Wheelchair Presciption / Evaluation
Auger, C., Demers, L., Gelinas, I., Jutai, J., Fuhrer, M., & DeRuyter, F. (2008). Powered Mobility for Middle-Aged and Older Adults - systematic review of outcomes and appraisal of published evidence. Americal Journal of Physical Medicine and Rehabilitation 87(8).
Brown, T. R. and J. Sliwa (2005). "Wheelchair prescription for People With MS: ask the right questions, get the right answers." International Journal of MS Care 7(3): 115-116.
Canning, B. (2005). "Innovations in practice. Funding, ethics, and assistive technology: should medical necessity be the criterion by which wheeled mobility equipment is justified?" Topics in Stroke Rehabilitation 12(3): 77-81.
The article will explore the use of the term medical necessity as it relates to wheeled mobility. Health insurance will cover a wheelchair if it is determined that it is medically necessary for a particular client. There are many different types of health insurance, and no universal definition of medical necessity. This presents a problem for clients and for individuals who are making wheelchair recommendations for clients. Case studies describe how equipment is currently recommended based on the limitations of the client's insurance coverage. As more equipment becomes available to improve the quality of life for people with disabilities, it will become harder for therapists recommending equipment to determine the limits of medical necessity.
Cooper, R. A. (2009). "SMARTWheel: From concept to clinical practice." Prosthetics and Orthotics International
33(3): 198-209.
Wheelchair prescription is complex with thousands of choices and options. Theoretically, a higher quality or innovative wheelchair that is appropriately matched to the user and their unique needs will increase participation. It is well accepted that there is an alarmingly high incidence of carpal tunnel syndrome, and rotator cuff injuries among manual wheelchair users. Since the initial conceptualization, the SMART(Wheel) was intended to better understand the physiological and physical effects of wheelchair propulsion on the body. Initially, little was known about wheelchair propulsion and the SMART(Wheel) transformed the nascent field of wheelchair propulsion biomechanics. Although still an important area of clinical research, the SMART(Wheel) has been critical to the study of the relationship between the type of wheelchair, set-up, activity, technique, anatomy, and physiology and repetitive strain injury. There has been growing evidence that the wheelchair-user interaction explains a substantial portion of the risk of developing a degenerative injury and on community participation. A noteworthy contribution of this work was the release of the clinical practice guideline, entitled, Preservation of Upper Limb Function Following Spinal Cord Injury in 2005. The SMART(Wheel) has been used by other scientists in areas that were not originally envisioned to be applications. It has been used to support the design of tools for developing a trail mapping rating and description system. It has also supported the design of accessible pedestrian walkways standards, accessible playground surfaces, and to evaluate carpets for wheelchair accessibility. It is likely that there are more new areas of exploration to emerge. This article describes the evolution of the SMART(Wheel) as new technologies became available and its applications in the field of wheelchair biomechanics and clinical service delivery.
Di Marco, A., M. Russell, et al. (2003). "Standards for wheelchair prescription." Australian Occupational Therapy Journal 50(1): 30-39.
Wheelchair prescription for individuals with a spinal cord injury is a highly complex and challenging clinical intervention. Evidence exists that successful outcomes are not always achieved for the wheelchair user and that therapists are experiencing increasing pressure to be accountable for and to justify their wheelchair prescription practice. This paper describes the process of establishing an evaluation of wheelchair prescription practices by occupational therapists in a spinal injury rehabilitation unit in South Australia. The evaluation process centred on the development of standards of practice to monitor performance and led to improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery. Steps taken to develop the standards of practice to monitor performance and the benefits and limitations of the evaluation are described.
Finucane, C. (2006). "Equipment. Choosing a suitable powered wheelchair: a guide." International Journal of Therapy & Rehabilitation 13(2): 87-90.
A number of factors need to be considered when prescribing the right wheelchair for a client, including the user's disability, long-term needs, functional ability, size and sitting ability. The correctly prescribed product has a huge impact on the user's quality of life and thorough assessment is therefore vital. Powered wheelchairs have the advantage of providing ease of movement, speed and more independence for the user.
