PRESCRIPTION OF WHEELCHAIR

By: Khushali JoganiThe Sarvajanik College Of PhysiotherapyRampura,Surat

Contents•Introduction•Parts of wheelchair•Checklist for prescribing wheelchair•Evaluation and Examiantion• Goals of prescription•References

Introduction

•Wheelchair prescription involves combined work of many professionals and Physical Therapists are the integral part of them.

•A properly prescribed wheelchair can be a useful device in reintegrating a person with a disability into the community.

•A wheelchair is truly a mobility orthosis.

•Wheelchair should fit correctly.•It should be cosmetic to the user.•Entire team should take decision as per the

patients condition and needs and should properly prescribe wheelchair.

•After prescribing, all team members are responsible for adjusting and final setting and teaching the patient and caregivers how to use and maintain the device.

Parts of wheelchair

Checklist

•The SEAT *2 checklist is used so the team can jointly understand, prioritize and agree on the goals that can be accomplished with wheelchair.

•It is an essential communication tool for entire team.

•Support(SCALPS) for Safety and Comfort /Cosmesis ,Arms, Legs, Pelvis, Spine and Head •Skin•Easy propulsion•Easy transfers•Alteration of tone•Accomodation (GrOW FAST) of Growth, Other(i.e

miscellaneous),Worsening medical condition,Functional activities,Structural deformities,Technology

•Transportability•Terrain

Evaluation

•Medical history -ask the patient ,family and caregivers

their understanding and expectations for the purpose of evaluation

-to know about the natural course of underlying disease

-so review of systems should be carried out(skin, cardiopulmonary and circulatory , gastrointestinal,renal,endocrine,neurologic,musculoskeletal)

•Surgical history -any past operations-any future plans for surgery-any fractures, decubitus ulcers and serious

injuries•Seating history-questions regarding all seats and positioning

aids used in past-about that equipment-any limitations about that equipment-how frequently and duration he used?

Examination

•Physical examination - It is done to know the person’s strength

and range of available movement. - to preserve spinal alignment whenever

possible maintaining natural lumbar curve

-ROM measurement

•Examination can be done -using existing equipment -supine examination -seated examination

•Using existing equipment -To observe the patient in his best or

assumed position -postural alignment at

head,shoulders,trunk,pelvis and lower extremities using visual observation and hands on palpation

-pelvic alignment by palpation along pelvis crests,ASIS

-position of pelvis(rotation, posterior or anterior tilt) should be noted

-trunk posture should be noted

•Supine examination

-patient should be transferred on firm surface-range of available pelvic and hip movements

as they relate to pelvic and spinal alignment should be determined

• Examination of upper and lower extremities evaluation in upper extremities include:-ROM and strength-grasp patterns-eye-hand coordination-joint stability-movement patterns-functional use of hands

Evaluation in lower extremities include:-ROM-joint stability-movement patterns and function-foot propulsion-weight bearing and transfers

•Seated examination

-sitting measurement to be done on thin seating surface so providing adequate knee flexion

•Evaluating complex medical condition-patients requiring passive positioning to

inhibit gastroesophageal reflux and facilitate gastric emptying

-patients with restrictive lung disease require therapeutic positioning for pulmonary toilet

-patients with aging and dementia have loss of depth perception so it should be prevented by providing security through more surface contact and comfort through cushioning

•Functional considerations It include-transfer skills and methods-size and arrangement of living and work

environments-need for rest and change of position to

maintain comfort-type of transportation available-type of propulsion used-optimal positioning for mobility and work-cosmetic factors affecting self esteem

Goals of prescription

•A well planned seating system should be able to:-

-normalize tone-decrease pathological reflex activity-improve postural symmetry-enhance range of movement-maintain or improve skin condition-increase comfort and sitting tolerance-decrease fatigue and improve ANS

•To achieve goals of prescription various equipments and positions are used for checklist. For eg:

-Safety(antitip devices, wide base, durable frames that wont break

-Comfort and cosmesis(allow patient to make cosmetic choices)

-Arms(arm rests and wrist wraps)

-Legs(abductor wedges,adductor pads, foot rests, leg rests, shoe holders, contoured seats)

-Pelvis and trunk(seat belts,pelvic positioners etc)

-Spine and head(high back, curved collars, custom head support etc)

-Skin(cushions, custom molded seats etc)

-Easy self propulsion(light weight equipment, position of wheels,high friction coated handrims)

-Easy transfers(swing away and detachable positioners, supports, accessories etc)

-Accomodation (considering ADLs, growth, prognosis etc)

-Alteration of tone(head position,hip position,skin support and comfort,short foot rests )

-Transportability(lightweight, removable or modular parts, folding)

-Terrain(brakes, grade aids, pneumatic tires etc)

•Other aspects- Consideration should be given to financial

status -alternate positioning is essential for skin

integrity, circulation,movement and comfort-follow up and maintenance

REFERENCES

•Rehabilitation medicine principles and practice

-Joel A Delisa (third edition)•Physical rehabilitation -Susan B O’ Sullivan (fifth edition)•The Rehabilitation specialists handbook-Jules N Rothstein•Textbook of Rehabilitation-S Sunder (second edition)

THANK YOU