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wheelchair Socks

Wheelchair Socks

Today, Dr. Eugene Emmer, owner of RehaDesign Wheelchair Accessories announced the launch of ‘Wheelchair Socks’ an innovative cover for wheelchair casters, the small front wheels on wheelchairs. The launch of Wheelchair Socks comes after years of requests from wheelchair users.

RehaDesign offers three types of wheelchair tire covers for manual wheelchairs. Wheelchair Slippers cover the big rear wheels. Mud Eaters also cover the rear wheels but are made from water resistant neoprene. The new product, Wheelchair Socks are the first covers designed for the small front casters.

Wheelchair Socks

Wheelchair Socks and Slippers

Wheelchair Socks and Slippers

Dr. Emmer said: “For a decade we have sold RehaDesign Wheelchair Slipper covers for rear wheelchair tires. Wheelchair users have told us that they appreciate that Wheelchair Slippers help to keep their floors clean from dirt and free from black tire marks. But for many years wheelchair users have demanded a solution for the front casters too. Until now, we have always given the disappointing answer that it was impossible to cover casters due to the way the caster is mounted on the wheelchair”.

Dr Emmer explained, “Last year after receiving an angry email from a disappointed customer who could not see the point of covering the back wheels and leaving the front wheels uncovered, I had a Eureka moment. In the middle of the night, I woke up and traced out a pattern for a new design. After a few modifications to the new design, ‘Wheelchair Socks’ were born. Wheelchair Socks require more precise and elaborate cutting and final sewing than Wheelchair Slippers do because they must fit the casters precisely. But like Wheelchair Slippers they solve the annoying problem that all wheelchair users have – they help keep floors and carpets clean and protected from damage. The impossible is now possible.”

Wheelchair Socks

Wheelchair Socks

Wheelchair Socks

When asked about the names “Wheelchair Slippers” and “Wheelchair Socks”, Dr Emmer explained: When able bodied people come home, many put on slippers or take off their shoes and wear socks in order to prevent tracking outside dirt and germs throughout the house. Now wheelchair users can use their Wheelchair Slippers and Wheelchair Socks in order to keep prevent tracking dirt and germs throughout the house. In addition, Wheelchair Socks and Wheelchair Slippers will help prevent damage and tire marks to floors and carpets.

Like Wheelchair Slippers, Wheelchair Socks feature a special fabric with a lining that grips to the wheels to prevent slippage. The new specially designed closure makes it possible for wheelchair users to quickly cover the caster wheels while sitting inside or outside of the wheelchair. Like Wheelchair Slippers, Wheelchair Socks are machine washable. Wheelchair Socks’ unique design is pending patent approval in the USA and is now being submitted in several other countries.

About RehaDesign Wheelchair Accessories

RehaDesign is an innovative brand of wheelchair accessories, designed in Europe but distributed worldwide via the www.RehaDesign.com website, Amazon and via a network of independent dealers. Wheelchair dealers interested in joining the RehaDesign network are encouraged to contact Dr. Emmer for more information.

Resources

wheelchair-lovers-hands

Quadriplegic Love Lasts

Quadriplegic love lasts and I was about to find out just how long. It was May10th 1999 and I had only been working as a taxi driver for a few days when at my local rank several drivers wandered over to introduce themselves. Shortly afterwards the passenger door of my car opened and a man got in. “Hi, I’m Steve, hope you are settling in ok.” I looked into the sexiest blue eye’s I had ever seen and fell in love at first sight. Steve was flirty and easy to talk to. After chatting for a while he gave me his phone number and told me to call him anytime, if I needed anything, or even if I didn’t. He said we should grab a coffee back at the garage where everyone went once the night’s work was finished.

There was just one problem. I was married and so was he. Neither of us happily, as it turned out. Additionally some weeks later I discovered I was pregnant. My husband was a violent man who thought nothing of repeatedly raping me. On top of that Steve was already seeing a girl. None of this stopped us growing closer and spending time together whenever we could. Long after everyone else had drifted home from the garage Steve and I would still be there talking. While at work he would look out for me by removing drunk passenger’s from my car if he didn’t think I would be able to deal with them, and was just generally my all round protector.

wheelchair taxi

I knew that our feelings for each other were growing stronger. One night we happened to pull into the garage at the same time to fuel up during a shift. We went in to pay for our fuel and walked out onto the forecourt together. As I went to walk towards my car, he grabbed my hand, pulled me into his arms, and kissed me. I could feel the heat from his body as I surrendered completely to the embrace. In that instant, I knew the feeling’s I had for him were reciprocated.

Steve had to travel 150 miles to work and stayed with family, or friends in the area. A few times he even stayed with my husband and I. As I mostly keep my marital problems to myself it wasn’t until years later Steve would come to tell me he always had a bad feeling about my husband. He knew something was not right between us and could see there was no love.

Steve’s own marriage was in bad shape. During work one night he picked up Kathy, an old girlfriend from his teenage years. He had pretty much separated from his wife so began dating her. As soon as the relationship began he realized it was not going to work. He wanted out but was worried about hurting her as Kathy was in a job that had a time limit on it and she was clinging to him as a savior.

The Game Plan

I took a phone call late one night towards the end of August. “Sarah, are you busy babe? I need to talk to you. It’s kind of urgent.” I replied, “No Steve, I’m at a rank and it is dead quiet. Where shall I meet you?” “Garage, fifteen minutes.” was the reply. I was there in ten, parked my car and got into his. He drove us out of town to a quiet area and began to talk.

Steve explained how he wasn’t sorry about the fling with Kathy, as he had ended his marriage, and that he missed his two son’s. He felt things with Kathy were going nowhere but she kept talking about their future. He wanted out and didn’t know how. I told him there was no easy way and pointed out how during the fling he had neglected work and his friends. He needed to get a grip on things and the relationship would naturally fizzle out. I think deep down we both knew the real reason it wasn’t working out with Kathy.

We talked for several hours that night. Steve knew the thing with Kathy had to end, he knew what he wanted, and I knew what I wanted too. I would have to end my, very unhappy marriage, and try to escape it to be free. Steve was the first person to feel the baby I was carrying move in my belly, everyone assumed it was his, and that we were already seeing each other. Someone had told his estranged wife we already were, but we didn’t know who.

Steve started working more, and things began to get back to normal. He was desperately trying to extract himself from Kathy’s grasp but she kept telling him she would fall apart if he left. He struggled with the guilt, and his ever increasing feelings for me. On the 21st of September, it was Steve’s older brother Mark’s birthday. Kathy, Mark and his girlfriend Louise, plus another driver and his girlfriend all went out to a local pub/club. I drove them to the venue.

No More Secrets

As they got out of my car Steve said I should get there 20 minutes earlier than they had asked me too, and text him when I got outside. So I did, and two minutes after I sent the text, Steve came outside alone and got into the front seat. He pulled me into his arms, kissed me passionately, and said to me, “Right, I’m going to tell her it’s over, tonight, I can’t take it anymore. Sarah, it’s you I want, and if I have been reading this right, I know you feel the same.” I looked at him, “Steve, you know I do, I just didn’t know if I should say anything.”

We did everything but make love right there in the car. Only because there wasn’t time, I wish there had been, no one had ever made me respond the way he did that night without actually having sex. I had never wanted someone so much in my life. He wasn’t put off by me being pregnant. He told me I was incredibly sexy, and he wanted me, so badly, but he had to end it with Kathy first. We arranged to meet for breakfast/lunch the following day. I figured I would tell him everything about my marriage then, and how scared I was of my husband.

I dropped everyone off home, Steve and Kathy last. I got out of the car to say goodnight and he hugged me like he never wanted to let me go. I saw the realization on Kathy’s face, she knew what was coming, and she knew why. She was slim, kind of pretty, younger than me, and a professional stripper. She knew she was going to lose Steve to a married, pregnant, taxi driver. It had been raining heavily on and off most of the night, so after getting me to promise I would drive home safely, and me telling him not to do anything stupid, he promised to call me the next day.

I drove home to my very drunk and unpredictable husband. He was still awake when I arrived. He looked up at me from his chair, “Dropped your lover and his bird off have we?” I looked at him, “George, it’s over, I don’t love you. I want a divorce. Steve isn’t my lover but I can’t do this anymore. I can’t lie about how I feel and I don’t want to. I want a divorce because I want to be with Steve and he wants to be with me. I’m sorry, but there it is.” He freaked out, “I knew it, you’re fucking him aren’t you, that baby is his, isn’t it, that bastard slept in my house, drank beer with me, and all along you and him were fucking each other behind my back! Well, he can have you, I don’t want you, after he’s had you, dirty little slut!.” And with that he stamped off to bed, after about half an hour I followed him, and slept, not very well.

The Accident

At 7.45am my mobile phone was ringing. I woke to a voice on the other end asking who I was, and explaining, “This is Paul, Mark’s twin brother, where is he, it’s urgent.” Fear gripped me. I knew something bad had happened to Steve. “What’s happened, its Steve isn’t it. Tell me what’s happened!” His reply will never leave me as long as I live. “Yes, he’s been in a car crash, it’s not looking good. I need you to find Mark and get him to hospital quickly, may not be much time, I’ll keep ringing around, just get there quick, and safely, ok?”

tetraplegic crash

I was dressed in a shot, my heart pounding, crying and praying to who I don’t know. George woke up, I told him what had happened, told him I was going to the hospital and I would be as long as it took. He watched me in silence as I finished dressing and ran out of the bedroom.

When I arrived at Mark’s house he was waiting for me. “It’s all my fault, I told him he had to move his car. It was across my driveway. He was driving that stupid bloody TVR of Kathy’s. I think they had a row, about you. He’s in love with you isn’t he Sarah?” I just looked at him with tear’s pouring down my face and nodded. “I’ll drive, Sarah you are in no fit state love.” I just totally disintegrated. Louise put her arms around me as I sobbed uncontrollably, and we got into the back of my car. She held me tightly as I wept on the way to the hospital.

On arrival at the intensive care unit of our local hospital we were informed Kathy had died instantly in the crash. The car had hit a massive puddle and slammed into a large oak tree at about fifty mph. She was not wearing a seat belt. We were not allowed in to see Steve. They were too busy trying to stabilize him, so we waited… and waited.

Paul and Mark talked in low voices in the corner. I heard my name mentioned, and Paul say that I should go home, as I was six months pregnant, and they were worried that it was all too much for me. I walked over to them, “I’m not leaving, I’m staying. I want to see him. He needs to know I’m here.” Glancing at Paul, “Does he know, Mark?” Paul looked at me, “Yes, I know, we all knew before he even admitted it to himself. For the last four months all Steve has talked about is you Sarah. Of course I knew, he’s my baby brother after all.”

After what seemed like years, and about a million cups of strong sweet tea, a nurse came to us and asked who was first. Paul and Mark both indicated me, and she asked me to follow her. I went into a bay with four beds. Steve lay in the furthest from the door on the right. His neck brace still on, lines and tubes everywhere, and surrounded by machines. She told me he was heavily sedated but would hear me and know I was there.

She found me a chair but I stood there, next to his bed, more tears came. “Oh Steve, I told you not to do anything stupid and you didn’t listen did you? Oh baby please, hold on, I can’t be without you, not now, I need you.” His eyes flickered open for a second, “Sorry Babe, I’m not dead yet, I’m trying… I love you.” I had to lean in close to hear him, my tears falling on his face. “Don’t cry Babe.” he whispered. I stayed with him, for about half an hour, and then realized that I should let his family in to see him, so I kissed him, on the forehead and promised to come back the next day.

Quadriplegic Ventilator

I walked out into the family waiting room and collapsed into Mark’s arms sobbing uncontrollably and shaking from head to foot. He guided me to a chair, and Louise found a nurse, who took my blood pressure, and asked if I had eaten anything. It was two in the afternoon by then. I shook my head at her, unable to speak. She said someone should take me for food, or home. Louise looked at me and asked which. I said food, so she took me for something to eat, and Mark went in to see Steve.

Turning Points

By the time we came back, everyone but Louise had been in. Steve’s parents had arrived and Steve’s wife was with them. She didn’t want to see him, and caught the train home the next day. Mark and Louise drove me home. Mark promising he would drop my car back later in case I needed the distraction of work. He told me not to worry, Steve was a stubborn git, and he would pull through. At this stage it was unclear what his injuries actually were.

I walked slowly into my flat where I was greeted by my now belligerent husband who without preamble asked if Steve was dead. I shook my head, told him I needed to sleep, and could he keep quiet, and look after Sean, our 2yr old son. He huffed, and agreed. I went into the bedroom, undressed and got into bed. Lying there, on my own, I cried myself to sleep.

I was woken around 10pm by a text message alert, with shaking hands I picked up the phone, and opened the message. It was from Shawn, another driver who worked for the same people I worked for. The text asked where I was, and Mark, and Steve, and how the phone was going mental with work. I sighed and rang him to explain what had happened. I tried so hard not to cry as I explained.

Shawn asked if that was why my car was parked outside Mark’s house, and offered to come and get me, so I could pick it up. I accepted, might seem a little weird, but I didn’t want to be at home with my husband. I had a quick shower and got dressed. George watched as I got ready to leave. “So, what are you going to do if the bastard dies then, stay and dump his kid on me?” I shook my head, “Not now George, drop it, please, I’m going to work.”

