Introduction to Wheelchair Service Provision

Original Editor - Naomi O'Reilly as part of the Wheelchair Service Provision Content Development Project

Top Contributors - Naomi O'Reilly  

Introduction

The wheelchair is one of the most commonly used assistive devices for enhancing and enabling personal mobility, which is a precondition for enjoying human rights and living in dignity, supporting individuals with mobility impairments to become more productive members of their communities. For people who have difficulties walking, a wheelchair which meets their physical, lifestyle and environmental needs is an essential tool, enabling them to enjoy vastly improved health, social and economic well-being. Mobility opens up opportunities for wheelchair users to study, work, engage in social and cultural activities and access services such as health care. For many people, an appropriate, well designed and well fitted wheelchair can be the first step towards inclusion and participation in society. An effective way of meeting the individual needs of wheelchair users is the provision of wheelchairs through wheelchair services. However, statistics show that currently less than 5% of those in need actually have access to either a properly fitted wheelchair or adequate wheelchair services. Furthermore, there are also limited training opportunities for health care personnel to gain the skills needed to prescribe a wheelchair effectively.[1]

The United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and World Health Assembly Resolution WHa58.23, which deals with disability including prevention, management and rehabilitation, all emphasize the importance of wheelchairs and other assistive devices. The (UNCRPD) advocates for “effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities”. To ensure effective personal mobility, wheelchair users need a wheelchair which fits them correctly and meets their specific needs. This requires an approach which is responsive to individual needs including the development of national policies and wheelchair provision services incorporating increased training opportunities in the design, production and supply of wheelchairs. [1][2][3] According to WHO one of the most important factors in the successful rehabilitation of people who need a wheelchair for mobility is appropriate provision of wheelchairs. Historically, however, wheelchair service delivery has not been an integral part of rehabilitation services. This is due to many factors, including poor awareness, scarce resources, a lack of appropriate products, and a lack of training for health and rehabilitation personnel in wheelchair service delivery. Reliance on charity or external donations for access to wheelchairs is common in many countries, which often inappropriate and of poor quality, giving further problems for the user and for the country in the long term. Mukherjee and Samanth [4] highlight that up to 60% of wheelchair users who had received donated wheelchairs in India stopped using them as a results of both discomfort and unsuitability of the wheelchair design for the environment in which it was used. The result is that many people who require a wheelchair do not receive one at all, while those who do often get one without any assessment, prescription, fitting or follow-up often resulting in wheelchairs without a cushion or basic instructions, which can lead to pressure sores and even premature death. [1][4]

There is, however, increasing awareness of the importance of providing adequate wheelchair provision incorporating individual assessment, fitting and training in how to use a wheelchair since the Convention on the Rights of Persons with Disabilities and its Optional Protocol were adopted by the United Nations General Assembly on 13 December 2006 to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity and the World Health Organisations (WHO) commitment at the Fifty-eighth World Health Assembly to provide support to Member States in building up a system for producing, distributing and servicing assistive devices. [1][2][3]

Guidelines

To ensure that people with disabilities have access to an appropriate wheelchair, particularly in less resourced parts of the world, the World Health Organisation (WHO), United States Agency for International Development (USAID) and the International Society for Prosthetics and Orthotics (ISPO)d developed the Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings, in partnership with the Centre for International Rehabilitation, the Motivation Charitable Trust and Whirlwind Wheelchair International, to assist WHO Member States to implement Articles 4, 20 and 26 of the (UNCRPD) through development of a system for wheelchair provision with effective measures to ensure personal mobility and rehabilitation by facilitating access to good quality mobility aids, devices and assistive technologies at an affordable cost, and to encourage entities that produce mobility aids, devices and assistive technologies.[1] While these guidelines specifically focus on "Manual Wheelchairs" and the needs of long-term wheelchair users in less-resourced settings, many of the guidelines are equally applicable to other types of mobility aid or device (e.g. hand-powered tricycles, power wheelchairs), for other types of user (such as temporary wheelchair users) and in well-resourced settings.[1]

The Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings are presented in five chapters; [1]

  1. The Introduction gives an overview of the need for wheelchairs, users of wheelchairs, types of wheelchair, wheelchair provision and stakeholders.
  2. Design and production provides recommendations on how to design, evaluate and select wheelchairs.
  3. Service delivery suggests the tasks and structure of a system for providing wheelchair services.
  4. Training provides assistance in the design, development and implementation of training opportunities for personnel involved in wheelchair provision.
  5. Policy and planning provides information to guide decisions on wheelchair provision.

Following the release of the Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings in 2008, WHO in partnership with USAID following extensive expert consultations, field trials and an expert review further developed the Wheelchair Service Training Package to support the Guidelines in the training of health care personnel fulfilling clinical and technical roles in a Wheelchair Service. The purpose of the overall training package is to create awareness and develop the skills and knowledge of all personnel involved in wheelchair provision. [5][6][7]

The Wheelchair Service Training Package (WSTP) incorporates;

  1. Wheelchair Service Training Package - Basic level (WSTP-B); This first part of the WSTP Series aims to develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery. [5]
  2. Wheelchair Service Training Package - Intermediate Level (WSTP-I); This second part of the WSTP Series focuses more on addressing the needs of people who have severe difficulties in walking and moving around who also have poor postural control, with special attention given on the provision of appropriate wheelchairs for children who have poor postural control and are unable to sit upright independently. [6]
  3. Wheelchair Service Training Package for Managers and Stakeholders; The final part of the WSTP Series consisting of two sub-packages: the Wheelchair Service Training Package for Managers (WSTPm) and the Wheelchair Service Training Package for Stakeholders (WSTPs) recognises that in order to develop an effective and sustainable wheelchair service provision; managers and stakeholders need to be informed about the importance and benefit of a proper wheelchair service provision. [7]

Wheelchair Services

Wheelchair services provide the framework for assessing individual user needs, assist in selecting an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services where appropriate and requires careful planning and management of resources. Here we specifically look at the elements to support manual wheelchair provision.

Function

Wheelchair services at a minimum should incorporate the following functions;

Assessment

  • This is a process of mutual consultation and full assessment between a person with a disability and wheelchair service personnel, the aim being to assist the user to select the right product for them which should produce a wheelchair prescription detailing the features of a wheelchair most suitable to meet the needs of the individual in question.[1]

Provision

  • Provision of an appropriate wheelchair follows the assessment process which should incorporate ordering, assembly, and fitting of the wheelchair.[1]

Training

  • Wheelchair service personnel should provide adequate training for both the wheelchair user and their family, in the use and maintenance of the wheelchair in order for users to gain maximum benefit from their wheelchair.[1]

Support

  • Support, both in terms of clinical and technical, should be provided to ensure the wheelchair user has basic health care advice, in particular in relation to prevention of pressure sores, contractors, complications. This support should also provide information and advice in relation to follow-up and repair services.[1]

Referral

  • Wheelchair service personnel should also be able to identify and refer wheelchair users for additional services which will allow them to maximise the use of the wheelchair in daily living, such as physiotherapy, occupational therapy, peer group training and vocational training.[1]

Role

In addition to the key functions listed above, providers of wheelchair services will play a role in:

Awareness

  • Promoting awareness, advocacy including dissemination of basic information about the needs for and benefits of using a wheelchair; and convincing policy-makers about the benefits of investing in wheelchair provision rather than leaving people with disabilities to survive on charity;[1]

Identification

  • Using a screening tool to identify those who can benefit from available services;[1]

Awareness of Referral Networks and Suppliers

  • Promoting the role of wheelchair services,including participation in activities aimed at educating referral networks and raising the awareness of suppliers and funding agencies regarding the role and importance of wheelchair services;[1]

