Tag Archives: wheelchairs

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

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.

wheelchair provision 01

Policy and Planning for Wheelchair Provision

 
Policy and Planning to Implement Sustainable Wheelchair Provision 
concludes our five part series on wheelchair provision in less resourced settings brought to you with permission from the World Health Organisation. In this article we cover the following policy and planning guidelines;

  • present key activities for the planning and implementation of wheelchair provision
  • suggest strategies for costing and financing wheelchair provision
  • suggest links between wheelchair services and other sectors

Testimonial from a user in the Philippines

wheelchair provision 01Michelle lives on the rural island of Masbate, a remote area of the Philippines. She is 20 years old, and was born without legs and with on one arm. Unable to propel a standard wheelchair, Michelle has lived without one for most of her life. For mobility she has had to “walk” with one arm and her torso. In 2005, Michelle was referred by community workers to a wheelchair service operated by an international nongovernmental organization.

The service team saw that for a wheelchair to be useful to Michelle, it would need to be operable by one arm, be suitable for rough surfaces, and be easily portable on public transport for travel into town. A local wheelchair factory that operates in partnership with the wheelchair service team was able to create a wheelchair to these specifications.

Michelle is now able to propel herself in her wheelchair, and no longer has to move herself along at ground level. She uses the wheelchair to attend church, make social visits and play basketball. Most importantly, Michelle, who has a keen entrepreneurial spirit, aims to improve the economic well-being of her family. With improved mobility, her opportunities for this are greater.

5.0 Purpose and Outputs

The purpose of the policy and planning guidelines is to develop and implement policies for cost effective and sustainable wheelchair provision. Implementation of these guidelines will lead to:

  • develop a national wheelchair policy
  • plan wheelchair provision programs at national level in collaboration with all stakeholders, based on identified needs
  • integrate wheelchair services into existing health and rehabilitation services
  • develop national standards for wheelchair provision
  • calculate costs and establish sources of funding
  • link wheelchair provision with existing sectors and institutions in society

Stakeholders and Resources

Stakeholders involved in policy and planning include policy-makers, planners and implementers, manufacturers and suppliers of wheelchairs, providers of wheelchair services, disabled people’s organizations and users.

5.2 Policy

Developing a Policy

A national policy on wheelchair provision can ensure that users receive wheelchairs that meet minimum requirements for safety, strength and durability and that are appropriate for their individual needs. A national policy can also ensure that wheelchairs are provided by trained personnel who know how to properly assess users’ needs and how to train users and caregivers on how to use and care for the wheelchairs.

When developing a national policy it is recommended that the following relevant areas are considered; 

  • issues addressed by relevant international policies
  • design, supply, service delivery, training and user involvement
  • funding
  • links with other sectors

To avoid a separate policy for wheelchair provision, wheelchairs can be included in a general policy for provision of assistive devices. However, specific issues related to wheelchair provision may need to be addressed in additional policy documents.

International Policies

The two main international policy instruments related to wheelchair provision are: 

  • the Convention on the Rights of Persons with Disabilities; and
  • the Standard Rules on the Equalization of Opportunities for Persons with Disabilities

The Convention

The Convention on the Rights of Persons with Disabilities consists of 50 articles. Articles 4, 20, 26 and 32 are particularly applicable to wheelchair provision as follows;

Article 4. General obligations

1. States Parties undertake to ensure and promote the full realization of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability. To this end, States Parties undertake:

(a) To adopt all appropriate legislative, administrative and other measures for the implementation of the rights recognized in the present Convention;

(g) To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost;

(h) To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities;

(i) To promote the training of professionals and personnel working with persons with disabilities in the rights recognized in this Convention so as to better provide the assistance and services guaranteed by those rights.

Article 20. Personal mobility

States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by:

(a) Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost;

(b) Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost;

(c) Providing training in mobility skills to persons with disabilities and to specialist personnel working with persons with disabilities;

(d) Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities.

Article 26. Habilitation and rehabilitation

3. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.