That night was busy. Steve’s phone was still diverted to mine, so all his customers were calling for a taxi, and asking where he was. I broke down and wept many times that night. The majority of his customers had seen us together, and knew how he felt about me. They were all very understanding. Mark was at work too, we met up for a coffee at the garage once work was over.

“You ok Egg Belly? Want a coffee?”  “No thanks Mark, Steve get’s me chocolate, I’m off coffee” (Egg Belly was Mark’s nickname for me as my pregnancy began to show). He looked at me, “You’re going to cry again, aren’t you? Come here silly girl, he’ll be ok, and you two will be together.” We sat in the garage, Mark hugging me gently while we chatted about why he felt so guilty about the crash. I have to admit for a short while I also blamed him. And myself because I knew if I had come clean that night in the car park, about how violent John was, Steve would have come home with me. Mark never found out about the violence until much later either.

Hospital Visits

The next couple of months were odd. I went to the hospital every day. On each occasion the nurses giving me a laundry list of the dangers Steve was in. Steve had broken C4-C5, damaged his liver and punctured a lung which was filling with fluid, and blood. He would be paralysed from the shoulders down for life. At the time of the crash Steve was 32 and I was 31.

One day I went to see him, and his mum and dad were there, and strangely so was his wife. She walked up to me asked if the baby I was carrying was Steve’s. I just stared at her, and shook my head no. I later overheard a heated discussion between her and Mark, she told him that she didn’t want him back, and if he lived, I was welcome to him. I didn’t see her again after that.

After a couple of weeks they had to do a tracheotomy, and told Steve he was not allowed to talk. You never tell Steve he’s not allowed to do anything, he talked! I explained that they would do better if they told him that it wasn’t a good idea. His memory at this period was shaky but he was certain that he loved me, and wanted to be with me. After two months he was moved to a hospital further away, a Spinal Unit in Sailsbury. I was by this time almost ready to give birth, and my marriage was dead, the love of my life was paralyzed and my whole life was in ruins.

Tetraplegic Love Lasting

I continued to work, until the day before Kieran was born on the 30th of December 1999. I had an emergency C section with the previous baby, seven weeks early. Unknown to me at the time, this weakens the uterus, so while in normal labour, the uterus ruptured, and I pushed him out by myself. The bleeding wouldn’t stop, the placenta did not deliver, my blood pressure was falling, and somewhere inside me, I knew I was dying.

I panicked as they took me to theater to manually deliver the placenta, the anesthetist was a friend of mine, and I was lying there on the trolley saying Ken, hurry up, I’m dying, please hurry, I don’t want to die, he tried to reassure me but I knew. Several hours later I woke up in intensive care. A male nurse standing by my bed looked at me, and said he knew me, but wasn’t sure where from. I grinned weakly and said Steve’s full name. He said, “Right of course, you’re his girlfriend. I remember now, blimey, he had the girlfriend who died in the crash, you, and a nasty wife.”

I was in the ITU for a week, and in hospital another week. They had to perform a hysterectomy, and were not exactly delicate about how they told me, “You have four children, you don’t need to have any more, we had to do the hysterectomy, or you would have died.” I was off work for exactly eight weeks. When Kieran was three or four months old I went to the hospital to see Steve.

Mark told me they would be ok, and that I needed to get on with my life. I was absolutely inconsolable for months. I couldn’t get over it. Suffering severe post natal depression, the loss of my ability to have more children, and the biggest loss of all Steve, I went and did the most stupid thing ever in the history of stupid. I had an 18 month affair with Mark, Steve’s older brother.

Kieran was 10 months old, it was my 33rd birthday in the October, and Mark organised a small party, at his house. His four kids were there, my four, Mark’s girlfriend, and my husband. Mark and I still dealing with our guilt over the crash, me with the death of my marriage, and my hopes for my relationship with Steve, my husband with his headlong dive into alcoholism and drug abuse, and of course wife beating.

Mark’s girlfriend and I went to the local on foot, leaving the others at the house. Mark and my husband had a fight. He asked Mark if he was fucking me, ever the smart arse Mark said no, but I’d like to. When we returned it escalated. My husband threatened me with a carving knife. Mark bounced his head off a wooden garden table, telling him, if he touched me again, he’d kill him, adding if his little brother was there he would not have offered the courtesy of a warning. The police were called and George was arrested. I was told I could stay there if I wanted to, they would make room, and with hindsight I should have, but I got a taxi home.

Closing Old Wounds

I arrived to find my husband attempting to burn the house down after having trashed everything. I called the police, they came, told me I was winding him up, it was the marital home, and he could wreck it if he wanted. On the 19th of November he kicked me across the living room in front of our 2yr old son and ruptured my bowel. I didn’t get to go to hospital for about four hours. I cleaned up the dinner he had thrown at me, and sat on the sofa, while the pain increased. Eventually he called an ambulance, warning me if I told them what really happened he would take our boy, and my precious bastard baby of Steve’s, and I would never see them again.

quadriplegic abuse
As we walked down the stairs at home, husband on one side a paramedic on my other, I began to feel sick. The paramedics shoes or my husband’s? No contest, as I felt the vomit rise in my throat I turned my head and puked all over his shoes. That made me feel so much better. I was in hospital for two days, before they figured out what was wrong, I was prepped for surgery, I had bowel resection.

Jim, a driver I worked with, and was good mates with came to see me. He sat next to the bed, looked me in the eye, and said, “Sarah, I know what’s been going on. I know you are frightened, and I know that’s why you haven’t left him, but this can’t go on. He will kill you in the end, talk to the police, please I’m begging you!” I looked at him, tears rolling down my cheeks. “You call them here, I’ll talk to them.” It took two hours to take my statement, they wanted me to go home, and said they would arrest him a day or two later… I looked at the police officer and said, “Who do you want to take out of there in handcuffs, and who in a body bag? Because I won’t be leaving in a body bag.”

Mark came to see me in hospital. I told him it was his fault. That if the family had not vetoed Steve being with me, none of this would have happened, he looked at me, and just nodded. The night before I was going home George came to talk me into forgiving him, promising to get help. I said the same thing I said the night of Steve’s accident… That it was over, and I wanted a divorce, and he was to leave when I got home, immediately. He was not to threaten to take the boy’s and he should be packed to go as soon as I arrive. He accepted this and left, taking my baby with him. I was terrified he would harm our kids.

The next morning it was like a military operation, my drugs were dispensed, and ready for 9am. Jim went to the house and met the police, they arrested George. Jim collected the kids, house keys, and came to the hospital to collect me. I went home in my pajamas!

My recovery took longer this time and as I couldn’t drive, I became the radio and phone operator at work, kept amused by all the drivers. Mark and Jim, to name a few, became my support network. Mark and I talked about how I felt about what had gone on with Steve and came to an agreement that it may have been the wrong choice to send him home to his wife. I never understood why they did it. None of them liked her, she was an awful wife, cheating, neglecting the kids, and the house. She was mentally abusive to Steve from the moment he got home. So while Steve was being abused by her, and I was being beaten to within an inch of my life, I completely failed to see who benefited. Mark did, he got what rightfully belonged to Steve, for a short while anyway.

Wake Up Call

One night at work a taxi driver I didn’t always get along with and I were sitting outside the garage smoking, and having a coffee. He turned to me and said, “Sarah, what are you doing?” “Well John I’m sitting here…” “No, you daft moo, with Mark. He’s not Steve, he won’t ever be like him, he won’t ever be him. No matter how much you want him to be. He just isn’t so you need to stop it, now! You get me? It’s only hurting you, not helping, it never will.” I looked at John, tears rolling down my cheeks, “I miss him John, it’s not fair, he should be with me, not being Annie’s pet husband, it’s wrong, it’ll end badly, I just know it.” And unaccustomed as he was to random weepy women, and show’s of affection, he hugged me tight, and said, with a great deal of foresight, as it turned out, “Don’t worry honey, it’ll all come right in the end, you two are meant to be, just keep the faith, don’t ever let go, and you’ll be together someday, I just know it.”

Wheelchair Couple Coffee

I don’t think I need go into the details of the following relationships, of which there were three, suffice to say, I ended it with Mark only a few days after John and I had our little talk. Soon after this my husband who was arrested for GBH with intent, skipped bail, and threatened to kill me. The council refused to move me until he tried, and I had been vaguely seeing the guy who fixed the company vehicles he offered for me to stay with him, we spent three years together, he was an alcoholic too. I had several affairs during that relationship, and as became my habit, when someone got too close I longed for Steve again, and sabotaged the relationship.

Frying Pan To Fire

I moved on, and had a short lived, sex based relationship with a soldier, 12 years my junior it was very short lived, but mostly enjoyable. I then got involved with someone 20 years younger. We were together for almost six years. During our relationship Facebook was invented and became a world wide access point for people to bugger up their lives, friendships and relationships. I found Steve and sent a friend request which he accepted. That was in December 2009, we didn’t speak much to start with, not directly. Annette didn’t like it so we commented on each others photo’, and generally kept track of each other. Steve has told me since that he was overjoyed when I sent the request. He had been looking for me but only remembered my married name, which I no longer used, and had bypassed me several times while searching Mark’s friend list, thinking it wasn’t me.

In August 2010, Annette got caught out in one of her numerous affairs, and while on the family holiday, announced the marriage was over, had been for many years in her eyes, she spent the insurance money, that Steve had got, and when that ran out, she started visiting sex sites, and meeting random men for sex. The bottom fell out of Steve’s world, he knew they had been in trouble for years, but she had systematically destroyed his self confidence. By the end of November we were in regular contact. In December we had some of the worst snow in year’s. My car was broke down in -20 degree temperatures and was out of action for three weeks. For those weeks, because our house is so remote, Luke my partner at that time went to stay at his mother’s. So he could catch the train to university. And I was alone with my two sons and my laptop.

Sweet Contentment

Steve and I talked for hours on end, with me filling in all the gaps in his memory of the crash, and of the following weeks. Telling him all the stuff that happened to me in those ten years apart and out of touch. He told me how awful that everything was after he came home, how every time they argued she threw the accident in his face blaming him for fucking up her life. When she had alone decided he would go back to her after discovering how much money he would get, plus all the benefits that came along too. Steve recalled, “She took me back to get my money, and pulled me away from you for financial gain, the spinal unit told her I had five years, six max, and once I passed six, that was it.”

By Christmas my car was fixed but my life was in turmoil once again. Steve thought I was happy with Luke, but I wasn’t. I felt like his mother, he was lazy, mean to the kids and our sex life was none existent. After about two weeks of arguing with myself, while Luke was fixed to the Xbox, I started an early evening chat with Steve. I had told him about my fling with Mark very early on during our chat’s and then said I had something else to confess, “You slept with Steve (Steve’s oldest brother) too.” He joked. “God, Steve, no! Credit me with some taste.” I replied, “What then?” he asked. I took a deep breath, and began to type, this is what I said: Steve, it’s you, it’s always been you, I am in love with you, I always have been from the moment we met, and that hasn’t changed. In all these year’s I never stopped thinking about you, wanting to be with you, see you, I am so unhappy with Luke, I just want you…

There was a long pause, it seemed to last forever. Then, “Really? when we started talking so much, I thought for a minute, maybe, hoped, but dismissed it, decided you were just being a mate, but you really still feel that way, you know I’m a cripple, don’t you Sarah? I didn’t get better Baby Girl, you know all this right?” “Yes Steve, I know, why would it make a difference?”

There’s things you need to know he told me, we talked a lot on MSN, when we got kicked off Facebook chat for using it too much. He told me all about his injury, his needs, and the hardest thing he ever told anyone ever, about his erectile dysfunction, and that he and his wife had never had sexual intercourse since his injury. But there are ways we can he said, she just couldn’t be bothered. He wrote it all on MSN with his Dragon dictate software, and the pause, while I read it, seemed like a eternity, the next thing he wrote was “Oh no, what have I done, it’s too much. I want to make love to you and I might not be able too… say something Sarah.”

I answered him, immediately, “No, Steve, I was just reading it, carefully, so I took it all in, so, tell me, what can we do, for us to be able to make love?” His response was one I will never, ever forget…” Oh God Sarah, you really do love me, and want me, don’t you, do you know, how I write text messages, let me tell you, I write them with my tongue, I can drive you to total ecstasy with my tongue, you’ll think you are dying with pleasure, I promise you, I’ll make you come, for hours, and when you think you’ve had enough, you’ll be begging me for more, I can satisfy you more than any man has ever before I promise, but we may not be able to have actual sex, do you think you can spend your life that way?” “Yes, Steve, oh my God yes, I am turned on just thinking about it.” “Good, and there are tablets that can help with erectile dysfunction, I tried Viagra but it made me dysreflexic, and Annette didn’t want to have proper sex with me anymore she had plenty of that elsewhere”

That conversation took place in the first week or so of January 2011, Annette had met a new guy online and stayed with him most weekends, which became four or five days, leaving Steve with her two kids from her first marriage, and her and Steve’s two son’s, who when they said they were splitting both opted to stay with Steve. We spent loads of time on the phone, having both taken out a contract with the same mobile network, we talked endlessly about before the crash, and after, and laughed, a lot. we sent dirty texts, he drove me to orgasm by talking to me, we had phone sex, my vibrator got a lot of use in those weeks, he loved to hear me coming while I gasped his name, and screamed it too.

