Wheelchair Assessment

Introduction

Assessment is the second wheelchair service step. Information collected from the assessment will help the wheelchair service personnel and wheelchair user to; choose the most appropriate wheelchair from those available; determine the most appropriate wheelchair components from those available including any possible additional postural support required and decide what training or support the wheelchair user and family member/caregiver may need to use and maintain their wheelchair. [1]

A wheelchair assessment consists of multiple components, the order of which will depend on the nature of the users needs and the specific service delivery setting. The overall assessment process should consider and reflect the domains and classification structure of the  International Classification of Functioning, Disability and Health: Body Structure and Functions; Activities and Participation; and Environment and Current Technology. Within each of these domains, a number of items should be explored with the user in order to gain a full understanding of what the user wants and needs in a wheelchair to meet their goals. Depending on the clinical judgment of the professionals and the complexity of the users needs including diagnosis, prognosis, and environmental considerations, some domains may require additional assessment while other domains may require only a screening and no further exploration. [2]

The assessment should begin by addressing the reason for the referral and the desired outcome of the intervention. At a minimum this should include the client’s primary problems/issues related to their mobility status, postural support, health, safety, and ability to function within the environment. Assessment should also include the treatment strategies previously used to address the mobility impairments and the outcomes of that intervention. For the service provision team, understanding the users articulated goals and expectations is a fundamental outcome of the assessment. [2]

A close relationship exists between the wheelchair features/components and a users functional ability and safety while using the wheelchair. The type of wheelchair and frame design, individual wheelchair options, seating and positioning components, and the overall configuration have a direct influence on a user’s independence, comfort, and safety in different environments and settings of anticipated use. The wheelchair service personnel should always keep this at the forefront throughout the assessment process. [2]

Assessments should always be carried out in a clean, quiet space, which may be a space within the wheelchair service, at another health care or community facility, or at the user’s home. If it is necessary to check whether a person has a pressure sore, do this in a private space. Respect the dignity and privacy of the wheelchair user irrespective of their age, gender, religion or socioeconomic status.[1]

Objective

The objective of good assessment practice is to accurately assess the needs of each individual user in order to prescribe the most appropriate wheelchair available. Every user requires an individual assessment, carried out by a person or persons with the appropriate skills. The assessment should be holistic, taking into account the lifestyle, living environment and physical condition of the user. It is important that the user and, if appropriate, the family are fully involved in the assessment. Depending on the complexity of the needs, the assessment process can take up to 2 hours and should incorporate the following parts: [1][4]

Assessment Interview

  • The first part of the wheelchair assessment is the assessment interview. During this part of the assessment the wheelchair service personnel gather information about the wheelchair user, which will help to identify the most appropriate wheelchair for the wheelchair user. [1][4] Read More

Physical Assessment

  • Following the assessment interview .The final part of the physical assessment examines the strategies and process for taking Body Measurements. A well-fitted seating and wheelchair mobility system requires a ‘made-to-measure’ solution. Generally, the more seating surface that is in contact with the wheelchair user, the more body measurements need to be obtained for a wheelchair prescription. [1][4] Read More

Wheelchair Skills Assessment

  • Finally assessing the wheelchair skills of the wheelchair user is vital to ensure safe and efficient use of their new wheelchair. This should be done at intake, as part of the prescription and fitting steps (e.g. to compare how well the wheelchair user can perform skills with a rigid vs. a folding wheelchair, or with the rear axles in more and less stable positions) and during follow-up to determine what revisions in the wheelchair are needed. Wheelchair Skills will be covered in its own specific course.

Good Practice

Resources

Assessment Forms

References

  1. 1.0 1.1 1.2 1.3 1.4 Sarah Frost, Kylie Mines, Jamie Noon, Elsje Scheffler, and Rebecca Jackson Stoeckle. Wheelchair Service Training Package - Reference Manual for Participants - Basic Level. World Health Organization, Geneva. 2012
  2. 2.0 2.1 2.2 RESNA. Wheelchair Service Provision Guide. Rehabilitation Engineering & Assistive Technology Society of North America. 2011 https://www.resna.org/sites/default/files/legacy/resources/position-papers/RESNAWheelchairServiceProvisionGuide.pdf (accessed 9 July 2018)
  3. Assistive Technology for All. WSTP Intermediate Video Series: 6. Physical assessment overview. Available from: https://youtu.be/Xq5IDjlkNAQ[last accessed 30/10/17]
  4. 4.0 4.1 4.2 4.3 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.