F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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The day-to-day maintenance of the wheelchair is the responsibility of the user, and
it is in his own interest to keep the chair in good running order, regularly cleaned and well
lubricated. This is so very important for maintaining the paraplegic's independence and
working capability.
Special mention should be made of the wheelchair problem in the many economically
restricted countries in the world. There are hundreds of thousands of spinal cord
sufferers in Africa alone as a result of polio, tuberculosis, transverse myelitis and trau
matic lesions following fractures of the spine, stab wounds and gunshot injuries, let alone
victims of other disabling afflictions, who are in need of suitable wheelchairs. Yet,
wheelchairs designed and manufactured in Europe and U.S.A. are unacceptable by the
developing countries in Africa and Asia for two reasons: firstly, they are too expensive
to be made available for a large number of paralysed and other severely disabled people;
secondly, these chairs are, as a rule, unsuitable for use in the bush and on the rough
conditions of the roads, especially during the rainy season; thirdly, local repair of the
chair is at present practically non-existing. In recent years, attempts have been made to
design and construct wheelchairs at low cost which can stand up to these tropical con
ditions. In this respect, R.Huckstep, former Professor of Orthopaedic Surgery at
Kampala University in Uganda, has carried out pioneer work. He designed a wheelchair
which can be manufactured locally by semi-skilled labour from easily available material
and which is strong enough to stand up to rough ground, sand, dust and water. The cost
of the chair (without sorbo-rubber cushion) is only £8 (1968), as compared with £30-
£50 (1968) for modern wheelchairs manufactured in Europe and U.S.A.
Electrically propelled wheelchairs
In recent years, various types of electrically propelled indoor and outdoor wheelchairs
have been designed for tetraplegics who, on account of their severe paralysis of both
upper limbs, are unable to use hand-propelled wheelchairs and are dependent on the help
of others to be moved about in their wheelchairs. For patients under the Health Service,
these power-driven wheelchairs can be supplied free on loan on the recommendation
of a hospital consultant. Most of the conventional indoor wheelchairs can be adapted to
an electric wheelchair by the provision of a small electric motor and a joy stick acting as
control. For instance, the Everest-Jennings Power Drive Wheelchair is supplied with two
6 V batteries and a special yj A heavy-duty battery charger for fast overnight charging
and for tetraplegics with complete or severe paralysis of deltoid, biceps and triceps but
with some function of the fingers, with a control panel which gives finger-tip control over
speed and direction. The chair turns in its own space, which is of great advantage in
confined spaces. The disadvantage of the original power drive chair was, that the joy-stick
was operating against four micro-switches and, therefore, one had only on/off control.
Jerkiness occurred by speed acceleration, affecting the tetraplegic's arm causing oscil
lation. This was obviated by a special device, developed at my suggestion by Mr R.G.
Maling in the former electro-medical research unit of the Stoke Mandeville Spinal Centre,
which allows proportional control over speed and smooth performance (Guttmann &
Maling, 1965). Fig. 247 demonstrates this device controlled by hand in a tetraplegic girl