Annette and her new man found a flat together, they were moving in on the last day of February, I arranged to go and see him, that weekend, the 3rd of March, I lied to Luke about where I was going, Steve had said he would hold me to nothing, until he looked into my eyes when I first saw him, and knew I meant it when I said, to his face that I love him, and his spinal injury changed nothing.

Quadriplecic Love

I arrived at his house around midnight on the Thursday, Callum, his 13yr old son let me in, and I followed him upstairs, I was so nervous, it had been so long, what if I was not how he remembered me, what if he decided it was a terrible mistake. I walked into the bedroom. Steve was in bed as the carers come to put him to bed at 9.30pm, I walked to his side of the bed, all the nerves melted away, we looked at each other for a few seconds, and he said, “Hi Babe, been a while, you look just the same as I remember.” I leaned over and kissed him, we forgot for a second that Callum was there, and he kissed me back passionately, and then said, whoa, children! Callum stayed for twenty minutes, went and made a cup of tea, and then, bless him, made a tactful departure.

Fatal Rapture

In minutes, I was down to my red (Steve’s favourite colour) knickers and bra, and in bed, in his arms. “Get that bra off, this instant, I want your nipples, where I can get them.” I did as he asked, “Come here, then, but remember you are the boss, you say how far we go, or not.” And that night, my nipples got more attention than they had ever had before, and I was gasping for breath by the end, Steve is super sensitive around his neck, shoulders, ears, and head, and I worked this out very quickly. We fell asleep, with Steve’s arms wrapped around me, and his body curled towards me, my knickers lost somewhere on his bedroom floor.

The next morning the nurses arrived, at 8.30 to do bowel care, just walking in like they owned the place, I had in the night kicked the duvet off me, so the sight that greeted them was me naked, wrapped in Steve’s arms, they didn’t know where to put themselves, but made no sign of leaving the room so I could cover myself up. Steve woke up, and said, can you get out, please, Sarah needs to get some clothes on, she can’t stand around on the landing naked while you do what needs doing, can she? they went out onto the landing, and I found my dressing gown, and dragged it on, I went and found the kitchen, made coffee, and waited while his bowel care was done, I could hear them, questioning him, about me, him telling them, that we had known each other for years, and get used to my being around. Is this the new girlfriend then Steve? Yes, his very firm reply.

It was an amazing weekend, the second night he did as he promised with his tongue, by far  the most stable position for this is me facing his feet, where he can get to every part he wants with ease, but I like to face him, because he likes to watch my face as I come, and look into my eyes as he works me into a frenzy, but that way, plays hell with my legs, which start to give way. “Turn around Sarah, I want that cute little arse in my face.” so I do, and in minutes I am experiencing the most intense orgasm I have ever had in my entire life.

My body takes over completely, rocking back harder and harder against the firm pressure of his tongue, while I scream his name, over and over, gasping that I am coming, like he was in any doubt! And just when I think it’s stopping it washes over me again, he pushes his tongue inside me, moaning softly as he does so, pulling me harder towards his mouth, murmuring “Come on Baby, there’s more I know there’s more” And he is right, I push back again, “Oh god, Oh Steve, Oh please, I can’t, can we stop…No, don’t stop, don’t ever stop Oh Steve, I’m coming.” A muffled groan is the only reply, and a giggle, as I change my mind about a break, and then change it again.

While this is happening, I glance at his penis, which with some attention from my mouth had hardened, and then changed its mind, but is in my hand anyway, and it’s hard, properly, “Steve, you are hard! stop a sec, I keep a firm hold, and switch back to facing him, then gently guide it inside me, his face registers surprise, I can feel that, he says, not all over but the warmth, the pressure, oh Sarah, you are a clever girl, I move gently, so we don’t lose it, feeling him hard inside me is just wonderful.

Looking into his eyes, as I move up, and then gently back down, then keep still, and use my fingers to make myself come, at this point, as I do, his eyes widen, in surprise, I can feel you tightening on it, and then he says he has this odd, fluttery feeling in his stomach, which he says is so pleasurable, and I can feel him hardening more inside me, this feeling intensifies, then slowly stops, I think that that was the first time I had an orgasm since my injury, he says, and that was just well WOW.

Wheelchair Love Lasts

So, although there is some erectile dysfunction, with the right stimulation, it’s not all the time, we use a drug called Cialis, if we want it to last longer, and be harder, but most of the time, I can get it to become hard, with a combination of him watching me give him oral sex, and the use of a mini vibrator called a bullet, or just him giving me mind blowing orgasm’s

Quadriplegic Love Lasts

The weekend flies by, and it’s Monday, before I know it, we have time to go to lunch with Victor, a friend of Steve, since they were 17, he is a lovely guy, but his and Steve’s friendship has suffered over the years, due to Victor’s intense dislike of Annette, and her treatment of Steve, and herself serving reasons for taking him back. He told me all about it as time went on, just before the accident.

Victor clearly remembers Steve visiting with Kathy, and telling him, don’t get too used to her, it won’t last, don’t let Justine (Victor’s wife) get too friendly, there’s someone else, I have fallen in love with, but Fuck, it’s so complicated, she’s married, but he is a dick, and I think she is scared of him, and she’s pregnant, and no it’s not mine, but Victor I want her and I know she feels the same.

I just have to get out of this, I can’t deal with her, she’s suffocating clingy, and keeps on about us getting custody of the boy’s, she doesn’t know anything about kids, and I just don’t love her, not that way, what the hell am I going to do? Victor told him to tell the married woman how he feels.

Then we are standing in his back garden, having a cigarette one day, and Victor suddenly realizes he saw me, the totally devastated pregnant woman at the hospital was me, and it all slots into place, and he say’s, “And you still love him after everything that’s happened, incredible.” So friends believe me when I say quadriplegic love lasts.  After all the pain, distance, and time, plus our many obstacles and mistakes, our love for each other has endured to this day.

3D Wheelchair Art Modeling

3D Wheelchair Model Animation

Creating 3D wheelchair model animation is easy with so many user friendly programs available these days. You no longer need a degree in kinetics to easily create realistic animations. I explained how to set up some simple 3D wheelchair models previously using free 3D software Daz3D. Now here are a few 3D wheelchair model animations I put together. One of the options in the Daz3D 4.6 free version is export as an AVI movie. I then simply rip to GIF format to be cross browser friendly and post here.

The 3D wheelchair model animation below is a short endless loop of 50 frames. Our female model Susan in sports gear is walking beside our male model Michael in a Flex wheelchair on a warm sunny day.

3D Wheelchair Model Animation Walking

3D Wheelchair Model Animation

This second 3D wheelchair model animation is sexy Susan in a bikini on roller blades pushing a shirtless Michael in his Flex wheelchair. This one is an 80 frame loop. Sometimes it’s the simple things that make it look most realistic, like Susan’s hair blowing, and Michael’s head bob on each push. Did I over do her boobs lol? The scene in the background is a single image making the rendering process (saving as video) faster.

3D Wheelchair Animation Roller Blades

Wheelchair Model Animation of sexy bikini girl jiggle on roller blades pushing guy in flex wheelchair

Once you get the basic movement right there are many easy to apply options; skin color, hair type, clothing, body type, muscle size, plus lighting effects, endless camera angles, and so on that all conform or magnetize to your base 3D wheelchair model animation. I created the above short animation simply by making a few changes to the first countryside one.

3D Wheelchair Animation

Bookmark this page and have a go at making your own 3D wheelchair animation. I’m here to help and happy to post any of your creative works on a page of your own.

Mad Spaz Club copyright wheelchair icon

Website Help and Updates

Mad Spaz Club wheelchair welcome icon copyright streetsie.comWelcome to the Mad Spaz Club website where all the cool wheelchair people hang out. Please report bugs, make feature requests, post complaints and general feedback in the comment section below. We are constantly improving the Mad Spaz Club website to make your visit a safe enjoyable one. Simply register an account to access all our features.

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11 February 2014 Extra Chat Features and Author Pages

We have made adjustments to our live chat to reward our loyal members including; online user list country flags, message window refreshes every 3 seconds (was 4), 500 characters per message max (was 400), anyone with contributor status (has written an article for us) can access moderation tools and initiate private chat windows, and we un-banned several words eg. viagra sex vagina ejaculation. We do allow discussions about sex as long as it is not offending anyone. You can now also read more about an article author by clicking on their name at the end of an article.

8 September 2013 Chat and Gallery Upgrades

Has it really been a year? We have made many improvements site-wide and helped hundreds if not thousands of people living with spinal cord injury. Major upgrades were recently made to our Live Chat feature after a conflict arose with the gallery. The gallery problem is an external scripting one out of our control so we are seeking a new gallery solution. A big thank-you to all our supporters and helpful members assistance over the last twelve months. I will try to post more updates here before another year passes us by.

12 Sept 2012 Amended Registration Agreement

Added “Wheelchair Dating” and “Artworks” forums, opened quick reply feature, upgraded versions and made minor layout adjustments. Amended registration agreement to include; “POST SOMETHING. The more you post the more access and privileges you are given. Members with 0 posts are given a rank of “Voyeur, one who spies on another’s private moments.” As we respect and protect our active members privacy, members with 0 posts are often deleted. To avoid this please make a post.”

11 June 2012 Forum Upgrades

Our forum has been updated to the latest stable version. We also added new avatars, a disability field to profiles, and enabled a “quick reply” feature on all posts. The disability chat room refresh rate has been bumped from 6 to 7 seconds to reduce server load and make it more stable when busy.

13 Mar 2012 Theme Updated

75% of people viewing our website use Internet Explorer. Updating our theme to display correctly in IE and the top 5 browsers is a never ending process. We rolled out several cross-browser fixes bringing our theme upto date today. Let us know if you have any problems viewing our website.

1 Oct 2011 Memberships Increase

600 images were added to our galleries during september. We wish to extend a warm thankyou to all who uploaded and the regulars who assisted new members and visitors during Graham’s absence. We’ve seen memberships steadily increase on our forum. The live chat area has been busy and our most prolific member there Deb has been promoted to a chat Admin. We greatly value all our members and appreciate your continued support.

27 Aug 2011 Article Submission Form Added

Website updates this month saw our article submission form go live to the public. I hope by making it easy, it will prove popular, as I love to read all your stories and experiences. Adding a math quiz to our member registration form cut down spam allowing me more time to work on Mad Spaz Club articles. While there have been several background improvements made the only other noteworthy mention is that over 300 images were added to our image galleries this month. Thank-you all for your continued support.

6 July 2011 JPG Image Upload on C omment Form

We have added the optional ability to upload an image along with your comment. We hope this enhancement makes it easier to share photos and interact with your fellow members here at the Mad Spaz Club.

20 June 2011 Upgraded Gallery Features

Thank-you to all our members who submitted photos to our galleries this month. Nearly 300 images in total. In appreciation we have added new features allowing you greater control over descriptions and how images are displayed. Any registered member can create a gallery and upload images, here’s a step-by-step how to.

  1. In your profile> Gallery> Add Gallery/Images
  2. Click “Add new gallery” tab
  3. Type in your gallery name
  4. Click “Add Gallery” button
  5. Click “Upload Images” tab
  6. Select your gallery name from the “chose galley” drop down
  7. “Browse” to and add your images, you’ll see them listed below the Browse box
  8. When you’re ready click “Upload images” give it time to process and create thumbnails
  9. Then you can add descriptions, alt and title tags, adjust your thumbnails etc.

1 June 2011 New Comment Notification Design

Our exciting new HTML comment notification design was launched today. Simplistic and sleek, if you comment on our website and leave the “Notify me of new comments on this page” box checked you will receive a visually stunning thank-you email notice on your first-time comment and an email notification everytime a new comment is posted on the page you are subscribed to. All MSC notification email includes links to opt-in/out of our services. We hope you enjoy this improvement.

1 May 2011 Reinstated Disability Forums

A flashback to the heady days when websites were built around forums. We get quite a few requests for forums and so after an extensive overhaul the forums we began in 2003 are back with retro flair. Some images and SP posts were not retrievable and we are working on bringing it into line with our one login for all website features policy but it’s up and running with a new “Personals” section so register and post your profiles.

29 Mar 2011 Bluce Ice Theme New Default

We will be rolling out our Blue Ice theme this week. Those resistant to change will still be able to revert to our Ruby theme with our theme switcher for a limited time. Blue Ice is the new default theme. Why? Features; Less clutter to find what you’re looking for faster. Quicker loading pages. Lightweight sub pages. Upgraded security. Easy to read fonts. Footer includes hot topic lists and quick contact form.

4 Mar 2011 Building Blue Ice Website Theme

We are developing a new black blue and white disability friendly theme with simplicity in mind. Soon you can find what you are looking for faster. But you don’t have to cross your legs and wait, use our Theme Switcher and check Blue Ice out now! Be sure to tell us what you think.

