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[[File:ME-CFS-patient-Unrest.jpg|thumb|Aysha Lee, a young girl with ME/CFS, sits in her manual wheelchair, encouraging people to watch the film [[Unrest]].<br />Photo by [https://commons.wikimedia.org/wiki/File:Aysha_Lee.jpg Emma Mizuno.]|alt=A young girl wearing red and white sits in a manual wheelchair, holding a sign saying #Time for Unrest.]] '''Wheelchairs''' are mobility aids designed for people unable to walk, or who have considerable difficulty walking and/or standing, which may result from having [[ME/CFS]].<ref name="NHS-aids">{{Cite web|url=https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/walking-aids-wheelchairs-and-mobility-scooters/ | title = Walking aids, wheelchairs and mobility scooters|website=[[National Health Service]]|access-date=2022-03-25}}</ref><ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/treatment/ | title = Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|website=[[National Health Service]]|access-date=2022-03-25}}</ref><ref name="UKinclusive">{{Cite web|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/3695/inclusive-mobility.pdf | title = Inclusive mobility|website=UK Government|access-date=2022-03-25}}</ref> The wheelchair is also used worldwide as the international symbol for disability.<ref name="FritschISA">{{Cite journal | title = The Neoliberal Circulation of Affects: Happiness, accessibility and the capacitation of disability as wheelchair| date = 2013-11-15|url=http://hcs.pitt.edu/ojs/index.php/hcs/article/download/136/182|journal=Health, Culture and Society|volume=5|issue=1|pages=135–149 | last = Fritsch | first = K. | author-link = |language=en|doi=10.5195/hcs.2013.136|pmc=|pmid=|access-date=|issn=2161-6590|quote=|via=}}</ref> The mobility problems caused by ME/CFS are complex, and are not the result of excessive activity or [[deconditioning|lack of fitness]]<ref name="niceng206" /><ref name="CDC-symptoms" /> and are not a severe form of normal [[tired all the time|tiredness]].<ref name="AmScientist2017">{{Citation|url=https://www.americanscientist.org/article/an-illness-observed-a-conversation-with-julie-rehmeyer | title = An illness observed: a conversation with Julie Rehmeyer | first=Dianne | last =Timblin | date = May-June 2017|work=American Scientist|volume=105| issue=3}}</ref><ref name="Wirth2021a" /> Attempting to increase activity levels through [[exercise]] has been shown to be harmful to most ME/CFS patients, and ineffective in the majority of other patients.<ref name="DangerousEx" /><ref name="OxfordBrookesSurvey">{{Cite web|url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title = Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT | last =Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)| date = Feb 27, 2019}}</ref> ==Types== ===Self-propelled wheelchair === A self-propelled or manual wheelchair has very large rear wheels and is lightweight.<ref name="NBK559231">{{Cite book | url = https://www.ncbi.nlm.nih.gov/books/NBK559231/|vauthors=Owens J, Davis DD | title = Seating And Wheelchair Evaluation |location=Treasure Island (FL)|publisher=StatPearls Publishing| date = May 9, 2021}}</ref><ref name="Giesbrecht2009" /> The person sitting in the manual wheelchair uses their hands and arms to turn the wheels in order to move, although some may have lowered seating in order to use their feet to help them move.<ref name="NBK559231" /> The person can grip either the handrims (push rims) that are fixed in parallel to the rear wheels, or the grip the tyres, although this is generally not recommended.<ref name="Giesbrecht2009">{{Cite journal | title = Participation in community-based activities of daily living: Comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair| date = 2009-01-01|url=https://doi.org/10.1080/17483100802543205|journal=Disability and Rehabilitation: Assistive Technology|volume=4|issue=3|pages=198–207 | last =Giesbrecht | first=Edward M. | last2 = Ripat | first2=Jacqueline D. | last3 = Quanbury | first3 = Arthur O. | last4 = Cooper | first4=Juliette E.|doi=10.1080/17483100802543205|pmid=19241234|issn=1748-3107}}</ref><ref name="Ripat2020" /> The front wheels are small and are known as casters.<ref name="Ripat2016" /> Most self-propelled wheelchair have handles at the back to allow someone to help, for example by pushing up a ramp, slope, or over a step. Some self-propelled wheelchairs have power-assisted wheels fitted.