Wheelchair Prescription Health Article

Definition

A wheelchair is a mobile chair used by individuals who have impairments that limit their ability to walk. A wheelchair prescription defines the specifications of a chair according to an individual's particular needs.

Purpose

Wheelchairs are used either as primary or secondary means of mobility, depending upon the extent of an individual's functional limitations. When using a wheelchair as a primary means of mobility, an individual may spend the majority of his or her day in the chair and use it for movement within his or her home, work, school or community setting. As a secondary means of mobility, a chair may be used just for longer distances by an individual who has low endurance or tolerance for walking. The wheelchair prescription is used to define the type of wheelchair required, seating needs, and details about components.

Description

Selection of a wheelchair, its fit, and components depends largely on the following factors:

• What are the patient's disability, medical, and management issues? These can include considerations such as level of independence, pressure relief, orthoses, etc.
• What is the patient's size, weight, and posture? Does the patient need a heavy-duty chair? Is there a fixed scoliosis or kyphosis that needs to be accommodated?
• What is the individual's functional ability? Sitting balance, ability to transfer oneself and provide pressure relief, upper extremity strength and dexterity, and cognitive level are just a few of the things that must be considered.
• What are the patient and family goals for using the chair? What has been tried already? Will the chair be used as a primary or secondary means of positioning and mobility? Will it be used around the house, at school/work, outside, for sports participation?
• What are the environmental concerns? Access to public and private settings, including work, school, libraries, and transportation, must be considered. Is the individual's own home wheelchair-accessible?
• What are the funding issues? The cost of basic and special features, sources of funding, rental/leasing options, future maintenance, and upgrade costs should all be considered.

The prescription should include the following categories of specifications:

Type of wheelchair

There are standard and heavy-duty adult chairs, in addition to junior, youth, and "growing" frames. In a user assessment study in 2000, ultra lightweight chairs with a high degree of adjustability were shown to be preferred over lightweight chairs for ride comfort and ergonomics in long-term wheelchair use. Chairs for people with hemiplegia include a seat that is lower to accommodate for propulsion with a lower extremity. One-hand drive chairs allow a chair to be propelled with one handrim controlling both wheels. Chairs for people with lower-extremity amputations are designed to widen the base of support, compensating for the loss of anterior weight. Sports wheelchairs are lighter and easier to maneuver, for active individuals. They include a lower back, canted

wheels for more efficient propulsion, and small handrims. Reclining and tilt wheelchairs offer individuals the opportunity to either recline, opening up the angle at the hips, or tilt their entire position back. Reclining chairs tend to be used for relief from orthostatic hypotension, while tilt chairs address pressure relief and gravity-assisted positioning. Power wheelchairs may be used by individuals who would have difficulty with operating a manual wheelchair. Dependent bases, which allow only for a caregiver to push the chair, also exist; however, great care must be taken in choosing this option because it does not allow for the user to self-propel the chair in any capacity.

Standard measurements

Measurements should be taken with the individual seated on a firm surface in an erect posture. The individual may require physical support to maintain this position while being measured. If an additional seat cushion or back will be used with the chair, those measurements also must be figured in to the individual measurements.

Specific formulas exist and should be used to determine: seat height, depth and width; back height and armrest height. The size of a standard adult wheelchair is:

• Seat width = 18 in (45 cm).
• Seat depth = 16 in (40 cm).
• Seat height = 20 in (50 cm).

Standard sizes exist for smaller adults and children as well; custom fabrication also is available but can be costly.