Introduction to Wheelchairs
PTA 101 Introduction to Clinical Practice

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Contact howardc@lanecc.edu for permissions.

Lesson Objectives

1. Identify the major components of a wheelchair

2. Compare and contrast stability versus mobility of different wheelchair seating systems

3. Describe the parameters and values of standard wheelchair measurements for proper fit

4. Describe potential adverse effects from improper fitting of wheeled devices

5. Describe the role of members of the health care team in selecting and obtaining a wheelchair for a patient

    

Wheelchairs are Orthoses

1. Much like an orthotic (brace) for a joint or an extremity, a wheelchair is an which supports and corrects deformities to maximize function
2. Patients with significant losses of neuromuscular control can use a wheelchair as a means of maintaining body support in upright functional postions.
3. Thus, wheelchairs should be as light weight as possible and be comfortable (functional and aesthetic) for the user.
4. Maximal functional capacity depends on a thorough wheelchair assessment and prescription process; proper wheelchair fit is important.
5. Seat cushions vary depending on the patient's condition: incontinence, memory, sensation, and finances will impact decision-making for wheelchair cushions

Standard Wheelchair Measurements

There are several versions of standardized tools and templates to measure and document wheelchair and wheelchair component recommendations. One is included on this left hand side of this page as a handout.

Signs and Symptoms of Poor Fit

• pressure sore development (redness)
• ankle edema
• skin discolorations
• numbness and/or tingling

Wheelchair Prescription

A wheelchair is medical equipment, therefore, a trained professional should complete a thorough wheelchair assessment before a patient purchases a wheelchair. Wheelchair assessments can be complete by the PT OR the PTA. Depending on the setting and the patient's needs, OT, case management/case worker, and the wheelchair vendor will collaboratively complete the assessment.

In most cases, wheelchair prescriptions and evaluations are subject to approval or a prior authorization process before a wheelchair can be fitted and dispensed for long term use. The time to complete a prior authorization can take days to months. If the patient's medical plan does not find that the wheelchair prescription is medically necessary, the wheelchair will be denied for insurance eligibility. If approved delivery can take up to 3-4 months depending on customization needs.

Many patients have limits on what their insurance plan will cover for durable medical equipment (DME). Therefore the most appropriate wheelchair may remain financially inaccessible. Financial limitations may also prevent or limit modifications to the home setting to allow for wheelchair access. PTs and PTAs must be sensitive to external factors which limit optimal wheelchair prescriptions, and should advocate (through documentation and other communication) for systems and resources for wheelchair users to move freely and safely at home and in the community

Types of Wheelchairs and Components

• Standard - dimensions follow standard measurements, typically folding
• Light weight - components are made of carbon-fiber or similar material to decrease the overall wheelchair weight; indicated when there are strength or mobility barriers that prevent independent or optimal locomotion using a standard chair; may also be used for sport and recreation (ultralight)
• Reclining - seat back is tall; allows for variable hip angle for pressure relief and recumbent positioning; manual (dependent) and power options
• Tilt-in-space allows the chair to move on an arc, maintaining the hip angle while moving from upright to recumbent
• Power - locomotion is driven by battery and maneuvered with a joystick, head controls, voice, and/or breath control; indicated when patient is unable to propel a standard chair
• Arm rests, leg rests, wheels and tires are also modifiable based on patient need. Any components that are not standardized require medical and functional justification

Role of PTA

It is within the scope of practice for a PTA to:

• instruct in strength training for transfers
• instruct in wheelchair mobility indoors and outdoors in a variety of environments

• assess safety and motor planning with wheelchair-based activities
• adjust components of a wheelchair to modify and improve fit
• instruct in fall recovery from a wheelchair
• train family members, caregivers, and/or patients in safe wheelchair mobility, effective pressure relief techniques and wheelchair maintenance/care

• educate in the signs and symptoms of skin breakdown
• coordinate and consult with a certified equipment vendor for recommendations and coordinated in-clinic assessments
• prescribe a wheelchair - includes measurements, frame selection, cushion selection
• document medical necessity for specialized components
• advocate for wheelchair access in the community.

Communication and rapport with the supervising physical therapist will ensure that the wheelchair fitting and seating activities are facilitating progression toward discharge goals. The PTA must select seating interventions which support the goals of the PT evaluation.

Active Learning Exercise - Video Analysis and Applying your Learning

(Note: the demonstration begins at 2:28 and I have included the intro because I appreciate the perspectives of the speaker and her experiences as someone who uses a wheelchair)

Take a look at methods that are effective in developing independence in getting on/off the floor from a wheelchair by watching this video. Observe the movements, actions, and sequence of this activity. Using the CAN YOU HELP ME? forum describe one thing that you noticed, reinforced, or question that connects to last week's lesson on body mechanics and postural observation. Challenge yourself to use appropriate medical terminology that has been introduced or reinforced in the course so far. How do you think this type of reflective thinking will help you develop clinical reasoning or clinical documentation skills in lecture and lab?

Clinical Cases

This brief video demonstrates some advance wheelchair mobility techniques. See if you can apply characteristics from this case to the WHO-ICF. How does this skill effect his participation in the community? If you were his PTA, what follow-up questions might you have once can successfully demonstrate fall recovery?  

End of Lesson