PT on the Net Research

Wheelchair Client


Question:

Bob, a 54-year-old client, is interested in learning more about a "pressor effect." Bob has been disabled for 25 years and is in great shape, exercising regularly. He is wheelchair bound and has some use of his abdominal wall but no use of his legs. He frequently uses the Free Motion equipment to work out, so he has great upper body ability.

When using your upper extremity only for long periods of time (such as hand cycling), your intrathoracic pressure increases, which in turn increases your blood pressure and heart rate. Sometimes Bob finds his heart rate is around 180. Is this okay? How much pressure can he tolerate? What type of training should we include in his routine to improve or, better yet, lower his pressure/heart rate? He is not training for anything but does wish to remain active and ride.

Answer:

Although I haven’t assessed your client’s individual function, our experience with wheelchair clients and therefore recommendations or ideas for you to apply are as follows:

Try moving your client out of the sagittal plane position. You mentioned he is able to use Free Motion equipment, and his upper body and core (partial) is functioning. Therefore, knowing that a wheelchair client is usually pushing in predominately the sagittal plane, we place a concentration on the frontal and transverse planes while conditioning (flexion compresses the abdominal contents, which can increase intra-thoracic pressure, especially as his posture adapts to these forces). However, before creating functional strength, we often teach our clients to distract their own spines by placing their wheelchair underneath a Smith machine or bar, grabbing the bar overhead and lifting themselves upward to decompress their spine from the chair. Also, in many cases we have our wheelchair-bound clients sit on a Dyna disk or disc sit. This will allow multi-planar pelvic-spine movement, especially as they move in the chair. Note: The best posture is NO ONE posture!

The key to reducing the negative affects you have mentioned is to use the body’s ability to load and unload in all planes of motion so optimal pressures throughout the abdominal region fortify proper health. Please realize this should not take the place of his doctor's recommendation. Please monitor his blood pressure and apply the above mentioned “tweaks.” This will allow you to obtain objective results. If you’re wondering, yes the distraction followed by applying movements in the frontal and transverse planes from the top down (upper body) and bottom up (with use of a Dyna disk) have proved wonders for our wheelchair clients. We just follow the client’s ability level and attempt to expand the client’s functional threshold. I hope this gives you ideas to “tweak” your client's current routine and improve his ability to function.