Answering Your Mobility Questions
As you walk down the aisle at a medical exhibition, it is easy to become overwhelmed. Everywhere you look, there are new, improved, and tried and true technologies all promising to benefit your clients and make your job easier. In today's medical equipment market there are definite choices to be made. How do you find the best mobility base and component parts that will fit your client, provide independent mobility, enhance function, meet a variety of individual needs and look good? Many of your clients are more educated, demand choice, and know what they are looking for in a seating and positioning system. It is up to you, the supplier or clinician, to facilitate smart choices and plan ahead for the long term. While every product has its place, you must be able to make the right match for each client. To do this, you must look at a variety of options and determine how to put the pieces together in a sensible manner.
Functional Implications
First, you must consider the long-term functional implications of, specifically, manual wheelchair use. Foremost, is the impact of fit or function. If a chair fits properly, it will contribute to function in a variety of ways:
- It will enhance mobility.
The shoulders will be positioned correctly over the axles making propulsion easier. Also, a smaller frame will allow the client to maneuver more easily at home and in the community.
- It will contribute to improved endurance.
The client will use the chair and be more likely to increase activity level. Basic functional tasks like transfers will become simpler as endurance improves.
- It will be comfortable.
When talking about selecting and funding a wheelchair, we often downplay the importance of comfort. Compare it to a new pair of shoes. If the shoes are too large, you feel awkward, it is difficult to walk, and it takes a lot of energy and concentration not to trip. If the shoes are too small, they can be painful, cause blisters, and you want to take them off as soon as possible. Whether too large or too small, an improperly fit wheelchair and seating system will be uncomfortable and unlikely to be used.
- It will foster a more positive self-image.
You can't underestimate the importance of this. We all want to look good, looking good makes us feel better about ourselves, and when we feel good about ourselves we are more social, active and lead a better quality of life.
After years of manual wheelchair use, (and abuse) these things become even more important when you look at the anatomical and physiological impact of long-term propulsion.
All of us are living longer, more active lives. As a result there is also an increased likelihood for some type of orthopedic injury or health problem. In the case of your client who uses a manual wheelchair, problems encountered include an increased risk for skin breakdown. As we age, the strength of our skin changes, and since manual wheelchair users are already at risk, they are more likely to encounter problems. Also, the more active, the better chance that the individual will be seated for longer periods of time and transferring to multiple surfaces where they continue to need skin protection. Chronic pain is also an issue. Whether a result of the initial injury or disease process or anatomical deformities resulting from a poor seated posture, pain can have a significant impact on health and well being and may be prevented through proper seating interventions early.
Another significant problem is the incidence of upper extremity pain and injury in the population of manual wheelchair users. Over the past few years many studies have been completed that examine the incidence of upper extremity dysfunction in manual wheelchair users. Studies indicate that between 40 percent to 100 percent of subject with paraplegia complain of upper extremity pain, the incidence increasing as the length of time post-injury increases. The most common injuries include rotator cuff tear, tendonitis in the elbow, wrist and hand and carpal tunnel syndrome. These injuries are usually caused by repetitive motions, such as manual wheelchair propulsion, and have obvious detrimental effects on function. Further studies have shown that weight, wheelchair configuration, and propulsion technique all have significant impact on the biomechanics of the upper extremity and the risk for injury.
Equipment Choice
So, for all these reasons, your equipment choices and recommendations have much broader impact than you may assume. With this in mind, there are certain things you should examine before making decisions:
- Material and design characteristics. Look carefully at the materials being used and ask why systems are built certain ways. There have been many advances in materials and technologies, the use of titanium for example, and you should embrace these changes if it will benefit your client. It is like buying a car. Which would you choose, a Pinto or a Cadillac? Don't your clients deserve to have the opportunity to drive a high performance vehicle? Treat the frame and its components equally, often the importance of items such as wheels are overlooked and the best configuration of the entire system is missed.
- Durability and longevity. Equipment is being used more often and in a wide variety of settings and funding is limited. A recent study at the University of Pittsburgh showed that the fatigue life of ultralight wheelchairs was significantly less than standard depot and lightweight chairs. This means they will last longer and perform better over the long-term. Also, consider the reliability and reputation of the company manufacturing products. A company that has been producing specialty seating for 30 years may provide a better product than a company trying out the rehab market. Know the history of the companies you choose from and look for innovative ideas. Of course, don?t let funding get in the way. Give your clients the option and responsibility for fighting for the most appropriate system or the option to pay out of pocket if they are able.
- System compatibility. Often, a lot of time and consideration is spent choosing the appropriate wheelchair frame. However, it seems that the combination of the frame and components is thought of separately. For a system to be effective and functional, you must consider how all of the pieces fit and function together. For example, you make a decision to choose an ultralight wheelchair frame because of the benefits of weight, and then it is paired with heavy mag wheels and a gel cushion. This seems to negate the benefit and increased expense of the ultralight frame. The combination of the frame, seat surface and wheels should complement each other, not make up for the drawbacks of one another. Although all components may come from different manufacturers, compatibility and functionality of the parts as a whole should be considered.
Even with the myriad of choices, taking a logical approach to selecting the right equipment will help to ensure that each system matches the lifestyle and functional requirements of the client. It is up to you to give clients choices, and facilitate choices that will contribute to long-term success. Recognize the functional, social, physiological and anatomical implications of wheelchair use and learn to match components effectively. Looking a little deeper, asking questions about technologies and design and trialing new equipment, will make you more effective at your job. Ask questions and be open minded and perhaps you will feel less overwhelmed as you try to make smart product choices for your clients.
This article originally appeared in the April 2003 issue of HME Business.