28 Feb 2011 Visit Our New Live Chat Area

We promote disability adventure and publish personal stories from wheelchair users and other people living with and caring for people with disabilities. We share knowledge and experience providing information and support to those impacted by spinal cord injury and all that wheelchair life involves.

Get Published

Your story could bring comfort to many. We love to hear from wheelchair users and people living with paraplegia quadriplegia and spinal cord injury as equally from anyone who’s life has been impacted by disability. We want to publish your story, if you are willing to share your story tell us briefly in a comment or our live chat area and we will contact you.

Our Gallery

To upload pictures and share with us you must have a registered account. Your images will not appear until they are approved by an admin. You may also upload images in our forum once registered, these will appear immediately. Visit our live chat area to request an account or higher access to advanced features. Anyone found abusing fellow members or our services will be dealt with severely. We reserve the right to delete any account and services without notice.

Create Your Account

We have taken steps to block spammers but allow legitimate users to still register an account with us. If you have any problems registering simply post or comment here or drop by our new live chat area and we’ll do our best to help you. Admin’s can create accounts and answer any questions about uploading images and publishing articles.

We apologize for having to delete previously registered member accounts and any inconvenience that may have caused. We take your security very seriously and take any action we feel necessary to safe guard you and your privacy. No accounts were compromised, we only deleted previous member accounts as a precaution.

Contacting Us

Other than our live disability chat and comment areas we offer a contact form at the bottom of our home page. We encourage you to ask and be answered in article comment areas so others can read learn and offer answers. We make it easy to post a question, comment or have your story published. So get cracking, shake off that granny blanket and show the ability in disability.

Many people don’t realize a spinal cord injury not only affects the person living in a wheelchair, their immediate family friends and loved ones lives are also affected. Relatives, work colleagues, even your local doctor becomes involved in one way or another. Did you know one third of the population has or cares for someone with a disability.

Dean Pusell Love the Universe in You

Dean Pusell Love the Universe in You

In the summer of 1988 the smell of salt hung in the air by the beach in Australia. I decided to escape the heat and go surfing with friends. We all ran into the water diving in at waist deep. As I floated to the surface face down unable to move. I knew the blood in the water was mine. Thankfully my friends noticed and rolled me over. Unable to feel from my bottom lip down I sucked in a big breath of our precious sky. Funny, I lost a lot of blood but not a tear in the ocean that day.

Dean Pusell Love the Universe in You

Love the Universe in You

I was placed in a halo brace to stabilize my quadriplegia and for the next fourteen months in hospital I was nurtured and doctered to use a cold steel wheelchair for the rest of this mortal life. I was only sixteen. After re-learning how to dress and feed myself it came time to write. Though it was most difficult I not only learned to write again, I came to allow my feelings to flow through my hands, drawing and painting over the next few years.

From 1994-2005 my creative works featured in 65 exhibitions around the world involving surreal painting, charcol drawings, collage, photography and poetry. I even turned my hand to writing lyric’s for a blind man to air on public radio. It lead to more television comericals and interviews.

For the last 18 months I have squinted through my heart, purely absorbing this mystically breathing life of spirit, breeze, and vibes- from pulse to paper in “Love the Universe in You” my scribbles began happily.

In a minds gentle silence and a hearts soft voice this smiling light was healing in a peaceful surrender, what grew in this pink and purple dusk amongst the closing lavender lotuses was the birth of a waking dream… piercing stars now whispered a gentle bliss. – Dean Pusell

“Love the Universe in You” is my latest published book. It was written with a glowing smile, deeply feeling the dual meanings of the title. Grab a copy and find your bliss.

Peace and smiles to all,
Love Dean Pusell
DeanPusell.com

sarah casteel wheelchair tennis champion

Sarah Casteel Wheelchair Tennis Champion

Sarah Casteel two time national wheelchair tennis champion suffered a paralyzing spinal cord injury when a drunk driver slammed into the car she was driving on Independence Day in 2002. Tragically her 15 year old brother in the car at the time, did not survive the accident.

sarah casteel wheelchair tennis champion
Sarah Casteel Wheelchair Tennis Champion

Casteel, 18 years of age, was taken to the University of Missouri Hospital where she not only had to cope with the loss of her younger brother but the loss of her mobility. Now a paraplegic, she would not walk again.

Sarah remained in the hospital for three months before returning to her home in Greenville, South Carolina to continue with physical therapy.

Life with Paraplegia

Prior to the accident Sarah Casteel was an all-state volleyball player who excelled in tennis, competing on the boys’ tennis team in high school because there was no girls’ team and later played for Stephens College in Columbia, Mo. In her freshman year of college she wanted to study fashion design and art, but that all changed in an instant.

After the accident Casteel returned to Stephens College where she quickly discovered it was not wheelchair accessible. Many of her classmates were less than compassionate unfamiliar and uneasy with her new found paraplegia.

It was not good. It was weird; my life had changed so much. I found out I didn’t have friends anymore. A lot of people I thought were my friends disappeared. I guess they couldn’t deal with it. It was very hard. I decided this was not the place for me anymore. – Sarah Casteel

Casteel began looking for another school, one that could accommodate her wheelchair and improve her quality of life. She found such a place at the UTA (University of Texas in Arlington). She applied and received a wheelchair tennis scholarship to attend the UTA.

The occupational therapist I worked with in Missouri actually introduced me to wheelchair tennis, so I started looking for a school with a wheelchair tennis program, and the University of Texas actually was offering a scholarship for wheelchair tennis. I made friends there and I was No. 1 on a team of four. I competed against other colleges and in national tournaments. – Sarah Casteel

National Wheelchair Tennis Champion

Sarah Casteel

Sarah Casteel

The two time USTA (United States Tennis Association) national champion 2004-2005 Sarah Casteel has also competed in the World Cup held in the Netherlands. Graduating from Stephens College in 2005 with an Inter-disciplinary Studies degree with a focus on biology, she decided to pursue a career helping others.

A connection made with an occupational therapist in Missouri inspired her to become an Occupational Therapist. This led her to the Medical University of South Caroline (MUSC) where she graduated in 2009 with a Master’s in Occupational Therapy.

Training for a spot on the USA Paralympic wheelchair tennis team to compete in the Beijing Paralympics 2008 was interrupted when the steel plates and screws that fused her spinal vertebrae together began to irritate. After further spinal surgery and several week’s recovery, the unstoppable Casteel was back in training with her coach, Crafton Dicus, and competing nationally. Becoming a member of the U.S. Tennis Association High Performance Wheelchair Tennis Team.

Wheelchair Tennis Paralympic Games

Now with the guidance of pioneering wheelchair tennis coach Chuck McCuen, striving to hold a place in the World Cup Team 30 year old Sarah Casteel, a world-ranked wheelchair tennis champion feels she has a shot at representing her country in the Paralympics Games in London 2012. With the formidable tenacity Sarah Casteel has approached life with and a mean top-spin backhand that could snap your head off, whether Sarah makes the Paralympic team or not she will continue to inspire as all.

Loving Somebody Extraordinary

It was September 24th 2006 when my path crossed with my soul mate. At 35 I had all but lost faith in eligible men and monogamous relationships, never mind conventional marriage. There he was sitting in the only patch of sun at a Bar-B-Que and I couldn’t resist joining him to soak up the warmth. I had just given up alcohol for good, and offered him a taste of my ginger beer. His cousin, our neighbour of 34 years, was having a farewell BBQ and Francois almost didn’t come. Meeting Francois changed my life forever. 

Loving Somebody Extraordinary

Loving Somebody Extraordinary

Francois is a wiz on computers and online games. At the time he was busy with Lineage II. He explained how he was able to gather with other online gamers across the world to arrange sieges, defend castles and fend off fierce dragons. He called himself a “lowly warrior”. I have since discovered he is more likely a Knight. With many of his fellow swordsmen being North Americans, most of the online battles were scheduled for 4am. This was no trouble for Francois and he would be awake and ready to support his guild. 

His lifestyle was akin to that of a vampire, drawing the thick curtains during daylight so the glare wouldn’t reflect off the graphics, and awake all night to battle. He fought with pride, honour and dignity, and this seemed to mirror his inner core. Francois was clearly a gentleman who encompassed good old fashioned chivalry. He also has a deep understanding of human nature, and a permanent good humour. These are rare and precious qualities that were obviously enhanced through his disability. Francois has a level C5-6 spinal cord injury (SCI) and is completely paralysed from his chest down to his feet. He has partial movement of his upper arms running down into wrist extension, but sadly it stops short of hand and finger movement. 

At 5:20pm on a warm Monday afternoon in 1992, a car drove into Francois flinging him off his motorcycle and breaking his neck. What would you do if you could alter 10 minutes in your lifetime? He was 18 years old and had just started working. He spent six months at the Conradie Rehabilitation Centre for spinal cord injuries where he recovered and was taught how to adapt to his new life. The first three months were spent in a head brace which was fastened tightly to prevent any movement at all so that the bones in his neck could fuse. They didn’t realize that his scapula was broken, and the pressure of the brace against his shoulder was agonizing. The pain in his shoulder restricts pushing his wheelchair to this day. Suddenly lying on your back with no sensation and no movement in your entire body is a life sentence that one cannot compare to anything. It’s unthinkable. 

The ward was full of men forced to come to terms with their injuries. They developed an unspoken bond and deep understanding that would resurface years later when they bumped into each other again. Every three hours they were turned to prevent pressure sores, which meant a peaceful night’s sleep was impossible. Pressure sores are one of the worst afflictions of paralysis. They develop too easily from lack of blood circulation, mostly from a hip or bony extrusion pressing for too long on a surface. Being paralysed means not being able to feel anything below the level of the break, and often a pressure sore can go unnoticed until it’s very serious. Tragically, two thirds of people with a spinal cord injury suffer chronic, intractable pain in those areas where there is sensation. A “complete break” is when the nerve has been completely severed, whereas an “incomplete break” means there is still some connection and some level of recovery.

God’s miracle of creation is clearly evident in how the organs of the body know their respective tasks and carry on as per normal. Bladders and bowels still need to be emptied. This is one of the biggest hurdles that a paralysed person faces, how to manage their bowel routine and to retain some sort of dignity. Did you know that it’s impossible to cough without chest muscles? This change’s the dynamics of catching a simple cold for fear that it may become bronchitis. I certainly didn’t know. I knew virtually nothing about paralysis when I met Francois. But I was willing to learn one day at a time in order to spend time with him. I laughed more than I had in years, life had become adventurous and fun, I had found my very own Mr Bean and perfectly preserved Peter Pan rolled into one. 

Francois enjoys the view from his wheechair in Knynsa

Francois enjoys the view from his wheechair in Knynsa

Our first date was a drive to Ceres, stopping at Bainskloof pass for a picnic. It would be his first picnic in 15 years. Imagine not doing things for 15 years, not going to the movies, not believing you could have a loving partner or a normal life. It was a first of many more firsts to follow. But that picnic was our very first time and we hadn’t yet figured out the do’s and don’ts. That day I burnt his hand with a hot coffee cup (he still has a small scar); he developed the start of a pressure sore sitting on a hard car seat; and he got a bladder infection from an overfull legbag that he didn’t want to ask me to empty. It was love. And the physical attraction was undeniable. He had a twinkle in his gorgeous blue eyes that made my heart skip a beat. 

We both knew from the beginning that we had found the love we had once believed in. I had travelled around the world and found the centre of my universe on my doorstep. We used to play together as carefree children. Francois proposed to me on 7/7/2007 during a weekend away at Cape Agulhas. Our friends and family joined in an awesome engagement celebration at Wiesenhof, in the heart of nature. We had a BBQ at the lapa overlooking the dam, with each guest receiving a straw sunhat as a special memento.

Computer keyboard typing splint

Computer keyboard typing splint

Soon after we met, Francois embarked on an arduous journey of studying IT through UNISA. It’s a four year course that he has immersed himself into, determined to make a success. He has been richly rewarded with distinctions for almost all of his subjects. It’s a tremendous achievement, especially given the technical difficulties involved for him to study and write his exams. He is fortunately able to operate a computer easily with the aid of a typing stick. In fact, with another set of helping hands he has built all his own computers. However, a textbook poses much more of a challenge. To handle a book and turn pages without the use of hands and fingers is no easy feat.

Here Francois’ mother deserves a special mention, as she tirelessly assists him with his studies as his caregiver. The first examination that Francois wrote was nail-biting. Other students are able to write exams but Francois needs a computer to type on. They had designated a computer at the back of the normal exam venue upstairs. On that particular day the lifts were out of order. Mayhem and panic followed. They contemplated carrying Francois upstairs, but this was too daunting and dangerous.

The library was downstairs and they ended up using one of the quiet audio-visual rooms, make-shifting a desk for him. Telephone books were cleverly placed underneath to raise the level of the desk to the height of his wheelchair. Another desk was placed alongside for Francois to be able to lean on. Without him having stomach muscles he is unable to balance, so without support he would topple over. I’m not sure if he would fare well on a boat, it’s an adventure we’re still to try. Lastly, he brings his own keyboard and mouse for ease of use. This was to become Francois’ examination venue thereafter. A few years on, Johan Jacobs, the Deputy Director at UNISA, specially designed motorised adjustable desks suitable for people with any sized wheelchair, and purchased state-of-the art computers for people with any type of disability.

