Guidelines
on the provision of
Manual Wheelchairs
in less resourced settings
ISBN 978 92 4 154748 2
For more information, contact:
World Health Organization
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CH-1211 Geneva 27
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Tel.: (+ 41 22) 791-2715
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GUIDELINES ON THE PRO
VISION OF MANUAL WHEEL
CHAIRS IN LESs RESOURCED SETTINGS
Guidelines
on the provision of
Manual Wheelchairs
in less resourced settings
WHO Library Cataloguing-in-Publication Data
Guidelines on the provision of manual wheelchairs in less-resourced settings.
1.Wheelchairs - economics. 2.Wheelchairs - supply and distribution. 3.Wheelchairs - standards. 4.Disabled persons - rehabilitation. 5.Developing
countries. I.World Health Organization.
ISBN 978 92 4 154748 2
(NLM classification: WB 320)
© World Health Organization 2008
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Contributors:
Editorial committee
Geoff Bardsley, Marc Krizack, Abdullah Munish, Kim Reisinger, Sarah Sheldon
Editors
Johan Borg and Chapal Khasnabis
Authors
William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger,
Sarah Sheldon
Peer reviewers
Jocelyn Campbell, Stefan Constantinescu, Fiona Gall, K N Gopinath, Sepp Heim, Ralf Hotchkiss, R Lee Kirby, Anna
Lindström, Matt McCambridge, Shona McDonald, Ray Mines, Alice Nganwa, Jamie Noon, Tone Oderud, Alana Officer,
Valeria Rodriguez, Osten Safvelin, Elsje Scheffler, Harold Shangali, Edd Shaw, Gertrud Stehr Hott, Claude Tardif, Isabelle
Urseau, David Werner
Illustrator
Jen McKinlay
Testimonial authors
Elly Bernard, Anca Beudean, Tun Channareth, Fiona Gall, Matt McCambridge, Shona McDonald, Laura Morales, Keo
Sovann
Financial support
US Agency for International Development
Partner organizations Centre for International Rehabilitation, Disabled Peoples’ International, International Society for Prosthetics and Orthotics,
The Motivation Charitable Trust (Motivation), Whirlwind Wheelchair International (Whirlwind) at San Francisco State
University
Design and layout was done by L’IV Com Sàrl.
Preface
7
Executive summary
9
About the guidelines
13
1. Introduction
19
1.1 Appropriate wheelchairs
21
1.2 Users of wheelchairs
21
1.3 Need for wheelchairs
21
1.4 Rights to wheelchairs
21
1.5 Benefits of wheelchairs
23
1.6 Challenges for users
24
1.7 Wheelchair provision
25
1.8 Types of wheelchair
27
1.9 Stakeholders and their roles
30
1.9.1 Policy planners and implementers
30
1.9.2 Manufacturers and suppliers
31
1.9.3 Wheelchair services
31
1.9.4 Professional groups
32
1.9.5 International nongovernmental organizations
32
1.9.6 Disabled people’s organizations
33
1.9.7 Users, families and caregivers
34
2. Design and production
37
2.1 Introduction
39
2.2 Wheelchair design
40
2.2.1 General considerations in wheelchair design
41
2.2.2 Introducing wheelchair design
43
2.2.3 The design process
43
2.3 Wheelchair production and supply
45
Table of conTenTs
4
I
g u I d e l I n e s o n t h e p r ov I s I o n o f ma n ua l w h e e lc h a I r s I n l e s s r e s o u r c e d s e t t I n g s
2.4 Functional performance
46
2.4.1 Wheelchair stability
46
2.4.2 Manoeuvrability
49
2.4.3 Pushing efficiency
53
2.4.4 Other functional performance characteristics
54
2.4.5 Evaluating functional performance
56
2.5 Seating and postural support elements
56
2.5.1 Seat bases
58
2.5.2 Cushions
59
2.5.3 Backrests
60
2.5.4 Footrests
60
2.5.5 Armrests
61
2.5.6 Rear wheels
62
2.5.7 Evaluating seating and postural support elements
62
2.6 Strength, durability and safety
62
2.6.1 Requirements
63
2.6.2 Evaluating strength, durability and safety
65
2.7 User trials and follow-up
65
3. Service delivery
69
3.1 Introduction
71
3.2 Wheelchair service delivery
76
3.2.1 Steps in service delivery
76
3.2.2 Understanding individual user needs
77
3.3 Good practice in wheelchair service delivery
78
3.3.1 Overall service
78
3.3.2 Referrals and appointments
79
3.3.3 Assessment
80
3.3.4 Prescription
81
3.3.5 Funding and ordering
82
3.3.6 Product preparation
82
3.3.7 Fitting
83
3.3.8 Training of users, families and caregivers
84
3.3.9 Follow-up, maintenance and repair
85
3.4 Personnel in wheelchair service delivery
86
3.4.1 Manufacturers or suppliers
86
3.4.2 Referral networks
87
3.4.3 Service personnel
87
3.5 Monitoring and evaluation
91
3.5.1 The need to measure performance
91
3.5.2 Monitoring
91
3.5.3 Evaluation
93
ta b l e o f co n t e n ts
I
5
4. Training
97
4.1 Introduction
99
4.2 Training requirements
102
4.2.1 Referral networks
102
4.2.2 Role of wheelchair service providers
103
4.2.3 Trainers
106
4.3 Course modules and contents
107
4.3.1 Course modules
107
4.3.2 Course contents
107
5. Policy and planning
111
5.1 Introduction
113
5.2 Policy
113
5.2.1 Developing a policy
113
5.2.2 International policies
114
5.2.3 Specific wheelchair provision issues
116
5.3 Planning
118
5.4 Funding strategies
121
5.4.1 Costing
121
5.4.2 Sources of funding
121
5.5 Links with other sectors
123
5.5.1 Health services and community outreach campaigns
123
5.5.2 Education
123
5.5.3 Livelihood
124
5.5.4 Social
124
5.5.5 Infrastructure
125
5.6 Inclusion and participation
126
Annex A
128
Training resources
128
Other resources
129