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?

It is not unusual that therapists focus more on how to position the client than consider the propulsion abilities. Most wheelchairs are designed in a way that almost all adjustments will influence both the seat unit and the propelling unit.

A stable and comfortable position is fundamental for the client. A correct supported position will simplify the propulsion. But is the optimal seating position also the optimal functional position? Clients will have different needs. It doesn’t matter if your client is a child or an elderly person whose arm and/or foot propel. Proper adjustments for the propelling, will not only activate the client, but also counteract a poor position which can result in secondary injuries.

But “the perfect” adjusted wheelchair will not automatically improve the client’s propelling technique. The client needs practice.

This training can be divided in two steps. The first step consists of training the client to use an ergonomically and power saving method when propelling. This is a good opportunity to analyse the result of the assessment. It is not unusual that you discover a need for additional fine wheelchair readjustment. Sometimes the change of an adjustable backrest strap is enough to improve function.

The second step consists of practical skills, such as how to transfer, start propelling, making turns, open a door or to accomplish a kerb. The degree depends on the client’s personal abilities and needs. But did you know that the most trying part when propelling is to get the wheelchair in motion. The client can save a lot of energy from just being able to keep the chair in motion, instead of constantly starting and stopping.

Our ambition is to create the best for the client. There are many aspects to consider, both physically and environmentally. In many cases we need to compromise. But that doesn’t mean that the result will be poor, if you and your client are aware of how and why specific choices are made. As long as we focus on the client’s comfort, stability, mobility and function.