Each exam has had its own set of challenges. Once, Francois had to re-write his exams. It was a very bleak day indeed. As Francois was finishing up and preparing to print, MS Word froze and all his answers were corrupted. That day Francois and his invigilator sat for seven hours straight as he diligently rewrote the entire paper. Tricky too is when questions require him to draw a technical diagram, which he cannot do. This can be beyond frustrating. Frustration is the number one stumbling block. Able bodied people are able to go for a walk, go for a drive, do something else to release our pent-up frustration. How does a paralysed person handle the many frustrations that he encounters? Francois remains sane with an insane sense of humour.

It’s a daily reminder for me to be ever-grateful that I am physically able to get out of bed, take a shower, hop into the car and drive to work. The simple everyday things that we take for granted are actually the greatest gifts in life. Francois is unable to cross a road on his own because of the pavements. It takes a minimum of two hours to get us both ready in the mornings. All routine tasks take thrice as much time and effort.

Going out can become emotionally draining when things go wrong: if the legbag leaks and floods the shoe with urine; not being able to find parking in a designated wheelchair bay; no room for the wheelchair next to the car, a small oversight in some parking areas; the catheter not draining properly (this is life-threatening if not fixed in time); extreme hot or cold weather (quadriplegics don’t have normal temperature regulating bodily functions); transferring into or out of the car in rain where everything plus the wheelchair cushion gets wet. Yet after the rain there is always a rainbow. We had a magical wedding on 4/4/2009, it was a dream come true. The love and support from our family and friends was phenomenal. This was topped by the best adventure we’d ever had, a honeymoon in Kruger National Park.

Travelling-wheelie-Wall-E

Travelling companion Wall-E

Wall-E was our travelling companion, a young fluffy lion with wild hair and an eagerness to see untouched nature. Kruger is well equipped for wheelchairs, and each of the five parks we stayed in had designated bungalows that were wheelchair friendly. Though being wheelchair friendly doesn’t necessarily mean being quadriplegic-friendly. On two of the balconies I almost lost Francois as he went flying down a ramp that was too steep, once backwards! He also burnt his hand quite severely while tending to the fire one windy evening. We had duct-taped a long two-prong fork to his hand so that he could turn the meat. He is unable to feel heat on his hand and the fire must have been hotter than we realized.

 We both tend to put on our McGyver caps when trying to find clever ways of doing everyday things. Great successes are duct-taping a table-tennis bat to his hand, putting non-slip handgrips onto everything, which has amongst other things brought out the chef in him. Along our travels we were privileged to find QAWC (QuadPara Association of Western Cape) through which we have met so many other people in a similar situation as us. Some were recovering at Conradie at the same time as Francois, cementing strong friendships. They don’t let adversity hold them back. It is fascinating to observe how everyone finds ingenious ways of doing things. It is just a lot harder to physically do everyday things, and a person’s potential is dependent on their environment and support base. Which is why it’s uplifting when total strangers offer their help. On a particularly interesting day at the World of Birds, a steep pathway had become damp and slippery. We were stuck. Out of the blue a strong set of arms enveloped my shoulders and helped me push the wheelchair. It’s these moments that live forever.

Christopher Reeve named his first book “Still Me”. He was still the same person inside, regardless of his physical condition and appearance. He was still the same person, yet even better in many ways. As was Francois, he most likely developed a bucket load of patience, a deeper level of understanding, and an enhanced emotional intelligence* after his accident. Chris used his fortune and misfortune to encourage researchers to find cures and a better quality of life for paralysis victims. Chris’ work and legacy is paying off. Recently a paralysed victim of a car accident, Rob Summers, has been able to move again through ground-breaking electrical nerve stimulation. Although still early days, it pays homage to the title of Christopher Reeve’s second book, “Nothing is Impossible”

Jessica

3D wheelchair models Michael and Kay splash into some swimming pool fun

Wheelchair Models Pool Fun

This week 3D wheelchair models Michael and Kay get wet in pool fun. Water is a difficult medium to animate. Plugins can achieve a realistic effect but out of the box Daz3D is hopeless at animating water. Adjusting opacity works fine for still images. However, creating an animated splash effect as Michael plunges into the pool in Daz3D is a big fail.

Three solutions; purchase a plugin, create splashes in another 3D modeling tool to import and animate, or place the camera at water level and move the water surface. For the simple purpose of bringing you original wheelchair related content we did the latter for this short video clip.

Wheelchair Models Pool Fun Video

Realistic Wheelchair Models

Good lighting is essential to realistic effects. Get the movements right before adding lights as they slow render speeds dramatically. We import the pool scene and fill it with water. Animate disability models sexy paraplegic Michael in his briefs and Kay in a pink bikini jumping into the swimming pool. Then add eleven slightly yellow distant lights to replicate sunlight; a ring of five pointing down at -33 degrees, five up at 44 degrees, and one down at -59 degrees. We set raytracing on the last light with an intensity of 73 and a shadow softness of 2 for a realistic sun shadow.

Adjusting Lighting for Wheelchair Renders

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The Pool Fun Part

We understand most don’t care how we create content, you just want to see the end results, and that’s ok. We have no purpose without an audience. If our audience does create and share stories, photos, video, comments, etc we will grow faster and serve you better. We built this website so you can express yourself. These anatomically correct models can be made do much more than we have shown here. We are also interested in using real-life models, disabled or not.

Graham Streets
MSC Admin

Disabled wheelchair model animation Michael pushing manual Flex design wheelchair

Wheelchair Animation In Daz3D

Ok rock stars, here is our Flex design wheelchair animation in Daz3D. With a few quick steps you can have fun creating your own wheelchair animation in Daz3D at home for free. Download a free version of Daz 3D from their website. Previously I showed how to import 3D models and figures, set colors, textures, clothing, pose the figures and so on. Now let’s have some 3D anim movie fun.

Wheelchair Wheel Rotation

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To setup your wheelchair wheel rotation open Daz3D and click the Pose & Animate tab. 1) Import your wheels to the zero point. 2) Set X Rotate to 720. 3) Set Y Translate to 31. 4) On the timeline set 91 frames, a range of 0 to 90, and drop the frames per second (FPS) to 20. 5) On frame 90 set Z Translate to -389.36. Render to see if your wheelchair wheel rotation is correct and matches the distance. 

It might be worth explaining how I calculated wheel rotation and distance. 2 PI R equals the circumference of a circle. Imagine wrapping a string around the tyre then laying it out flat, we want to know that measurement to sync the wheel rotation to distance. PI is 3.14 and R (radius) is 31. So 3.14 x 31 x 2 = 194.68 for one full wheel rotation. Times 2 again for two wheel rotations and we get 389.36.

Posing Disabled Wheelchair Model

Now the wheelchair animation is looking good we start posing disabled wheelchair model Michael. Sit him in our flex wheelchair at frame zero and on frame 90 set Z Translate to -389.36. Then add key-frames and adjust his chest, arms, hands etc to give the illusion he’s pushing the wheelchair. Take a few renders going back and tweaking to achieve a realistic motion. Here’s our paraplegic hunk Michael in motion.

Sweet, all we do now is set a scene add a few lights and drop in a background. Indoor lighting can be a bit tricky in Daz3D so I won’t bore you with all that here. Just know in Daz3D you need raytracing on at least one light to get a realistic shadow effect. Here we have the sunlight (distant light) coming through the window and four down lights (spotlights) all set with raytracing on.

And with that I’m off to watch The Lorax.

3D Wheelchair Models

3D Wheelchair Models Ioke & Michael

More 3D wheelchair modeling creations. This female wheelchair model is Aiko from Daz 3D. I call her Ioke after the lovely Thai Airways flight attendant who assisted me on a recent trip to Thailand. I have been designing several working 3D wheelchair models to use on our website. And ladies, you’ll be happy to know I’ve included Michael, a handsome 3D male model.

Many good looking men and women with spinal cord injury in wheelchairs and several devotees are willing to model for me. Problem is they suddenly become shy when I talk of publishing their images on the internet. By using cyber 3D wheelchair models nobody’s feelings get bent. If you want to become a real-life model for us please use the “Quick Contact” form below.

3D Wheelchair Model Ioke

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(1) Our 3D wheelchair model Ioke sitting in a powerchair. (2) We zoom in to give her some personality. (3) Open her body suit collar for a little sex appeal. There are many parameters we can adjust; breast and nipple size, tummy, glutes, hips, wrist. Overal figure; voluptuous, muscular etc. Her face; Eyebrow frown, raise, wink, yell, purse lips, teeth open, tounge out, and eye color are just some options. (4) We give her a smile and (5) close her extraordinarily large eyes a little.

Now let’s disable her! It’s common for wheelchair users with spinal cord injury to have muscle wasting in their legs as they no longer function. It’s called flaccid legs. (6) Our selected leg components are given a small box with red blue and green arrows. These indicate the 3D models X Y and Z axis. (7) To make the leg muscels appear thinner and slightly narrower we reduce the X and Z scale axis. Wheelchair users will also be familiar with turned feet. (8) I turned the right foot in a little when adjusting hip and knee bed angles to sit Ioke in the wheelchair. (9) One hand on the wheelchair control joystick and (10) the other bracing our 3D model Ioke in her power wheelchair.

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How are we looking? I know it’s not perfect. I want to put yellow coil springs under the wheelchair seat, retractable arm rests, seatbelts and calf straps, but as a prototype it’s getting there.

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A chasm scene with lights positioned for anime effect. Once I optimise the 3D wheelchair model and import it as seperate parts I’ll be able to animate and render a movie. For now I better put up a preview of our male 3D model Michael, so our female members don’t lynch me.

3D Wheelchair Model Michael

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Our 3D wheelchair model Michael is doing a wheelstand in a manual hospital style wheelchair. I edited the wheelchair in Rhino 3D then pulled it into Daz 3D to position Michael in it.

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Victoria screams with fright as 3D wheelchair model Michael pops a wheelie in a blue hospital style wheelchair. It’s like Barbie dolls for grown-ups! Read on to see our dasterdly plans for world domination. A no plastic zone. Alloy is the future.

3D Disability Modeling

CGI in movies; Finding Nemo, Avatar, Harry Potter and Lord of the Rings. Movie studios employ dozens of CGI (Computer Generated Image) artists who toil for years just to produce a two hour movie. Most of us take months to learn how to use complex NURBS 3D modeling programs. Webmasters will be familiar with 3D modeling tools. I have experience with Lightwave, Maya, Max, Poser, Rhino, Cybermotion, Blender, Daz 3D and others. I thought you might like to see a few of my 3D disability modeling creations.

This 11 second video clip is so old I forget the name of the program it was made with. I do remember it allowed a photo of someones face to ba applied to the model. This is my friend Kylie. We then select clothes, soundtrack, and coreograph her dance moves. Set a camera angle and render (produce) the scene. Note* the full length video clip is much higher quality.

That was easy and fun, lets’ jump from this simple 3D modeling tool to a full on sophisticated CGI industry heavy weight, Rhinoceros 3D.

A 3D model in Rhino is a series of connected shapes that form a mesh. For example, a triangle is three connected lines making  three points. It’s only a frame until you color it in. Then it takes on the appearence of a flat surface (with three points). By adding more points along any side of the triangle, we can manipulate them to form complex shapes (polygons), which eventually become our 3D model. Here are some screen shots of building a Rhino 3D light bulb mesh.

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Now with a few additions our 3D light bulb can be used in a real world marketing applications like this ‘Self Illumination’ example by Andre Kutscherauer.

self illumination

self illumination

Color gloss and transparency bring to life a model in true Disney Pixar movie style. Things have come a long way since the early days of my 3D modeling Kylie. For a long time the complexity of the human face resembled mannequins but not any more. In the current CGI world, mathematical CAD (Computer Aided Design) and RPG (Role Playing Game) designers have blended, producing very realistic life like 3D models. It’s old world meets new school to stunning visual effect.

I have used Rhinocerous 3D for many years. Rhino 3D can create, edit, analyze, document, render, animate, and translate NURBS curves. Surfaces and solids have no limit on complexity, degree, or size. Rhino supports polygon meshes and point clouds. Rhino also has a very user friendly interface. I find the animation side over complicated however, so generally create .3ds or .obj models in Rhino then import them into another program like Blender or Daz 3D to animate and render. 

The really cool thing with Blender is it’s free. Yes completely free, and just as powerful as the 3D modeling big boys. Blenders downfall is an overly complicated interface. Simply importing a 3D model will have most new users scratching their head. Blender uses python scripting to animate which is great, but again difficult for beginners. If you start with a free .3ds model you’ll be off to a flying start.

Here’s a sneak peak at a wheelchair 3D disability modeling project I’m currently working on. I call her Ioke.

Ioke 3D disability wheelchair model

Ioke 3D Disability Modeling Wheelchairs

Stay tuned for more Ioke… coming soon.

