled manual wheelchairs in terms of muscle and back injury. This issue will only continue to grow as the trend toward heavier wheelchair users becomes ever more pronounced. Supported by HSE clinical evidence and guidelines, recommending the addition of a power pack to attendant-controlled manual wheelchairs is now an essential consideration. Motorised solutions from trusted suppliers such as TGA Mobility, can provide significant moving and handling benefits to all concerned with regular attendant-controlled wheelchair propulsion.


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