www.cilsa.org
Useful guide for people with motor disabilities • Health Care • Good Use and Maintenance of the Wheelchair • Legal Remedies and Rights
O.N.G. por la Inclusión
CILSA is a non profitable, Non Governmental Organization (NGO) founded 14th May 1966 in the city of Santa Fe, Argentina.
Mission To promote full integration of people who come from marginal sectors of the society such as children and teenagers in vulnerable situations and people with disabilities. Objectives • To create consciousness in society about the importance of integration in order to diminish levels of discrimination and to avoid margination caused by unfamiliarity on the subject. • To improve quality of life in people with any kind of disability. • To provide support and to work for the rights of those children whose families have scarce financial resources. • To bring over the possibility for people with disabilities to access to higher education, professional training and knowledge of technology; thus promoting their integration not only in a social aspect but also in employment.
Contributors CILSA develops its programs thanks to the contribution of Protector Members who participate and contribute to project the institutional message. A member is a contributor who has decided to commit himself to the cause, because he has understood the importance of this work. They are the main protagonists of CILSA’s acting. They take up a constructive and positive posture towards integration.
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Index Healthcare Weelchair Right position to sit in the wheelchair Resting position Skin care and identification of ulcers or sores How to avoid them? Some recommendations Exercises to relieve pressure Side inclination Forward inclination Lifting on the arms
Pag. 8 Pag. 9 Pag. 9 Pag. 10 Pag. 10 Pag. 11 Pag. 12 Pag. 12 Pag. 12 Pag. 13
Mobilization of the wheelchair Hand position when pushing Push forward How to slow down the wheelchair? Turn on the wheelchair
Pag. 14 Pag. 14 Pag. 14 Pag. 15 Pag. 15
Wheelchair transfers In case you need help to push the wheelchair over rough grounds To climb a slight slope To download a slight slope How to go downstairs and upstairs
Pag. 16 Pag. 16 Pag. 16 Pag. 16 Pag. 17
Transfers from the wheelchair Transfer with assistance, without the possibility of standing Transfer with assistance, with the possibility of standing
Pag. 18 Pag. 18 Pag. 19
In case you need help to push the weelchair over rough grounds Independent transfer, raising the legs without stopping Independent transfer, without stopping
Pag. 20 Pag. 21 Pag. 21
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Maintenance of the wheelchair Daily care Weekly care Monthly care
Pag. 22 Pag. 23 Pag. 23
Crutches and walking-sticks How to make sure that the crutches are appropriate for you? How to use crutches Crutches care Using the walking stick
Pag. 24 Pag. 24 Pag. 25 Pag. 25
Rights of people with disabilities Pag. 26 How can I enforce my rights? Pag. 28 What should we have in mind when writing a claim or a complaint? Pag. 29 Sample letter of complaint to the Ombudsman Certificate of Disability
Pag. 30 Pag. 31
The Certificate of Disability enables you to: Legal resources for people with intellectual disabilities Guardianship Support services Notes
Pag 32 P谩g 32 Pag 33 Pag 33 Pag 34
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HELLO! You are receiving a wheelchair free of charge. That is the reason why you have to sign a document called commodatum. The commodatum explains that after a year of using the chair, you have to call the organization to renew it; this allows you to change the chair for another in case it has broken. If you do not use your chair any more, bring it back to our institution so that it can form part of our lending stock. The chair provided to you is absolutely new. It was achieved thanks to the individual collaboration of CILSA members and the donation from organizations. Like you, other 27,500 people with disabilities around the country have received a wheelchair or orthopedic CILSA elements since 1995 up to the present.
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Health Care Wheelchair Push bar handle Armrest
Rear wheel Armrest lock
Leg rest
Han drim Footrest
Tipping lever
Front wheel
Breaks
We remind you that this is a traditional manual chair, for a general use and with standardized sizes. Therefore, we recommend you to consult your doctor so that he may consider whether this unit is appropriate to your pathology or not; and if not, he may recommend you the necessary adjustments.
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Right position to sit in the wheelchair
The pelvis should be level
The back should be straight
The hips, knees and ankles should be flexed to 90 째 Feet should be flat on the footrest
Resting position It is advisable to lie face down, at least for a while. This will help stretch the back, hips and knees
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Health care Skin Care and identification of ulcers or sores What ulcers or sores are?
These are injuries in de skin produced for resting a lot of time in the same position.
How to avoid them?
Observe pressure zones (back, gluteus, ankles, etc.) and verify that these are within their normal skin color. If everything is fine, you are able to continue your daily routine.
