10 Point Checklist for Wheelchair Fitting
Appropriate wheelchair selection takes time and consideration of many factors. When conducting a wheelchair assessment, you should incorporate the goals of the client, therapist and caregiver, which sometimes may not be in agreement. To streamline the process, we have put together a 10 item checklist to assist in getting the best-fitting wheelchair for your client's needs, comfort and optimal functional.
1. Environment – what is the environment in which the client will be using the chair - in a nursing facility, at home, outside in the community? What is the layout of the home or facility, and will there be any space constraint issues, such as tight doorways, narrow hallways or high countertops?
2. Usage of Chair – how will the client be using the chair? Is he going to be wheelchair dependent for all mobility? Is she using the chair to complete ADL's (Activities of Daily Living)? How many hours will he be in the chair throughout each day?
3. Client's Physical Features – a person's height, weight, hip width, femur length and stature will determine the width, depth and height of the wheelchair.
4. Wheelchair Mobility – is your client able to propel a manual wheelchair? Can he propel with upper and/or lower extremities? Does she lack strength in her upper body? These factors will also determine the height and weight of the wheelchair. How will he transfer into and out of the chair? What is his range of motion? If the client can not propel, will she qualify for a power wheelchair and what type of controls will she need for safe, independent operation?
5. Cognition & Visual Acuity – what is the client's capacity for being able to safely operate the chair, see and respond to obstacles in his path and stop as needed.
6. Skin Integrity – Consider skin breakdown and sensitivity issues. Will the client require special cushions, backrests, leg rests, arm rests, etc?
7. Balance – can the client sit upright and unsupported? Lateral supports, backrests, head supports and other options may need to be considered.
8. Posture and pelvic positioning – wheelchair positioning begins with the pelvis. Is there a pelvic tilt, obliquity or rotation? Note the client's posture. Is there any scoliosis or kyphosis? Also assess hip, trunk, head and neck alignment.
9. Justification – as you assess the client's needs, as well as wheelchair and accessory design characteristics, there must be medical justification in order to meet insurance guidelines and obtain prior authorization when required.
10. Client-centered Process – actively involving the client and caregiver in the process is key to achieving a good outcome in wheelchair selection. Valuable information such as goals, expectations, daily routine, level of activity, maintenance, transportation of the chair and environment can usually be obtained through discussions with the client and caregiver. In the end, the wheelchair must be comfortable for the client or it will never be used.
Fitting a client with the right wheelchair is a complicated and important process. Optimizing that fit is crucial to improving his function and ease of use in his environment. Plus, it will ensure your client's safety and alleviate his health concerns. With the multitude of wheelchair and accessory options available, working with an experienced provider is also important. A provider can serve as your partner in gaining the best equipment for your client, and will also be able to fit and adjust the chair to gain maximal performance and function for your client.
For more information, visit Mobility4LESS University at http://www.mobility4less.com/mobility_tips_tools
Author: Mary Martin, in conjunction with Melissa Fisher, MSPT, ATP
© 2011 Mobility4LESS.com, LLC. All Rights Reserved
1. Environment – what is the environment in which the client will be using the chair - in a nursing facility, at home, outside in the community? What is the layout of the home or facility, and will there be any space constraint issues, such as tight doorways, narrow hallways or high countertops?
2. Usage of Chair – how will the client be using the chair? Is he going to be wheelchair dependent for all mobility? Is she using the chair to complete ADL's (Activities of Daily Living)? How many hours will he be in the chair throughout each day?
3. Client's Physical Features – a person's height, weight, hip width, femur length and stature will determine the width, depth and height of the wheelchair.
4. Wheelchair Mobility – is your client able to propel a manual wheelchair? Can he propel with upper and/or lower extremities? Does she lack strength in her upper body? These factors will also determine the height and weight of the wheelchair. How will he transfer into and out of the chair? What is his range of motion? If the client can not propel, will she qualify for a power wheelchair and what type of controls will she need for safe, independent operation?
5. Cognition & Visual Acuity – what is the client's capacity for being able to safely operate the chair, see and respond to obstacles in his path and stop as needed.
6. Skin Integrity – Consider skin breakdown and sensitivity issues. Will the client require special cushions, backrests, leg rests, arm rests, etc?
7. Balance – can the client sit upright and unsupported? Lateral supports, backrests, head supports and other options may need to be considered.
8. Posture and pelvic positioning – wheelchair positioning begins with the pelvis. Is there a pelvic tilt, obliquity or rotation? Note the client's posture. Is there any scoliosis or kyphosis? Also assess hip, trunk, head and neck alignment.
9. Justification – as you assess the client's needs, as well as wheelchair and accessory design characteristics, there must be medical justification in order to meet insurance guidelines and obtain prior authorization when required.
10. Client-centered Process – actively involving the client and caregiver in the process is key to achieving a good outcome in wheelchair selection. Valuable information such as goals, expectations, daily routine, level of activity, maintenance, transportation of the chair and environment can usually be obtained through discussions with the client and caregiver. In the end, the wheelchair must be comfortable for the client or it will never be used.
Fitting a client with the right wheelchair is a complicated and important process. Optimizing that fit is crucial to improving his function and ease of use in his environment. Plus, it will ensure your client's safety and alleviate his health concerns. With the multitude of wheelchair and accessory options available, working with an experienced provider is also important. A provider can serve as your partner in gaining the best equipment for your client, and will also be able to fit and adjust the chair to gain maximal performance and function for your client.
For more information, visit Mobility4LESS University at http://www.mobility4less.com/mobility_tips_tools
Author: Mary Martin, in conjunction with Melissa Fisher, MSPT, ATP
© 2011 Mobility4LESS.com, LLC. All Rights Reserved
