This month Elder Voice welcomes guest writer, Barbara Purdy, Physiotherapist and Occupational Therapist
I often see people in poorly fitted wheelchairs, sitting for hours, slumped over in pain and discomfort and unable to correct their own positions. They may have slid forwards, a sign of that discomfort, as they tried to find a more comfortable position. Well-meaning caregivers may give them Tylenol every 4 hours to help with the pain, instead of looking at the real problem – the lack of a properly fitted wheelchair which would provide good seating support and stability.
For anyone who uses a wheelchair for several hours a day, proper fit is absolutely essential.
Properly fitted wheelchairs maximize the ability of the user to do things for themselves, reduce the occurrence of skin breakdown, and minimize or eliminate pain from sitting for a long time. A well fitted wheelchair ensures comfortable sitting, allowing the user to relax and feel safe. In short, they contribute to the quality of a person’s life, and increase their ability to participate and interact with their environment.
People may mistakenly believe that sitting in a wheelchair is just like sitting in a regular chair except the wheels make it easier to move. And, they may wrongly assume that all wheelchairs are similar and you can just go and buy one. This is true, if the wheelchair is to be used only as a “transportation” wheelchair to move someone for short distances. These wheelchairs are not intended for people to stay in for a long time. The people in these chairs must be able to move themselves and they just need help moving from one place to another.
For short periods, sitting with poor posture in a poorly fitted wheelchair is usually not a problem, but for longer periods, joints, muscles and skin become stressed. People with a disability may sit for many hours a day without the capability to reposition themselves. This may result in poor posture and lead to complications of pain, discomfort, fatigue, tissue breakdown, contractures, infections, respiratory problems and reduced functional ability.
To ensure that a wheelchair is appropriate for the individual user, it should be measured and fitted by a professional such as an Occupational Therapist (OT). OT’s are trained to do thorough assessments that identify seating needs dictated by a person’s abilities and limitations. An Occupational Therapist’s assessment includes a physical assessment of the client, measuring hip width and angle, leg lengths, back curvatures and arm lengths and also takes into consideration how the person will use the wheelchair.
The assessment process continues when shopping for a wheelchair. The OT will work closely with a skilled Home Health Care equipment dealer who is experienced with the many different types and sizes of wheelchairs to determine the most appropriate one for the client.
In summary, selecting the best wheelchair is much more complicated than many people would think. The services of an Occupational Therapist can provide the best seating solutions so that the wheelchair use will have the greatest level of comfort and safety possible. Customized wheelchairs may cost more money, but consider that the person using the wheelchair may be sitting for 3 to 10 hours a day. Adapting a wheelchair for correct fit will have a major influence on comfort, function and quality of life.
Barbara Purdy, Reg. OT, Reg. PT, is the consultant Physiotherapist and Occupational Therapist for Diamond Geriatrics. She is also the owner of Free to Be Rehabilitation Consulting through which she produces emergency evacuation and worker safety programmes.
Modifying and Fitting Wheelchairs: Examples
by Barbara Purdy, Reg OT, PT
The following are just a few examples of modifying wheelchairs. Your Occupational Therapist, along with the home health equipment provider, can discuss others with you.
- Seat: Most wheelchairs have a “sling” seat to permit folding. Sitting directly on this sling can cause the pelvis to be out of alignment and may lead to back pain and skin breakdown. To give good pelvic alignment, the seat should have a firm base of support with a good cushion. There are several styles of cushions on the market providing different levels of pressure relief and support. These vary from foam to gels, liquid and air. Each supply various degrees of comfort and the type chosen is dependent on the client’s needs. As well, the overall size of the cushion is important, as it needs to provide support to the thigh. It must be entirely stable within the chair so that it does not become dislodged with the result that the individual sits at an angle, however slight.
- Wheels: The type of wheel chosen is partly determined by how the individual will be using the wheelchair. For example, if they will be pushing themselves, then customized placement of the wheels can make the chair easier to push. If they are dependent on others to push the wheelchair, the large wheels may not require an extra “push rim”. If they will be foot propelling; their feet will not get caught if the little front wheels are designed smaller.
- Wheelchair Seat Height: Chair heights will vary according to need or usage. For example, if the user is able to foot propel the wheelchair; the seat needs to be lower so they can reach the floor. But, if the seat is too low, they may not be able to get out of the wheelchair.
- Back Support: Many wheelchairs have a straight back. However, if a person has a curvature of the spine (called kyphosis) they will sit with their spine in a “C” shape. The flat back of the wheelchair does not accommodate their own back and they will be sitting slouched forward with their head protruding and looking down. A way of customizing the chair is to replace the straight back with a “personal back”. This personal back curves out so the curvature of the individual’s spine is supported. This helps them to keep their head in an optimal position so they can be looking forward not down.
Finding and Purchasing a Wheelchair
You can find an Occupational Therapist through the professional societies in your state of province. In B.C. It is the British Columbia Society of Occupational Therapists. If you are in hospital, you can be assessed for a wheelchair before discharge. Diamond Geriatrics associates will also do assessments for wheelchairs and other equipment as part of our assessments.
To purchase a wheelchair, you can go to any home health equipment company. They have personnel who can help you with the chair, but you should ask about their training before you purchase.
If you wish to purchase a used wheelchair, begin your assessment first, to make sure the basics of the chair fit your needs. You can then have the chair customized as the OT and home health company personnel work with you.
You can find used wheelchairs on Elderpost or on Craigslist. If you have a wheelchair which you do not need or other equipment, please post them for sale or to give away on Elderpost. Your kindness can save someone else a lot of money and help them to have equipment they might not otherwise be able to afford.
The Red Cross runs equipment loan programmes, for short and long term, and for palliative care. Eligibility for long term is based on a financial assessment. All referrals much come from a health professional, Diamond Geriatrics personnel can make those referrals for you. For more information click here