Article 32. International cooperation

1. States Parties recognize the importance of international cooperation and its promotion, in support of national efforts for the realization of the purpose and objectives of the present Convention, and will undertake appropriate and effective measures in this regard, between and among States and, as appropriate, in partnership with relevant international and regional organizations and civil society, in particular organizations of persons with disabilities. Such measures could include, inter alia:

(b) Facilitating and supporting capacity-building, including through the exchange and sharing of information, experiences, training programs and best practices;

(d) Providing, as appropriate, technical and economic assistance, including by facilitating access to and sharing of accessible and assistive technologies, and through the transfer of technologies.

The Standard Rules

The Standard Rules on the Equalization of Opportunities for Persons with Disabilities consists of 22 rules. With regard to preconditions for equal participation, Rules 3 and 4 apply to wheelchair provision. With regard to implementation measures, Rules 14, 19 and 20 are applicable.

Rule 3. Rehabilitation

“States should ensure the provision of rehabilitation services to people with disabilities in order for them to reach and sustain their optimum level of independence and functioning.”

Rule 4. Support services

“States should ensure the development and supply of support services, including assistive devices for people with disabilities, to assist them to increase their level of independence in their daily living and to exercise their rights.”

Rule 14. Policy-making and planning

“States will ensure that disability aspects are included in all relevant policy-making and national planning.”

Rule 19. Staff training

“States are responsible for ensuring the adequate training of personnel, at all levels, involved in the planning and provision of programs and services concerning people with disabilities.”

Rule 20. Monitoring and evaluation

“States are responsible for continuous monitoring and evaluation of the implementation of national programs and services concerning the equalization of opportunities for people with disabilities.”

Both the Convention and the Standard Rules clearly state that the government has the primary responsibility for wheelchair provision. It is therefore recommended that wheelchair provision be an integral part of national strategies.

Article 32. International cooperation

1. States Parties recognize the importance of international cooperation and its promotion, in support of national efforts for the realization of the purpose and objectives of the present Convention, and will undertake appropriate and effective measures in this regard, between and among States and, as appropriate, in partnership with relevant international and regional organizations and civil society, in particular organizations of persons with disabilities. Such measures could include, inter alia:

(b) Facilitating and supporting capacity-building, including through the exchange and sharing of information, experiences, training programs and best practices.

(d) Providing, as appropriate, technical and economic assistance, including by facilitating access to and sharing of accessible and assistive technologies, and through the transfer of technologies.

Specific wheelchair provision issues

There are five areas to be considered when developing a policy for basic wheelchair provision.

1. Design: Each person has a unique set of individual or environmental needs that dictate the wheelchair design that is best for him or her. Because user needs are so diverse, no single wheelchair design will be appropriate for all users under all conditions. It is recommended that policies:

  • require that several types of wheelchair be made available to service providers to ensure that each user receives a wheelchair that meets his or her needs; and,
  • specify minimum national requirements to ensure that wheelchairs will be safe, durable and locally maintainable.

2. Production and supply: Wheelchairs can be produced and acquired in a number of ways. They should be tested for strength, durability and suitability for the context in which they will be used. Decisions will need to be made on how wheelchairs will be produced and acquired. It is recommended that policies:

  • approach the overall need for wheelchairs in relation to the funding available, the sustainability of supply over time, local economic development, and the impact on the local wheelchair provision infrastructure;
  • encourage assessment of wheelchairs against minimum guidelines;
  • encourage participation of users and service providers in the selection of wheelchairs; and,
  •  take into account other national policies on related issues, such as support of local production and local employment.

3. Service delivery: Providers of wheelchair services play an important role in liaising between the users and the wheelchair manufacturers. They can ensure that individual users are provided with an appropriate wheelchair. They provide education and training about the user’s needs, as well as ongoing support and referral to other services. It is recommended that policies:

  • promote user empowerment and choice;
  • require that wheelchairs be provided through a proper wheelchair service delivery system;
  • require that all wheelchair service providers follow recommended practices regarding of wheelchair availability, prescription, fitting, training of users and follow-up services; and,
  • require wheelchair service providers to demonstrate transparency, fair pricing, and monitoring and evaluation of their services.

