Module 2 - Developing a Client Profile: Getting the Big Picture
Psychosocial considerations
- cognition and ability to learn new skills such as set up and maintenance of equipment, and the ability to operate a power wheelchair
- perceptual skills, such as motor planning and visual spatial orientation
- communication skills, interpersonal and intrapersonal skills
- judgement and safety awareness
- behaviour and personality traits
- motivation, attitude, tolerance of technology
- self-image, the aesthetics and cosmetic preference towards wheeled mobility, and
- co-morbidities such as mental illness and brain injury.
This information can be acquired through observations and inputs from the client's health care providers. Refer to any psychological/neuropsychological reports when available.
Histories of mental illness and/or neurological changes such as brain injury and strokes are co-morbidities among some clients with a spinal cord injury. Consultation or referral to a medical practitioner, occupational therapist in neurology or psychologist may be indicated, particularly if there are safety concerns with independent wheeled mobility.
A social history and background will provide some guidance in setting realistic goals for seating intervention:
- Socioeconomic circumstances: funding sources, family support and prospects of returning to work should be explored to maximize client's choice in equipment selection
- Living situations/arrangement, for example residential care, independent living units in group house, own home, rental etc)
- Family/carer support and its availability
- Cultural influence on attitudes towards disability, carer's role and health care providers
Functional skills
It is useful to ask the client to describe chronologically the activities involved in a regular day and then activities on the weekend:
- How and where are they performed? What other equipment is used to participate in these activities?
- How often are they performed?
- How easy or difficult are they to perform in the current seating and wheeled mobility system?
Ask the client to demonstrate the activities or organise a site visit if needed.
Generally, activities of daily living can be categorised as:
- Self-maintenance
- Personal care: toileting, bathing, eating, grooming
- Domestic task: meals preparation, washing etc
- Mobility: what are the primary & secondary mobility means, indoor and outdoor mobility preference?
- Transfers: bed, chair, car, commode, toilet
- Rest
- Rest should be considered over a 24-hour period: in bed or wheelchair, using tilt or assistance required
- Leisure
- What is involved in these leisure activities:
- Indoor, outdoor, terrains
- Climate, daytime, night time
- In confined, unpredictable, wet areas
- Special accessories or tools
- What is involved in these leisure activities:
- Productivity
- Employment, schooling/studies
- carer duties, voluntary work
- community participation
Explore and discuss with the client the features of the seating and wheeled mobility required to carry out their activities of daily living. Record the discussion.
Environment
Environmental factors commonly considered in seating and wheeled mobility prescriptions are:
- Access to residence: dimensions required for wheeled mobility and particular areas where care activities are carried out
- Office, workstations and work areas: clearance under desk/table; access to switches/control; access to office areas and bathrooms
- Vehicles and other modes of transport(private/public/taxi):
Terrain
- Home backyard
- Topography of the surrounding areas: flat or steep terrain
- Rural areas: farm, dirt track
Take note of the environmental factors that will determine the features required in wheeled mobility.