Module 9 - Manual Wheelchair
A thorough initial interview, a MAT evaluation and body measurement should be conducted as part of a seating and wheeled mobility assessment (see Modules 2-5). A detailed record of the current mobility system is often the baseline for all manual wheelchair assessments and interventions. Click to download sample form for manual wheelchair assessment and wheelchair assessment form with prompts.
A manual wheelchair user's first wheelchair should be prescribed with adjustable components that optimise the client's ability to perform in his/her environment after hospital discharge. A client review to reassess and adjust wheelchair configuration should be planned for 6-12 months after discharge as the client's balance and community wheelchair skills improve with functional demands. At the review, improving the ease of doing a 'wheelie' is a strategy for overcoming challenging obstacles and terrains, and to optimise efficiency of wheel propulsion.
Experienced wheelchair users usually have clear ideas on the required features of the replacement wheelchair (e.g what worked, what didn't and what are the must haves). 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 upper limb degeneration. Provision of wheelchair skill training may also be considered.
Please refer to Wheelchair Skills Program (WSP) produced by Dalhousie University, Halifax, Nova Scotia, Canada, accessed 2008.
Indications for manual wheelchair assessment and interventions are:
- clients with SCIÂ undergoing rehabilitation and requiring a manual wheelchair as a mobility aid
- wheelchair safety concerns for client or carers
- development of pressure ulcers as a result of wheelchair condition or configuration
- increased asymmetry and risk of fixed deformity
- significant weight loss or gain
- a change in functional mobility status
- refinement to manual wheelchair manoeuvrability as the client's wheelchair skills improve
- upper limb pain impacting on the efficiency of wheeled propulsion
- replacement of manual wheelchair in cases for example of frame structural misalignment, rust and/or frame fatigue. Issues are identified in Module 5
- manual wheelchair as an alternative means of transport, leading to increased community participation, access and social integration.
Interventions include:
- review and adjustment of current wheelchair setup
- prescription or replacement of selectable and adjustable features of the wheelchair components and accessories
- a new wheelchair prescription.
Referral to the Spinal Seating Services is indicated for clients who:
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have non-healing, sitting-acquired/related pressure areas
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have history of recurrent pressure ulcers
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have custom fabricated products that require replacement