Ⅰ. Fundamental Features
1. Types of Wheelchairs①②

Self-propelled Wheelchair
For user who can propel the wheelchair by themself

Can also be propelled by an attendant

Attendant-propelled Wheelchair③

For user who is unable to propel the wheelchair by themself

Tilt-in-space and Recliner WheelchairFor individuals who cannot maintain their posture

Mainly used indoors



Tilt function (tilt-in-space): Backrest can be tilted while
maintaining a seated position

Reclining function: Ability to tilt backrest for reclining
position④

Power WheelchairPowered by electric motor and operated by users with ajoystick12. Wheelchair Basic Structure
Push Handle
Hand grip

ArmrestClothing GuardBackrest

SeatBrake

Frame

Hand rim

Tipping lever

Footrest

Driving wheel(rear wheels)
Caster wheel(front wheels)

1) Armrest⚫

Provides support for the elbows of the user⚫

Two types: normal arm type and desk arm type⚫

The desk arm type is lower in front, making it easy to place in front of a table⚫

Detachable type and flip-up type armrests are available⚫

These facilitate transfer in and out of the wheelchair; for example, to bed, etc.

Normal arm type

Desk arm type22) Clothing Guard⚫

To prevent clothes from becoming dirty or catching in a wheel

Clothing Guard

3) SeatMaterials used⚫

Vinyl: stain-resistant⚫

Nylon: durable

Folding state3

Backrest⚫

Helps with postural retention⚫

Reclining type can be tilted backward for user who has difficulty with maintaining a seated position for a long
period of time

Reclining typeFrame⚫

Provides support for the entire wheelchair⚫

Main component is aluminum alloy, a high-strength material
FrameFootrest⚫

Plates on lower part of the frame where feet are placed⚫

Both can be individually folded up

4Footrest

Push Handle⚫

Used by attendant for moving the wheelchair⚫

The handle is a right-angle or curved shape⚫

Set at a height that is easy for attendant to walk and move chair

Hand Grip⚫

Shape that is easy for attendant to grasp

Push handle
Hand grip

Tilt Lever and Recline Lever⚫

Tilt lever: used to adjust seat angle while maintaining backrest angle⚫

Recline lever: used to adjust backrest angleTilt Lever

Recline Lever

5

Brake⚫

Wheel brake: apply by pulling backward⚫

Assist brake: used for control of wheelchair by attendant⚫

Foot brake: used to stop large wheel from the rear by attendant with one-touchoperation

6

Hand Rim⚫

Attached to driving wheels (rear wheels)⚫

The user uses the hand rims to propel wheelchair by themself⚫

Materials: stainless steel, aluminum alloy, plastic
Hand Rim

Tipping Lever⚫

Used to lift wheelchair so as to go on steps or over ledges⚫

The attendant can easily lift the wheelchair's caster wheels (front wheels) by stepping on the tipping lever with
their foot7

Caster Wheel (Front Wheel)⚫

Smaller diameter than rear wheel and ability to rotate 360 degrees⚫

Used for changing direction

Driving Wheel (Rear Wheel)⚫

Wheel used to transmit driving force⚫

Tire is often the same thickness as a regular bicycle tire

Driving Wheel(Rear Wheel)

Caster Wheel(Front Wheel)83. Body Mechanics⚫

Techniques for promoting physical fitness, with focus on the skeleton, muscles, internal organs,etc.

⚫

Safe movements must be performed without placing a burden on either the person requiring
assistance or caregiver①

Set the patient's body close and into a small sphere②

Set the caregiver’s body as close as possible to the patient's body③

The caregiver makes the supporting surface wider by spreading their legs④

Establish the center of gravity as low as possible.

⑤

Avoid bending from the waist (be aware of large leg muscles and lumbar muscles)⑥

Avoid twisting the body⑦

Move in horizontal directions①

Set the patient's body close and into a small sphere

Weight percentage of each body part in a supine position:
head 7%, chest/abdomen 33%, buttocks 44%, lower extremities 16%

It is easy to become unstable when forces are distributed

Make the body as spherical as possible

Place arms over chest and bend knees up

A compact posture makes it easier to provide assistance

.