Resources

Wheelchair service monitoring

Wheelchair Service Delivery

Part three of the provision of manual wheelchairs in  less resourced settings. Published with permission of the World Health Organization. This chapter covers the structural guidelines for wheelchair service delivery systems that provide and improve access to wheelchairs. The need to provide wheelchairs together with these related services is essential. Careful planning, management and sound strategies for wheelchair provision, as well as user instruction and care are needed to facilitate the important link between the user and the wheelchair.

We cover all stages of the service delivery process, from referral to assessment and prescription, funding, ordering, product preparation, fitting, user training and maintenance. Including discussion of the roles of those involved in wheelchair service delivery, from manufacturers and clinicians, to technical and training personnel. Recommendations are made on monitoring, how to obtain feedback from wheelchair users, and evaluating and analyzing information on wheelchair service delivery.

  • Manual wheelchair sourcing supply, manufacture, supply suggest strategies for introducing wheelchair service delivery.
  • Describe basic wheelchair service delivery.
  • Provide practice guidelines.
  • Suggest roles for the personnel involved.
  • Make recommendations on monitoring and evaluation.

Testimonial from a user in Romania, Ciprian is 25 years old and lives in Sfantu Gheorghe, Romania. Three years ago he became paraplegic after falling from a roof while at work and lost any hope that he would ever have a normal and active life again. Sometime after the accident, however, he heard about a local nongovernmental organization that provided support for users. Through the wheelchair service run by the organization, Ciprian received an active-style manual wheelchair that was fitted for him. He was also invited to participate in a peer group training camp. 

Once I got there I realized that I could have an independent life. Through the peer group training, I learnt to use my wheelchair very well. I also had the chance to talk with other users involved in the programme. At the end of the camp, I was asked if I would like to become a peer group trainer. Of course, I was very happy about this chance that had just been offered to me. In January 2006, I started my work as an instructor.
 
Through my wheelchair, and peer training, I have recovered the independence I thought I had lost because of the injury. In addition to my peer group training work, I take part in various competitions and sports activities for people in wheelchairs. Working with people with disabilities makes me feel that I am useful again and that I finally have a normal life after I had had such a hard time overcoming the health problems brought about by the injury. — Cipran of Romania

The purpose of these manual wheelchair service delivery guidelines is to improve the way in which users receive wheelchairs and to ensure that the wheelchairs are appropriate. The implementation of the recommendations in this chapter aim to see more success stories like Cipran come true. We begin with these basic principles: 

  • A greater number of wheelchair services.
  • Better knowledge of wheelchair service delivery among health care and social service workers.
  • Better service quality delivered by existing wheelchair services.
  • A greater number of appropriate wheelchairs provided to users.
  • A greater number of users able to make informed decisions about the most appropriate wheelchair for them.
  • A greater number of users and caregivers receiving training in the use and maintenance of wheelchairs and on how to stay healthy in a wheelchair.
  • Links between users and producers, leading to producers obtaining feedback on the wheelchairs they produce.
  • Coordinate efforts in the planning, implementation and support of wheelchair service delivery among stakeholders.

In the rehabilitation of a person with a spinal cord injury the provision of an appropriate wheelchair is critical. It is important that the wheelchair fits correctly and meets the user’s physical, functional and environmental needs as much as possible. This requires an approach that responds to individual needs. An effective way of meeting the individual needs of users is to promote the provision of wheelchairs through wheelchair services.

Wheelchair services provide the framework for assessing individual user needs, assist in selecting an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services where appropriate. In addition providers of wheelchair services will play a role in the following.

  • Awareness: disseminating basic information about the needs for and benefits of using a wheelchair (this can also be done by personnel involved in community-based rehabilitation, health and education programmes as well as by disabled people’s organizations) and convincing policy-makers about the benefits of investing in wheelchair provision rather than leaving people with disabilities to survive on charity.
  • Identification: using a screening tool to identify those who can benefit from available services.
  • Awareness of referral networks and suppliers: promoting the role of wheelchair services, including participation in activities aimed at educating referral networks and raising the awareness of suppliers and funding agencies regarding the role and importance of wheelchair services. 
  • Sustainability: developing sustainable financial solutions for the continuing provision of mobility equipment through wheelchair services.
  • Training: providing or supporting the training of wheelchair service personnel.
  • Standards: raising wheelchair standards within the country or region through being aware of current wheelchair availability and advocating for improvements in and a greater variety of wheelchair products.
  • Accessibility: supporting or facilitating the adaptation of homes (including toilets, furniture and fittings) and public buildings and places, and lobbying for a barrier-free environment.

Wheelchair Service Delivery Strategies

Wheelchair service delivery requires careful planning and management of resources. There are a number of strategies that can be employed to initiate or further develop wheelchair services. Provide wheelchairs together with services. There are different methods of wheelchair supply to meet the range of contexts in which users live. Whatever the method or structure chosen, it is important to at least deliver the essential wheelchair services.

Utilize existing personnel. It is not necessary to create a new profession to provide wheelchair services. With additional training, many health and rehabilitation personnel would be able to take on the duties required for basic wheelchair service delivery. For example, community health care workers, community-based rehabilitation workers, nurses, physiotherapists, occupational therapists, orthopedists and prosthetists could be trained to fulfil the clinical role in wheelchair services. Likewise, with additional training, skilled craftspeople, mechanics and orthotic and prosthetic technicians could fulfil the technical role.

Meet the needs of users at community level. Some aspects of wheelchair provision can be carried out in the community, through a network of community-based organizations (for example rehabilitation and health programmes) supported by a local wheelchair service delivery centre. The personnel of the community-based programmes could be trained by wheelchair service personnel in basic service delivery. This system of service delivery would best suit users who require a basic wheelchair, without modifications, postural support or pressure management care.

Users with more complex needs are likely to require the skills of personnel with greater training than can be provided to all community-level personnel. This need can be addressed by outreach services coordinated by the wheelchair service centre. If outreach services are not developed, these users would need to travel to the wheelchair service centre. However, once provided with an appropriate wheelchair, they may be supported by community-based personnel.

A wheelchair service can make use of the skills, technologies and capacities of local industries. For example, bicycle repair shops can also repair wheelchairs, and tubular furniture makers have the basic skills and knowledge to build wheelchairs.

Two Tier Wheelchair Service Approach

This shows a possible model of linking a wheelchair service centre with a number of community-based wheelchair services. To provide adequate support to the community-based centres, it may be necessary to first develop the wheelchair service centre. Alternatively, a collaborative effort between existing community based centres could work towards the development of the wheelchair service centre. In either case, the development process should be based on a needs assessment and other aspects of the local context.

The Wheelchair Service Delivery Centre

Characteristics: Centre-based. Facilities (possibly shared with existing health or rehabilitation services): clinical and user training facilities, workshop facilities. Staff: dedicated wheelchair service centre personnel trained to meet the needs of all users.

Key functions: Wheelchair service delivery for all users. Community outreach linking with community based wheelchair services and referral networks. Training, support and supervision of community based wheelchair services and personnel. Education of referral sources. Linking with education, employment and other key development sectors.

Community Based Wheelchair Services

Characteristics: Centre-based, with some wheelchair service delivery carried out entirely in the community. Facilities (shared with other community health and rehabilitation programmes): access to clinic, user training facilities, basic workshop facilities. Staff: community health and rehabilitation workers trained in basic wheelchair service delivery, supervised and supported by wheelchair service centre personnel.

Key functions: Wheelchair service delivery for users requiring basic wheelchairs without custom modifications or postural support components. Identification of users with complex needs, and referral to wheelchair service centre. Where appropriate, support of users with more complex needs for follow-up, maintenance and repair in the community. Support of accessibility, including adaptation of user’s environment such as wider doors and ramps.

Intergrating wheelchair service delivery with other departments can be established within existing rehabilitation services. Such services are already likely to have users accessing the service for health or rehabilitation needs. They would therefore already have much of the infrastructure required. Examples of rehabilitation services well suited to the integration of a wheelchair service include prosthetics and orthotics services and spinal injury centres.

Wheelchair service delivery could play a dual role, providing wheelchairs directly to users and supporting basic services in the community through partnerships with community-level programmes and organizations.

Stakeholders and Resources

Stakeholders directly involved in the planning, implementation and participation in service delivery include: 

  • Users and their families or caregivers.
  • Government authorities, including ministries responsible for health, social welfare and education and other relevant departments and local authorities.
  • Existing health and rehabilitation services (including referral networks) managed by governmental, private, nongovernmental, international nongovernmental or disabled people’s organizations.
  • Supporting organizations providing technical input or funding.
  • Rehabilitation personnel and their organizations.
  • Wheelchair service personnel.

The resources required to implement the recommendations include:

  • A reliable supply of wheelchairs that meet agreed standards.
  • Access to different types and sizes of wheelchair to meet the varied needs of individual users.
  • Personnel with training in wheelchair service delivery.
  • Facilities (which may be shared with existing rehabilitation or health services): clinical facilities providing sufficent space for assessment basic user training and storage of wheelchairs and workshop facilities particularly where modifications to wheelchairs are offered or support is provided.
  • Materials for wheelchair modifications and custom components.
  • Funding to support wheelchair service delivery (products and services).

Wheelchair Service Delivery Network

In Papua New Guinea, an estimated 50 000 people need a wheelchair. Throughout 2003 and 2004, governmental health and rehabilitation organizations and national and international nongovernmental organizations developed a strategy for wheelchair provision. As a result, a pilot wheelchair service network, closely linked to the existing health and rehabilitation services, was set up.

The wheelchair service delivery network consists of a “regional wheelchair service” supporting four “satellite wheelchair services”. The regional service is based at the National Orthotics and Prosthetics Service in Lae. At the regional service, technical personnel from the National Orthotics and Prosthetics Service team and physical therapy personnel from Lae’s Angau Hospital together carry out assessment, prescription, fitting, user training and follow-up. The National Orthotics and Prosthetics Service provides repair services for users. This mixture of clinical and technical facilities has made the setting up of the wheelchair service relatively easy, and the recent provision of dedicated premises for the service has given it a stronger identity.

Two of the satellite services are based in local hospitals, one in a local prosthetic unit and one in a local community based rehabilitation service. The community-based rehabilitation link with each service is strong. The community based rehabilitation networks provide excellent referral, and the personnel work with hospital-based personnel to provide users with a wheelchair.

Training in basic wheelchair service delivery for all of the clinical and technical personnel involved in the service network was provided over two weeks by the international nongovernmental organization Motivation. Further support for both clinical and technical personnel for one year was provided by a volunteer physiotherapist.

The network has the capacity to provide 25 wheelchairs per month. This is still not sufficient to meet the needs in Papua New Guinea. However, through the success of this pilot exercise in using existing services and personnel, much has been learnt about the role of wheelchair services. In future, all stakeholders are keen to see the establishment of more satellite services, as well as an increase in the capacity of the network to meet the needs of users with more complex needs.

Steps in Wheelchair Service Delivery

Wheelchair services are commonly delivered in a sequence of steps. A summary of eight (8) key steps typically involved in wheelchair service delivery are as follows:

  • Referral and appointment The system of referral will depend on existing services in the country. Users may self-refer or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities.
  • Assessment Each user requires an individual assessment, taking into account lifestyle, vocation, home environment and physical condition.
  • Prescription (selection) Using the information gained from the assessment, a wheelchair prescription is developed together with the user, family member or caregiver. The prescription details the selected wheelchair type, size, special features and modifications. Also detailed is the training the user needs to effectively use and maintain the wheelchair. 
  • Funding and ordering A funding source is identified and the wheelchair is ordered from stock held by the service or from the supplier.
  • Product preparation Trained personnel prepare the wheelchair for the initial fitting. Depending on the product and service facilities, this may include assembly, and possible modification, of products supplied by manufacturers or production of products in the service workshop.
  • Fitting The user tries the wheelchair. Final adjustments are made to ensure the wheelchair is correctly assembled and set up. If modifications or postural support components are required, additional fittings may be necessary.
  • User training The user and caregivers are instructed on how to safely and effectively use and maintain the wheelchair.
  • Follow-up, maintenance and repairs Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. It is appropriate to carry out follow-up activities at the community level as much as possible. If the wheelchair is found to be no longer appropriate, a new wheelchair needs to be supplied starting again from step 1.

Understanding Individual User Needs

When planning wheelchair service delivery, it is important to recognize that each user has a unique set of needs. These needs can be categorized as:

  • Physical: the user’s health situation and postural and functional needs.
  • Environmental: where users live and where they need to use the wheelchair.
  • Lifestyle: the things users need to do in the wheelchair to lead their chosen way of life.

Physical Needs. Some users will have a more complex mix of physical needs than others. Users with spinal cord injury, postural deformities, reduced skin sensation and problems with muscle tone (for example spasticity) will require an assessment conducted by personnel with appropriate skills and knowledge. These users will also require more frequent follow-up and support. Here we consider some postural needs of users related to their need for personnel skill and support:

Users of manual wheelchairs without modifications. Children or adults who can sit well without any postural deformities or abnormalities.

Needs: Mobility and postural support for comfort, function and the prevention of postural problems associated with permanent wheelchair use. Mobility and postural support provided through a well-fitted wheelchair and seat cushion.

Users of manual wheelchairs with supportive seating. Children or adults with mild to moderate postural deformities or tendencies. If unaddressed, these deformities will limit comfort, health and function.

