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LEARNING OBJECTIVES
Describe the components of the examination process for prescribing a wheelchair.
Discuss the relationship between elements of patient history and the wheelchair prescription.
Describe the optimal sitting posture for an individual using a seating system.
Explain the different methods of seating simulation and the expected outcomes.
Describe factors that affect determination of seat and back support features.
Discuss the benefits and contraindications of various seating system features.
Recognize the components of a problem solving model and describe each component when presented with a clinical case study.
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Physical and occupational therapists are often called on to prescribe a wheelchair. A properly prescribed wheelchair can be a useful device in reintegrating a person with a disability into the community, whereas a poorly prescribed one can actually exacerbate the problems associated with activity limitations and disability. This chapter presents a systematic approach to determining the appropriate components of a prescriptive wheelchair, beginning with a thorough examination and culminating with a plan of care (POC) that includes the proper seating system and wheeled mobility base. The seating system and mobility base combine to create a prescriptive wheelchair, a seated environment from which the patient can achieve maximum function.
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Optimal fit of a wheelchair is important to assist the person in improving mobility, posture, and function. Properly fitted wheelchairs assist with preventing problems associated with poor posture, including pressure sores, respiratory difficulties, discomfort, and abandonment of equipment. Cosmetics (appearance), durability, weight, and intended use need to be considered when determining the most appropriate wheelchair system.
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Determining the appropriate wheelchair and seating system requires a thorough examination to ensure optimal equipment is obtained. Too often, a basic commercial system is provided, but this is frequently not the best solution. The solution must consider multiple patient-, environmental-, and diagnosis-related factors and requires a comprehensive examination by the professional team. The examination is time consuming and may require several sessions to complete. However, additional time provided "up front" will decrease errors and future costs associated with the mistakes created by data obtained from a less than optimal examination.
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Wheelchairs are not just mobility devices but are also seating support devices. If inappropriate seating supports are provided, the end user (i.e., the patient) may be unable to propel a manual wheelchair, operate a power wheelchair, or achieve effective positioning at a table for meals. All relevant aspects of a person's lifestyle should be considered to ensure safety and optimal function.
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The entire team contributes to the wheelchair prescription decision making. It is important that all those concerned with the person's present and future function be a part of this team. The team may include the wheelchair user, therapists, family members, caregivers, nurses, physicians, educators, vocational counselors, and a qualified rehabilitation technology supplier. To ensure that the most suitable device is obtained, the team must have a clear idea of who will be ...