In Canada, funding agencies for mobility devices vary province by province and each agency has different criteria by which a person may be eligible to receive a manual wheelchair and which type or category of manual wheelchair can be considered for a qualified individual. Therefore, it is difficult to make generalizations about funding programs, but, typically, funding sources consider funding the provision of a manual mobility device if a person is expected to require the device on a long-term basis (e.g., at least six months). Please note that this is different from a temporary or short-term need, which is often accommodated through rental, which may be covered through a person’s extended health care benefits. Thus, when looking at prescribing a mobility device for an individual for a long-term basis, therapists need to look at the future needs of the person. Since funding cycles typically are a minimum of five years, therapists need to look ahead to anticipate a person’s future needs, in addition to immediate needs, to prescribe a mobility device that will work for an individual not only now, but also in the future.
One thing to consider when selecting a model of manual wheelchair for an individual is how well the wheelchair can be retrofitted to accommodate changes in size or function. Some models of manual wheelchairs have parts that can be swapped out to shrink or grow the wheelchair to accommodate weight gain or loss. In a modular, folding-frame wheelchair, the parts that can be changed to grow or shrink the chair include the cross-brace, upholstery, and foot plates. Depending upon the model/design of the wheelchair and the manufacturer, these parts often are provided by the manufacturer at no charge within a specified period of time (e.g., within five years of original ownership of the wheelchair). For example, if the original wheelchair was configured with sling upholstery in an 18” width, but the original owner lost weight since the purchase of the wheelchair and now needs a wheelchair that is 16” in width, the manufacturer would provide the required sling upholstery, cross-brace, and footrests to enable the wheelchair to “shrink” to the required smaller size. The consumer would pay a vendor a labour charge to change the parts on the wheelchair. Although many government funding programs pay for the cost of a new wheelchair if there has been a change in body size, retrofitting a wheelchair to meet new size requirements is a less expensive solution rather than purchasing an entirely new wheelchair. This saves money for the funding agency (and by extension, taxpayers if it is a governmental agency) and for the wheelchair owner, who may be required to pay a co-payment with the provision of each new wheelchair. Thus, when you are considering the provision of a manual wheelchair, consider the stability of the individual’s weight and the likelihood of the individual losing or gaining weight in the future. If in doubt, consider a model of wheelchair that can be changed in size by the substitution of only a few parts.
A change in function is another reason why a wheelchair may require retrofitting or reconfiguration for an individual. Again, this option is available on only some models of wheelchairs as it is a function of the design of the wheelchair. A modular frame wheelchair, in which the cross-brace is separate from the front frame and rear frame of the wheelchair, allows for changes in configuration to accommodate different functional or postural needs after the original prescription was completed.
The picture to the far left below illustrates what I mean by a modular frame. The black piece in the centre of the frame is the cross-brace, which is positioned between a separate rear frame and separate front frame, both grey/silver in colour. The centre picture (shown without a firm back support) illustrates how a modular frame wheelchair can be configured for positioning for a less active user with elevating legrests and a more open angle on the back canes with the addition of a stroller handle. The picture to the right shows a configuration for a more active user. The pictures help to illustrate how configuration of a modular frame wheelchair is important to suit functional abilities and positioning needs of an individual.
Funders typically want to know that a person’s condition is stable before a prescription is finalized for an individual and funding is sought. Sometimes, however, a person’s condition or functional status changes after the wheelchair has been delivered, whether it is an unanticipated improvement or deterioration in function. A modular frame wheelchair allows for the change in the rear frame or front frame of the wheelchair to adapt the originally prescribed wheelchair to suit the person’s current condition, assuming a folding-frame manual wheelchair is still the most appropriate choice for that individual. Changing the configuration of a modular, folding-frame manual wheelchair to suit current needs often can be done through a change in parts. Again, this type of modification to an existing wheelchair tends to be less expensive to a funder and to a wheelchair owner, rather than purchasing an entirely new wheelchair. Thus, in prescribing a manual wheelchair for an individual, it is important to consider not only any possible changes to weight, but any possible changes in function or positioning needs. Consider the design of the folding-frame manual wheelchair and whether or not it may help to meet future needs – that is, begin with the future in mind!
As always, please provide your comments, questions and suggestions regarding Clinical Corner on my blog. I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, OT Reg. (Ont.)
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2013 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.