There is a vast range of powered wheelchairs to meet different users' needs. This article offers information on the different types of electric wheelchairs and their features. It aims to provide a useful guide for occupational therapists involved in wheelchair assessment and prescription.
Gavin-Dreschnack, D. J. (2003). Development of a safe wheelchair seating screening tool, University of South Florida. Ph.D.: 92 p.
The premise of this study is that elderly nursing home residents who need wheelchairs are not being assessed individually to ensure proper prescription for safe mobility, and as a result, are placed at increased risk of critical health problems. Individualized prescriptive (adaptive) wheelchair seating has traditionally been an overlooked intervention in the long-term care setting. Lack of awareness and lack of funding are most often cited as the two major barriers to implementation of wheelchair seating programs in long term care settings. To explore the ability of nursing home staff to identify potential wheelchair seating needs, the present study involved the development, implementation, and evaluation of a "Resident Ergonomic Assessment Profile for Seating (REAPS)" for use with different raters employed within the nursing home of a veterans medical center. Fifty subjects were recruited and assessed by four raters and one expert criterion. Based on previous pilot study work, it was hypothesized that the REAPS would show substantial interrater and test-retest agreement, and that the expert opinion would provide concurrent validity for the REAPS. It was anticipated that there would be differences in REAPS scores between participants with and without skin problems and with and without swallowing problems, and that REAPS scores would be predictive of wheelchair mobility, head angle, and patient-perceived comfort.
Results indicated modest to excellent interrater and test-retest agreement with mixed results on certain questions. Expert opinion provided significant concurrent validity of the REAPS, and with the exception of the LPN, there was moderate sensitivity of the REAPS. There were no significant differences in REAPS scores between those subjects with and without skin problems, and those with and without swallowing problems. However, there was a trend suggested by the expert, as he recommended change for seven of the nine subjects with skin problems, and for twelve of the fifteen subjects with swallowing problems. REAPS scores were predictive of mobility and head angle, but not discomfort. With some revisions, the REAPS may offer excellent potential as a brief wheelchair seating screening tool for use in long term care settings.
Gavin-Dreschnack, D. (2004). "Effects of wheelchair posture on patient safety." Rehabilitation Nursing 29(6): 221-226.
Wheelchairs originally were designed to transport people from one place to another quickly and easily. They have evolved to rank among the most important therapeutic devices used in rehabilitation. Currently, an estimated 2.2 million people who use wheelchairs generally are living longer and moving about more. However, the increased use of wheelchairs has been accompanied by many types of adverse events and repetitive stress injuries. Wheelchair prescription, posture, training, and maintenance are critical components of safety in this population, and may be enhanced through increased awareness and education. Since nurses and nursing staff are most often involved directly with wheelchair users (particularly in long-term-care settings), providing specialized programs for adaptive wheelchair fitting allows for a proactive approach to seating problems.
Gregorio-Torres, T. L. (2006). "Wheelchair and seating evaluation: an occupational therapy approach." OT Practice 11(11): CE-1-CE-8, 2p.
"Occupational therapy practitioners' understanding of their clients' daily occupational needs, abilities, and contexts make them ideal collaborators in the design, development, and clinical application of new or customized technological devices" (American Occupational Therapy Association [AOTA], 2004, p. 678). It is understood that occupational performance results from the complex interaction of an individual performing an occupation within contexts (AOTA, 2002). An effective wheelchair mobility system is perhaps the most essential tool that persons with mobility impairments use to regain some of the control lost as a result of trauma or disease. Having an optimal wheelchair and seating system is crucial to occupational success whether a person is pursuing a career, managing a household, or volunteering in the community. An appropriate mobility system improves the likelihood that a person will have a healthy, productive life. Prescribing an appropriate wheelchair and seating system can be daunting for any occupational therapist, especially for today's therapist. Over the past 20 years, an explosion of new technology has greatly enhanced the effectiveness of seating for persons needing a wheelchair. At the same time, these advances in mobility technology have presented many challenges to occupational therapy practitioners who wish to stay abreast of the latest options (Cooper, 1998; Isaacson, 2004). In contrast, as wheelchair technology has expanded, financial issues surrounding the payment for such systems have become increasingly complex and, at times, very limiting. Most recently, changes in Medicare coverage guidelines for powered mobility challenge therapists to adapt their practice in this area once again. This article presents an overview of the elements of an effective evaluation for mobility and seating systems, with an emphasis on occupational outcomes, and outlines resources and ways to continue to remain current in this ever-changing aspect of practicea.