<ref name="Ripat2016" /> ===Power chair === A [[power chair]] or powered chair or electric wheelchair is typically moved by a joystick-type control used by the person sitting in the wheelchair, who controls the direction and speed.<ref name="NBK559231" /><ref name="Giesbrecht2009" /><ref name="Ripat2016" /> Power chairs cannot be pushed and are typically used by people unable to walk and/or stand, and are unable to use a self-propelled wheelchair.<ref name="UKinclusive" /> Power chairs are usually allowed in all indoor and outdoor areas including shops or public areas, although this may depend on their size or maximum speed.<ref name="Ripat2016">{{Cite journal | title = The Effect of Transport Accessibility on the Social Inclusion of Wheelchair Users: A Mixed Method Analysis| date = 2016-06-07|url=https://www.cogitatiopress.com/socialinclusion/article/view/484|journal=Social Inclusion|volume=4|issue=3|pages=24–35 | last = Velho | first = Raquel | last2 = Holloway | first2 = Catherine | last3 = Symonds | first3=Andrew | last4 = Balmer | first4=Brian|language=en|doi=10.17645/si.v4i3.484|issn=2183-2803}}</ref> Powered chair should not be confused with [[mobility scooter]]s,<ref name="Ripat2020">{{Cite journal | title = Winter Mobility and Community Participation Among People Who Use Mobility Devices: A Scoping Review| date = 2020-03-01|url=https://www.sciencedirect.com/science/article/pii/S2590109519300205|journal=Archives of Rehabilitation Research and Clinical Translation|volume=2|issue=1|pages=100018 | last =Ripat | first=Jacquie | last2 = Sibley | first2 = Kathryn M. | last3 = Giesbrecht | first3=Ed | last4 = Curtis | first4=Brittany | last5 = Touchette | first5 = Alexie|last6 = Borisoff | first6 = Jaimie | last7 = Ethans | first7 = Karen | last8 = Li | first8 = Yue | last9 = Morales | first9 = Ernesto|language=en|doi=10.1016/j.arrct.2019.100018|issn=2590-1095}}</ref> which do not have the same specialized seating (for example, no trunk support), and are not designed for full-time or indoor use.<ref name="NBK559231" /><ref name="Ripat2016" /><ref name="Davies2017" /> Mobility scooters are frequently used by people with a disability that limits their ability to walk, but in recent years have been increasingly used by able-bodied people.<ref name="UKinclusive" /> ===Transit wheelchair === A transit wheelchair or attendant wheelchair cannot be moved by the person sitting in it, which means the person cannot move around independently; transit wheelchairs have small wheels and are moved by a carer or attendant who pushes the chair from behind.<ref name="Davies2017" /> These wheelchairs are often provided for temporary use in airports, hospitals, in some supermarkets, or in very large public buildings where elderly or disabled people who have difficulty walking distances but can walk a limited distance may visit.<ref name="Davies2017">{{Cite journal | title = An exploratory study of the experiences of wheelchair users as aircraft passengers – implications for policy and practice | date = 2017-07-01|url=https://www.sciencedirect.com/science/article/pii/S0386111217300493|journal=IATSS Research|volume=41|issue=2 | pages = 89–93 | last =Davies | first=Andrew | last2 = Christie | first2 = Nicola|series=Safe and Sustainable Transport for All|language=en|doi=10.1016/j.iatssr.2017.05.003|issn=0386-1112}}</ref> ==ME/CFS patients as wheelchair users== [[Severe myalgic encephalomyelitis or chronic fatigue syndrome|Severe ME/CFS]] is typically described as causing severe difficulty with walking and sometimes standing, to the degree that a wheelchair is needed,<ref name="NHS" /> and these patients vary from being mostly housebound to fully bedbound.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last=NICE Guideline Development Group | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]]| date = 2021-10-29}}</ref><ref name="CDC-symptoms"><nowiki>{{Cite web|url = </nowiki>https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html | title = Presentation and Clinical Course of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]]|access-date=2022-03-25}q}</ref> Around 25% of people with [[ME/CFS]] are severe at some point in their illness, and many rely on a wheelchair as a result.