By Jenny M. Lieberman, MSOTR/L, ATP
As a clinician responsible for evaluating clients for wheelchairs for more than 10 years, I have developed an appreciation for and an understanding of the importance of a thorough assessment for those clients who are wheelchair mobile.
For each of my clients, multiple factors must be considered. The results of a physical assessment and an understanding of the client’s needs are important; however, equally, if not more important, is a clear understanding of the client’s expectations.
With this initial column in a series on the subject of wheelchair positioning and seating, I want to introduce you to this process and, I hope, raise awareness about the importance of getting the right fit to be followed up regularly with further information regarding assessment, equipment, research, and function in relation to wheelchairs and seating systems.
With the introduction of computer access and readily available durable medical equipment sites, many people have pursued wheelchairs and seating systems online. The advantage to this is lower cost items delivered directly to the home. The disadvantage is that the item ordered may not be physically appropriate. United Spinal’s Wheelchair Medic (www.wheelchairmedic.com) is the rare Web site that will work with you to make sure you and your equipment are a match and won’t try to sell you equipment if their technicians are not certain it will improve your quality of life.
As a clinician, my role is to look at the body and attempt to promote function while preventing the client from developing deformity and pressure sores. I examine the individual, comparing my knowledge of their physical status to my experience with working with similar clients, postures and conditions.
For example, through experience I have learned that certain postures will become fixed over time. Like anyone, as clients who are wheelchair mobile begin to age, their systems age. Skin becomes thinner, digestion worsens, and pain can be more prevalent. If you are young and sit in a certain posture-for example, shifted to the side or collapsed forward-this posture will only worsen with age.
This is what experience has taught me as a clinician. I have all too frequently evaluated clients who have been injured for years and who now present with pain, deformity, or pressure sores for the first time in over 20 years. I know clients with impaired trunk control position themselves in certain ways in order to function. I respect that, knowing how important function is (I am after all an occupational therapist). However, what I also know through experience is that clinical intervention can encourage continued function without leading to permanent deformity.
Clinical intervention must first begin with an evaluation of client needs. What does the client need to do every day? Do they take care of children, drive, work or go to school; transfer independently or with assistance; cook, shop, live in a small apartment or large private house; or complete their own self-care or with assistance? These are all activities that must be considered.
In addition, what equipment is currently being used, and how has that been modified over time to promote function? The needs assessment identifies the functional aspects that need to be addressed. Once this is determined, a physical assessment must be completed.
The specifics of this will be explored in an upcoming column.
Jenny M. Lieberman, MSOTR/L, ATP is a clinical specialist in wheelchair seating and positioning in the outpatient rehabilitation department at Mount Sinai Hospital in New York.
