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.
The Assessment Process
Whether a manual wheelchair or a power wheelchair is being considered as a mobility device for an individual, a thorough assessment must be completed! The assessment includes an interview and a hands-on assessment. For more information on the assessment and the steps to wheelchair provision, please refer to these previous Clinical Corner articles:
Using a structured assessment form helps to ensure that vital information is captured during the assessment. For a sample Seating and Mobility Assessment form, see the JAY Seating Assessment Form.
When assessing an individual for a power mobility device, it is important to remember that the evaluation is for the potential to use a power device, rather than for a specific device at the outset. Does an individual understand the concept of movement? Cause and effect? Stop and go? Directions? An individual does not need to drive proficiently the first time they use a power wheelchair as it is important to remember that all individuals will require training on the use of the power mobility device! A future Clinical Corner article will address more on power mobility training.
When assessing an individual for a manual wheelchair, method of propulsion must be considered. The method of propulsion – hands, feet, or a combination of the two – will have an effect on the set up of the wheelchair. In establishing the potential to use a power mobility device, identification of how the client will operate the wheelchair is required. Will the client be able to use a standard joystick, mounted to either the right or left side? Will a standard handle on the joystick suffice, or will an alternate handle be required to accommodate any limitations in hand function? If the hand cannot be used to control a standard joystick gimble, what alternate access site will be used? Potential alternate access sites include the fingers (for operation of a micro control), knee, foot, toes, head, chin, cheek, and the mouth. Reliable, consistent movement in two directions (e.g., flexion and extension) is required in order to operate an input device, such as a switch.
For more on specialty input devices, refer to the previous Clinical Corner articles:
Considerations in Power Mobility
Prior to determining the type of power mobility device that will be trialed, there are several key considerations to be addressed during the assessment process to determine if power mobility is a feasible option for a client. One consideration is home accessibility – will home modification be required for accessibility into/out of the home? Does the interior of the home permit the movement of a powered mobility device, given the greater turning radius of a power wheelchair compared to a manual wheelchair? Where will the power wheelchair be stored when not in use? Is an electrical outlet nearby to permit charging of the batteries? Who will be responsible for charging the wheelchair?
Another consideration is transportation. For an individual who is able to transfer to the original equipment manufacturer's (OEM) seat in a vehicle, a manual wheelchair with power assist may be more easily transported in a private vehicle than a power wheelchair. A manual wheelchair is lighter in weight than a power wheelchair. In addition, a manual wheelchair may fold, either through the cross-brace or possibly through the back canes. With the introduction of a power wheelchair, vehicle modifications may be required if the individual is using a private vehicle, whether or not the client transfers to the OEM vehicle seat. If the client transfers to the OEM vehicle seat, the power wheelchair must still be secured into the vehicle for safety during transportation. If the client remains seated in the power wheelchair during transit, a lift may be required for access to the vehicle and then securement of the wheelchair and restraint of the individual while in the wheelchair will need to be established.
Another consideration that is part of the assessment is determining what other devices the client will be controlling through the wheelchair. For example, will an augmentative and alternative communication (AAC) device be operated through a switch mechanism? Will Bluetooth or infrared technology be required to operate devices through the joystick?
The potential need for power positioning devices will also be considered during the assessment. This includes the need for power tilt, recline, elevating leg supports/power centremount, and/or seat elevate.
For more information on the clinical indications for these dynamic positioning components, refer to these past Clinical Corner articles:
Prior to Wheelchair Trial
Equipment recommendation and selection follows the assessment. The seating and mobility goals that are established as a result of the assessment are used to identify products that have the features and capabilities required to meet the identified goals. It is important for a client to trial the seating and wheelchair, or a reasonable approximation, prior to its prescription to determine how well the seating and mobility system will meet the client's needs in the client's environment. Prior to a client trialing a power wheelchair, it is critical that the seating and positioning is optimal for the client. In addition, the programming of the wheelchair must be optimal for the client. A therapist must understand the programming parameters set on the wheelchair prior to a client using the power device in order to anticipate how the device will respond to the client's commands through whichever input device is used.