Wheelchair and Mobility-Aid Repair

Who it is for. Beginners with no formal certificate, including school leavers, wheelchair users and other persons with disabilities, family members who care for a wheelchair user, bicycle repairers and community volunteers. National Proficiency I is the first level of Ghana's TVET framework, for routine tasks done under close supervision.

Many of you use a wheelchair, crutches or a frame yourselves. That is a strength. You already know what a badly fitted or badly repaired aid feels like. Every practical in this book has a seated option, and the workbench is set at wheelchair height.

Why this trade

• WHO estimates that about 80 million people, about 1% of the world's population, need a wheelchair, and the number is growing as people live longer.
• WHO's training package says fewer than 5% of people who need a wheelchair have access to a properly fitted one.
• In Ghana, more than 2.1 million people have a disability, about 8% of the population.
• Wheelchairs given away without repair support are often left unused. In the Oti Region, more than 50 donated wheelchairs were left outside for about five years. Many had faulty castors, push rims, footplates and other parts, and users said repairs of about GH¢300 a chair were too costly.
• Donations keep coming. Tullow Ghana and the WalkAbout Foundation planned custom-fitted wheelchairs for about 175 students from the Western Region in 2023. The Jomoro Municipal Assembly gave wheelchairs to 20 persons with disabilities in 2022. Every one of these chairs will need repairs.
• A lack of repair systems makes people abandon wheelchairs and shortens their life.

How the module works

Each unit has learning outcomes, performance criteria, the range (where and on what you work) and the evidence your assessor needs. You are judged Competent or Not Yet Competent. About 70% of the time is practical. Each unit ends with Check yourself (three quick questions) and a homework task.

This book uses ideas from the free WHO Wheelchair Service Training Package. That package is meant for people who provide wheelchairs, including technicians, local craftspeople and wheelchair users themselves, and takes about 35 to 40 hours. WHO lists the Basic level package under a Creative Commons licence that allows non-commercial use only. This book does not copy the WHO text; it teaches in its own words and points you to the WHO package as your best free next read.

Competency standard

Range. Manual wheelchairs (folding and rigid), commode chairs, elbow and underarm crutches, sticks, walking frames, hand tricycles. Evidence. Labelled parts drawing; oral questions; observation of a client conversation.

The people you serve

Wheelchair users are children, adults and older people, men and women, in towns and villages. Each has different needs. Common reasons for using a wheelchair include cerebral palsy, polio, spinal cord injury, stroke, amputation and frailty in old age.

A wheelchair that fits and works well helps a person move independently, stay healthy, go to school or work, and take part in community life. The UN Convention on the Rights of Persons with Disabilities, Article 20, asks countries to support personal mobility with the greatest possible independence.

Types of wheelchair

Bigger and wider wheels roll more easily over rough, sandy or muddy ground.

Other mobility aids

• Walking stick (cane): one point of support.
• Elbow (forearm) crutches: a handle and a cuff just below the elbow.
• Underarm (axillary) crutches: the top sits below the armpit. The user pushes through the hands and wrists and must not lean on the armpits.
• Walking frame ("Zimmer frame"): four legs, lifted and moved forward; some have front wheels. Most have a height adjuster on each leg.
• Hand tricycle: a three-wheeled cycle driven by the arms. WHO notes that a tricycle can help wheelchair users who must travel longer distances. Some Assemblies in Ghana have given tricycles from their disability fund.

The parts of a manual wheelchair

Respect comes first

Workshop safety

Check yourself

1. Name two places where a long-wheelbase wheelchair is better than a short-wheelbase one.
2. Who do you speak to first: the wheelchair user or the person pushing?
3. Name three parts of a wheelchair that touch the ground.

Competency standard

Range. Two different wheelchairs; one crutch or frame. Evidence. Completed safe-and-ready checklists; tool kit list; observation.

The basic tool kit

NCHPAD's home tool kit for wheelchair users lists a lubricant, screwdriver, rags, metric and imperial Allen keys, a spoke wrench, an adjustable wrench, a spare tube, a valve adapter and tyre levers.

