Power and Manual Wheelchair Assessment and Selection Dina Mastrogiovanni, OTR/L, ATP Linda Lantieri , MS PT, ATP

Process  Screening  Formal evaluation  Trials  Final specifications  Documentation  Funding approval  Final fitting and training  Follow-up

Considerations  Diagnosis – static or progressive  Secondary conditions Skin issues Size and weight of client Cognitive function Sensation deficits Endurance Pain  Physical Abilities  Postural evaluation findings  Architectural barriers  Transportation

Equipment  Current equipment status, age and condition  Need for other technologies computer, EADL, AAC compatibility and interfacing

Assessment  Simulation  Trialing multiple chairs  Discussing options/goals  Prioritizing  Home assessment  Measurements  Final decisions

Power W/C Bases  Front, Mid or Rear Wheel Drive

Front Wheel Drive  Examples – Permobil  Smaller turning radius than rear wheel  Negotiate over high thresholds and curbs  Legs in natural position

Front wheel drive  Advantages  Very stable from side to side  Attractive appearance  Disadvantages  Clients sometimes need to drive at lower speeds or “Fishtailing” feeling  Can be unstable anteriorly on uneven surfaces

Mid Wheel Drive  Examples – (Pride/Quantum Edge, 614) (Quickie QM710, Quickie Pulse)(Permobil M300)  Smallest turning radius; narrow footprint  Negotiates over thresholds and curbs

Midwheel  Advantages  Very stable front to back (6 wheels)  Disadvantages  Some models unstable side to side  Slower than rear wheel drive  Can’t be manually “tipped” over obstacles if required

Rear wheel drive  Examples – (Permobil C350) (Quantum R4000) (Invacare Ranger and Arrow) (Quickie 636, 646)   Some can move up to 8 mph with greater accuracy Can do “wheelies” to get off of challenging terrain (i.e. wood chips, soft dirt)  Disadvantages: largest turning radius  Unstable backward (especially with tilt)

Power Seat Functions  Tilt in space  Recline  Elevating leg rests  Seat elevator  Passive standing  Lateral tilt

Tilt in space  Pressure redistribution for pressure sore prevention  Postural stability  Comfort  Gravity assisted positioning

Reclining back  Supine position for bladder management; clothing management following bladder or bowel routines  Additional pressure relief in conjunction with tilt  Contraindications  Shearing forces  Sliding out of chair; and can trigger spasms

Elevating leg rests  Lower extremity edema  Lower extremity extension contractures  Cast or brace

Seat Elevator  ADL’s – reaching, level transfers  Not usually considered medically necessary by payers  Medical necessity – reaching  Meal prep. so they can eat!

  Medicine cabinet; keep medication away from children Thermostat – temp control  Light switch - safety

Passive standing   Not considered medically necessary by most insurances Can improve   Bladder emptying Bowel function      Bone density Circulation Pressure relief Joint movement Function

Electronic Aides to Daily Living “The Smart Room”

Electronic Aides to Daily Living

Electronic Aides to Daily Living

Electronic Aides to Daily Living  iPhone,iPad, Android access with switch or wheelchair controls