4. Training: Training of all personnel involved in wheelchair provision ensures that service delivery can be maintained at a nationally accepted level. It is recommended that policies:

  • encourage that training be made available for all individuals directly associated with the development and implementation of wheelchair provision, including those involved in design, production, testing and service delivery.

5. Financing: Each of these four areas of basic wheelchair provision requires funding. Different funding strategies are described in Section 5.4. Typically, the costs of designing, producing and supplying a wheelchair, the delivery of wheelchair services and training of personnel are included in the price of the provided wheelchair, unless the costs are covered in other ways. It is recommended that policies:

  • specify funding mechanisms;
  • set eligibility criteria for funding;
  • specify the categories and standards of wheelchairs and services that are funded under the scheme; and
  • promote user empowerment and choice.

Other policy support mechanisim governments could consider

  • waiving import duties on raw materials used to build wheelchairs;
  • waiving import duties on wheelchairs if they are not available in the country;
  • supporting local nongovernmental and disabled people’s organizations that provide wheelchairs and related services through direct grants, or by facilitating relationships between local and international nongovernmental organizations, business communities and other stakeholders;
  • supporting private wheelchair manufacturing businesses through competitive tender offers, loans and training grants;
  • promoting the participation of users at every level of service planning and implementation;
  • removing architectural barriers to increased mobility, independence and participation, thus stimulating interest in, use of and demand for better wheelchairs; and
  • including wheelchair provision and allied issues (such as accessible environments and accessible transport) in other national policies.

Example of a policy in India related to wheelchair provision

In India, the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act (2) was adopted in 1995 as a result of continual lobbying by disability activists and nongovernmental organizations. This lobbying involved extensive consultations with officials, protest marches and press conferences (3). Regarding wheelchairs, the Act states in Chapter VII: “The appropriate Governments shall by notification make schemes to provide aids and appliances to persons with disabilities.”

On the basis of this Act, the Indian Government introduced the Assistance to Disabled Persons of India scheme, under which people with a monthly income of less than US$ 160 can get a wheelchair free of charge. If the monthly income is between US$ 161 and US$ 250 the user has to pay 50% of the cost, and if the income is above US$ 250, the user has to pay the full cost of the wheelchair.

Example of a policy in Afghanistan related to wheelchair provision

In October 2003, the Ministry of Martyrs and Disabled in Afghanistan published a Comprehensive National Disability Policy. The policy was “developed in collaborative manner by all stakeholders including primarily disabled people organizations and self help groups; disability NGOs both national and international; major line ministries including Ministry of Education, Ministry of Public Health, Ministry of Labor and Social Affairs, Ministry of Women Affairs, and Ministry of Martyrs and Disabled (MMD); related UN agencies including UNOPS/CDAP, WHO, ILO, UNICEF, and UNHCR; National Constitution Commission; and President Office” (4). It is expected that the initial policy will lead to a more detailed and prioritized plan of action that needs to be developed in order to achieve the ultimate objectives of this policy. The policy goes on to state:

Provisions for people with physical disability for example, should include orthopedic rehabilitation centers; physiotherapy services; and orthopedic, assistive and mobility devices. These services should be close to a regional or provincial hospital with orthopedic surgical services so that the local population has easy access. They could be located ideally, in cities with medical teaching faculties such as in Kabul, Mazar, Herat, Kandahar and Jalalabad. Future services should provide for an expansion in orthotics as this is underserved.

All patients have the right to receive devices. Devices should be well-made, well-fitting, of local materials whenever possible and repairable locally. Appropriate technology should be standardized throughout the country. A mechanism for national standardization should be created with relevant experts in collaboration with MOPH [the Ministry of Public Health].

5.3 Planning

There are six key activities in planning and implementing wheelchair provision.

1. Identifying the need for wheelchairs and services

Identifying the need for wheelchairs is necessary to determine the numbers of services and personnel required and where to locate services. Such assessments also provide information on user satisfaction with wheelchairs that are in use and may have been distributed with or without service provision. Statistics should include the number of users, prevalence of different health conditions, impairments and restrictions in participation, and the geographical location of these individuals. Collection of data can often be facilitated by collaborating with community-based rehabilitation programs and disabled people’s organizations. Where collection of data is not possible, the conservative estimate that 1% of the population will require wheelchairs can be used.

