Protecting Carers From Pushing Excessive Wheelchair Loads

Ailsa Reston, Occupational Therapist (OT), highlights the benefits of prescribing motorised TGA Wheelchair Powerpacks to protect carers from excessive back strain, when propelling manual attendant-controlled wheelchairs

About the Author: Ailsa Reston, Occupational Therapist
Ailsa Reston qualified as an OT in 1986 from St. Andrews School of Occupational Therapy. She initially worked in the NHS in the field of adult physical medicine and then specialised in the field of neurology and the treatment of Stroke. In 1999, alongside fellow OT and COTSSIP member Bev Kelly, she set up the independent OT Practice, RKS Occupational Therapist Services based in Cheshire. RKS recommends the TGA Wheelchair Powerpack range to its clients including the Solo, Duo, Duo HD and PLUS models.

As average wheelchair occupant weight increases, fitting a TGA Powerpack can be a proven solution to help push a manual wheelchair

A TGA Wheelchair Powerpack is a powered unit that can be fitted to the underside of a manual attendant-controlled wheelchair. It can include one or two drive wheels that are powered by an on-board battery connected to controls mounted on a wheelchair handle. With a top speed of 3-4mph, it is the perfect solution to help push a manual wheelchair.

This is particularly important for carers who regularly have to negotiate slopes, ramps, kerbs or uneven surfaces - it eliminates potential overexertion. TGA Powerpacks fit a wide variety of wheelchairs including many tilt-in-space models and the recently introduced bariatric 'PLUS' helps push an occupant and wheelchair weighing up to 32st. Models can also provide forward and reverse motion to assist with manoeuvring in restrictive spaces. 

When OTs prescribe a TGA Powerpack, they have complete confidence it will deliver the appropriate assistance for clients and their carers. Ergonomically speaking, TGA's design has been carefully considered to ensure unhindered walking as its Powerpacks fit further underneath wheelchairs than competitor versions. The new PLUS, 32st capacity version, can greatly reduce moving and handling risks for carers attending to bariatric clients - a major issue faced by many healthcare professionals.

With the growing trend towards larger, heavier care home residents and private individuals, motorised assistance to propel attendant-controlled manual wheelchairs is becoming ever more essential. TGA Powerpacks allow wheelchair users, without independent mobility, to engage more fully with local communities and benefit from improved wellbeing.

The evidence for change - why TGA Wheelchair Powerpacks help to protect the health and safety of carers

Most independent OTs receive countless enquiries from disabled people and carers who are seeking powered assistance to push an attendant-controlled wheelchair. It is critical that wheelchair attendants in the community can manoeuvre immobile people in a strain-free manner and without affecting posture. 

Fitting a battery-powered TGA Powerpack can provide appropriate assistance for carers, so that the effort needed to exert is nominal, ie. steering the wheelchair rather than pushing it. This gives carers protection against back and shoulder injuries, as well as safeguarding those with heart or respiratory conditions. 

A TGA Powerpack will also provide benefits to employers in the care home sector. It can ensure carers are not put at risk in relation to pushing loads that exceed Health & Safety Executive recommendations (HSE). This in turn can reduce the potential for staff being off work or working less efficiently due to injury or illness. As a proven product range in the long term care sector, the TGA Wheelchair Powerpack significantly improves the quality of life of care home residents and individuals living in the community along with their families. It allows manual wheelchairs to be easily pushed outside in areas that may otherwise have been inaccessible.

Loads that are safe for carers to push are based on guidelines issued by the HSE. These clearly state that the exertion of force in excess of the guidelines, increases the likelihood of injury. It should be noted that HSE guidance assumes that the wheelchair being pushed is well maintained and being operated on a smooth surface. Unfortunately this may well not reflect most real life situations for carers and wheelchair users, especially those negotiating uneven paving, carpet and kerbs. 

Pushing the combined weight of a wheelchair and occupant can easily exceed HSE guidelines - both for initiating momentum and also keeping the wheelchair moving. 

The excessive stresses and strains being commonly placed on carers today can also be illustrated clearly by the following data:

A six-year-old child weighing 20kg will, in conjunction with a standard wheelchair (12kg), have a combined weight of approximately 32kg. This is just over the safe limit for a female to push in order to maintain a chair's momentum, on a gradient of 1:12, without risk of injury. In the same scenario, an 80kg adult in conjunction with a standard wheelchair (15kg) will weigh 95kg, well beyond the safe limit for males and females to push.