An accessible workspace

(Bench heights here are a teaching suggestion; adjust them to your trainees.)

The "safe and ready" check

WHO's training package says every wheelchair must be checked before a user tries it. Use this check every time a chair comes in and every time it leaves.

The six home-care jobs to teach every user

WHO's package lists six things users can do at home to make the chair last longer and prevent injuries:

1. Clean the chair with warm water and a little soap; rinse and dry. Wash the cushion separately and dry it in the shade, not in the sun.
2. Oil moving parts after cleaning.
3. Pump the tyres (if air-filled) so the thumb presses in only about 5 mm, the same on both sides.
4. Tighten loose nuts and bolts, but do not over-tighten.
5. Tighten loose spokes with a spoke wrench.
6. Make regular checks for rust, torn upholstery and a worn cushion.

Motivation's manual for its Multisport wheelchair adds: check tyres are hard daily, fix punctures at once, check spokes and quick-release axles at least once a month, and check the cushion and upholstery at least once a month. NCHPAD suggests a full wipe-down about once a month, more often in hard use.

A simple maintenance schedule

Check yourself

1. How far should your thumb press into a correctly pumped wheelchair tyre?
2. Where should you dry a washed cushion, and why?
3. Name three "danger" faults that stop a chair being used.

Competency standard

Range. Air-filled (pneumatic) and solid tyres; rear wheels and castors. Evidence. Two punctures repaired; spoke check record; observation.

Air-filled or solid?

• Air-filled (pneumatic) tyres are softer and roll better over rough ground, but can puncture. The right pressure is printed on the side of the tyre.
• Solid tyres cannot puncture, but give a harder ride and must be replaced when worn.
• Soft tyres make the chair harder to push, wear out faster and stop push-on brakes from holding.

When to replace a tyre

Replace a tyre when the tread is worn to half its original thickness, when it has major cuts or tears, or when the side walls bulge.

Fix a puncture: step by step

You need: tyre levers, patch kit (sandpaper, glue, patches), pump, bowl of water, chalk or marker, a spanner if the wheel has axle nuts.

Take the tyre off

1. Put the brakes off. Remove the wheel (press the button on a quick-release axle, or undo the axle nut).
2. Let all the air out.
3. Push both edges (beads) of the tyre towards the middle of the rim to loosen them.
4. Hook a tyre lever under one bead. Put a second lever about 3–5 cm along. Pull both down to lift the bead over the rim.
5. Move one lever along and repeat until one side is free.
6. Pull the tube out, starting opposite the valve. Push the valve out last.

Find the hole and the cause

7. Pump the tube until it is about twice its normal width. Listen, feel with your cheek, or put it in water and look for bubbles.
8. Mark the hole with four small marks around it, not on it, so sanding does not rub them off.
9. Find the cause. Run your fingers carefully round the inside of the tyre and look at the outside for thorns, glass or wire. Check that the rim strip covers every spoke hole and that no spoke end sticks out.

Patch it

10. Lightly roughen the area round the hole with sandpaper. Do not sand deep grooves.
11. Wipe clean and let it dry.
12. Spread a thin layer of glue a little bigger than the patch.
13. Wait until the glue is dry, several minutes. Touch only the outer edge to test.
14. Peel the patch, holding it by the edges. Press it over the hole, firmly, especially at the edges, for a minute or more.
15. Check that all edges are stuck down.

Put it back

16. Put a little air in the tube so it holds its shape. Put the valve through the rim hole, pointing straight at the hub.
17. Tuck the tube into the tyre all the way round.
18. Push the second bead over the rim with your hands, working from the valve both ways. Use a lever only if you must, and never pinch the tube.
19. Pump a little air, then check that the line on the tyre sits evenly above the rim all the way round on both sides. If a bead sticks, use soapy water, never oil or grease.
20. Pump to the pressure on the sidewall. Refit the wheel and check the axle is locked.

Common mistakes

Spokes: the simple check

Loose spokes can make a wheel buckle and collapse.

