So, how does someone without any information or expertise in this area know if they need a wheelchair or even how to acquire one? Common signs such as having decreased standing balance, poor endurance during ambulation, and decreased strength may be why a person initially schedules an appointment with their family physician, a physiotherapist, or another healthcare professional to determine their next steps. In a perfect world, the healthcare professional initially assesses them, then refers them to a prescriber who completes their assessment, and once funding is approved, they get their wheelchair. Sounds simple. Unfortunately, this is not always the case, and the process tends to be much more complicated.
Too often, people normalize their mobility challenges, and they end up using a cane or walker unsafely, feeling fatigued all the time, or resorting to other unsafe options to assist their mobility. Alternatively, they recognize that they need a wheelchair but end up getting inappropriate equipment or waiting on a funding source to approve the right equipment. Unfortunately, these paths are less than ideal and can often result in secondary physical and mental health injuries, falls, and overall decreased quality of life. To navigate this process’s complexity, everyone involved (i.e., the end users, caregivers, healthcare professionals, and dealers) must know when a wheelchair is needed, how to justify funding, and how to prescribe the most appropriate wheelchair.
As an Occupational Therapist who has been prescribing mobility aids to clients for over five years, I have seen many clients in different situations. You may be familiar with the aging client who doesn’t recognize their limitations and, despite countless efforts and encouragement from their family members, still refuses to use a wheelchair. Or maybe you’ve heard of the client who’s never used a wheelchair before but, due to a recent spinal cord injury, are in immediate need of one to regain independence. No matter how complex or severe the situation is, there is one goal in common—the need for an appropriate wheelchair that considers the end user’s functional and health needs in the prescription process.
To help illustrate the process of acquiring a wheelchair from start to finish, I would like to introduce you to my client Bob, whose wheelchair I prescribed a few years ago. Bob was a tall, hefty man with a great sense of humor. He was a retired fire Chief and a big family man. He was highly active throughout his life and occupied his leisure time with scuba diving, hiking, and rock climbing. He was diagnosed with primary progressive multiple sclerosis at the age of 75 and had increased difficulty managing at home with his wife, who had been his caregiver over the past year. This prompted him to make the difficult decision to move into a long-term care home, which was where he was referred to me for a mobility assessment.
Functional Mobility & Client-Centered Goals
At the time, Bob was using a transport wheelchair for mobility, transferring with a sit-to-stand lift, and walking very short distances in the parallel bars with assistance from the physiotherapist. Bob was determined to walk again and often attempted to self-transfer without staff assistance, which sometimes resulted in him falling. He was quite frustrated that he had lost the ability to use the toilet independently and disliked sitting in the transport wheelchair because it was uncomfortable and hard to propel. Bob understood that his scuba diving and rock-climbing days were over, but he was determined to resume walking and made this very clear during the initial assessment. He said, “I’m going to walk again, and you’re going to help me.” As his therapist, I wanted to support his goal; however, after collaborating with his healthcare team, it was clear that walking was, unfortunately, no longer a realistic functional goal for Bob. After some time and a lot of education, Bob eventually accepted that he would need a more appropriate wheelchair to continue to be as independent as possible with his mobility
It did not take much to convince Bob that the transport wheelchair he used was inappropriate for every day, all-day use. He understood that prolonged use of the transport wheelchair would eventually cause secondary injuries, and pain, making getting around a daily challenge. He was determined to maintain his strength and wanted a wheelchair that would enable him to continue to live a healthy, active lifestyle. With his new goal in mind, I recommended a lightweight folding manual wheelchair.
My clinical reasoning for this decision was based on a few things: First and foremost, Bob’s goal is to be active and as independent and safe as possible. Following that, I considered Bob’s overall functional and health needs. Bob demonstrated decreased strength in his upper and lower extremities but had adequate strength to independently reposition himself and weight shift while sitting—this confirmed that an upright wheelchair would be sufficient and that a tilt wheelchair would not be necessary. Bob was also able to use his hands and feet to propel the wheelchair but demonstrated decreased strength and endurance when propelling long distances—this prompted me to choose a wheelchair with a maximum seat-to-floor height and rear wheel adjustment to increase hand/foot propulsion efficiency and prevent injuries related to propelling with poor body mechanics.
Bob was never able to resume walking, but he was able to independently propel his wheelchair from his bedroom to the dining room for meals, he was able to propel himself outdoors to go for outings with his family members, and he was able to propel to the main floor of the long-term care home to the exercise room when he continued to walk with the physiotherapist using the parallel bars. Although many of Bob’s life goals changed, he found peace and happiness in his new normal, which wouldn’t have been possible without an appropriate wheelchair that was prescribed specifically for him.
So how do you know if you, your loved one, or your client need a wheelchair? Well, the answer is: it’s complicated! But a good way to approach it is to think about the end goal and work backward. Consult your healthcare providers or colleagues and ask many questions so that the next steps become clearer. Advocate for yourself, your loved ones, or your clients. Like Bob, everyone deserves the opportunity to be safe, and independent and to have an appropriate wheelchair made specifically for them.