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Power Wheelchair Assessment: The Team Evaluation

Power Wheelchair Assessment: The Team Evaluation
Michelle Lange, OTR/L, ABDA, ATP/SMS
February 17, 2015
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Overview

As clinicians, we need to determine if the client is an appropriate candidate for a power mobility device.  I do not think it is nearly as hard as doing driving assessments with actual vehicles.  However, there are safety concerns and we want to make sure that this person is appropriate for power mobility.  We need to determine the appropriate power wheelchair as there are a lot of them on the market, the components that need to be part of that power wheelchair, and the actuators.  Actuators are power seating options like a power tilt in space system or power recline with elevating leg rests.  We then need to be able to justify the recommended equipment to get funding and that means we need to know how to document this information.  Finally, we have to provide adequate support and training so that this person can have a successful outcome, and hopefully that is independent mobility.  Once that chair is delivered, our job is not over.  We need to then provide that mobility training. 

In a mobility assessment, it is important to look at the client's goals, and often the caregiver's goals as well.  We also need to review current mobility skills; there are a number of related factors we will discuss; medical and cognitive issues, the future needs of the client, the age of the client, any mobility training requirements; and finally how to get this equipment funded.  It is easy for me to want to start with my goals, but it is important to remember that first we start with our client's goals. 

Client/Caregiver Goals

Our client and caregiver goals do not always match up.  I work primarily in pediatrics.  I do see adults as well.  A lot of the information that we are dealing with today could apply to both populations as we are determine the power wheelchair needs.  The client might have a goal such as “I want a fast wheelchair.”  I remember when I evalulated Justin.  He needed his second power chair.  He was in late elementary school at the time, and he knew exactly what chair he wanted, because his chair had lost during their wheelchair Olympics at school. He wanted the chair that won.  His mom was much more concerned about the state of the walls in the home.  Oftentimes, we need to build consensus during a power mobility evaluation. 

Current Mobility Skills

Does this person have any form of independent mobility?  It could be that this client is ambulating, but perhaps they need to augment that ambulation with power mobility.  This does not mean that funding is not available, even if this person is ambulatory or is able to use a manual chair.  What we are looking at is efficiency.  Can this person be efficient with their mobility?  Efficiency means the amount of effort and the amount of time.  Let's take a high schooler getting from Math class to English class.  If it takes them too much time, they are late for class.  If it takes them too much effort, they are worn-out and cannot pay attention to the teacher.  In that case, whatever their ambulation method is, it might be that it is inefficient for them and that a different mobility category is required. 

A lot of people who are using manual chairs but still need a power chair are people that primarily push with one hand, and because of that, tend to go into circles.  People who are used to propelling a manual chair with one hand when they first get into a power chair often tend to put the chair into reverse.  When you are in a manual chair and can only propel with one hand, you pull one of those wheels back and then push forward again to repeatedly correct your course. It may take some additional training to let them know that that is not required on the power chair to change course.  On some of these electronics, we can even temporarily disable reverse so that that is not an issue. 

It is also important to know if this person has had any prior power mobility experience as well.  If that experience was not successful, we want to reassure the client that we will stick with them and try to make this positive and beneficial experience for them. 

 

michelle lange

Michelle Lange, OTR/L, ABDA, ATP/SMS

Michelle Lange is an occupational therapist with over 35 years of experience and has been in private practice, Access to Independence, for over 15 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the co-editor of Seating and Wheeled Mobility: a clinical resource guide. She is the former NRRTS Continuing Education Curriculum Coordinator and Clinical Editor of NRRTS Directions magazine. Michelle is a RESNA Fellow and member of the Clinician Task Force. Michelle is a RESNA-certified ATP and SMS.



Related Courses

Wheelchair Seating For The Pediatric Population
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Video
Course: #5907Level: Advanced2 Hours
Pediatric seating and mobility equipment are not simply smaller than equipment designed for adults. This course will present the importance of pediatric positioning, clinical considerations, how to determine if a child is positioned adequately, as well as alternative positioning. A detailed case study will pull all the information together in a practical way.

AAC: Early Intervention and Transition
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS, Jill Tullman, MS, CCC-SLP
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Course: #5226Level: Advanced3 Hours
Master skills to implement in your practice immediately with continued Master Class. This three-hour master class addresses the complex needs of children with multiple disabilities in the early intervention setting, including successful transition to school. A multi-disciplinary approach to augmentative-alternative communication (AAC) and interventions are addressed and case studies are included.

Pediatric Power Wheelchair Assessment And Training
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Live WebinarTue, Apr 16, 2024 at 12:00 pm EDT
Course: #6317Level: Advanced3 Hours
Pediatric power wheelchair assessment, including determining and developing cognitive and motor readiness, team evaluation, and mobility training as a part of the school day, will be comprehensively addressed in this course. Assessment, skill development, and skill training are critical to achieve functional and independent use of power mobility.

Secondary Supports: It’s All In The Angles!
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Video
Course: #6111Level: Intermediate1 Hour
Wheelchair seating systems often include secondary supports including pelvic belts, anterior trunk supports, and ankle straps. This course will explore secondary supports and appropriate clinical applications, as well as what to do when secondary supports are required, and team members have restraint concerns. Case studies will be included.

Continued Conversations, The CE Podcast: The Top Ten Mistakes Clinicians Make During Seating and Mobility Evaluations
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Audio
Course: #4610Level: Introductory1 Hour
This podcast will be a conversation about common mistakes made during wheelchair seating and mobility evaluations. The discussion will give you new ideas to improve the evaluation process!

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