2. Planning wheelchair provision at national level

It is recommended that governments be actively engaged in the planning, establishment and continuing development of wheelchair services. Governments are advised to consider funding wheelchair services along with other rehabilitation services. Where government funding is already allocated to wheelchair provision, it is recommended that the services be assessed to determine whether they are being provided in accordance with the recommendations made in these guidelines.

3. Encouraging collaboration between governmental and nongovernmental service providers

Wherever possible, national and international nongovernmental organizations involved in wheelchair provision are encouraged to collaborate closely with relevant ministries and departments to assist in developing and implementing the national plan for wheelchair provision. A coordinated plan can help to make maximum use of resources and ensure that the appropriate services are accessible to those who need them.

4. Integrating wheelchair services into existing rehabilitation services

Wheelchair services will be enhanced by integrating them into other rehabilitation and health care services where possible. Integration helps to coordinate efforts among key stakeholders, make the best use of resources such as health centres and personnel, and facilitate strong referral and consulting networks. A good example is that of the Kilimanjaro Christian Medical Centre, where a multidisciplinary group of medical professionals have established a wheelchair committee to address issues related to production, service delivery, distribution and maintenance (6).

Referral networks are critical to the sustainability of wheelchair services, and help to ensure that the services are accessible to those who need them. Consulting networks and access to health care professionals such as physicians, occupational therapists, physiotherapists, speech and language therapists and other specialists help to ensure that appropriate services and equipment are provided to users. This is particularly important for those with complex needs.

5. Adopting national standards of wheelchair provision

National authorities and providers of wheelchair services are urged to develop and adopt national standards. National standards need to address issues associated with the quality and testing of wheelchairs, personnel training and service delivery. These guidelines may serve as a starting point for developing standards. It is also recommended that monitoring and evaluation be carried out to ensure wheelchair services meet the established standards.

6. Empowering consumers

National governments and international development agencies can create and support an enabling environment. Users need to have the opportunity to choose the right product for themselves from among a variety of products. A good information package about these products, including possible sources of funding or subsidy, could be very useful for the user in making the right decision.

The best strategy for developing a national wheelchair provision programme will depend on the current state of wheelchair services in the country, the available resources and the needs the service has to meet. It is useful to consider the following questions when planning wheelchair provision.

  • What are the characteristics and specific needs of the user population?
  • Do stakeholder groups exist and, if so, what are their interests and opinions?
  • Do wheelchair services already exist (through local workshops, community-based rehabilitation, disabled people’s organizations, other nongovernmental organizations, the private sector or government)?
  • Is there any wheelchair provision outside the formal infrastructure, for example provision of mass imported wheelchairs?
  • What can be done with existing resources?
  • What are the current funding mechanisms?

Strategies for Developing a Wheelchair Provision Programme

  1. The government wants to establish a national wheelchair service programme. The government may contact interested nongovernmental and disabled people’s organizations, users, training  programs for health professionals, international organizations such as WHO and the International Society for Prosthetics and Orthotics and relevant international nongovernmental organizations to help in developing an appropriate plan for a national wheelchair service. The government may look at its own prosthetic and orthotic services and use these as a basis for developing a wheelchair service. It may also contact government bodies in other countries to learn from their experience and seek advice.
     
  2. Wheelchair provision exists but on a small scale through independent organizations; there is no collaboration. The government, local organizations or an international nongovernmental organization could assess the possibility of scaling up the operation. A resource centre can be set up to involve people from the different organizations in a collaborative effort. The resource centre can then evolve into either a coalition of organizations interested in wheelchair services or an independent nongovernmental organization in its own right.
     
  3. There are organizations in the country but no wheelchair service delivery. An interested nongovernmental or disabled people’s organization can serve as the nucleus for a resource centre. The organization needs to identify an appropriate organization with wheelchair provision experience as a partner (e.g. a governmental or nongovernmental organization in a neighbouring country or an international nongovernmental organization) and should follow the other initial steps in scenario 4 below. Alternatively, this process may be started by an international nongovernmental organization, which then seeks out local nongovernmental and disabled people’s organizations as partners. Efforts should be made to identify and network with other countries or organizations that have had similar experience in initiating wheelchair services.
     