Needs: Mobility and postural support to stabilize posture for comfort, function and prevention of further postural problems. Supportive seating provided through individual modifications to a basic wheelchair, or a specialized seating system.

Users of complex supportive seating and mobility equipment. Children or adults with complex, fixed postural deformities. Even with support, many cannot sit normally.

Needs: Mobility and individually prescribed and customized wheelchairs to provide postural support and accommodate fixed deformities. Increased need of skill and support and accommodate fixed deformities.

Environmental and lifestyle needs. These factors require consideration during the assessment. They will influence the choice of a wheelchair, based on performance characteristics, durability and other features. How many users require more than basic wheelchair provision?

In a survey of 147 users conducted at the Western Cape Rehabilitation Centre in South Africa in 2006, it was found that 58% of users required some form of wheelchair modification or basic postural support. Some 22% required complex postural support, while only 20% were able to use a basic manual wheelchair without any modification. A supervisory chief physiotherapist states:

Since our service began, we have found that many users need more than just a basic wheelchair. Many have deformities from living so long without a wheelchair and now need their wheelchair modified so that it fits them. We also have more and more children with cerebral palsy coming to us, and they need wheelchairs with extra postural support. — WCRC Chief Physiotherapist

Good Practice in Wheelchair Service Delivery

This section covers planning and initiating wheelchair service delivery and evaluating existing services. Recommendations are presented in nine areas: good practice in overall service and for each of the eight key steps in wheelchair service delivery. Good practice in wheelchair service delivery includes the following: 

  • Wheelchair services recognize users as clients of the service and adopt a “client-centred approach”. This means, inter alia,that: Users receive information about the process the wheelchair service will use to provide a wheelchair, and the rights and responsibilities of the user in this process. Users are actively involved as members of the service team in all steps leading to the provision of their wheelchair. Services actively collect feedback from users about their opinion of the service and how it may be improved.
  • The service is equally accessible to all users, regardless of gender, age, ethnicity, religion or social status.
  •  The service has personnel trained in its clinical, technical and training roles, who work closely with users to provide advice, assessment, prescription, fitting, training and follow-up.
  • The service has a designated service manager or coordinator.
  • A referral network is in place.
  • The service is well integrated with other rehabilitation and health services.
  • Services are knowledgeable about the range of wheelchairs available locally.
  • Services are able to offer more than one type of wheelchair, giving the user a choice based on the assessment.
  • Wheelchairs are sourced from a range of suppliers, including local and international, depending on their appropriateness and affordability.
  • Services carry out quality control to ensure that every wheelchair is assessed for safety before the user tries it and for safety and correct fit before each user leaves the workshop or rehabilitation centre with the wheelchair.
  • Repair services are available to provide continuing support to users.
  • Services identify local needs and measure their effectiveness in meeting these needs through regular monitoring and evaluation.
  • Services promote teamwork between clinical and technical personnel in providing service to users.

Referrals and Appointments

Objective: The objective of good practice in referrals and appointments is to ensure that users have equitable access to wheelchair service delivery, to increase the efficiency and productivity of the service, and to minimize waiting lists.

Referral System: This pertains to the way in which users access the service. This may be through “self-referral”, whereby users contact the service directly, or through a “referral network”, whereby users are referred by another organization.

Appointment System: This refers to the method of establishing appointment times with users for assessment and prescription, fitting, basic user training and follow-up. The most common method is to list appointment times in a service diary, which are then filled as users are referred. The benefits of an appointment system include reduced waiting times and increased work efficiency.

Waiting Lists: Where there is high demand for the wheelchair service, a waiting list will need to be established. Users on the waiting list can be offered an appointment as the service works through the list. The administration of appointments will depend on the context.

Good Practice in Appointment and Referral Systems

  • When a user is referred to the service, a file is established and an appointment is made or the user is put on the waiting list.
  • Services provide training for referral network personnel to increase their awareness of wheelchair service delivery and to show them how to refer users to the service.
  • Services develop and distribute a form for referral network agencies to complete when referring users.
  • Services use clear guidelines to prioritize appointments. This is particularly important where there are waiting lists. Examples of high-priority users include those with a terminal illness and those at risk of developing life-threatening secondary complications such as a pressure sores.
  • Services set targets and measure their performance in relation to the number of referrals, the length of time between referral and appointment, and reduction of waiting lists.
  • Services have a screening procedure to minimize the scheduling of inappropriate referrals.

Assessment

The objective of good assessment practice is to accurately assess the needs of each individual user in order to prescribe the most appropriate wheelchair available.

Every user requires an individual assessment, carried out by a person or persons with the appropriate skills. The assessment should be holistic, taking into account the lifestyle, living environment and physical condition of the user. It is important that the user and, if appropriate, the family are fully involved in the assessment. Depending on the complexity of the needs, an assessment can take up to two (2) hours.

  • Assessments are carried out in a private, quiet and clean space. This may be a dedicated space within the wheelchair service, at another health care or community facility, or at the user’s home.
  • Assessments are carried out by trained personnel. Culture, age and gender sensitivity while carrying out assessments increases credibility and acceptability.
  • Equipment for the assessment is readily available, including an assessment bed (plinth, mat, table), measuring tape, device for measuring angles (goniometer), foot blocks and infection control supplies.
  • Assessment takes into consideration the user’s physical condition; home, school, work and other environments where the wheelchair is used; lifestyle; size and age.
  • Assessments are clearly documented on an assessment form and filed for future reference.
  • Where a service is unable to meet the user’s needs owing to the lack of an appropriate product or personnel with sufficient skills, the service either; refers the users to another service that is staffed and equipped to service the user, hosts outreach visits of more qualified personnel or, documents the user’s needs to help build a picture of unmet need to guide future service development.

Prescription

The objective of good prescription practice is to match the needs of the user, as identified through the assessment, with the most suitable wheelchair available. Wheelchairs need to be available in different types and sizes and with different options. The prescription (or selection) represents the process of matching the needs of the user with the most suitable available wheelchair. The completed prescription form is a full description of the wheelchair required and selected by the individual user.

  • Users are given the opportunity to see and, where possible, try samples of wheelchairs, cushions and postural support components. This assists users and personnel together in selecting a wheelchair and the necessary features.
  • The importance of features is prioritized to help to make the most appropriate choice from what may be a limited range of available wheelchairs.
  • Each wheelchair prescription is documented, either on the assessment form or on a dedicated prescription form. The prescription details; the type and size of wheelchair, any additional components required (for example pressure-relief seat cushion), any modifications or custom comments required and, the information or skills the user needs to know, or be able to perform, before leaving the service with a new wheelchair.
  • Wheelchair service personnel are given time to write up assessment and prescription notes immediately after each appointment.
  • Services give users an estimate of when their wheelchair will be ready (depending on funding, see below). Where possible, an appointment for the user’s fitting is made at the time the prescription is made.

Funding and Ordering

Objective: The objective of good practice in funding and ordering is to order or procure the selected wheelchair for the user, as early as possible.

Funding: Following prescription, it is possible to closely estimate the cost of the product being recommended. For most services, it will be essential to ensure a funding source has been identified before an order can be placed for equipment. Wherever possible, this should be in the hands of administrative rather than clinical or technical personnel.

Ordering: When not in stock, wheelchairs need to be ordered from an external supplier or procured from the wheelchair service workshop, which usually maintains a stock of different sizes and types of wheelchair.

  • If a wheelchair is not immediately available, services inform the user when the wheelchair will be ready for fitting.
  • Services maintain a stock of wheelchairs and components to ensure faster delivery times.
  • Services encourage suppliers to develop clear order forms and procedures.
  • Services agree with suppliers on delivery times and aim to minimize delays.
  • Services ensure ordering is completed within two working days of completing the user’s prescription, provided that funding is in place.
  • Services have a system in place to monitor pending orders from suppliers.
  • Services have a system for providing feedback to suppliers about quality issues.

Product Preparation

The objective of good practice in product preparation is to prepare the wheelchair for the fitting, including modifications or custom postural support components. Good practice in product preparation include:

  • Each wheelchair being prepared is labelled with the user’s name and a serial number or bar code.
  • Modifications to wheelchairs (permanently altering the frame or a component of the wheelchair) are carried out only by personnel with the appropriate knowledge and skills, since any such modification may have structural and functional implications.
  • The production and installation of custom seating systems or individual postural support components should be carried out by personnel with the appropriate knowledge and skills. This work should also be done in close collaboration with the assessment personnel.
  • All mobility equipment is checked for quality and safety before the user tries it.

Fitting

The objective of good practice in fitting is to ensure that the selected wheelchair has been correctly assembled and to make final adjustments to ensure the best fit. Fitting is a critical step. At the fitting, the user and clinical and technical personnel ensure that the wheelchair fits correctly and supports the user as intended. A fitting may take between 30 minutes and 2 hours or more, depending on the complexity. During fitting, the user and competent personnel together check that:

  • The wheelchair is the correct size.
  • The wheelchair is correctly adjusted for the user.
  • Any modifications or postural support components are fitting correctly.
  • The wheelchair meets the user’s mobility and postural support needs and minimizes the risk of the user developing secondary deformities or complications.
  • All users have their wheelchair individually fitted by personnel trained to do so.
  • Whenever possible, fitting is carried out by the same personnel that assessed the user.
  • The fit of the wheelchair (including any seating or postural components) is first assessed with the user sitting in the stationary wheelchair. When the fit is acceptable, it is then further assessed while the user self propels or is pushed.
  • If the wheelchair fit is not acceptable, further adjustments are made. If an acceptable fit cannot be achieved, alternative equipment or a reassessment may be necessary. The wheelchair cannot be provided to the user until the fit is acceptable.
  • There is provision for more than one fitting appointment for users with more complex needs, such as those with postural deformities.

Training of Users Families and Caregivers

The objective of good practice in training is to ensure that all users are given the information and training they need to be able to use their wheelchair safely and effectively. Key areas of training include:

  • How to transfer in and out of the wheelchair.
  • How to handle the wheelchair.
  • Basic wheelchair mobility.
  • How to stay healthy in the wheelchair, for example prevention of pressure sores.
  • How to look after the wheelchair and cushion and, if appropriate, dismantle and reassemble the wheelchair.
  • Who to contact in case of problems.
  • A user training checklist is completed together with the user, covering the skills the user needs to have in order of priority. The checklist is used by the trainer, and as each skill is taught and demonstrated by the user it is checked off.
  • Where possible, peer trainers (active users with strong wheelchair skills and training in how to teach and support other users) provide basic user training, with supervision by clinical personnel.
  • Wheelchair services link closely with any user groups in the community, providing peer training to strengthen training given at the service.
  • Written or visual materials, including pamphlets or posters in local languages, are used to assist the training of users.

Follow-up Maintenance and Repair

The objective of good practice in follow-up, maintenance and repair is to evaluate the effectiveness of the wheelchair in maximizing the user’s functioning, comfort and stability, and to ensure that the equipment has been maintained appropriately and is in good condition. Follow-up should include a review of:

  • How well the wheelchair has worked for the user.
  • Any problems the user has had in using the wheelchair.
  • The wheelchair’s fit, in particular checking that the wheelchair is providing good postural support for the user.
  • The user’s skills, and whether further training is required.
  • The condition of the wheelchair and whether any adjustments or repairs are required.
  • The user’s ability to care for and maintain the wheelchair, and whether any further training is required.

The frequency of follow-up will depend on the individual needs of the user. Some users should be followed up more frequently than others. As a guide, follow-up appointments are usually made within six months of receiving a wheelchair. Basic wheelchair repair work can often be done locally at bicycle or car repair workshops.

  • Whenever possible, all members of the wheelchair service team are involved in follow-up appointments. This includes clinical, technical and training personnel.
  • The frequency of follow-up is determined by the individual needs of the users.
  • Follow up appointments are given as a priority to users in the following categories: children (whose needs change as quick as they grow), users at risk of developing pressure sores, users who have a wheelchair with postural support modifications or additions, users or family members or carers who have difficulty following the basic training given at the service.
  • Services use follow-up appointments as an opportunity to gather feedback from the user to help evaluate the quality of the service provided.

Manufacturers or Suppliers

Wheelchair services usually receive wheelchairs from manufacturers or suppliers. The scope of these guidelines does not allow a discussion of all production and supply personnel, but a few points are made here concerning managers and technical production personnel.

Management: As well as day-to-day management, managers of wheelchair production facilities are responsible for design selection and production quality. It is therefore important that managers receive feedback from users and wheelchair services about how well their wheelchairs meet their needs.

Technical production personnel: Technical production personnel are concerned with the technical side of wheelchair production. They are not necessarily involved in the fitting or modification of wheelchairs for individual users. This differs from technical personnel in wheelchair services, who are involved in the assembly, modification and fitting of wheelchairs for specific individuals. Nevertheless, some technical personnel, typically those in smaller workshops, may be involved in both the manufacture and fitting of wheelchairs. The term “technical production personnel” as used in these guidelines is limited to wheelchair manufacturers and does not include the provision of services to individual users.

Referral Networks

Referral networks play a crucial role in wheelchair service delivery. Well-functioning referral networks help to ensure services are accessible to users. Referral networks may consist of health and rehabilitation personnel or volunteers working at community, district or regional level.