Significant evidence continues to mount regarding the moving and handling risks associated with carers pushing manual wheelchairs. As an example, the 'Keeping the Wheels Turning' white paper produced by the University of Dundee in association with NHS Fife, states why Powerpacks significantly reduce pain and health-related difficulties for attendant carers:

'….shoulder pain for example is over four times as common for carers propelling attendant-controlled manual chairs as for those where the user has a power assisted chair. It is also noticeable that carers propelling manual wheelchairs are very much more likely to report heart, breathing or balance problems than those supporting powered wheelchair users….'

Within the data, it also confirms that without the use of powered momentum, the number of healthcare professionals complaining of back pain increases by 25%. Coupled with statistics demonstrating that the majority of wheelchair occupants and attendants are aged 40+, the health and mobility benefits of fitting a Powerpack are heightened even further. 

When you consider the above, unfortunately best practice in moving and handling will not be adhered to on a regular basis throughout the community. Therefore the added use of powered propulsion, as provided by fitting a TGA Wheelchair Powerpack, should be a critical consideration when prescribing a manual wheelchair.

Making a real difference at community level - RKS and the TGA Wheelchair Powerpack

We have recently provided a TGA Powerpack to a customer who came to us with a voucher from NHS Wheelchair Services. He approached us for a lightweight wheelchair and a Powerpack to enable him to access the shops and local amenities with his wife. The gentleman had a severe visual impairment, Arthritis and was unable to walk more than 20 yards. He was given a choice of transit wheelchair that fulfilled his prescription and he chose one that was lightweight so his wife could lift it in and out of the car easily. 

At RKS we have a selection of Powerpacks in the showroom that were demonstrated to them. They decided on the TGA Powerpack as this was the lighter option and was easier for his wife to fit to the wheelchair. She found the controls much simpler to use too. When demonstrating the chosen wheelchair and TGA Powerpack, the gentleman stated that the provision of this would 'change his life'. Previously if he went out with his wife he had to sit in the car or alternatively remained housebound. 

At RKS we also carry out work for local military veteran charities such as SSAFA and the Royal British Legion. I recently recommended a lightweight wheelchair with a TGA Powerpack to a 90-year-old ex-serviceman who suffered from Angina and a severe back problem. As he was unable to walk any distance due to his medical condition, his daughter wanted to take him out to the local shops, amenities and on day trips. His daughter also had trapped nerves in her back and struggled to push their existing NHS wheelchair, especially on inclines. The provision of a TGA Wheelchair Powerpack has made pushing the wheelchair and her father around hilly Cumbria strain-free. Both wheelchair and Powerpack did not require excessive lifting to place in a car boot, which also helped to improve the quality of life for the client and his daughter.

Another recent example involved provision of a TGA Wheelchair Powerpack to a gentleman who had experienced a Stroke - resulting in left-sided weakness. He was able to propel himself around his home in a wheelchair but outside accessibility was not possible as he lived on a steep hill. The provision of a TGA Powerpack enabled his wife to take him into the local village with far greater ease, especially when coming back up the hill to their home.

Benefits to carers and wheelchair occupants of specifying a proven TGA Wheelchair Powerpack

The TGA Wheelchair Powerpack is light-in-weight and therefore makes lifting easier for carers when placing in a car. This is especially important as many may themselves be elderly or have medical problems such as back issues or Arthritis. The ergonomic controls make handling of the Powerpack straightforward and the battery can be removed quickly for off-board charging. The extended, padded handles provide better grip - which is of benefit if reduced dexterity is a problem for carers.

The simplicity of connecting the TGA Powerpack drive unit to the controller is also a feature that OTs feel enables easy use. This TGA Powerpack it is not as fiddly as some other models on the market. Being able to put the TGA Powerpack on the majority of wheelchairs makes, with the multitude of bracket options available, gives the customer choice over the type of wheelchair that fulfills their needs. The Powerpack can also be fitted to wheelchairs with a tilt-in space-feature. As some of these specialist wheelchairs are quite big and bulky to push, it is a significant advantage to have powered propulsion with these chairs. 

The TGA Wheelchair Powerpack can be positioned further under the wheelchair and therefore does not pose a tripping hazard for the attendant. The ability to change speed also allows the individual pushing the wheelchair to walk at a pace that is comfortable for them. The use of a Powerpack enables the wheelchair and occupant to be more easily propelled across grass or gravel and up or down slopes and ramps. 

Conclusion - why the TGA Wheelchair Powerpack is a proven, trusted choice

Working in independent practice for many years now, I have seen the negative impact of excess strain on carers pushing attendant controlled manual wheelchairs in terms of muscle and back injury. This issue will only continue to grow as the trend toward heavier wheelchair users becomes ever more pronounced. Supported by HSE clinical evidence and guidelines, recommending the addition of a TGA Powerpack to attendant-controlled manual wheelchairs is now an essential consideration.