  4. There are no organizations in the country and no regular wheelchair service delivery. An international nongovernmental organization, either on its own initiative or at the invitation of or in partnership with the government, could establish a resource centre in the capital or other major city. The resource centre could be an integral part of an already existing rehabilitation institute. The resource centre should begin by providing important information to users, their families or caregivers and health professionals about mobility needs and wider issues pertaining to mobility. The international nongovernmental organization should develop a stakeholder analysis and survey people who use or require wheelchairs, in order to identify gaps and determine the need for wheelchairs and services. Preliminary participatory research will present options for meeting the needs. Funding should be secured to begin wheelchair provision. Efforts should be made to establish a working relationship between the resource centre and relevant governmental bodies as a first step in establishing a national wheelchair service.
     

5.4 Funding Stratagies

An important part of setting up a wheelchair service comprises costing and establishing sources of funding in order to ensure the financial sustainability of the service.

Costing

 The first step towards financial sustainability is the accurate calculation of the direct and indirect costs of wheelchair services. It is important that the cost of service delivery and the cost of the product are accounted for. Initial costs of setting up a wheelchair service should also be provided for but do not need to be included in the calculation of running costs. When estimating funds needed to establish and sustain wheelchair services, planners are advised to consider the total cost of wheelchair provision. The total cost is the sum of all direct and indirect costs.

Direct Costs

Product

  • Manufacturing cost or purchase price of wheelchair
  • Shipping and transportation of wheelchair

Initial Service

  • Personnel costs (clinical, technical, training) for assessing, ordering, fitting and training
  • Personnel costs for ordering and inventory of wheelchairs
  • Materials and equipment for assembly and modifications
  • Supplies (assessment forms, record-keeping, etc.)

Follow-up service

  • Personnel costs
  • Maintenance and repair

Indirect  Costs

  • Management
  • Administration
  • Overheads
  • Capacity building – training of service personnel

Sources of Funding

Many individuals who need a wheelchair cannot afford to buy one. Nevertheless, everyone who needs a wheelchair is entitled to one, regardless of his or her ability to pay for it. Thus, funds will need to be made available to users needing financial assistance. Different funding mechanisms are described below.

Government Funding

Government funding is usually the most reliable funding source where the government is committed to wheelchair services. Where wheelchair services are being established or provided by nongovernmental groups, it is recommended that there be continued consultation with the relevant government departments. Consultation should include long-term planning to determine when, how and to what extent the government is able to assume overall responsibility for the service in the future, including financial contributions.

Donor Funding

In many contexts, the initiation of a wheelchair service may depend on funding from national and international donors. Owing to its usually short-term nature, donor funding should be complemented by advocacy for government and other more sustainable sources of funding.

Wheelchair Funds Managed by Committee

A local “wheelchair fund” may be established to subsidize the cost of wheelchairs for individual users. Wheelchair funds exist to source funding and equitably manage donations secured for wheelchair provision. Users apply to the fund committee for a full or partial subsidy of the cost of a wheelchair. It is recommended that such funds apply a means test to determine how much financial assistance should be given. Government funding may also be channelled through a wheelchair fund.

Committees should comprise a cross-section of individuals who have a vested interest in sustainable wheelchair provision, such as (though not limited to) users, representatives of disabled people’s organizations, clinicians and technicians, government representatives and local dignitaries.

Contributions From Users

Unless full government funding is provided for wheelchair purchase, it is recommended that any financing system incorporates an element of financial contribution from users themselves. Contribution  programs should be run in conjunction with individual means tests to ensure that users contribute no more and no less than they can realistically afford. Users’ contributions also stimulate demand for products and services of appropriate quality.

A credit scheme is an option that allows users to borrow funds to purchase a wheelchair and to repay it over a period of time. Another option is an employment scheme, linking wheelchair provision with the opportunity for the user to obtain a job or funds to start a business and to pay for the wheelchair over time.