The importance of a strong link between specialist services and rehabilitation or health care programmes is stressed in a joint statement of the International Society for Prosthetics and Orthotics and the World Health Organization.

Wheelchair services are an example of a specialized service that cannot always be fully provided within every community. In developing countries, the majority of those people with disabilities live in rural areas and find it difficult to access rehabilitation services, which are often restricted to large cities. Health and rehabilitation workers therefore need to play a proactive role in ensuring that people living in rural areas can also access wheelchair services without difficulty. The role of referral networks in wheelchair service delivery can include:

  • Identifying and referring people requiring wheelchairs.
  • Liaising between the users, their families and the wheelchair services to facilitate assessment, fitting and follow-up.
  • Reinforcing wheelchair service training such as pressure sore prevention, prevention of secondary complications, wheelchair maintenance and mobility skills.
  • Providing support, advice and possibly assistance in adapting the user’s home environment.
  • Encouraging measures to facilitate accessibility in the community.
  • Providing information to the wheelchair services about the acceptability and use of prescribed wheelchairs.
  • Assisting the user to arrange repairs.
  • Promoting the benefits of wheelchairs.

Wheelchair Service Delivery Personnel Roles

Wheelchair service personnel carry out managerial, clinical, technical and training duties. These roles may be fulfilled by personnel from a range of training and educational backgrounds. They may also overlap: in a small service, for example, one person could carry out both the clinical and technical roles. In another scenario, one person could carry out the clinical, training and management roles with the support of a part-time technician.

At times, particularly when working with users who have complex needs, personnel may draw on the expertise of other specialists such as occupational therapists, physiotherapists, speech and language therapists, paediatricians, neurologists, physiatrists, orthotists, prosthetists and orthopaedic specialists.

Management Role: For a wheelchair service to operate effectively, a designated manager is critical. The manager ensures a framework is in place to enable the wheelchair service to operate. This includes adequate staffing, facilities, funding, products, referrals and appointment systems. Managers also play a key role in promoting wheelchair services. The manager therefore requires a thorough understanding of wheelchair service delivery in addition to general management skills. The duties of wheelchair service managers should include.

  • Building awareness of wheelchair service delivery among all stakeholders.
  • Developing a referral network through promotion of the wheelchair service and its functions.
  • Organizing training opportunities for referral network personnel.
  • Ensuring the service is accessible to all users within the service area, including women, children and minority groups.
  • Managing waiting lists.
  • Identifying and securing sources of funding to support the service.
  • Facilitating the development and training of service personnel.
  • Evaluating the effectiveness of the service in meeting users’ needs.
  • Continuously improving service quality.
  • Developing links with disabled people’s organizations and community-based rehabilitation programmes.
  • Asssisting in the formation of wheelchair users’s groups.

Clinical Role: Clinical personnel work directly with the user in assessment, prescription, fitting and follow-up. Ideally, the clinical personnel work closely with technical personnel, particularly on prescription and fitting. The main duties of clinical personnel include:

  • Wheelchair service delivery, following the eight-step process listed earlier.
  • Quality control to ensure equipment is adjusted correctly and is safe for each user.
  • Training users in mobility and health issues, or supervision of such training provided by a trainer.
  • Follow-up with users to ensure that equipment continues to be appropriate to their needs.
  • Record keeping and documentation.
  • Education of referral network personnel.
  • Keeping up to date with the range of available wheelchairs.
  • Participation in overall service evaluation.

Technical Role: Technical personnel ensure that the technical requirements of the prescription are met through the correct assembly or modification of the wheelchair. Technical personnel have direct contact with users, at least in the prescription and fitting stages. When working with a user who requires modifications or postural support, it is increasingly important that technical personnel are directly involved in the user’s assessment, fitting and follow-up. The main duties of technical personnel include:

  • Assembling or preparing wheelchairs according to prescription.
  • Making or assembling modifications or custom postural support.
  • Training users in wheelchair maintenance and basic repair, or supervising such training provided by a trainer.
  • Ensuring that each wheelchair and any modifications are technically safe before each fitting and before the user leaves the service with the new equipment.
  • Keeping records and documentation.
  • Following up users to ensure equipment continues to be appropriate.
  • Facilitating maintenance and repairs of wheelchairs and associated equipment.
  • Participating in overall service evaluation.

Training Role: One of the key steps in wheelchair service delivery is basic skills training for wheelchair users. The bulk of the training may be fulfilled by clinical or technical personnel or by dedicated trainers. They also provide users with the necessary advice on maintaining their wheelchair. Experienced, well trained wheelchair users (“peer trainers”) are useful in training other users.

Provided with the right resources and training, peer trainers may have some advantages over trainers who are not users. Such advantages include an ability to empathize and to draw on first-hand experience. For those receiving a wheelchair for the first time, there is added value in training given by a peer trainer. By working with peer trainers, users are better able to recognize their own potential. The main duties of trainers include:

  • Training users and caregivers, individually or as a group, in: transferal in and out of the wheelchair, wheelchair handling, basic wheelchair mobility, health issues specific to wheelchair use (pressure sore prevention, etc.), wheelchair maintenance.
  • Participating in routine and more intensive follow-up for those users at risk, or who require additional training and support.
  • Educating referral network personnel.
  • Participating in service evaluation, focusing on the needs of users.

In addition, trainers could become involved in: 

  • Activities to promote the wheelchair service.
  • Liaison with disabled people’s organizations and community-based organizations.
  • Referral of users to relevant community programmes such as disabled people’s organizations, vocational schemes and peer group training.

For 11 years now, the Motivation Romania Foundation (MRF) based in Bucharest has provided peer training. The MRF wheelchair service and peer training programme is based on the principle that all wheelchair recipients should undergo peer training (including, but not limited to, wheelchair skills) to maximize their independence. The peer training team currently consists of four users and a physiotherapist. Each year, some 160 users access the peer training programme, which includes:

  • Training in wheelchair skills
  • Individual and group discussions, in which users can talk about the challenges they have faced and try to find solutions together.
  • Provision of information, for example about dealing with health problems.
  • Participation in sports and social activities to facilitate the development of outgoing, people-oriented attitudes and prevent isolation.

Peer training is carried out at the MRF centre and through regular peer training camps. Peer trainers are recruited from among former recipients of peer training. They receive training in teaching and counselling from experienced peer group trainers, thus enabling them to take on the role themselves.

The costs of the peer training programme are covered by the Romanian Ministry of Labour and Social Protection, the National Authority for People with Disabilities, and national and international donors. 

An overview of the clinical, technical, training and management duties of wheelchair service personnel. 

Overview of the duties of wheelchair service personnel

Monitoring and Evaluation

The need to measure performance. Monitoring and evaluation of a wheelchair service can help identify those areas that are successful and those that can be improved. Monitoring is the regular ongoing collection and analysis of information to track the quality and effectiveness of the wheelchair service. Evaluation refers to an overall evaluation, usually conducted over a short period of time. Evaluations are often carried out annually or sometimes biannually.

Information gained through regular monitoring is often used as part of an overall evaluation. It is recommended that services establish a system for regularly monitoring the service, and conduct annual overall evaluations to assess service performance and impact. Monitoring and evaluation can provide important information that enables services to:

  • Improve the quality of services and products.
  • Improve service processes such as referral, appointments and follow-up.
  • Contain costs by increasing efficiency.
  • Demonstrate the benefits of wheelchair service delivery for users.
  • Demonstrate the effectiveness of the service.
  • Identify and quantify unmet needs.
  • Plan further development of the service.
  • Allocate resources appropriately.
  • Justify current and proposed service funding.
  • Develop stronger partnerships with service recipients.
  • Enhance credibility and funding opportunities. 

Monitoring

Regular monitoring can be established as follows:

  1. Identify the areas and activities of the service that should be routinely monitored. Examples are the rate of referrals, waiting times, the number of users receiving wheelchairs, the types of wheelchair prescribed, the number of follow-ups and the level of user satisfaction.
  2. Set “performance targets” for these areas and activities. A performance target is a statement of how well the service would like to perform in that area. This may often be linked to funding. For example, funding may have been provided to the service based on agreed objectives or targets. Performance targets should be realistic, taking into account the resources available.
  3. Identify the information that needs to be collected in order to be able to monitor service performance for each area – and how it will be collected. Ideally, gathering information should be part of the service’s normal record keeping, and should thus require very little additional work by service personnel.

Now we visit an example of service areas that could be monitored, performance targets, and ways to collect information for each service area. It is important to note that the performance targets are examples only; actual targets need to be worked out according to the resources available to each service. Examples of service areas that could be monitored, performance targets, and ways of collecting information:

Wheelchair service monitoring

Feedback from users: In addition to the routine collection of monitoring information, it is recommended that services establish methods of regularly gathering feedback from users and their families. There are several ways in which such feedback can be gathered.

  • A few questions about the service can be formulated and put to users after they have received their wheelchair.
  • A short questionnaire can be developed, asking users for their thoughts on the performance of the service. This could be offered to every user or to a specified number of randomly selected users each month.
  • Users can be encouraged to write down their impressions of the service and post them in a “feedback box”. Feedback can be anonymous, thus allowing people to feel more comfortable about providing honest feedback. It is important to note that this type of system is open only to those with a sufficient level of literacy, and should therefore not be the only method used to gather feedback.

Analysing the collected information. The information collected through regular monitoring and user feedback will be most useful if it can be centrally stored and organized. A basic database can be very useful for this where computers and personnel are available. Alternatively, information can be organized and analyzed manually.

Once information is organized, it is possible to measure how the service is performing against the performance targets. A regular analysis of information can be used to identify problems and action can be implemented to solve the problems. For example, if fewer referrals than expected are being received, a service may choose to contact all referral sources to remind them about the service or offer additional training.

Evaluation

An overall evaluation is more comprehensive than ongoing monitoring. An evaluation provides an overview, highlighting the service’s strengths and weaknesses. Previous evaluation reports can be used as a basis for subsequent evaluations.

Service evaluations can be carried out externally or internally. An external evaluation involves having one or more people from outside of the service carrying out the evaluation. This can be useful, as external evaluators will view the service from a different perspective. Internal evaluations can be carried out by one or more personnel who have been designated the responsibility to gather and analyse the necessary information. The use of computers in data collection, programme monitoring and follow-up will facilitate the evaluation of service provision.

Suggestions for gathering evaluation information for some key service areas. 

Quality of service delivery. The good practice recommendations made in Section 3.3 of these guidelines can be used as criteria to assist in evaluating the quality of service delivery.

Users served and the intervention they received. Information from ongoing monitoring should enable evaluators to quantify the number of users provided with a wheelchair, training and follow-up; the different types of wheelchair provided; and the number of users with needs that could not be met by the service. A thorough evaluation would also include information on users accessing the service, including age, gender, ethnicity, disability and home location.

Cost of service, including cost of products and service delivery. Information from ongoing monitoring should enable evaluators to review and summarize the cost of the service. An audit of accounts may also be used to determine the cost of products and services.

Staffing, numbers of personnel and their roles and competences. Evaluators can assess numbers and roles of personnel by talking to service management or reviewing personnel records. Staff competences can be assessed by observing personnel carrying out their duties. Good practice recommendations=, the personnel roles, and the clinical competences, are criteria to assist in evaluating personnel competence. Staff educational records should be reviewed to help determine competences and professional development. Feedback from users and individual interviews with personnel can help to identify strengths and weaknesses in the staffing structure.

Facilities and equipment available to the service. Evaluators can assess the suitability of facilities and equipment by observing the service in practice. Feedback from users and individual interviews with personnel can help to identify any strengths and weaknesses in service facilities.

Impact on users and their families. Information may be gathered from users and their families on the impact of the service. Measures can include increased participation in family or community activities (for example education, employment in or outside of the home, participation in social activities) and increased earning potential of wheelchair users or their families. Methods of gathering information include the following:

  • Evaluators may review assessment and follow-up forms. Assessment forms can provide information about users and their families before they receive a wheelchair through the service. Follow-up reports can provide information about how the service has affected the lives of the user and his/her family. 
  • Home visits will enable evaluators to meet the users of the service and see for themselves what impact there has been. Home visits may provide additional information not gained through a follow-up appointment carried out at the service. 
  • A detailed survey may be developed to assess the service impact on the quality of life of users, including participation in school, employment and other activities.
  • Users (and family members) may be gathered as a focus group to provide evaluators with information about how they believe the service has affected them.

Conclusions

Wheelchairs need to be provided together with services. Existing rehabilitation personnel can be utilized to provide wheelchair services. Integrating wheelchair services with existing health or rehabilitation services is recommended. Where possible, the needs of users should be met at community level. Wheelchair services facilitate the assessment of individual user needs, provide an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services.

Each user has a unique set of physical, environmental and lifestyle needs. Groups of personnel involved in wheelchair service delivery include manufacturers and suppliers, referral networks and service personnel. The main roles of service personnel are managerial, clinical, technical and educational. Peer trainers play an important role in wheelchair provision. Wheelchair provision should be regularly monitored and evaluated, especially in helping to identify those areas that are successful and those that need to be improved.

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