Clinical Corner

We are in strange times.  COVID-19 has become a global pandemic.  People are practicing social distancing to “flatten the curve”, or as I like to say, we are practicing physical distancing with social cohesion to help stop the spread of COVID-19 and to ease the strain on overburdened healthcare systems.  People are aware of the need for frequent hand-washing and the need for frequent cleaning of high contact surfaces.  As health care professionals, we have always been aware of the need to practice infection prevention and control in our practice settings.  Now is a good time to review best practices for cleaning and disinfecting seating and mobility equipment.

Last month, Clinical Corner addressed frame length in rigid frame wheelchairs.  The difference between standard and classic frame lengths and the resulting effects on wheelbase, turning radius and maneuverability were reviewed.  If you missed that article, click here to read it.  This month, Clinical Corner will address frame angle and front inset on rigid frame wheelchairs and some of the key considerations associated with them. 

Clinical Corner addressed rigid frame wheelchairs in the article, Understanding Choices in Rigid Wheelchairs, in March 2019.  The article described what a rigid wheelchair is, how some models may permit folding (e.g., with fold-down back posts), and why a rigid wheelchair tends to offer greater efficiency of propulsion over a wheelchair with a folding cross-brace.  The article also outlined various choices in rigid frame wheelchairs, including open frame and closed frame designs, “active” models and adjustable models, and why so many choices are available on the market, even within a single manufacturer.  If you missed that article, click here to read it.  This month, Clinical Corner will continue to look at rigid frame wheelchairs, with a focus on frame length and why it is important to understand choices offered. 

Last month, Clinical Corner re-visited the topic of batteries in power wheelchairs and provided an update regarding sizes and types of batteries and battery chargers.  If you missed the Power Wheelchairs: Batteries article, click here to read it.  This month, Clinical Corner will address the topic of battery maintenance to answer the questions I often receive about how to care for batteries in power wheelchairs. 
 

This month, Clinical Corner will re-visit the topic of batteries in power wheelchairs.  This topic was first addressed in a 2012 blog post, De-mystifying Power Wheelchairs: Batteries and Motors.  (Click here to read the 2012 article.)  This month, Clinical Corner will review and update the information first presented in 2012 regarding batteries.  Batteries are an important consideration in power wheelchairs as they provide the power required to operate the system. 

If you follow Clinical Corner, you will notice that the article in October often is a little different than usual.  October marks another anniversary with Sunrise Medical for me.  It is 9 years now!  October also marks Occupational Therapy month nationally.  What better way to celebrate both than with a focus on clinical resources available on the Sunrise Medical website.  In addition, this article will look back at Clinical Corner with a catalogue of Clinical Corner articles for ease of reference.  You may want to Bookmark this page!

September often is thought of as a time for new beginnings.  School begins for school-aged children.  Depending upon where you live in the country, the leaves may be starting to change colour signalling the beginning of autumn.  Registration is open for our next Cyber Series of webinars for therapists, therapist assistants, funders and vendors in Canada!  The first webinar in our annual series is on “The Assessment Process” as the assessment is the beginning for all seating and mobility.  A thorough assessment provides a solid foundation for what follows in seating and mobility prescription.  This month, Clinical Corner will discuss considerations prior to the assessment – what should be on-hand to ensure optimal results from the physical assessment.

The focus of Clinical Corner for the past 2 months has been on outcomes and outcome measures.  The June 2019 article, Outcomes and Outcome Measures in Seating and Mobility: Current Practice, distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding their use of outcomes and outcome measures.  The July 2019 article, From Outcomes to Outcome Measures: Next Steps, reviewed the relevance of outcome measures and the key considerations when selecting outcome measures. Clinical Corner will continue the theme on outcome measures this month with a focus on specific outcome measures that can be used in seating and mobility.

Last month, Clinical Corner distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding the use of outcomes and outcome measures.  See Outcomes and Outcome Measures in Seating and Mobility: Current Practice to refer to that article.  This month, Clinical Corner will continue its focus on outcome measures with a look at key considerations when selecting outcome measures.

There is a subtle difference between outcomes and outcome measures in seating and mobility. Whereas outcomes may include subjective descriptions, outcome measures can be objective, quantifiable means of validating interventions. The results of an on-line survey suggest that many therapists involved in seating and mobility in Canada consider outcomes when working with clients. Some outcomes, such as pressure mapping, sitting tolerance and using SMART goals, allow for some aspect of measurement to occur. A future Clinical Corner article will provide additional details on outcome measures that help to provide objective quantification of outcomes such as those mentioned in this month’s article.

What are the similarities and differences between assessing an individual for a power mobility device versus a manual wheelchair? What is important to consider for a power wheelchair versus a manual wheelchair? Does it matter if an individual cannot drive effectively the first time they use a power wheelchair? These questions, and more, will be answered this month in Clinical Corner.

This month, Clinical Corner has reviewed the updated terminology used for pressure injuries and the staging of pressure injuries. In addition, the position statements of the NPUAP related to pressure injuries have been reviewed. More information on Pressure Injuries can be found on the NPUAP website.

Rigid frame wheelchairs offer some choice in the type of frame – from open frame to closed frame and from fully welded to models with fold-down back canes. Some models of rigid wheelchairs provide adjustability in the rear axle while others are fully fixed. Rigid frame wheelchairs promote efficiency of propulsion due to their light-weight design and minimization of moving parts, which allows for more efficient propulsion. A thorough assessment is required in order to match the needs of clients with the products that are available on the market for optimal fit, function and performance.

There is never going to be one model of wheelchair that is right for every client. Manufacturers recognize this and often provide several models of wheelchairs within a category to meet the various needs and demands of clients. This allows for optimizing both fit and function for a client through the selection of an appropriate model of wheelchair. How we choose between models of wheelchairs goes back to the assessment and then matching the goals of seating and mobility with the choices that are available.

Just as there are many factors that contribute to the risk for falls, there are many interventions to address the risks. A multi-disciplinary, multi-factorial approach is important to take for older adults who are identified at high risk for falls.