Section XVII: Wheelchair Assessment and Prescription

Introduction

Wheelchair selection is best performed by a client-centered team. The seating clinic has evolved in present-day rehabilitation facilities and hospitals as a service to both inpatients and outpatients. An individual and his/her family/caregiver can network with a therapist, a qualified rehabilitation technology supplier (RTS), the physician, and other clinicians in a clinic setting dedicated to providing assessments for wheelchair and seating equipment and sometimes other assistive technology devices. The clinic is typically set up with evaluation tools, a mat table, demonstration equipment, samples, equipment catalogs, and other resources. Trial and simulation of demonstration equipment and samples are excellent tools to determine the potential outcome(s) of a prescribed piece of equipment. Proper education in the use of the device is essential and follow-up is arranged for fitting and delivery. People of all ages with various disabilities (e.g., spinal cord injury, spina bifida, cerebral palsy, muscular dystrophy, CVA, traumatic brain injury, multiple sclerosis, amyotrophic lateral sclerosis, post–polio syndrome, burn injuries, osteogenesis imperfecta) can be served.

Goals of a Wheelchair/Seating Assessment

1. Improved function: Maximization of the client's learning potential or independence in mobility related activities of daily living (MRADL). Must be specific on letters of medical necessity. How does the equipment improve transfer ability, dressing, toileting, bathing, meal preparation, eating, computer access, driving, work access, and so on?

2. Comfort: Improved sitting tolerance (preferred terminology for medical reviewers), documented in hours.

3. Physiological optimization: To diminish the progression of deformity, correct deformity, reduce sitting pressures, improve skin integrity, improve sitting balance, normalize muscle tone, decrease influence of abnormal reflex patterns, improve pulmonary hygiene, prevent injury or trauma, and conserve energy.

4. Cosmetic: Will the client accept the device(s)? It has to be a mutually agreed-on piece of equipment by all parties involved.

5. Durability: Frequent maintenance and repairs are costly and time consuming, and prevent the client from living the benefits of the mobility and seating system.

6. Financial sensitivity: Will the equipment meet insurance guidelines? Education is provided in potential insurance coverage and other resources available. A letter of medical necessity is typically generated by the therapist. It should clearly reflect the thought processes behind the evaluation and the recommendations generated. The letter must describe why each feature is needed based on a specific goal. The insurance provider wants to know that each item is the least costly alternative.

Wheelchair Seating and Positioning Assessment

Assessment Elements

• Medical/surgical history

• Home environment: House or apartment; alone or with family/caregivers; accessibility; ramp entry? Narrowest doorway.

• Mode of transportation; ability to drive.

• Community activities and access; school, work.

• Cognitive/visual status.

• ADL status: Dressing, bathing, feeding, grooming, toileting, meal prep.

• Bowel/bladder status.

• Mobility skills: Transfers; gait (functional vs. nonfunctional); manual wheelchair propulsion; power wheelchair propulsion/mode of control; ability to perform weight shifts; hours in wheelchair per day?

Current Equipment

Define the advantages and disadvantages ...