9

②

Set the caregiver’s body as close as possible to the patient's body③

The caregiver makes the supporting surface wider by spreading their legs (stability)

Standing with feet too close together

10Standing with feet too far apart④⑤

Set the center of gravity as low as possible (stability, helps patient to not fall over)High center of gravity

Low center of gravity

Narrow supporting surface

Wide supporting surface

Avoid bending from the waist (be aware of large leg muscles and lumbar muscles; i.e., rectus
abdominis, back muscles, pectoralis major, gluteus maximus, quadriceps)

Stress on the lower back caused by posture(relative percentage with upright position as 100%)

Supineposition

Upright
position
Lateralposition

Lifting while
leaning forward
Standing while
leaning forward

Nachemson A: The lumbar spine An orthopaedic challenge. Spine 1:59-71,1976

11

⑥

Avoid twisting the body

Change position by shifting weight⑦

Move in horizontal directions
Adjust wheelchair armrest height to match seat height of dental chair

12

Ⅱ. Transfer: From wheelchair to dental chair
1. Approaching the patient(1) Talk to the patient and explain:“Hello, Mr./Ms. △△. I am a clinical intern and my name is 〇〇.”
“I would like move you to the dental chair. May I do that now?”
2. Wheelchair positioning and braking(1) Position wheelchair close to the dental chair.
The wheelchair and dental chair should be parallel if possible, or up to 20 to 30 degrees to reduce the travel distance(2) Lock the wheels(3) Position the dental chair to be at the same height as the wheelchair
Adjust the dental chair seat to the same height as the wheelchair seat
Reduce the horizontal movement distance as much as possible
If the armrest can be removed, make sure the wheelchair seat and dental chair are at the same height
3. Caregiver position and posture(1) The caregiver stands behind the wheelchair(2) Asks/helps patient to cross their arms across their chest(3) Caregiver places their arms under patient’s upper arms and grasps their wrists(4) When caregiver is on the upper body side, both legs should be opened(5) When caregiver is on the lower body side, both legs should be opened and patient's knees held
Widen the angle of the feet
Lower the center of gravity
Keep close to the patient's body.
Bend the back as little as possible.
Step with both legs open
4. Transferring patient to dental chair(1) Caregiver on upper body side initiates and leads the lift with a prearranged count (ex., “1-2-3-lift”)
Caregiver lowers their center of gravity.
Use muscles in the lower extremities
Caregiver should bend their back as little as possible
Perform transfer by caregiver shifting their weight(2) Caregiver supports patient until stabilized with their back against the backboard of the dental chair
Caregiver should remain on the upper body side and support the patient's body until the end of the examination
Ⅲ. Transfer: From dental chair to wheelchair
1. Talk to the patient and explain
Inform the patient that they will be transferred to a wheelchair:“We are now going to move you to a wheelchair.”
2. Wheelchair positioning and braking(1) Position the wheelchair close to the dental chair
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The wheelchair and dental chair should be as parallel as possible, with no more than 20 to 30 degrees difference(2) Lock the wheels(3) Position the dental chair to be at the same height as the wheelchair.
3. Caregiver position and posture(1) Caregiver stands behind wheelchair.
(2) Caregiver places their arms under patient’s upper arms and grasps their wrists.
(3) Stay close to patient’s body(4) The caregiver on the lower body side holds the patient's knees
4. Transferring(1) Transfer on cue (ex., “1-2-3-now”)
Transfer slowly on upper body side following caregiver cue
Shift in horizontal direction
Reduce travel distance(2) Place patient's body into wheelchair
Seat the patient deeply
Ensure that the patient's body is not leaning to one side
Place the patient's feet on footrests
References
Toru Naito, Jun Akitake, Michiko Makino, Shinsuke Mizutani: Dentistry for the Elderly: First Steps, Basic Skills forCare and Assistance, 1st Edition, Tokyo: Ishiyaku Publishers, p70-71, 2017
Committee for Preparation of Textbooks for Training of Nursing Care Workers: "Textbook for Initial Training ofNursing Care Workers, Volume 3: Mechanisms of the Mind and Body," First edition, 4th printing, p.65-67, publishedby the General Incorporated Foundation for the Development of Longevity Society
Toshiyuki Ito and Noriko Kamakura: ADL and its surroundings - Practice of evaluation, guidance and care, 1stEdition, Tokyo: Igaku-shoin, p80-81, 1994
Nicholson A: The lumbar spine. An orthopaedic challenge. Spain 1:59-71,1976
Keiko Aoyagi: One-point nursing care techniques (Vol. 85): Be aware of body mechanics and assist with transfers,
Fureai care, 24:38-39, 201814