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?
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.”1 For many patients, participation in meaningful life activities is greatly expanded using 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.”2 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.
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, and so on) 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 and existing resources. Improper wheelchair prescription can actually create additional problems, adversely affecting people’s physical well-being and social interactions. Studies indicate that a large number of people abandon their prescribed chairs because of a poor match to their needs.3–5 Even worse, in a study of 150 wheelchair users, 68% of their wheelchairs were found not to be suitable for them.6
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 ...