If the observed pressure zones (back, gluteus, ankles, etc) show that the skin is redder or darker than usual, avoid contact in that zone and diminish the time you are on the wheelchair.
If the observed pressure zones (back, buttocks, ankles, etc) contain injuries in the skin, visit your doctor urgently.
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Some Recommendations When sitting, make sure that ankles, inner and outer sides of the knees and hips are not held together with the parts of the wheelchair. Be careful not to bump or hit your body with the chair. Change positions every 30 minutes to avoid prolonged periods of pressure on the skin. Pay attention to any zone that remains red after changing position. When you pass from the wheelchair to the bed, check the parts of the body that have been under pressure all day long. Examine in greater detail every zone that contains prominent bones (ankles, elbows, heels, hips, gluteus). Look for reddened zones, cuts and scrapes.
Use a mirror in order to reach those areas which you are not able to see. If you can not do it alone, ask for help. Check twice a day the zones that have been under pressure and relieve pressure every 30 minutes (by making changes in the position or lifting and holding the body with your arms in the armrests).
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Exercises to relieve pressure Side inclination
Stop the wheelchair and remove the armrest of your wheelchair. Incline to one side of the chair, holding with the other hand from the armrest on the opposite side, trying to raise the weight of one of your gluteus from the wheelchair. This exercise can be done by crossing one leg over the other, considering that one of the gluteus should lift. Do so by 30 to 90 seconds and change into the other leg.
Forward inclination Place the chair so that the wheels are in a forward direction; then stop the wheels of your wheelchair
Incline your torso forward trying to touch your feet with your hands. Keep this position for 30-90 seconds. When doing this exercise, you should be careful not to bend down so much since you may fall off the chair.
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Lifting on the arms Stop the wheelchair.
Place your hands on the armrests and lift the gluteus from the seat of the wheelchair stretching your arms by 10 to 15 seconds. Repeat this exercise several times a day.
Changing positions constantly during the day is really necessary. If these changes can not be done independently, the assistant must perform these movements every 30 minutes in order to avoid sores for keeping the same position for a long time. In some cases, depending on the type of injury and after medical indications, we recommend the use of a “cushion anti sores.� The cushion will help relieve the pressure of the thighs and it will allow a better posture.
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Mobilization of the wheelchair Hand position when pushing Push the hand rims with the fingertips of the thumbs and bend your fingers. WARNING: It is important not to hold the wheels but the hand rims in order to avoid accidents.
Push forward Before you start, put your body in the right position. Right position: incline your head and body slightly forward. The propulsion movements to move forward with the chair should be large, not short, in order to avoid the fatigue.
Push with your hand the upper part of the hand rims.
Push extending your arms forward.
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Before pushing again, wait until your arms are on the right position again.
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How to slow down the wheelchair? Lean back putting your arms into a straight position. Press the foreside of the hand rims to start braking. Do not hold the hand rims at once because the chair may fall forward.
Turn on the wheelchair To turn, push forward with a hand and, at the same time, the other hand should push backwards.
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Wheelchair Transfers In case you need help to push the wheelchair over rough grounds The assistant must incline the chair to the rear wheels until achieving a balance. The assistant needs to keep control on both handles. The user of the chair should help by moving the wheels.
To climb a slight slope When climbing a slope, do so with some help from behind. The assistant should have his hands close to the handles just in case the chair falls backwards.
To download a slight slope Lean backwards with your arms straight. Press the foreside of the hand rims to start braking. Do not hold the hand rims at once because the chair may fall forward. 16 || USEFUL GUIDE FOR PEOPLE WITH MOTOR DISABILITIES
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How to go upstairs and downstairs Go upstairs:
Go downstairs:
Lace yourself backwards to the stairs. Place the chair with the rear wheels touching the first step. The assistant from behind the chair will incline the chair backwards.
The person in the wheelchair sits in front of the stairs.
The second assistant will lift the front part of the chair from the framework; do NOT grab the footrest or the person in the wheelchair.
The second assistant will take care of lifting the front part from the frame of the chair; do NOT grab the footrest or the person in the wheelchair.
On the count of three, the assistant from behind should pull up the chair and upload the steps, while the other will push and lift the chair too. Repeat the same for each step, making sure the chair is correctly grabbed.
The assistant will be located behind and he will incline the chair back.
On the count of three, the assistant should push back and lift the chair walking down the steps, while the other assistant will sustain and raise the chair. Repeat the same process for each step. Make sure the chair is correctly grabbed.
