Wheelchairs and Seating

A.  Evaluation process

Much time goes into determining an appropriately fitting wheelchair and seating system.
A thorough clinical evaluation of an individual’s needs, environment, and functional strengths help determine an appropriate wheelchair.
A team approach is ideal when selecting an appropriate wheelchair and seating system. The team should consist of:

• patient
• patient’s family and caregivers
• physician
• therapist: OT, PT, ST
• vendor/manufacturer representative
• assistive Technology practitioner

B. Manual vs. power mobility

There are many things to consider when deciding which type of mobility meets your needs:

Some reasons to select manual mobility:

• You have sufficient upper body strength and overall endurance to propel a manual wheelchair all day over various surfaces.
• Reducing the weight or increasing the maneuverability of a wheelchair will enhance your independence.
• You are able to perform all your daily activities in a manual wheelchair.
• A manual wheelchair is smaller, lighter, and less expensive to maintain and repair.
• You are able to independently perform a weight shift
• You have no chronic pain in your arms or shoulders.

Some reasons to select powered mobility:

• You have insufficient endurance or functional ability to propel a manual wheelchair independently.
• Powered mobility would enable you to be more independent in your daily living, working, and recreational activities.
• You are unable to independently perform a weight shift.
• Your personal and public environments and modes of transportation accommodate a power chair
• Financial considerations.

 
C. Positioning in a wheelchair

• Proper positioning begins with proper-sized equipment.
• One of the primary goals of wheelchair positioning is achieving an aligned body posture, which is important to prevent orthopedic deformities and pressure ulcers.
• The spine should maintain its normal curvature and pelvis should be neutral.
• A posterior pelvic tilt should be avoided, although it is frequently used to increase trunk balance, particularly with patients with cervical and upper thoracic level injuries.
  • The hips, knees and ankles should be flexed to about 90 degrees.
  • Shoulders should be aligned with the rest of the trunk.
  • Head and neck should be centered with respect to the rest of the body
  • Positioning must be balanced with feeling secure in the wheelchair and allowing for function.
• The hips, knees and ankles should be flexed to about 90 degrees.
• Shoulders should be aligned with the rest of the trunk.
• Head and neck should be centered with respect to the rest of the body
• Positioning must be balanced with feeling secure in the wheelchair and allowing for function.

D. Other general suggestions

• When selecting a vendor for repairs, ask if they have experience with your brand and type of chair. Contact the chair manufacturer for a recommended vendor in your area.
• Ensure the vendor has a contract with your insurance company.
• You can also call your insurance company and ask what DME companies are ‘in-network’ for your plan.  (In-network and out-of-network benefits are often different…there is typically better coverage from insurance with an in-network provider)

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