1. Squeeze pairs of spokes together all the way round the wheel. You can also pluck them like a guitar string and listen.
2. A spoke that "gives" when you pull it gently may be too loose. Tighten its nipple a quarter turn with the spoke wrench, then check again.
3. A spoke that feels very rigid may be too tight and should be loosened a little.
4. Use a spoke wrench that fits exactly: a loose-fitting wrench rounds off the nipple.
5. Replace broken or missing spokes quickly. Truing a whole wheel is taught at Level 2.

Check yourself

1. Why must you look inside the tyre before you put a patched tube back?
2. What do you do if a spoke "gives" when you pull it gently?
3. When should a tyre be replaced?

Competency standard

Range. Castors, rear hubs and push-on brakes on two different chairs. Evidence. Job cards; before-and-after spin test; brake test; observation.

Castors

Castors swivel so the chair can turn. Problems:

• Hair and threads wind round the axle and inside the bearings. Remove them with tweezers; you may need to take the castor off to clean it well.
• Nicks, chips and cuts in the castor tyre make it wear out fast; repair or replace it.
• Flutter (shimmy): the castor shakes from side to side at speed. How fast flutter starts depends on the weight on the castor and the "trail" (the distance between the swivel line and the axle). Extra friction in the swivel, for example a washer, can control it. At Level 1, check first for worn bearings and loose stem bolts; deeper fixes are Level 2.

Bearings

Each rear hub, each castor wheel and each castor stem usually has two bearings, so an adult chair has about four of each kind.

• A bearing is a ring of steel balls between an inner and an outer ring. Shields or seals on each side keep out dirt and water.
• ZZ means two metal shields; 2RS means two rubber seals. Metal shields roll more easily; rubber seals keep out more dust and water. For dusty roads and rain, 2RS is usually the better choice.
• Bearings are named by a number printed on the side. For example a 608 bearing is 8 mm inside, 22 mm outside and 7 mm wide, a common size often called a "skate bearing". Always read the number on the old bearing, or measure it, before you buy.
• Signs of a worn bearing: squeaking, grinding, or a wheel that does not roll freely. Motivation's manual says: if the castors or rear wheels do not run smoothly, the bearings may need changing.
• Water causes rust, which makes the chair harder to push.

Replace a sealed bearing: step by step

You need: spanners or Allen keys for the axle, a punch or an old bolt, a hammer, a socket or pipe the same size as the bearing's outer ring, rags, a new bearing of the same number.

1. Take the wheel off the chair. Note how washers and spacers sit; lay them in order on a tray.
2. Read the number on the bearing. Buy two (both sides) of the same number and seal type.
3. Tap the old bearing out from the other side with the punch, moving round the inner ring so it comes out straight.
4. Clean the hub hole and the axle. Check the axle is straight and not worn.
5. Start the new bearing square in the hole. Press or tap it in only on the outer ring, using the socket or pipe. Hitting the inner ring or the seal damages the new bearing.
6. Fit the spacer, then the second bearing the same way.
7. Refit the wheel with washers in the original order. Tighten the axle until there is no side play but the wheel still spins freely.
8. Spin test: the wheel should spin several turns and stop slowly, with no grinding.

(Teaching method. WHO lists replacing sealed wheel bearings among the repairs users and repairers can do with common tools.)

Brakes (wheel locks)

Brakes keep the chair still while the user gets in or out; they are essential for every user. Most manual chairs have a lever that presses a bar against the tyre.

Adjust a push-on brake

1. Pump the tyres to the right pressure first. A soft tyre stops the brake from holding.
2. Loosen the brake clamp bolts on the frame.
3. Slide the brake towards the tyre until, with the lever on, the bar presses about 3–5 mm into the tyre (teaching guide; check the maker's instructions where you have them).
4. Tighten the clamp bolts evenly.
5. Test: brakes on, push the chair hard. It must not move. Brakes off: the wheel must spin freely without rubbing.
6. Do both sides the same.

If the rear wheel position is moved, the brakes must be adjusted and checked again.

Check yourself

1. What is the difference between a ZZ and a 2RS bearing?
2. Why must you pump the tyres before adjusting the brakes?
3. Where do you press when fitting a new bearing into a hub?

