Stephanie, 15 years old, has cerebral palsy. She has been ambulating with forearm crutches since she had surgery for tibial derotation osteotomies 9 years ago. Recently, however, her increased weight, along with her increased muscle tone and impaired motor control, have made it more difficult for her to walk. Stephanie is now ready to begin using a wheelchair for locomotion over longer distances. What factors should be considered in her wheelchair prescription?
For many patients, participation in meaningful life activities is greatly expanded through the use of a professionally prescribed wheelchair. More than simply a chair on wheels, a wheelchair is a postural support system on a mobility base. While in use, this dynamic seating environment allows patients to achieve stability, controlled mobility, and skill in daily functions. As such, a wheelchair can accurately be described as a “mobility orthosis.” That is, it is “a combination of a postural support system and a mobility base that are joined to create a dynamic seated environment”1 (see Box 13-1). Like other orthoses, the wheelchair should be selected and fitted within the context of skilled patient care. Knowledge of the patient’s physical condition, activities of daily life, and personal preferences are therefore essential and preliminary to wheelchair selection and fitting.
Box 13-1 Definition: Orthosis
An orthosis is “any device added to the body to stabilize or immobilize a body part, prevent deformity, protect against injury, or assist with function.”3
The postural support system of a standard manually operated wheelchair is made up of the parts of the chair that come in direct contact with the patient: the seat, back, upper-extremity (UE) and lower-extremity (LE) supports, and any positional devices (straps, etc.) attached to the wheelchair. The mobility base comprises the frame and wheels, which allow the seating system to move (see Fig. 13-1).
Standard manual wheelchair with components as labeled. (A) Side view. (B) Front view.
Selecting a Wheelchair: The Process of Matching Needs and Resources
As a therapeutic intervention, wheelchairs must be selected following a thorough patient examination and with an understanding of the patient's health condition and prognosis.
Identifying Needs and Resources
The process of selecting an appropriate wheelchair is a matter of matching the patient's needs, desires, and abilities with the available resources. A particular wheelchair or specific wheelchair option is neither good nor bad in and of itself. Its value can be determined only within the context of the patient's needs and resources. The patient's needs are not limited to physical conditions; they may also include, for example, social, vocational, or recreational needs. Needs may range from obvious requirements of locomotion in the home and community to less obvious concerns, such as being accepted ...