Prescription of a manual wheelchair
Manual wheelchairs are far more than just a means of transport for SCI clients. They must also provide adequate pressure management and postural support throughout a full day of use while allowing the user to maximise their functional capability and comfort. Furthermore, as the MWC is a visible accessory for the client there are also aesthetic and psychosocial considerations. Reviewing and scripting manual wheelchair seating will typically happen periodically throughout a client’s life, as current equipment needs replacement, or the client’s needs change.
Indicators for manual whrseelchair assessment and intervention:
- Selection of a manual wheelchair to address a new need for primary mobility
- Safety concerns with an existing manual wheelchair Pressure injuries related to wheelchair condition or configuration
- Development of postural asymmetry and risk of fixed deformity
- Significant weight loss or weight gain
- Refinement of wheelchair configuration to match changed client ability or wheelchair skills
- Upper limb pain reducing the efficiency of wheeled propulsion
- Replacement of a manual wheelchair due to wear or damage (see Module 5)
- Requirement of a manual wheelchair for increased community participation, access and vocational opportunity.
Considerations for new and experienced use
The client’s first manual wheelchair should be prescribed with adjustable components to allow the configuration to be fine-tuned as the client learns over time how best to fit the chair to their environment of use. A client review to reassess and adjust wheelchair configuration should be planned after the first 6-12 months of use. Typically wheelchairs skills and needs will change over time, and the client’s functional capability also changes.
Experienced wheelchair users usually have clear ideas on the features needed in a replacement wheelchair (e.g. what features worked, what didn’t and what is essential). While keeping the client’s expectations in mind, clinical assessment and advice on new wheelchair technology should be given to improve the performance of the wheelchair and reduce the risk of upper limb injury. Provision of wheelchair skill training should also be considered.
Manual wheelchair interventions include:
- Review and adjustment of the current wheelchair configuration
- Prescription or replacement of selectable and adjustable features of available wheelchair options, components and accessories, and
- Prescribing a new wheelchair.
In some instances there may be complicating factors, and local therapists may require support. In these cases, the client can be referred to a Spinal Seating Service.
Referrals to a Spinal Seating Service are indicated for clients with:
- Significant postural deformities
- An inability to maintain a good seating posture throughout the day
- Complex postural and functional needs where commercial products are not able to meet the desired outcome
- Custom-fabricated products that require replacement, such as: cushions, custom-made backrests, armrests and foot supports
- Unmanageable discomfort or skin marking
- Non-healing, sitting-acquired pressure injuries
- A history of recurrent pressure injuries
- Previous surgical interventions relating to pressure injuries, or
- Dependence on a respiratory ventilator