Competency standard

Range. Foam cushions with covers; slung seat and backrest upholstery. Evidence. Cushion check record; oral questions; role-play of a referral.

Why cushions matter

Every wheelchair user should have a cushion. Cushions give comfort, help the user sit upright and relieve pressure. People at risk of pressure sores need a pressure-relief cushion.

Pressure sores: what you must know

A pressure sore is damaged skin and flesh. It can start in a few hours, last for months and can even cause death.

Three causes

• Pressure: sitting or lying too long without moving.
• Friction: rubbing, for example an arm on the wheel or armrest.
• Shear: skin held still while bones move, for example sliding down in the chair.

Risk factors

A person who cannot feel, cannot move, is wet from sweat or incontinence, sits badly, has had a sore before, eats or drinks poorly, is old, or is very thin or very heavy is more at risk. WHO's assessment form treats a person who cannot feel, or who has three or more risk factors, as at risk.

The four stages

Teach pressure relief

WHO says every user at risk should learn at least one way to take pressure off the seat bones in the chair, such as leaning forward or leaning side to side, alone or with help. Other prevention steps: sit upright, use a pressure-relief cushion, check the skin every day (with a mirror or a family member), change wet clothes at once, never sit on a wet cushion, eat well and drink plenty of water.

Checking and caring for a cushion

1. Take the cushion out of its cover.
2. Look for worn spots, dirt and holes in the cover and the foam.
3. Squeeze the foam. Foam flattens and becomes firmer with time; foam cushions should be checked often and usually replaced every 1–2 years.
4. Wash the cover; wash foam only if needed. Dry fully in the shade before refitting.
5. Refit the right way round. A contoured cushion used back-to-front or upside down does not work and may cause sores. Mark "FRONT" and "TOP" on it if needed.
6. The cover should not be stretched tight over the shape of the cushion.
7. For a user who is incontinent, two cushions used in turn let one dry while the other is used.

Upholstery (seat and back)

• Slung seats stretch and sag; a saggy seat makes it hard to sit upright.
• If upholstery rips suddenly, the user can be injured. Look for tears, wear, dirt and metal sticking out; check the tension of seat and backrest.
• A tailor can repair upholstery. Give the tailor the old piece as a pattern and ask for strong fabric and double stitching.

Check yourself

1. Name the three causes of pressure sores.
2. What does a stage 1 pressure sore look like?
3. What do you do if a user shows you a blister on the seat area?

Competency standard

Range. Elbow and underarm crutches, sticks, walking frames, a hand tricycle. Evidence. Checklists; ferrule replaced; observation.

Crutches and sticks: the checks

Height. A clinician sets crutch height for a patient, and the user should not change it, because a wrong height can affect posture and cause pain. As a repairer, you check the height and report problems; you set heights only when the user has no clinician and asks you, using these guides:

• Elbow crutch: handle level with the wrist crease, cuff just below the elbow crease, shoulders relaxed, elbow slightly bent. Too high: shoulders hunched, elbow very bent. Too low: shoulders dropped, hunched forward, elbow very straight.
• Underarm crutch (child guide): the top 2–3 finger widths below the armpit, handles set so the elbows are almost straight when standing.

Replace a ferrule

1. Wriggle and twist the old ferrule off firmly. Rubber gloves give extra grip; a second person can hold the leg still.
2. Check the size: the new ferrule must match the tube diameter.
3. Twist the new ferrule firmly onto the end.
4. Check it sits right to the bottom with no gap.

Walking frames

Hand tricycles

A hand tricycle is a mix of a wheelchair and a bicycle. Use the bicycle skills you already have:

• Tyres and tubes: as in Unit 3.
• Brakes: squeeze and test; a tricycle on a slope must stop and hold.
• Chain: clean, lightly oiled, not too slack. A chain stretches as it wears. Quick check: put a ruler along the chain with one rivet at zero; count 24 more rivets. If that rivet is more than 1/16 inch (about 1.6 mm) past the 12-inch mark, replace the chain. A worn chain wears out the sprockets fast.
• Steering and hand cranks: no play, no grinding.
• Seat and frame: look for cracks, especially near welds.