Guerette, P., D. Tefft, et al. (2005). "Pediatric powered wheelchairs: Results of a national survey of providers." Assistive Technology 17(2): 144-158.
A national survey of providers of pediatric powered wheelchairs was conducted to collect background data on these professionals and to develop a "model" of their current assessment and recommendation practices. Data collected in the survey included provider demographics, frequency of powered wheelchair provision to young children, common reasons for not recommending a powered wheelchair, reasons why a child who is recommended a powered wheelchair does not receive one, current pediatric powered wheelchair assessment and recommendation practices, and subjective data regarding the efficacy of these practices and the impact of powered wheelchairs on children. Respondents rated the frequency with which they performed various wheelchair assessment and recommendation practices, and these ratings were analyzed to determine activities that were performed frequently. These activities were then combined into common "factors" using factor analysis, and the results of the factor analysis were used to create a model of current pediatric powered wheelchair assessment and recommendation practices. A total of 140 surveys were received from providers in 46 states. Of these providers, 54% were clinicians (e.g., physical therapists, occupational therapists), and 46% were suppliers (e.g., Rehabilitation Technology Specialists), representing a variety of geographic locations and facility types. The 3 major reasons for not recommending a powered wheelchair included cognitive, physical, and behavioral factors. The 3 major reasons why a child who is recommended a powered wheelchair does not receive one included funding issues, lack of family support, and transportation issues. The model of current pediatric powered wheelchair provision includes 4 assessment factors: Preliminary Clinical Assessment, Intake, Advanced Clinical Assessment, and Consideration of Other Factors. Typical recommendations include both therapeutic and nonclinical interventions. A modified version of this model, which addresses some issues identified in the survey that limit wheelchair recommendations, is currently being tested at 4 clinical sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Huhn, K., P. Guarrera-Bowlby, et al. (2007). "The clinical decision-making process of prescribing power mobility for a child with cerebral palsy." Pediatric Physical Therapy 19(3): 254-260.
PURPOSE: Powered mobility has been shown to be an effective method for children with disabilities to achieve independent mobility. The purpose of this case report is to describe the physical therapist's clinical decision making related to power mobility for a child with multiple disabilities. CASE DESCRIPTION: Power wheelchair evaluation for a nine-year-old child was conducted using Furumasu's tasks for wheelchair readiness moving through a doorway, maneuvering through three cones, and driving in a hallway. Ongoing team assessment with family consultation informed clinical decision-making. OUTCOMES: A mid-wheel-drive chair afforded improved performance on Furumasu's tasks compared with a rear-wheel-drive chair. SUMMARY: This case describes the clinician's role in prescribing power wheelchairs to affect the user's functional skills, as well as how, in the absence of evidence, clinical experience and patients' needs can guide clinical decision-making.
Jan, Y.-K., Jones, M., Rabadi, M., Foreman, R., & Thiessen, A. (2010). Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 91(11), 1758-1764.
Karmarkar, A. M. (2010). Prescription, outcomes, and risk assessment of wheelchairs for aging population. US, ProQuest Information & Learning. 70.
Older adults are the largest and fastest growing users of wheeled mobility devices (wheelchairs). Research in the areas of: utilization; and outcomes is very limited. Lack of evidence based research often results in the provision of lower quality of wheelchairs to aging adults. This problem is more predominant for those living in Nursing Homes (NH) or other institutional settings. The goal of this dissertation work was to present a continuum of research studies, conducted with older adults that emphasized on: the development of a methodology (utilization review); measurement of outcomes; and identification of problems associated with use of wheelchairs that may pose a threat to the health, and safety of older adults. We anticipate that the overall outcomes of this work will help rehabilitation professionals to move towards performing utilization reviews through appropriate use of clinical environment. Such research will help in both the development of standard of care guidelines, and proving effectiveness and efficiency of service provision. We also expect to see this work influencing the outcomes research for older adults using wheelchairs. This will help in needs assessment of potential users (of wheelchairs) and will also help to evaluate: quality of services (devices) provided, and impact of types of wheelchairs on mobility and safety of users. Finally, we anticipate to see application use of the Wheelchair Assessment Checklist (WAC) by clinicians in detection of problems associated with wheelchairs and prevention of component failures, which in turn, will control (to some extent) the occurrence of unintentional (acute and chronic) injuries.