Sustainability

  • Developing sustainable financial solutions for the continuing provision of mobility equipment through wheelchair services;[1]

Training

  • Providing or supporting the training of wheelchair service personnel;[1]

Standards

  • Raising wheelchair standards within the country or region through being aware of current wheelchair availability and advocating for improvements in and a greater variety of wheelchair products; and [1]

Accessibility

  • Advocating, Supporting or facilitating the adaptation of homes (including toilets, furniture and fittings) and public buildings and places, and lobbying for a barrier-free environment.[1]

Principles of Wheelchair Provision

Finally the guiding principles related to assistive technology - mobility devices, outlined in the Convention on the Rights of Persons with Disabilities need to be considered when developing a provision system for appropriate wheelchairs should include;

Acceptability; People with disabilities must be involved in all stages of mobility device provision.

Accessibility; Mobility devices and related services must be accessible to everyone with an identified need.

Adaptability; Mobility devices and related services need to be adapted and modified to ensure they are appropriate to the needs of the individual.

Affordability; Mobility devices and associated services must be affordable.

Availability; Facilities, personnel and products must be sufficient for the needs of the population and provided as close as possible to the people’s own communities.

Quality; Products, facilities and services are of an appropriate quality. [9]

Conclusion

There is no one wheelchair type that will meet the needs of every wheelchair user. Wheelchair users need a wheelchair that meets their needs, suits their environment and is safe and durable. [9] Appropriate provision of wheelchairs is one of the most important factors in the successful rehabilitation of people who need a wheelchair for mobility and an effective way of meeting the individual needs of wheelchair users is the provision of wheelchairs through wheelchair services. Wheelchair services work directly with wheelchair users to find the most appropriate wheelchair among those available for that user. During this course we will examine in detail the individual elements of Wheelchair Service Provision in relation to Manual Wheelchair Provision only in order to develop theoretical principles for the management of wheelchair service delivery in all contexts.[1][5][6][7]

Most importantly, remember that wheelchair service provision is not only about the wheelchair, which is just a product, but more importantly wheelchair service provision is about enabling people with disabilities to become mobile, remain healthy, improve quality of life and participate fully in community life.[1]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. World Health Organization; Geneva: 2008. 
  2. 2.0 2.1 Resolution WHA58.23. Disability, Including Prevention, Management and Rehabilitation. World Health Organization, Geneva 2005 (http://www.who.int/disabilities/publications/resolution/en/index.html, accessed 6 June 2018).
  3. 3.0 3.1 Convention on the Rights of Persons with Disabilities. United Nations. New York, 2008 (http://www.un.org/disabilities/default. asp?id=259, accessed 6 June 2018).
  4. 4.0 4.1 Mukherjee G, Samanta A. Wheelchair Charity: A Useless Benevolence in Community-Based Rehabilitation. Disability and Rehabilitation, 2005, 27:591–596.
  5. 5.0 5.1 5.2 World Health Organisation. Wheelchair Service Training Package - Basic Level. http://www.who.int/disabilities/technology/wheelchairpackage/en/ (accessed 2 May 2018)
  6. 6.0 6.1 6.2 World Health Organisation. Wheelchair Service Training Package - Intermediate Level. http://www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/ (accessed 2 May 2018)
  7. 7.0 7.1 7.2 World Health Organisation. Wheelchair Service Training Package for Managers and Stakeholders. http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ (accessed 2 May 2018)
  8. Assistive Technology for All. WSTP Basic Video Series: 1. Introduction. Available from: https://youtu.be/eu6KhB9d2HQ [last accessed 6/6/2018
  9. 9.0 9.1 Sarah Frost, Chapal Khasnabis, Kylie Mines, and Lourdes de la Peza. Wheelchair Service Training Package for Stakeholders - Trainers Manual. World Health Organization; Geneva: 2015.
  10. Motivation Charity. The Right Wheelchair; In the Right Way. Available from: https://youtu.be/2B94nzs9tTg [last accessed 6/6/2018]