<ref name="niceng206" /> Some people with [[Moderate myalgic encephalomyelitis or chronic fatigue syndrome|moderate ME/CFS]] may depend on or benefit from a wheelchair, or may use other [[:Category:mobility aids|walking or mobility aids]], because of their combination of symptoms.<ref name="NHS" /> ===Post-exertional malaise === [[Post-exertional malaise]] (PEM) is increasingly recognized as the hallmark symptom of ME/CFS, this means that patients suffer a [[relapse]] or [[crash]] when they exceed their limited [[energy limit]].<ref name="Vink2015" /><ref name="Vink2019">{{Cite journal | last = Vink | last2 = Vink-Niese | date = 2019-09-20 | title = Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418 | first = Mark | first2 = Alexandra|pmc=|pmid=|quote= | author-link = Mark Vink | authorlink2 = Alexandra Vink-Niese|via=}}</ref><ref name="NHS" /><ref name="CDC-symptoms" /> The [[Centers for Disease Control and Prevention|CDC]] states: <blockquote>"During PEM, any ME/CFS symptoms may get worse or first appear, including difficulty thinking, problems sleeping, sore throat, headaches, feeling dizzy, or severe tiredness. It may take days, weeks, or longer to recover from a crash. Sometimes patients may be house-bound or even completely bed-bound during crashes."<ref name="CDC-symptoms" /></blockquote> Dr [[Mark Vink]], a former marathon runner and international hockey player who now has severe ME states that walking the few steps from his bed to the toilet is only possible every 12 hours, due to the severe PEM it causes him.<ref name="marathon">{{Cite web|url=http://anilvanderzee.com/for-patients-with-cfs-going-to-the-bathroom-is-similar-to-running-a-marathon/ | title = For patients with CFS, going to the bathroom is similar to running a marathon. | last=de Visser | first=Ellen|authorlink=Ellen de Visser| date = 2017-10-03 | website = [[Anil van der Zee]]|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2018-12-29}}</ref> === Orthostatic intolerance === A significant proportion of ME/CFS patients have forms of [[orthostatic intolerance]] e.g., [[Postural orthostatic tachycardia syndrome|POTS]], which can cause injuries or falls from [[Syncope|fainting]], in addition to [[tachycardia]], [[dizziness]] and blurred vision.<ref name="CDC-symptoms" /> === Periodic paralysis === Patients with ME/CFS may experience episodes of [[paralysis]], particularly affecting their legs and/or arms, making them unable to temporarily unable to walk. De Becker et al. (2001) conducted a large study of [[chronic fatigue syndrome]] patients, and found that 27.2% of patients meeting the [[Fukuda criteria]] and 33.2% of patients meeting the [[Holmes criteria]] for CFS experienced episodes of [[paralysis]].<ref name="DeBecker2001">{{Cite journal | last =De Becker | first=Pascale | author-link = Pascale De Becker | last2=McGregor | first2 = Neil | author-link2 = Neil McGregor | last3=De Meirleir | first3=Kenny | author-link3 = Kenny De Meirleir| date = Dec 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref> Crowhurst and Crowhurst (2013) surveyed patients with severe myalgic encephalomyelitis, and found yhat [[hypokalemic periodic paralysis]] was particularly common.<ref name="Crowhurst2013">{{Cite web|url=http://carersfight.blogspot.com/2013/08/paralysis-qualitative-study-of-people.html | title = Paralysis, a qualitative study of people with Severe Myalgic Encephalomyelitis | last =Crowhurst | first=Greg | authorlink=Greg Crowhurst | last2 = Crowhurst | first2 = Linda | authorlink2 = Linda Crowhurst | date = Aug 8, 2013 | website = [[Stonebird]]|archive-url=|archive-date=|url-status=|access-date=2018-12-28}}</ref> Hypokalemic periodic paralysis is a form of temporary paralysis caused by a rapid drop in [[potassium]] levels in cells, which prevents the nervous system from transmitting the signals needed to move despite the fact that the spinal cord is not damaged. This paralysis can be caused by a number of different triggers including [[Exertion|over-exertion]], and patients may have normal potassium levels between attacks. ===Muscle weakness=== Muscle weakness or paresis is common in patients with CFS, De Becker et al. (2001) found that 84% of patients with CFS had muscle weakness, which for some patients can be severe and affect walking or the ability to self-propel in a wheelchair.