RAYMOND G. PIFER, AA
The adaptive armrest, as described for a wheel chair, is an inexpensive aid for positioning of a paretic or a paralyzed upper extremity and provides a permanent surface on which the patient can con tinue some therapy on his own. The armrest may help prevent subluxation of the humeral head from the glenoid fossa and places the glenohumeral joint in a resting position with some •abduction and more external rotation than if the patient had his arm in a sling. The armrest also provides a surface for the patient to do hand activi ties and may decrease the possibility of developing a wrist flexion contracture. The minimal elevation of the hand may aid in venous return and prevent excess edema. The cost of building the adaptive armrest is under $4.00, and is designed so that it can easily be removed from, and reattached to the chair as nec essary. The wheelchair used in this illustration is a 63.5 cm wide, standard-size wheelchair, and the armrest adds only 50.88 mm to the overall chair width. The industrial foam-back carpet gives tactile feedback and is easily cleaned with soap and water.
MATERIALS REQUIRED 1 bottle contact cement, 3 oz 1 piece foam-back industrial carpet, 469.9 mm x 190.5 mm 1 heavy cloth strap, 25.4 cm x 132 cm, Velcro®* attached 1 piece wood, 469.9 mm x 190.5 mm x 19.05 mm 1 drill rod, 4.76 mm dia. x 152.4 mm long 1 adjustable hose clamp, #12 2 carriage bolts, 4.76 mm dia. x 50.8 mm long 2 nuts 2 rubber caps, 4.76 mm 1 Velcro®* safety strap Mr. Pifer assisted in the Physical Therapy Department at Ivy Nursing Home, when this device was developed. He is currently employed at the Vocational Rehabilitation Center of Allegheny County, 1323 Forbes Ave, Pittsburgh, PA 15219. * Smalley & Bates, Inc, 88 Park Ave, Nutley, NJ 07110.
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INSTRUCTIONS FOR CONSTRUCTION The following instructions are for a left armrest (Fig- 1). 1. Cut 19.05 mm thick wood 190.5 mm wide and 469.9 mm long. 2. Cut corners as shown on drawing and sand rough edges. Before performing Steps 3 & 4, note that the wheelchair used for this armrest has a distance of 254 mm between the holes used for attaching the armrest. This distance may vary slightly on some makes and models of chairs. 3. Drill two 19.05 mm holes approximately 6.35 mm deep in the top of board as shown. 4. Drill two 4.76 mm holes through these 19.05 mm holes. These holes should go completely through the board. 5. Drill one 4.76 mm hole 50.8 mm deep into the side of the armrest, closest to the center of the chair. 6. Using the side of a 4.76 mm drill, notch the area beneath the beginning of the hole. This will permit the restraining brace to be flush with the side of the armrest. 7. Place the top of board on the under side of the padded carpet to be used and trace the outline of the board onto the carpet. 8. Cut out the carpet along the outline. 9. Place one 44.45 mm x 4.76 mm carriage bolt in each of the two counterbored holes. 10. Spread a thin layer of contact cement over both the top of the board and the underside of the carpet. Let the cement dry, then apply the carpet to the top of the board according to the instructions on the container of the cement. 11. Bend the 4.76 mm drill rod at 44.45 mm from the end. Form a 90° angle at this point (Fig. 2). 12. Place the bent end of the rod in the 50.8 mm hole on the side of the wood. 13. Apply cement to all sides of the board and carpet.
PHYSICAL THERAPY
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Armrest Modification for Support of Paretic or Paralyzed Upper Extremity
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38 / 2SM
(Left) Fig. 1. Top and end view of left armrest. (Measurements in mm). (Right) Fig. 2. Approximate shape of drill rod after bending. (Measurements in mm)
14. Also apply cement to one side of the 138 cm heavy cloth strap. 15. Apply the strap all the way around the sides of the armrest covering both edge of carpet and the sides of the board. Cut the strap to make it fit. 16. Install armrest on the arm of the wheelchair. Apply nuts beneath the wheelchair arm and tighten. Apply the rubber caps over the bolt extensions. 17. Bend drill rod so as to reach the bar under the armrest. Then, 38.1 mm from the end of the drill rod, bend the rod parallel to the bar and attach it to the bar with a #12 adjustable hose clamp. (Fig. 2 and Fig. 3). 18 Remove any excess of the hose clamp with wire cutters and file all rough areas. 19. Apply (optional) the safety strap across the top of the armrest to prevent the patient's arm from sliding off the board. (Fig. 4). Acknowledgments. The author wishes to thank Ingrid Lundberg, LPT, Ivy Nursing Home, for her help in designing the armrest, and George E. Carveil, LPT, Assistant Professor at the University of
Volume 58 / Number 2, February 1978
(Left) Fig. 3. Underside of armrest. Note the drill rod support bar and hose clamp attachment. (Right) Fig: 4. Positioning of hand with a Velcro® Safety Strap to keep the arm from sliding off the board. Hand positioning is optional according to specific problems and therapist's preference.
Pittsburgh, Department of Physical Therapy, for his help in preparing this article. Appreciation is also expressed to Thomas F. Jarrett, photographer, and Carl Cantella, technical illustrator.
