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can be fitted either independently on either side and operated by a separate handle, or
one brake can be operated by a lever fitted on one side with cable operation to the opposite
wheel, which ensures simultaneous action of both brakes. The latter arrangement is, of
course, essential for people with paralysis of one upper limb, who operate their specially
constructed wheelchairs with one arm propulsion. There is still room for improvement
of design of wheelchair brakes.
From all my experience with various designs of wheelchairs during the last 30 years,
I consider the Everest-Jennings model, manufactured in this country by Zimmer
Orthopaedic Ltd, Bridgend, and the more recently developed Vessa folding chair (Queen
Mary's Hospital, Roehampton, London), as the most suitable wheelchairs for paraplegics
and tetraplegics at present on the market. Both chairs can be provided with extra attach
ments for special requirements. The Vessa general purpose chair has the advantage of
being lighter than the Everest-Jennings general purpose chair and is also cheaper, but
less durable than the Everest-Jennings chair. Recently, Zimmer Ltd have also produced
lightweight wheelchairs (35-39^ lb).
The prescription of a wheelchair is the responsibility of a senior physician or surgeon
in charge of a spinal unit. It is highly recommended that Spinal Injuries Centres be
provided by the authorities concerned with sets of various designs of wheelchairs both
for adults and children, as this greatly facilitates the prescription of an appropriate chair
for the patient in accordance with his individual requirements. For special cases, especi
ally those in full-time employment in factories, a second wheelchair may be prescribed
which, as a rule, is granted by the authorities of the Health Service in this country.
Physicians and surgeons concerned with the treatment of paraplegics and tetraplegics
should realize that these patients need their chairs as early as possible during in-patient
treatment, to become efficient in its use in the shortest possible time during their daily
activities. Although there has been some improvement in the delivery of wheelchairs,
there are still unnecessary delays which are caused
1
by late prescription by the medical officer in charge of the case
2
delay by the administrative office in forwarding the application form of the medical
officer to the regional authorities of the Health Service
3
delay in the regional office of the Health Service in placing the order with the manu
facturers
4
despatching the wheelchair from the factory.
When a new wheelchair is delivered, several trial runs should be carried out during
the first few days to ascertain whether the chair is mechanically faultless. This applies
as much to fitting of screws, ball-bearings and bolts as to the function of the brakes and
the performance of the chair at speed. In particular, any deviation of the chair at speed
from the straight direction on removing the hands from the wheels must be reported
immediately to the makers. Serious damage to the chair must be reported to the Ministry's
authorities, so that the paraplegic can be provided with another chair pending the return
of his repaired wheelchair.
The Ministry of Health is responsible for all repairs and replacements due to fair
wear and tear or due to circumstances beyond the user's control, but the user will be
expected to meet the cost of any repairs or replacements caused by misuse or neglect.
