What is typically included in a wheelchair assessment?
Assessment is typically done with a wheelchair supplier and a clinician. The clinician looks at the clinical and functional aspects of the wheelchair, but the wheelchair supplier knows the equipment well and can match specific client parameters to product features.
Lightweight, ultra-lightweight, pediatric, and bariatric manual chairs are considered complex rehab equipment. Complex rehab equipment is typically recommended by someone with a specific credential, ATP, or Assistive Technology Professional. This is a certification from RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America. Depending on the funding source, a person must have an ATP certification to recommend complex rehab-level chairs.
Some suppliers and clinicians may also have an additional certification called the SMS, Seating, and Mobility Specialist. The ATP is a more general assistive technology examination, whereas the Seating and Mobility Specialist certification is an extra layer of expertise in this area. When we are assessing, the supplier must have adequate experience, including an ATP certification.
- Strength, range of motion, muscle tone, and orthopedic status
- Cardiopulmonary status and fatigue
- Potential for change in function or size
- Positioning needs
- Environmental needs
We need to look at the client's strength, range of motion, muscle tone, and the orthopedic status during the assessment. These areas are going to dictate their seating system needs and their ability to self-propel. This does not mean that you need to spend hours on standardized testing. You need to look at the client's strength and range of motion that are required to self-propel a manual wheelchair. The client's muscle tone and orthopedic status are also going to impact seating.
Cardiopulmonary status is another area to assess as this person might experience difficulty during self-propulsion if their heart rate goes up or their fatigue is excessive. There are some clients out there who absolutely could self-propel a manual chair. However, due to the cardiopulmonary cost, they need power mobility.
We also need to keep in mind the potential for change in functional abilities or size. If the client has a progressive condition, we need to decide if a self-propelling manual chair is appropriate. It might suit their needs now, but it may not after some years. Size changes are certainly expected in the pediatric population, but adults change in size as well.
Positioning in the manual wheelchair is incredibly important. If someone is not positioned well, they will not be able to propel the manual wheelchair very well.
Finally, we need to look at the environment. What type of environment is this person in most of the day? Do they live on smooth linoleum or shag carpets? What are their community needs?