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Transfers from the wheelchair
Transfer with assistance, without the possibility of standing Bring the chair to the place of transfer Stop the wheelchair The assistant must first be placed in the back of the disabled person and cross their arms under the armpits of the person in the wheelchair, at the same time; he should place a leg on the floor and the other knee on the bed. The disabled person must cross his arms The assistant must first hold the disabled person from the forearms pressing him against the chest The first assistant counts to three and then he lifts The second assistant helps to lift the legs
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It is important to note that people who assist in making the transfers should also take care of their body (specially their back); it is therefore necessary that they flex their knees and do not bend their backs. The force must be centered in the legs and not in the back so as not to harm themselves.
Transfer with assistance, with the possibility of standing Place the chair to the place of transfer Stop the wheelchair Remove the feet of the footrests Lift the footrests Sit on the edge of the chair The assistant should hold the user’s legs with the knees The arms of the assistant must be under the arms of the person with disability The assistant counts to three and lifts The other assistant lifts the person from behind
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Wheelchair Transfers
In case you need help to push the wheelchair over rough grounds The assistant must incline the chair to the rear wheels until achieving a balance. The assistant needs to keep control on both handles. The user of the chair should help by moving the wheels.
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Independent transfer, raising the legs without stopping Wheelchair close to the place of transfer. Stop the wheelchair. Located on the edge of the weelchair. Remove the feet footrest. Lift your feet to the bed. Use your arms to move.
Independent transfer, without stopping
Wheelchair close to the place of transfer. Stop the weelchair. Located on the edge of the weelchair. Remove the feet footrest. Raise the footrest. Use your arms to move..
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Maintenance of the wheelchair
Here we recommend some tips so that your wheelchair last longer.
Daily care The chair must be cleaned with a clean and wet cloth every day. If the chair gets wet it should be dried immediately or leave it under the sun, which will help prevent rust. If the chair has some contact with urine or other substance, it should be cleaned immediately with detergent and water and left it under the sun for ventilation. If it has a cushion, wash it with white soap and leave it under the shadow. If it has a cushion, check that seams or zippers are not at the higher pressure of the body such as the bony parts.
In case you need a spare part from your chair, contact the nearest CILSA office. 0810 777 9999 || cilsa@cilsa.org 22 || USEFUL GUIDE FOR PEOPLE WITH MOTOR DISABILITIES
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Weekly care Check the wheels to make sure that the spokes are not bent Check the front wheels, making sure they are centered and aligned correctly Check the tires to make sure are completely inflated. They should be firm.
Monthly care Check for loose nuts and bolts and tighten them. Check that nuts are aligned correctly. Push the chair with nobody on it in order to see whether it moves in a straight line. If not, inspect the running of the wheels Check the stuffing of the cushion so that it keeps the original form and does not lead to an incorrect posture
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Crutches and walking-sticks How to make sure that the crutches are appropriate for you? 1 - When the person stands, the crutch should be two or three finger widths from below the armpit 2 - The elbow should be slightly bent so that the person can get up and balance his legs forward
How to use crutches Taking steps: In order to be in a better position and have a better balance, advance the right crutch together with your left foot and the left crutch together with the right foot. Taking short hops: Place both crutches forward within a short distance from the body Carry out the strength in the hands and not on the armpit Move forwards, little by little, leaning on the crutches 24 || USEFUL GUIDE FOR PEOPLE WITH MOTOR DISABILITIES
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Crutches care
Verify that the ends of rubber crutches do not contain cracks or that they are not loose. Ensure that both crutches are equal. A crutch should not be longer, shorter, or different from the other. If crutches get wet, they should be dried with a clean dry cloth.
Using the walking stick
Move forward using the walking stick and move your weaker leg at the same time
LEG
LEG
WEAK
WEAK
The strong leg is moved first, then the weak leg is moved together with the walking stick and so on (see figure)
LEG
LEG
STRONG
STRONG STICK
STICK
It is important that you constantly review the rubber at the end of the walking stick in order to identify that it does not contain cracks or that they are not loose
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Rights of people with disabilities If our rights are not accomplished we have the right to claim. The rights of people with disabilities are guaranteed by the International Convention on the Rights of People with Disabilities. The principles expressed in this Convention are:
Non-discrimination
Accessibility
The respect for inherent dignity, individual autonomy, including the freedom to make their own decisions, and independence of people Equal opportunities
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It is very important for people with disabilities to recognize yours rights in order to know what we can do and what can not be prohibited to us.
By the mere fact of being people, we ALL have the same RIGHTS.
Full and effective participation and integration in the society.