Kirby, R., Bennett, S., Parker, K., & Thompson, K. (2008). Wheelchair kerb climbing: randomised controlled comparison of highly structured and conventional training methods. Archives of Physical Medicine and Rehabilitation, 89, 2342-2348.
Kittel, A., Marco, A. D., & Stewart, H. (2002). Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury. Disability and Rehabilitation, 24(1/2/3), 106-114.
Koontz, A. M., E. D. Brindle, et al. (2010). "Design features that affect the maneuverability of wheelchairs and scooters." Archives of Physical Medicine & Rehabilitation 91(5): 759-764.
OBJECTIVE: To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. DESIGN: Case series. SETTING: University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. PARTICIPANTS: The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). INTERVENTION: A mock environment was constructed to create passageways to form an L-turn, 360 degrees -turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. MAIN OUTCOME MEASURE: Minimum passageway widths for the 4 maneuverability tasks. RESULTS: Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360 degrees -turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. CONCLUSIONS: Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas
Laffont, I., HGuillon, B., Fermanian, C., Pouillot, S., Even-Schneider, A., Boyer, F., et al. (2008). Evaluation of a stair-climbing power wheelchair in 25 people with tetraplegia. Archives of Physical Medicine and Rehabilitation, 89, 1985- 1964.
Lee Kirby, R., Heimrath, O., Stewart, A., Smith, c., & MacLeod, D. (2010). Effect of Respiration on the Static Rear Stability of Wheelchairs. Archives of Physical Medicine and Rehabilitation, 91(8), 947-950.
Mortenson, W. B., W. C. Miller, et al. (2007). "Measuring wheelchair intervention outcomes: development of the Wheelchair Outcome Measure." Disability & Rehabilitation: Assistive Technology 2(5): 275-285.
Purpose. Provision of a wheelchair has immediate intuitive benefits; however, it can be difficult to evaluate which wheelchair and seating components best meet an individual's needs. As well, funding agencies now prefer evidence of outcomes; and therefore measurement upon prescription of a wheelchair or its components is essential to demonstrate the efficacy of intervention. As no existing tool can provide individualized goal-oriented measure of outcome after wheelchair prescription, a research project was undertaken to create the Wheelchair Outcome Measure (WhOM). Method. A mixed methods research design was employed to develop the instrument, which used in-depth interviews of prescribers, individuals who use wheelchairs and their associates, supplemented by additional questions in which participant preferences in key areas of the measure were quantified. Results. The WhOM is a client-specific wheelchair intervention measurement tool that is based on the World Health Organization's International Classification of Function, Disability, and Health. It identifies desired outcomes at a participation level and also acknowledges concerns about body structure and function. Conclusion. The new outcome instrument will allow clients to identify and evaluate the outcomes they wish to achieve with their wheelchairs and seating and provide clinicians a way to quantify outcomes of their interventions in a way that is meaningful to the client and potential funding sources.
Mortenson, W. B., W. C. Miller, et al. (2007). "Measuring wheelchair intervention outcomes: Development of the Wheelchair Outcome Measure." Disability and Rehabilitation: Assistive Technology 2(5): 275-285.
