Wheelchair Intervention: Principles and Practice

Abstract

The purpose of wheelchair interventions is to compensate for reduced walking ability, or the lack of it, with the ultimate goal to enable the individual’s activity performance and participation in society as well as quality of life. Occupational therapists working in this field have to have high-quality competence in products, health risks associated with using them, and the service delivery process. A successful solution is based on a therapeutic understanding of the interaction between the user, the assistive device, and the environment. It is especially important to note that in addition to providing mobility, a wheelchair is also a chair, which should comfortably and ergonomically seat the user while supporting effective mobility. Regular follow-ups of the prescribed wheelchair increase the professional’s knowledge and secure good clinical practice, enhancing the users’ occupational performance.

After my wheelchair got adapted to me and my needs, it became possible for me to cook and to go out with my friends.

Client

Case Study

Matching Maria’s Present Occupational Status to a Wheelchair: A Multifaceted Task

Keywords: Activity, Client-centered, Ergonomics, Evaluation, Participation, Prioritization

Introduction

The theme of this case study is to select a wheelchair and to match the wheelchair to the client’s needs, considering both mobility and seating as well as risks for the client.

Important references are:

• Engström B (2002) Ergonomic seating: a true challenge: seating and mobility for the physically challenged: risks and possibilities: when using wheelchairs. Posturalis Books.

• Stein F, Söderback I, Cutler SK, Larson B (2006) Occupational therapy and ergonomics. applying ergonomic principles to everyday occupation in the home and at the work, 1st edn. Whurr/Wiley, London/Philadelphia, pp 92–116

Overview of the Content

The aim of this case study is to come up with a suggestion for useful assessments, suggestions for solutions, and how to evaluate results.

The students’ tasks include:

• How to identify information that is needed in order to come up with a suggestion for a solution

• To identify risk factors to be considered

• To plan how to train Maria for efficient wheelchair use

• To identify how to follow-up and evaluate the suggested intervention

The Background History of Maria

Personal Information

The client is a female (Maria), 42 years of age, suffering from multiple sclerosis (MS) for more than 10 years. Maria is married and has two children (12 and 14 years of age). She lives with her husband and children in a villa with a big garden just outside the city. Maria works part-time at the office of a car dealer where she has been working for more than 10 years. She handles the bookkeeping and billing, and is very pleased with her work.

Maria drives her own adapted car to and from work; she has the responsibility for most household activities such as cooking, washing, and cleaning, while her husband does the grocery shopping. Maria drives her children to and from various activities and is an active parent both at school and in the leisure activities of her children. Her husband has a company of his own and works a lot.

Medical Information

During the latest couple of months, Maria’s disability has increased. She is now unable to walk more than a very short distance. Maria has realized that she will need some kind of wheelchair to cope with her everyday life, and therefore she seeks help from her occupational therapist (OT). Maria asks the OT for a wheelchair which will fit her and her needs.

Occupational Therapy Intervention

When meeting her OT, Maria identifies several needs related to her reduced balance, and problems in moving around by walking, both indoors and outdoors . She informs the OT that she needs a wheelchair, which is easy to transport, since she needs to bring it with her in the car. It is also important that it is possible for her to sit and work in the wheelchair, if needed. At home, the wheelchair will be used mostly outside in the garden where Maria likes to take care of all the flowers. Since there are some gravel paths in the garden, Maria is afraid that it will be very hard to propel a manual wheelchair there. The wheelchair must also be easy to propel since Maria moves about a lot at her workplace . There are no stairs at her workplace and all doorways are wide enough for a wheelchair.

The Student’s Report

The following guiding questions are to be considered in developing possible solutions to Maria.

• What do you need to know more about Maria’s physical conditions, which might have an effect on the choice of the wheelchair product and how it should be fitted?

• Are there other aspects of activity and participation that you need to ask Maria about, before making suggestions on a final solution?

• Do you see any risk related to wheelchair use, which you should keep in mind and consider in the matching process?

• How would you like to follow up results from this intervention?