Fees on Donated or Imported Wheelchairs

Even when a wheelchair is donated free of charge, there are costs associated with its responsible provision to the user, including follow-up with the user and maintenance of the wheelchair. Organizations that import wheelchairs on a large scale without ensuring the necessary services, as described in Chapter 3, could be required to pay a fee to support the services.

Income Generation

Wheelchair services can be subsidized through income from the sale of other products such as canes, crutches, walkers, and toilet and shower chairs.

Voucher System

A voucher system may enable users to make their own purchasing decisions. The user is assessed and receives a prescription for a wheelchair with certain features. The user is given a voucher to the value of the cheapest wheelchair that fits the user’s prescription and that also meets minimum standards for safety, strength and durability. Users who want a more expensive chair that meets the prescription have to find the additional funds themselves.
 

5.5 Links With Other Sectors

Wheelchair service stakeholders are encouraged to collaborate with other sectors and institutions. These linkages reduce the cost of establishing and operating a wheelchair service and allow the service to grow more rapidly. Professionals in these other sectors will learn about wheelchair services, while the services will benefit from the increased involvement of educated and trained professionals. Collaboration will also facilitate more enabling or barrier-free environments, and a higher level of inclusion and participation

Health services and community outreach campaigns

Existing health services provide an infrastructure into which wheelchair services can be integrated at the lowest possible cost. Information services can be expanded to include wheelchairs, thus facilitating the identification and follow-up of users. The advantages include a common location for all services, the use of existing referral networks, and greater awareness among health and rehabilitation workers. Visits by health services to outlying areas (for HIV/AIDS awareness, community-based rehabilitation  programs and vaccination campaigns, for example), as well as literacy, voter registration/political participation campaigns and any other outreach  programs, also provide an opportunity to provide wheelchair services.

Education

Linking wheelchair provision with the education sector can facilitate the development of training materials and implementation of training  programs. In some instances, core subjects may already exist within the academic institution. In these situations it may be possible to integrate training for wheelchair provision into existing courses.

Similarly, manufacturing and testing laboratories may exist, which can help facilitate the design, production and testing of wheelchairs. University students in a variety of technical and health disciplines can be recruited for careers in wheelchair provision. Service providers can engage students for field placements to obtain experience. Finally, academic institutions will be familiar with methods of accreditation, which may help in establishing nationally recognized, accredited training for wheelchair provision.

Wheelchair services can also work with the education sector to ensure education is accessible to people with disabilities, as stated in Article 9a of the United Nations Convention on the Rights of Persons with Disabilities. With a wheelchair and a barrier-free environment, a person with disability can access education in school or college. Schools and colleges need to have, as a minimum, easy access to classrooms, wide doorways and accessible toilets.

wheelchair provision 02Livelihood

It is likely that new wheelchair users will need help in finding a job or acquiring the necessary skills to find a job or return to work. Article 27 of the United Nations Convention states: Parties recognize the right of persons with disabilities to work, on an equal basis with others; this includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities.

Policies that encourage employment training, job referral  programs and mainstream education for people with disabilities can help to increase the employment opportunities for users. There are benefits for both users and society when users are able to secure their own livelihood. Through employment, users and their families can better secure the necessities of life and improve their economic and social situation.

wheelchair provision 03The Standard Rules on the “Equalization of Opportunities for Persons with Disabilities” notes that users have obligations as well as rights. With mobility, and a greater opportunity for work, users are in a better position to fulfil their obligations to society.

Social

Quality Of Life: With a wheelchair and a barrier-free environment, a person with disability can easily participate with dignity in social and community life. Active participation in the social, spiritual and cultural life of a community has a strong impact on the quality of users’ lives and their self-perception and self-esteem. Both participation in and appreciation of the arts, sports and recreational activities, can greatly contribute to a positive self-image and well-being.

wheelchair provision 04Active Participation: Barriers to participation of users include negative attitudes held by the public, the users’ families and sometimes the users themselves. An effective way of overcoming attitudinal barriers is for users to become more visible, demonstrating to family, friends and the broader public that they can participate in social activities (see Fig. 5.3.). Through direct experience, users and those around them learn the full extent of a user’s abilities. Users have the same rights and opportunities as others to have a family. In fact, a wheelchair makes family life easier and less stressful for a person with disability and his or her family.

