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included in the new handbook of the Ministry, if the consultant considers this as the most
suitable general purpose wheelchair for his paralysed patients (Guttmann, 1964).
Wheelchairs for spinal cord sufferers can be divided into three main groups:
1
Rigid-framed wheelchair for indoor use only. These should be used for exceptional
cases only.
2 Hand-propelled general purpose folding wheelchairs for use both indoors and out
doors, which are also suitable for transit.
3
Power-driven wheelchairs for tetraplegics with extensive paralysis of both upper
limbs.
In the following, only groups 2 and 3 are discussed in some detail.
Hand-propelled general purpose folding transit chair
This type is used by a great majority of paraplegics but also by tetraplegics with lesions
below the 6th cervical segment. It enables the paralysed to move independently about
indoors and outdoors, including to and from his place of employment, studies, enter
tainment, sporting activities, etc., when travelling in his motorized conveyance. There
fore, such a chair must have certain qualities which are indispensable: stability, reliability,
easy accessibility, light weight, easy manoeuvrability and good performance and, last
but by no means least, good appearance. The latter point is very important from a
psychological point of view, and it is significant that paraplegics (and other disabled
persons) instinctively prefer a wheelchair which has the least appearance of an 'invalid'
chair. In my view, no colour-painted wheelchair can compete in this respect with a
chromium-plated one.
With regard to stability, it must be admitted that the lighter the wheelchair the
greater the difficulty in securing stability. However, it has been proved that modern
all-purpose folding wheelchairs of 36 Ib weight can maintain adequate strength to ensure
satisfactory stability. Moreover, a weight between 35 and 38 Ib greatly helps the para
plegic to lift and stow the folded chair into his motorized tricycle or car unaided. The
width of the folded chair should not be greater than ic-ioj in. Easy manoeuvrability
of the wheelchair is essential. Therefore the overall width for adult's wheelchairs should,
as a rule, not be more than 25 in to allow free passage through doorways, the average
width of which is 28 in, and along corridors. A wheelchair-narrower, to diminish the
width of the chair by 3 in, should be one of the requirements of a general purpose chair,
even at the cost of increasing the weight, to enable passage through narrow doorways
in ships, bathroom, lift, etc. (Denley, 1964; Guttmann, 1964). Wheels, handrims and
castors are also important factors for the paraplegic's and tetraplegic's mobility in his
wheelchair. At Stoke Mandeville, we have for many years advocated 24 in for the large
wheels at the back, as they ensure correct upright position and facilitate negotiation of
kerbs and steps. For tetraplegics with paralysis of the fingers and who have to rely on
the extensors of the wrist, large wheels at the back provide a better leverage for self-
propelling with the extended wrist (Walsh, 1964).
The type of tyre on the wheels may vary in accordance with the condition of the floor.
On concrete road and other hard surfaces, for instance basket ball pitches on sports