The respect for the difference and the acceptance of people with disabilities as part of human diversity and condition.
Equality between men and women.
The respect for the evolving capacities of children with disabilities and their right to preserve their identity.
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Rights of people with disabilities And how can I enforce my rights?
1- Persons with disabilities count with three specially created national laws to protect their rights Law 22,431 is the “Comprehensive Protection of People with Disabilities” Law 24,901 regulates the “System of Basic Benefits” Law 26,378 approves the “International Convention on Rights of People with Disabilities for Argentina.
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2- We all have the possibility of free assistance, according to the legal issues that we need to solve. This means that we have a free lawyer who represents us and who also provides advice.
Consult a representative of CILSA as regards the most adequate place to address
3- We all have the possibility to claim. Here, we explain how to write a letter and where to take it. (Page 28)
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What should we have in mind when writing a claim or a complaint?
Include the date establishing when we have made the claim/ complaint. Describe the action that we think our rights are not being respected. If possible, identify the people involved with name and surname.
We need to identify ourselves by name and document number. The person that receives the complaint must respect the principle of confidence required by law. Make a copy of the complaint to the recipient so that he stamps it and firms it as received. Then, save it as proof that the complaint was made.
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Sample letter of complaint to the ombudsman
Day/Month/Year To Sir Ombudsman Present With the kindest regard: FIRST AND LAST NAME, ID No. _______________, domiciled______________________________________, City of______ _______________________________________, in my role as a citizen I state: I come to make this complaint _______________ _________________________________________________________ _________________________________________________________ _________________________________________________________ ________________________________________________. (Explain the problem, the insistence after the event, claims and responses obtained.) Proof: A copy of all related receipts (if any)
Sincerely. Signature and clarification.
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Certificate of disability
The Certificate of Disability is a public document given to anyone with a disability. To ensure only one valid certificate throughout the country and in every province, the Unified Disability Certificate (CUD) was created. This document is filed in the National Rehabilitation Service in the city of Buenos Aires: Address: 2250 Ramsay Phone: (011) 4783 8144 / 9077 / 4354 Timetables: Monday to Friday from 8:00 to 16:00 hours Website: www.snr.gov.ar/ Ask for the requirements by telephone or Internet. We are working so that we may process it in different parts of Argentina. Check with your municipality or in the National Rehabilitation Service about the nearest place where you can complete the process. There is also a Provincial Certificate of Disability. The certificate is valid in the province in which we live. It may be processed in some public hospitals. Check which are the hospitals where you can do the paperwork in your city.
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The Certificate of Disability enables you to: Acquire a free pass to travel on trains, medium and l ong-distance buses, local buses and undergrounds. Acquire pensions Request medications prescribed by the doctor to the Medical Insurance Process the exemption (possibility of not paying) to: - Lighting, Sweeping and Cleaning - License plate - Tolls Ask for the “International no Parking symbol” in order to choose where to park Process retirement after 20 years of employment and after 45 years old Process a franchise to buy a car Manage the reservation of a place in front of the dwelling in order to park the car
Legal resources for people with intellectual disabilities
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In some situations we need a resource that facilitates the legal decision making and the performance of certain procedures. This need will vary according to the type of disability, the possibilities and needs of each person with intellectual disability and the context in which they live.
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Guardianship By guardianship, the person with intellectual disabilities can be legally represented by a father, mother or guardian after reaching the majority of age (18 years). Guardianship allows the person with disabilities to be legally protected by the curators (father, mother or guardian) and helps to deal with some business related to the health insurance system, pensions and asset management. To complete this procedure, the person with a disability must be declared insane or
unable to perform some acts. Before starting the process of guardianship, you should get a clear idea of this since there are procedures which are irreversible and there are other options in many cases.
Support services The support service or “safeguard�, allows the person with a disability to participate in all legal decisions he is involved, though in some cases he will need support from a tutor. Those legal acts in which he needs help are defined according to the possibilities and needs of the person with disability. The Support Service (Section 12 Law 26 378) is a new resource which many people are not acquainted with yet. Nowadays, the service can be processed thanks to the International Convention on the Rights of People with Disabilities which was adopted in Argentina in 2008.
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Notes
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5220 / 0911
Notes
Translation: Matias Tombazzi - Celular: (0221) 15 5 62 20 71 - Particular: (0221) 453 35 65
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Useful guide for people with motor disabilities • Healthcare • Good Use and Maintenance of the Wheelchair • Rights and Remedies
Developed by the Institutional Area of CILSA
Argentina 2011
www.cilsa.org