Governments are encouraged to assist users in accessing wheelchairs and services that allow them to function as independently as possible. Users and their families also need to receive the social benefits to which they are entitled.

Infrastructure: Barrier-free environments create opportunities for users to exercise their rights, opportunities and freedoms, to become productive members of the family and to fulfil their duties to their family and community. The success and optimization of wheelchair provision in any country largely depend on the environment: a barrier-free environment will benefit not only wheelchair users but also others, especially older people. Basic aspects of the infrastructure that need to be accessible include:

  • buildings, i.e. housing and public buildings providing, for example, health services, education, employment, banking, government services and other public services;
  • public transport, such as buses, trains and ferries;
  • roads, streets and footpaths;
  • food, water and sanitation facilities such as open-air restaurants and markets, water taps, tube wells and toilets; and
  • facilities for culture and recreation, for example stadiums, cinemas, theatres, parks, public halls and community centres.

It is recommended that experts on wheelchair accessibility, for example users with adequate knowledge, be represented on local, regional and national committees that determine planning and construction. Universal design, including wheelchair access, could be included as a requirement in university  programs for civil engineering, architecture, urban planning and design.

Access for all in Sri Lanka

In Sri Lanka, a consortium of disability organizations was formed to support a campaign to promote the inclusion and participation of all people with disabilities in tsunami relief, reconstruction and development work. The Access for all campaign asks for the inclusion of people with disabilities when rebuilding the nation. This means rebuilding an accessible nation: making all public buildings, transport, places of employment, services and infrastructure accessible to all. It also means including people with disabilities in plans for the nation.
 

5.6 Inclusion and Participation

The ultimate aim of wheelchair provision is to facilitate inclusion and participation. Mobility is often a precondition for participation in society. Hence, provision of wheelchairs that enhance personal mobility is an essential element of interventions to ensure that all citizens of a country get equal opportunities to enjoy all human rights and fundamental freedoms.

Inclusion and participation of people using wheelchairs will require: 

  • barrier-free environments and disabled-friendly products and services;
  • general services and systems such as housing, health care, transportation, schools and income generating activities are made accessible; and
  • specific services and systems such as medical treatment, rehabilitation, wheelchairs and other assistive devices and support services are made accessible and affordable

It is important that all stakeholders in wheelchair provision are aware of and understand the ultimate aim of providing wheelchairs, and translate this understanding into appropriate action to ensure sustainable inclusion and participation. When the wheelchair needs of people in less-resourced settings begin to be met, this will benefit not only the individuals and their families but also their countries.
 

Conclusions

  • Countries have the primary responsibility for wheelchair provision, as stated in United Nations policy instruments.
  • Areas to consider when developing a policy for wheelchair provision include design, production and supply, service delivery, training and financing.
  • Key activities in planning and implementation wheelchair provision are:
    identification of need
    planning at national level
    collaboration among stakeholders
    integration of existing health care of rehabiliation services
    adoption of national standards
    emp0werment of users
  • Linking wheelchair provision to other sectors of the society can be effective.
  • Infrastructure and transport systems need to be accessible to all.
  • The ultimate aim of wheelchair provision is to facilitate inclusion and participation.
     

Resources

  1.  Scherer MJ. The change in emphasis from people to person: introduction to the special issue on assistive technology. Disability & Rehabilitation, 2002, 24:1–4.
  2. The Persons with Disabilities (Equal Opportunities, Protection of Rights & Full Participation) Act, 1995. New Delhi, Ministry of Social Justice and Empowerment, 1995 (http://socialjustice.nic.in/disabled/welcome.htm, accessed 11 March 2008).
  3. Wong-Hernandez l. Moving legislation into action: the examples of India & South Africa. Disability World, 2001, No. 6 (http://www.disabilityworld.org/01-02_01/gov/legislation.htm, accessed 11 March 2008).
  4. The Comprehensive National Disability Policy in Afghanistan. Kabul, Ministry of Martyrs and Disabled, 2003 (http://www.disability.gov.af/npad/publications.htm, accessed 11 March 2008).
  5. Oderud T et al. User satisfaction survey: an assessment study on wheelchairs in Tanzania. In: Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007.
  6. Munish A. Follow-up, service and maintenance (including repairs and maintenance), sustainability of service, service delivery system. In: Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007.
  7. Wiman R. et al. Meeting the needs of people with disabilities: new approaches in the health sector.Washington, DC,World Bank, 2002.

