People with disabilities are vulnerable to several healthcare-related conditions. Depending on the person, people who use wheelchairs may experience secondary conditions, age-related conditions, co-morbid conditions, and higher rates of premature death.
Motor and mobility impairments, often found with people who use wheelchairs, can speed up the typical aging process. Typical aging issues are usually accompanied by problems like heart disease and arthritis after reaching 70 years old. However, some individuals with a disability develop an “age gap,” which means the rates of medical and functional problems begin to show at about age 50 instead.
It’s important that people who use wheelchairs take the proper preventative measures to ensure that their health stays good and their mobility and independence continues. Here are the top preventative healthcare measures to consider if you or someone you know relies on a wheelchair:
Access to Healthcare: The healthcare landscape is changing for individuals all over the world. It is affecting the way the elderly and people with disabilities access care. Access to affordable health services and transportation are two of the main reasons why people with disabilities do not receive necessary preventative healthcare. If costs of coverage is what is causing the lack of access to healthcare, take the time to go over the options for accessing affordable healthcare. Physical barriers like inaccessible medical equipment, narrow doorways, inadequate bathrooms, and uneven access to buildings like hospitals and doctors offices make it difficult for some wheelchair users to access preventative healthcare. Women in wheelchairs who have reduced mobility are often unable to access mammograms and cervical screenings because examination tables and breast cancer screening machines are not height adjustable
Osteoporosis Screening: Individuals with reduced mobility over 40 years of age should receive an osteoporosis screening at least every 5 years. The exam uses X-rays to measure the amount of calcium and minerals present in the body. There are usually no symptoms of osteoporosis until there is a break in the bone. It’s important to request a bone mineral density test if there is concern about the osteoporosis status.
The most commonly seen fractures in people who use wheelchairs are breaks in wrists, spinal bones, and hips. The best way to prevent osteoporosis is by adopting a healthy lifestyle. Eat calcium-rich food and do light weight-bearing exercise. Leafy green vegetables like spinach and broccoli contain a high amount of calcium. Avoid drinking too much caffeine, because it can cause a calcium imbalance in the body. And this should go without saying, but stop smoking! It has been linked to severe bone damage leaving individuals at higher risk of osteoporosis.
Mobility Exams: A general mobility exam should be a part of an annual exam for anyone who uses wheelchairs or suffers from any other type of disability that reduces mobility. A lack of exercise is a danger to everyone, no matter their level of mobility. Focusing on having an exercise regime helps prevent poor circulation and blood pressure issues.
Sitting has been called the new smoking due to the huge risk factors that come with excessive sitting and exacerbated by limited mobility issues. It has been known to cause irreversible effects that cannot be rectified through exercise or other good habits. Sitting for long periods causes harm in the body because during prolonged sitting electrical activity in the muscles drop, creating a harmful metabolic effect. Here are some of the several exercises available that utilize seated or reclined positions:
- Chest presses. Reach outwards and back in, exhaling on the outreach for 1 second and pull back while inhaling for 2 seconds. Repeat this 15 to 30 times.
- Take to the gym for some time on the rowing machine or arm bicycle. These devices are more commonly ADA compliant and provide a great way to get the heart rate up, building cardiovascular strength and endurance.
- Perform stretching and strength-building exercises with a focus on form and speed instead of weight. This trains the muscles for cardio and strength building in the future.
Reproductive Health Exams: The National Center for Research on Women with Disabilities reports that women with physical disabilities find it difficult to get information on effective birth control methods for themselves. They are often discouraged from having pelvic exams due to inaccessibility in the physician's office. Many doctors do not conduct pelvic exams if transferring the patient onto the exam table seems too difficult.
Typically women with disabilities have no unforeseen or unusual problems with pregnancy, but doctors need to be aware of complications that can be associated with a spinal cord injury (SCI). Examples of issues can be respiratory problems, urinary tract infections, and increased spasticity of certain muscles.
Since some medications commonly used for SCI are toxic to the fetus, the safety of the medications taken should be evaluated if you become pregnant. If you use a wheelchair and are considering having a baby, talk to a trusted physician about the complications you may face based on your specific disability.
Shoulder Problems: The shoulder joint is the most mobile in the body. Because of this mobility, it is predisposed to injury caused by overuse. In wheelchair users, the shoulder is the primary joint used to transfer oneself and propel the chair. Even a minor injury affecting the shoulder can impair a person’s ability to be independent. With overuse injuries, it is common for there to be muscle strain, rotator cuff tears, and pinched nerves.
It is important to look at the specific kinds of injuries you may feel and sustain to help prevent their recurrence. Make sure that your health professionals (like your physician, athletic trainer, physical therapist, etc.) are aware of your disability and how it co-exists with your injuries. If you frequently suffer from shoulder impingements or rotator cuff issues, consider upgrading your wheelchair. One that self-propels can help reduce the strain on shoulders and decrease the possibility of overuse injuries.
Ulcers, Abrasions, and Blisters: These types of issues occur frequently with individuals who use wheelchairs. Blisters show up when the skin comes in repeated contact with wheelchair parts. Since there can be a continuous rubbing on the skin, it can cause a collection of fluid below the epidermal layer of the skin. To prevent the creation of blisters, use talcum powder or petroleum jelly to protect the skin. If you’re prone to hand blisters, wear gloves that fit properly to help propel your wheelchair.
Ulcers are another concern for people who rely on wheelchairs. To prevent developing bed sores or ulcers, make sure to position the hips in the middle of the seat directly between the armrests. Make sure the buttocks is at the back of the chair, and use a pillow if added support is needed. Keeping the feet on the floor of foot rests can ease the pressure put on the back of the thighs.
Carpal Tunnel Syndrome: Individuals who suffer from spinal cord injuries place a significant amount of weight-bearing stress on the upper extremities. This type of stress increases the chances of carpal tunnel syndrome on those in a wheelchair. While propelling a wheelchair or transferring to or from one, the wrists are at maximum extension and the forearms are strained. This type of simple movement over and over can produce carpal instability.
Carpal tunnel syndrome is a common side effect of long-term wheelchair use. Its severity is closely associated with the duration of wheelchair use and patient age. It has been reported that anywhere between 49 to 73 percent of manual wheelchair users experience carpal tunnel syndrome. Because people who use wheelchairs rely on their arms for usual activity, the repeated manual activity exacerbates the severity of the syndrome.
Depending on the amount of time you spend in a wheelchair, your chances of developing carpal tunnel will change. The best way to prevent or treat carpal tunnel syndrome is to treat is as soon as symptoms start. Make sure to take more frequent breaks to rest your hands and wrists. Apply cold packs to reduce any swelling that may come with the pain. Non-invasive treatments include wrist splinting and medication.
Mental Health Screenings: Mental health encompasses how we feel, think, and act as we cope with life. People who use wheelchairs report higher rates of stress and depression than people without a disability. New understanding of the brain indicates that early intervention sharply improves the outcome of depression and anxiety symptoms. Longer periods of abnormal thoughts of depression and behavior have a cumulative effect and can limit the ability an individual has to recover.
Basic preventative healthcare like exercise, not smoking, and having a healthy diet, combined with preventative screenings, should be a big part of an overall healthcare plan for all individuals. But if you or a friend suffers from a disability that requires the use of a wheelchair, it’s particularly important to address the above healthcare concerns to avoid future injury or suffering.