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The adaptive armrest, as described for a wheel chair, is an inexpensive aid for positioning of a paretic or a paralyzed upper extremity and provides a permanent surface on which the patient can con tinue some therapy on his own. The armrest may help prevent subluxation of the humeral head from the glenoid fossa and places the glenohumeral joint in a resting position with some •abduction and more external rotation than if the patient had his arm in a sling. The armrest also provides a surface for the patient to do hand activi ties and may decrease the possibility of developing a wrist flexion contracture. The minimal elevation of the hand may aid in venous return and prevent excess edema. The cost of building the adaptive armrest is under $4.00, and is designed so that it can easily be removed from, and reattached to the chair as nec essary. The wheelchair used in this illustration is a 63.5 cm wide, standard-size wheelchair, and the armrest adds only 50.88 mm to the overall chair width. The industrial foam-back carpet gives tactile feedback and is easily cleaned with soap and water.
MATERIALS REQUIRED 1 bottle contact cement, 3 oz 1 piece foam-back industrial carpet, 469.9 mm x 190.5 mm 1 heavy cloth strap, 25.4 cm x 132 cm, Velcro®* attached 1 piece wood, 469.9 mm x 190.5 mm x 19.05 mm 1 drill rod, 4.76 mm dia. x 152.4 mm long 1 adjustable hose clamp, #12 2 carriage bolts, 4.76 mm dia. x 50.8 mm long 2 nuts 2 rubber caps, 4.76 mm 1 Velcro®* safety strap Mr. Pifer assisted in the Physical Therapy Department at Ivy Nursing Home, when this device was developed. He is currently employed at the Vocational Rehabilitation Center of Allegheny County, 1323 Forbes Ave, Pittsburgh, PA 15219. * Smalley & Bates, Inc, 88 Park Ave, Nutley, NJ 07110.
182
INSTRUCTIONS FOR CONSTRUCTION The following instructions are for a left armrest (Fig- 1). 1. Cut 19.05 mm thick wood 190.5 mm wide and 469.9 mm long. 2. Cut corners as shown on drawing and sand rough edges. Before performing Steps 3 & 4, note that the wheelchair used for this armrest has a distance of 254 mm between the holes used for attaching the armrest. This distance may vary slightly on some makes and models of chairs. 3. Drill two 19.05 mm holes approximately 6.35 mm deep in the top of board as shown. 4. Drill two 4.76 mm holes through these 19.05 mm holes. These holes should go completely through the board. 5. Drill one 4.76 mm hole 50.8 mm deep into the side of the armrest, closest to the center of the chair. 6. Using the side of a 4.76 mm drill, notch the area beneath the beginning of the hole. This will permit the restraining brace to be flush with the side of the armrest. 7. Place the top of board on the under side of the padded carpet to be used and trace the outline of the board onto the carpet. 8. Cut out the carpet along the outline. 9. Place one 44.45 mm x 4.76 mm carriage bolt in each of the two counterbored holes. 10. Spread a thin layer of contact cement over both the top of the board and the underside of the carpet. Let the cement dry, then apply the carpet to the top of the board according to the instructions on the container of the cement. 11. Bend the 4.76 mm drill rod at 44.45 mm from the end. Form a 90° angle at this point (Fig. 2). 12. Place the bent end of the rod in the 50.8 mm hole on the side of the wood. 13. Apply cement to all sides of the board and carpet.
PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/58/2/182/4559702 by University of Texas at Dallas user on 05 February 2019
Armrest Modification for Support of Paretic or Paralyzed Upper Extremity
ut.i zsm
no.5
38 / 2SM
(Left) Fig. 1. Top and end view of left armrest. (Measurements in mm). (Right) Fig. 2. Approximate shape of drill rod after bending. (Measurements in mm)
14. Also apply cement to one side of the 138 cm heavy cloth strap. 15. Apply the strap all the way around the sides of the armrest covering both edge of carpet and the sides of the board. Cut the strap to make it fit. 16. Install armrest on the arm of the wheelchair. Apply nuts beneath the wheelchair arm and tighten. Apply the rubber caps over the bolt extensions. 17. Bend drill rod so as to reach the bar under the armrest. Then, 38.1 mm from the end of the drill rod, bend the rod parallel to the bar and attach it to the bar with a #12 adjustable hose clamp. (Fig. 2 and Fig. 3). 18 Remove any excess of the hose clamp with wire cutters and file all rough areas. 19. Apply (optional) the safety strap across the top of the armrest to prevent the patient's arm from sliding off the board. (Fig. 4). Acknowledgments. The author wishes to thank Ingrid Lundberg, LPT, Ivy Nursing Home, for her help in designing the armrest, and George E. Carveil, LPT, Assistant Professor at the University of
Volume 58 / Number 2, February 1978
(Left) Fig. 3. Underside of armrest. Note the drill rod support bar and hose clamp attachment. (Right) Fig: 4. Positioning of hand with a Velcro® Safety Strap to keep the arm from sliding off the board. Hand positioning is optional according to specific problems and therapist's preference.
Pittsburgh, Department of Physical Therapy, for his help in preparing this article. Appreciation is also expressed to Thomas F. Jarrett, photographer, and Carl Cantella, technical illustrator.
183
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