Maria Amnell, Occupational Therapist and Educational Manager
Etac, Sweden

Why isn’t mobility training (mobility pattern, technique and skills) a natural part of a wheelchair assessment as it is for a client starting to use leg prosthesis?

Is it because we therapists lack the knowledge and experience from how to propel a wheelchair in an ergonomically and energy saving way? How can we adjust the wheelchair correct and train a person with a Stroke or Parkinson if we haven’t analyzed and examined the client’s abilities to propel? How can we expect the client to remain in a proper position if we don’t analyze his/her mobility pattern? As soon as the wheelchair client starts to propel, it will affect the position. Our job is to see that the wheelchair client has a stable and functional sitting position, from which he/she can function. A correctly supported position will simplify the propulsion. But is the optimal seating position also the optimal functional position? Most modern wheelchairs are designed to enable adjustments for both the seat unit and the propelling unit. This makes the assessment easier. Because you always have the possibility to test and alter the adjustments. The chair can also be readjusted if the client’s condition will change. This means that the same wheelchair can be used in a functional way for a longer time. For a severely poorly positioned person it is often better not to be to aggressive in changing the posture. It can be wise to do the changes in steps, to enable him/her to get accustom and feel comfort.
We have to consider comfort. No one will remain in the same position without feeling comfort. Comfort is never constant. It is related to time and variation options. We have to accept that nobody remains seated without constantly changing the position of an arm, leg, lean to one side or slide forward. Just as we secure a safe transfer technique to and from the wheelchair, we also have to consider the client’s abilities to correct his/her position. Can it be done independently, or does someone have to assist? How many times a day? What technique is used? No wheelchair user should be trained to lift him/herself by pushing on the armrests if he/she can’t flex the trunk forward and hold the head low, so the behind can be lifted without having the weight of the whole trunk.

And for how many hours a day is the client using the wheelchair? By using is here meant being active. Active can be listening to the radio, drinking coffee or having a conversation. Because when he/she isn’t “using” it anymore, it is time to change to another chair or resting position.