Purpose: Provision of a wheelchair has immediate intuitive benefits; however, it can be difficult to evaluate which wheelchair and seating components best meet an individual's needs. As well, funding agencies now prefer evidence of outcomes; and therefore measurement upon prescription of a wheelchair or its components is essential to demonstrate the efficacy of intervention. As no existing tool can provide individualized goal-oriented measure of outcome after wheelchair prescription, a research project was undertaken to create the Wheelchair Outcome Measure (WhOM). Method: A mixed methods research design was employed to develop the instrument, which used in-depth interviews of prescribers, individuals who use wheelchairs and their associates, supplemented by additional questions in which participant preferences in key areas of the measure were quantified. Results: The WhOM is a client-specific wheelchair intervention measurement tool that is based on the World Health Organization's International Classification of Function, Disability, and Health. It identifies desired outcomes at a participation level and also acknowledges concerns about body structure and function. Conclusion: The new outcome instrument will allow clients to identify and evaluate the outcomes they wish to achieve with their wheelchairs and seating and provide clinicians a way to quantify outcomes of their interventions in a way that is meaningful to the client and potential funding sources.
Sabol, T. P. and E. S. Haley (2006). "Wheelchair evaluation for the older adult." Clinics in Geriatric Medicine 22(2): 355-375; ix.
This article focuses on basic principles of seating and wheelchair evaluation for the general population. The discussion includes wheelchair options, components, and accessories. Basic principles to guide the clinician in the process of selection for maximum function are addressed
Samuelsson, K. A. M., H. Larsson, et al. (1999). "Wheelchair intervention -- a client centered approach." Technology & Disability 10(2): 123-127.
The experience physiotherapists and occupational therapists gain from wheelchair prescription, adjustment and adaptation, is often a form of practical knowledge which may be difficult to generalize and communicate. This paper presents a method to make this experience and the discussion about goals and ranking of wheelchair functions more explicit and more systematically documented. According to our practice, illustrated by a case study, it seems to be a helpful tool for decision and evaluation in the individual cases. The next step will be to use this approach to gather quantitative data from different groups of clients.
Ward, A. L., M. Sanjak, et al. (2010). "Power wheelchair prescription, utilization, satisfaction, and cost for patients with amyotrophic lateral sclerosis: preliminary data for evidence-based guidelines." Archives of Physical Medicine and Rehabilitation 91(2): 268-272.
OBJECTIVES: To determine the features most frequently selected in a power wheelchair (PWC), level of satisfaction with the selections, and how often the PWC features are used by patients diagnosed with amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). DESIGN: Internally generated questionnaire. SETTING: An ALS/Muscular Dystrophy Association center. PARTICIPANTS: Convenience sample of current patients (N=45) of our clinic with ALS/MND who are PWC users (men, n=27; women, n=18; age range, 27-85 y). INTERVENTION: Self-administered survey. MAIN OUTCOME MEASURE: Thirty-two patients completed a 31-question survey investigating patients' patterns of selection, satisfaction, and frequency of PWC use; technical and psychometric influences; and other aspects of decision-making processes that patients experience before, during, and after acquiring a PWC. RESULTS: Ninety percent of respondents received their evaluations at a multidisciplinary ALS clinic, 1 via the Department of Veterans Affairs, and 1 was unknown. Sixty-six percent of patients thought the chair evaluation was timed correctly, and 19% wished they had started sooner. Forty-five percent of people were able to walk a few steps, and 55% were able to stand when their chairs arrived. When they first received the chair, 79% were satisfied with the overall comfort of the chair, and 86% were satisfied with the ease of use; currently, 69% are satisfied with the overall comfort, and 72% are satisfied with ease of use. There was a statistically significant difference in how patients used their wheelchair features initially and currently in terms of seat elevate and attendant control, but not tilt, recline, and elevating leg rests. The average cost for the power chairs was $26,404 (range, $19,376-$34,311), and the average cost a month is $917. Overall, 88% of respondents said they would get the same type of chair with the same features again, and 81% felt that the chair was a good value for the cost. CONCLUSIONS: We obtained first-hand knowledge from 32 patients with ALS/MND who are current PWC users on their use and satisfaction with their PWCs from initial to current use. Based on this survey, patients with ALS/MND seen for their wheelchair evaluation with experienced clinicians exhibit high use and satisfaction with their PWCs.
White, E. (2003). "Impact of training for wheelchair service specialists." British Journal of Therapy & Rehabilitation 10(2): 60-63.
This article aimed to assess the effect that course attendance had made to both personal and service developments by surveying 30 occupational therapists, physiotherapists and engineers who had attended a university-validated level 3 training course on wheelchair prescription and provision for professional practice.