 

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.

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.

Resources

  1. Rushman C, Shangali HG.Wheelchair service guide for low-income countries. Moshi, Tanzanian Training Centre for Orthopaedic Technology, Tumani University, 2005.
  2. Sheldon S, Jacobs NA, eds. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007 http://homepage.mac.com/eaglesmoon/WheelchairCC/WheelchairReport_Jan08.pdf, accessed 8 March 2008).
  3. McCambridge M. Coordinating wheelchair provision in developing countries. In: Proceedings of the RESNA 2000 Annual Conference: Technology for the New Millennium, Orlando, Florida, 28 June – 2 July 2000. Atlanta, GA, RESNA, 2000:234–236. 
  4. The manual wheelchair and its use. Stockholm, Swedish Institute of Assistive Technology, 1990 (In Swedish).
  5. Oderud T. Design. In: Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007. 
  6. The relationship between prosthetics and orthotics and community-based rehabilitation. A joint ISPO/WHO statement. Copenhagen/Geneva, ISPO/WHO, 2003 http://www.who.int/disabilities/technology/po_services_cbr.pdf, accessed 10 March 2008).
  7. Helander E. Prejudice and dignity: An introduction to community based rehabilitation, 2nd ed. New York, United Nations Development Programme, 1999
  8. Empowering the rural disabled in Asia and the Pacific. Rome, Food and Agriculture Organization of the United Nations, 1999 http://www.fao.org/sd/PPdirect/PPre0035.htm, accessed 10 March 2008).

 

Heart Attack Grill

Customers wear medical gowns and meal orders are written on hospital style wrist tags. Your waitress is dressed in what they claim to be sexy retro nurses’ uniforms. Customers of the Heart Attack Grill who weigh over 350 lb (160 kg) and consume a quadruple bypass burger not only eat free, they are escorted by one of the sexy waitress nurses to their car (or an ambulance) in a huge wheelchair. Does that sound like a fun night out?

The Heart Attack Grill is a hospital themed restaurant in Dallas, Texas, that has become famous for embracing and promoting a diet of extremely large hamburgers. Customers are referred to as “patients,” orders are “prescriptions,” and waitress are “nurses.” The owners of the artery hardening grease pit promote it as;

Nutritional pornography. — Jon Basso, Heart Attack Grill Founder.

Heart Attack Grill Quadruple Bypass Burger

Now that's an interesting slogan, she'll ride you to the car..

She’ll ride you to the car?

The Heart Attack Grill website disclaimer reads: “None of the women pictured on our website actually have any medical training, nor do they attempt to provide any real medical services.” Well duh, if you are having a heart attack, why would you go to a greasy hamburger joint? It doesn’t look like any of the waitress / nurses even eat where they work.

The menu includes Single, Double, Triple and Quadruple Bypass Burgers. The Quadruple Bypass Burger has 2 pounds of beef, eight slices of American cheese, a whole tomato and half an onion, all served in a bun coated with lard. That equates to around 8,000 calories (four times the recommended daily calorie intake for women). The massive burger has been listed as one of the;

World’s worst junk foods. — Charlotte Martin, The Sun.

Other menu items include Flatliner Fries (deep fried in pure lard of course), Lucky Strike no filter cigarettes, Pabst blue ribbon beer, tequila, butterfat milk shakes, Jolt, full sugar Coca-Cola, and even candy cigarettes for the kids!

The restaurant has come under fire for its poor portrayal of nurses and promoting bad health. Child welfare groups have also slammed the operators as irresponsible for allowing children into the “adult themed” restaurant. Funny, but we have not yet received any complaints from disability groups about the mis-use of wheelchairs.

Seriously girls stop the abuse of wheelchair armrests and get in the guys lap already. After all, the poor bastard probably hasn’t seen his penis for years and won’t live long after eating at the Heart Attack Grill.

Resources