Check yourself

1. How do you know a ferrule must be replaced?
2. Where should an elbow crutch handle sit?
3. How do you check a tricycle chain for wear with a ruler?

Competency standard

Range. The trainee's own plan. Evidence. Costing sheet; one-page plan; sample job card.

Who needs you

• Wheelchair users, crutch users and frame users, and their families
• Schools for children with disabilities and inclusive schools
• Hospitals, clinics and physiotherapy units that lend chairs and crutches
• Assemblies and charities that give out wheelchairs and tricycles
• Disability organisations such as the Ghana Federation of Disability Organisations

Who else is in the field

• The Orthopaedic Training Centre at Nsawam (Eastern Region) makes and repairs orthopaedic devices and runs a three-year prosthetics and orthotics diploma.
• In 2017, 27 people took a wheelchair technician course at the Centre with LDS Charities, and in 2023 ten Centre staff completed WHO basic wheelchair service training.
• In 2012 the WalkAbout Foundation trained 25 Ghanaians in wheelchair fitting, assembly and mechanics when it gave 250 wheelchairs.
• No dedicated wheelchair repair workshop was found in Takoradi during the research for this book (not verified by phone).

WHO lists bicycle repairers, motorcycle mechanics, welders, carpenters, tailors and users' own families as local people who can help repair wheelchairs. You can be the person who brings these skills together.

What things cost (Accra asking prices, October 2026)

A good repair that keeps a GH¢1,500 chair working for another year saves the user a lot of money.

Location settings that give good returns

Business ideas and ingenuity

Rules you must check

• Assembly permit. Sekondi-Takoradi's 2025 fee-fixing resolution has no line for wheelchair repair. The closest line, "Motorcycle / Bicycle / Tricycle Repairs", shows GH¢400 for 2024 and GH¢100 for 2025 a year, and annual fees were due by 31 March. Ask the Assembly which category it will use for you.
• Register your business name when you are ready (Level 3 covers this).

Market yourself

• A simple name and sign, for example "Wheels Well Repairs".
• A job card for every job: user's name and phone, aid, faults, work done, parts, price, date, next check date.
• WhatsApp: before-and-after photos (always ask the user's permission first), your price list and your repair days.
• Ask disability organisations, physiotherapists and Assembly disability desks to keep your number.
• Give every user a home-care card with the six jobs from Unit 2.

Accessibility

This trade suits persons with disabilities very well. WHO's training package was written for wheelchair users among others, and WHO names peer trainers as good trainers for users. Ghana's Persons with Disability Act 2006 (Act 715) requires public places to be accessible, but disability groups say this is still poorly enforced.

Deaf trainees: use the written checklists, picture cards and job cards; agree hand signals for "stop". Blind and low-vision trainees: tactile tool board, bearings sorted in labelled trays with raised markings, a talking tape measure if available, and partner checks for visual faults.

Check yourself

1. Name three things that make a workshop location good for wheelchair users.
2. What must you ask before taking a photo of a user's chair for WhatsApp?
3. Name two places where users might find help to pay for repairs.

1. Name four types of wheelchair.
2. Name eight parts of a manual wheelchair.
3. What is the thumb test for tyre pressure?
4. Why must you find the cause of a puncture?
5. What are the signs of a worn bearing?
6. Where do you press when fitting a bearing?
7. When is a brake correctly adjusted?
8. Name three causes of pressure sores.
9. What do you do if you see a pressure sore?
10. How often should a foam cushion usually be replaced?
11. When must a crutch ferrule be changed?
12. Name two things you must never do at this level.

Best next reads: the WHO Wheelchair Service Training Package, Basic level (free, non-commercial licence); the Park Tool repair help pages for tyres and wheels; the Hub's Basic Welding and Money Skills manuals.

What this module does not cover: assessing and prescribing a wheelchair, fitting and adjusting a chair to a user, making cushions, truing wheels, frame repairs, electric wheelchairs (see Levels 2 and 3), and any postural support for people with complex needs (a trained wheelchair service professional only).

Every source used in this manual is listed, with links, in the Teacher Copy.