Stephanie, 15 years old, has cerebral palsy, a congenital condition that affects her posture and motor control. 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, has 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 a device applied to the body that is designed to stabilize or immobilize a body part, prevent deformity, protect against injury, or assist with function.1 A wheelchair can be considered an orthosis on a mobility base. While in use, this dynamic seating environment allows patients to achieve stability, controlled mobility, and skill in daily functions. Similar to other orthoses, the wheelchair should be selected and fitted by a skilled professional within the context of the patient’s physical condition, activities of daily life, and personal preferences.
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, prognosis, participation goals, and existing resources. Improper wheelchair prescriptions can actually create additional problems, adversely affecting people’s physical well-being and social interactions. In a study of 150 wheelchair users, 68% of their wheelchairs were found not to be suitable for them.2 It is not surprising, then, that many people abandon their prescribed chairs because of a poor match to their needs.3–5
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 wheelchair option is neither good nor bad in and of itself. Its value can be determined only within the patient context. The patient’s needs are not limited to physical conditions. They may also include social, vocational, or recreational needs, for example. Needs may range from obvious requirements of locomotion in the home and community to less obvious concerns, such as being accepted by one’s peers. Similarly, resources that affect wheelchair choice may include the patient’s physical ability, ...