<ref name="DeBecker2001" /> ==Notable studies== * 2021, Pathophysiology of skeletal muscle disturbances in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref name="Wirth2021a">{{Cite journal | last =Wirth | first = Klaus J. | author-link = Klaus Wirth | last2 = Scheibenbogen | first2=Carmen | author-link2 = Carmen Scheibenbogen | date = 2021-04-21 | title = Pathophysiology of skeletal muscle disturbances in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://doi.org/10.1186/s12967-021-02833-2|journal=Journal of Translational Medicine|volume=19|issue=1|pages=162|doi=10.1186/s12967-021-02833-2|issn=1479-5876|pmc=PMC8058748|pmid=33882940}}</ref> - [https://doi.org/10.1186/s12967-021-02833-2 (Full text)] * 2020, Environmental accommodations for university students affected by myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS)<ref name="Chu2020">{{Cite journal | title = Environmental accommodations for university students affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)| date = 2020-01-01|url=https://content.iospress.com/articles/work/wor203176 | journal = Work|volume=66|issue=2|pages=315–326 | last =Chu | first = Lily | authorlink = Lily Chu | last2 = Fuentes | first2 = Lynn R.|author-link2 = | last3 = Marshall | first3 = Olena M. | author-link3 = | last4 = Mirin | first4=Arthur A. | authorlink4 = |language=en|doi=10.3233/WOR-203176|pmc=|pmid=|access-date=|issn=1051-9815|quote=|via=}}</ref> - - [https://content.iospress.com/articles/work/wor203176 (Full text)] * 2017, Dangerous exercise. The detrimental effects of exertion and orthostatic stress in myalgic encephalomyelitis and chronic fatigue syndrome<ref name="DangerousEx">{{Cite journal | title = Dangerous exercise. The detrimental effects of exertion and orthostatic stress in Myalgic Encephalomyelitis and chronic fatigue syndrome | date = 2017 | url=https://oatext.com/pdf/PMRR-2-134.pdf|journal=Physical Medicine and Rehabilitation Research|volume=2|issue=1|pages = | last = Twisk | first = Frank N.M. | author-link = Frank Twisk|language=en|doi=10.15761/pmrr.1000134|pmc=|pmid=|access-date=|issn=2398-3353|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Frank-Twisk/publication/318339604_Dangerous_exercise_The_detrimental_effects_of_exertion_and_orthostatic_stress_in_Myalgic_Encephalomyelitis_and_chronic_fatigue_syndrome/links/596497d00f7e9bfb63ca273e/Dangerous-exercise-The-detrimental-effects-of-exertion-and-orthostatic-stress-in-Myalgic-Encephalomyelitis-and-chronic-fatigue-syndrome.pdf (Full text)] *2015 - The Aerobic Energy Production and the Lactic Acid Excretion are both Impeded in [[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]]<ref name="Vink2015">{{Cite journal | last = Vink | first = Mark| date = 2015-09-10 | title = The Aerobic Energy Production and the Lactic Acid Excretion are both Impeded in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.researchgate.net/publication/282133390_The_Aerobic_Energy_Production_and_the_Lactic_Acid_Excretion_are_both_Impeded_in_Myalgic_EncephalomyelitisChronic_Fatigue_Syndrome|journal=Journal of Neurology and Neurobiology ( ISSN 2379-7150 )|volume=1|doi=10.16966/2379-7150.112}}</ref> - [https://www.researchgate.net/publication/282133390_The_Aerobic_Energy_Production_and_the_Lactic_Acid_Excretion_are_both_Impeded_in_Myalgic_EncephalomyelitisChronic_Fatigue_Syndrome (Full text)] ==News and articles == * 2017, [https://www.americanscientist.org/article/an-illness-observed-a-conversation-with-julie-rehmeyer An illness observed: a conversation with Julie Rehmeyer] - American Scientist * 2017, [http://anilvanderzee.com/for-patients-with-cfs-going-to-the-bathroom-is-similar-to-running-a-marathon/ For patients with CFS, going to the bathroom is similar to running a marathon] - Interview with Mark Vink ==Clinicians== ==Risks and safety== ==Costs and availability== ==See also== *[[Power chair]] *[[Severe and very severe ME]] *[[Disability]] *[[Ableism]] ==Learn more== *[https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/walking-aids-wheelchairs-and-mobility-scooters/ Walking aids, wheelchairs and mobility scooters] - NHS *[https://www.gov.uk/guidance/the-highway-code/rules-for-users-of-powered-wheelchairs-and-mobility-scooters-36-to-46 Rules for users of powered wheelchairs and mobility scooters] - UK Government Guidance *[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/3695/inclusive-mobility.pdf Inclusive mobility] - UK Government document ==References== {{reflist}} [[Category:Potential treatments]] [[Category:Management strategies]]
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